Predictors of evidence-based pressure ulcer prevention behaviors among recently graduated nurses in tertiary care hospitals in Lahore

Pressure ulcers (PUs) remain a critical and preventable challenge in hospital care, especially in resource-constrained settings. Despite formal training, early-career nurses often experience gaps in applying evidence-based PU prevention practices. This study identified the behavioral and contextual predictors of evidence-based PU prevention behaviors among recently graduated nurses in tertiary care hospitals in Lahore, Pakistan, by assessing their level of knowledge, attitudes, and self-efficacy, as well as the impact of clinical exposure, internship training, and perceived barriers to preventive practices. An exploratory design involving 135 BSN graduates who had completed their clinical internships within the past six months were recruited for the study using a purposive sampling method. Data were collected via a structured, self-administered questionnaire composed of validated tools, including the Pressure Ulcer Knowledge Assessment Tool 2.0, the Attitude toward Pressure Ulcer Prevention (APuP) scale, and constructs derived from the Theory of Planned Behavior framework. Descriptive statistics, Spearman correlations, and multiple linear regression were used for analysis. While participants showed moderately positive attitudes and self-efficacy, only knowledge of PU prevention emerged as a statistically significant predictor of evidence-based behavior (p = 0.003). Other factors, such as attitudes, perceived barriers, and clinical decision-making ability, did not significantly influence behavior. Despite high exposure to PU cases, most participants reported limited workshop participation and demonstrated low decision-making accuracy. This study highlights that factual knowledge, rather than attitudinal or perceptual factors, plays a pivotal role in shaping evidence-based PU prevention behavior among newly graduated nurses. This finding emphasizes the need for knowledge-intensive interventions and scenario-based training in early clinical practice. Further longitudinal studies are recommended to evaluate the impact of mentorship and institutional support on sustained preventive behaviors.