Pre–post changes in operating room nurses’ knowledge and attitudes toward medical device–related pressure injuries after a problem-based and simulation-based training program: a single-group pretest–posttest study

To examine within-participant pre–post changes in operating room (OR) nurses’ knowledge and attitudes toward medical device–related pressure injuries (MDRPIs) following a problem-based learning (PBL) and simulation-based training program. 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 h and each simulation session 1 h. 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). 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 56.36% to 73.93%. Significant gains were observed in all subdomains, with accuracy increasing from 64.57% to 78.88% for risk factors/prevention, from 50.75% to 68.90% 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 77.04% 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). Participants’ knowledge and attitude scores were higher at post-test than at pretest. Statistical analysis indicated an association between the training intervention and improved MDRPI-related cognition and attitudes. These findings suggest potential benefits of this PBL-simulation hybrid training for operating room MDRPI prevention, though causal inference is limited by the single-group pretest-posttest design.