Evaluation of a structured online continuing education program for pressure injury prevention among clinical nurses: a multicenter pre–post observational study

Background Effective pressure injury prevention requires nurses to identify risk promptly, select appropriate preventive measures, and reassess care when patients' conditions change. Online education may improve access to continuing professional development, but concurrent changes in self-rated knowledge, attitudes, and self-reported preventive practices after such training are less well characterized in large multicenter cohorts of frontline nurses. This study examined these changes following a structured online pressure injury prevention program. Methods A multicenter, single-group pre–post observational study was conducted among 997 clinical nurses from 34 hospitals within a regional nursing quality control network in southwestern China. The program was designed as a four-week curriculum comprising eight online modules informed by the 2019 international pressure injury guideline and pre-training learning needs. Participants completed the same 26-item study-specific KAP assessment before and after training. Domain scores were calculated on a 0–100 scale. Paired-sample t tests were used to estimate mean changes, with 95% confidence intervals (CIs). Wilcoxon signed-rank tests were conducted as sensitivity analyses. Results All 997 participants had matched pre- and post-training data. Self-rated knowledge increased from 91.24 ± 10.87 to 95.01 ± 7.86 (mean difference, 3.77; 95% CI, 3.45–4.08; p < 0.001). Attitudes increased from 95.05 ± 9.38 to 98.08 ± 3.94 (mean difference, 3.03; 95% CI, 2.65–3.41; p < 0.001). Self-reported practice increased from 74.04 ± 21.76 to 81.58 ± 18.62 (mean difference, 7.54; 95% CI, 6.72–8.36; p < 0.001). Sensitivity analyses yielded similar results. Conclusions After the program, nurses reported higher self-rated knowledge scores, more favorable attitudes, and more frequent self-reported preventive practices. The largest absolute change was observed in self-reported practice, whereas attitude scores were already high at baseline. Because the study lacked a comparison group and relied on self-reported outcomes, the observed changes cannot be attributed solely to the training and should be interpreted as changes in perceived knowledge, attitudes, and reported practice rather than objectively verified changes in bedside performance. Studies with comparison groups, longer follow-up, and objective practice or patient outcomes are needed.