Effects of a Problem-Based and Simulation-Based Training Program on Operating Room Nurses’ Knowledge and Attitudes Toward Medical Device–Related Pressure Injuries

Objective : To evaluate the effectiveness of a medical device–related pressure injury (MDRPI) care and prevention training program on the knowledge and attitudes of operating room (OR) nurses. Methods : A prospective, single-group, pretest–posttest quasi-experimental study was conducted in the OR of a tertiary hospital from March to June 2025. A total of 80 OR nurses who met the inclusion criteria were enrolled. The intervention consisted of eight small-group training sessions integrating problem-based learning (PBL), case discussions, and scenario-based simulation. Each theoretical PBL/case session lasted 2 hours and each simulation session 1 hour. MDRPI-related knowledge and attitudes were assessed before and after the intervention using the validated Chinese versions of the Pieper–Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) and the Attitude towards Pressure Ulcer Prevention instrument (APuP). Results : The mean total PZ-PUKT score significantly increased from 40.58 ± 9.00 to 53.23 ± 6.78 ( P  < 0.001), and the overall knowledge accuracy improved from 56.35% to 73.92%. Significant gains were observed in all subdomains, with accuracy increasing from 64.55% to 78.88% for risk factors/prevention, from 50.75% to 68.88% for staging, and from 51.46% to 72.33% for wound description. The total APuP score also significantly increased from 40.06 ± 3.33 to 44.60 ± 2.49 ( P  < 0.001), corresponding to an accuracy improvement from 76.97% to 85.77%. Significant improvements were found in personal prevention capability, prioritization of prevention, perceived impact of pressure injuries, and confidence in the effectiveness of prevention (all P  < 0.05). No statistically significant change was observed in the responsibility dimension ( P  = 0.157). Conclusion : The hybrid training program integrating PBL-based theoretical teaching with scenario-based simulation significantly improved OR nurses’ MDRPI-related knowledge and attitudes. These findings support the implementation of structured, small-group, interactive education to strengthen MDRPI prevention in the operating room.