Knowledge, attitudes and practices of healthcare professionals in nutritional management of patients with pressure ulcers: an online survey in Flanders and the Netherlands

ABSTRACT Background & aims Pressure ulcers (PUs) are prevalent chronic wounds associated with pain, infection, and prolonged hospitalisation. Adequate nutrition is important in both preventing and healing PUs; however, malnutrition frequently co-occurs and nutritional care in clinical practice remains suboptimal. This study aimed to explore healthcare professionals’ knowledge, attitudes, practices, and perceived barriers to nutritional care for PU patients in hospitals, nursing homes, and home care settings. Methods A cross-sectional survey of 284 Flemish and Dutch healthcare professionals was conducted between April and June 2024. Knowledge, attitudes, practices, and barriers related to nutritional management of PUs were assessed. Descriptive statistics and ordinal logistic regression were used to analyse data and identify gaps in implementation of nutritional interventions. Results Most respondents (93.7%, n=266) agreed or strongly agreed that inadequate nutritional guidance leads to more wound-healing complications, with dietitians reporting higher knowledge than nurses (p <0.01), reflecting their specialised training amid limited dietitian availability in Flemish/Dutch settings, where nurses often take on primary responsibility for nutritional tasks (e.g., screening and adjustments). However, more than 60% of all respondents reported insufficient knowledge of glutamine/arginine supplementation. Reported barriers included unclear guidelines (63.3%, n=180), insufficient knowledge of effective interventions (70.4%, n=200), and high costs of supplementation (80.3%, n=228), indicating a need for clearer guidelines and targeted education and policy support. Conclusion Although healthcare professionals acknowledge the important role of nutrition in PU management, significant knowledge gaps, particularly between dietitians and nurses, and systemic barriers hinder effective care. Clearer guidelines, targeted education, and supportive policy measures (e.g., standardised nurse-led protocols) are needed to strengthen nutritional practices and improve patient outcomes.