Knowledge and Attitude of Iranian Nurses Toward Pressure Ulcers: A Systematic Review and Meta-Analysis

Background: Pressure ulcers are major complications that increase hospitalization costs and extend the length of stay. Their occurrence is widely considered an indicator of the quality of nursing care. Given the essential role of nurses in the prevention and management of pressure ulcers, this study aimed to evaluate the knowledge and attitudes of Iranian nurses toward pressure ulcers through a systematic review and meta-analysis. Methods: In this systematic review and meta-analysis, articles were retrieved from PubMed, Scopus, ScienceDirect, and Web of Science using a combination of keywords including "knowledge," "attitude," "pressure ulcer," "nurse," "Iran," and their Persian equivalents up to the end of May 2023. Cross-sectional studies reporting the knowledge score (defined as the mean percentage of correct responses to standardized questions regarding the definition, causes, prevention, diagnosis, and management of pressure ulcers) and attitude score (defined as the mean percentage of favorable responses to standardized questions concerning the importance of prevention, responsibility, and willingness to implement prevention protocols) among Iranian nurses were included. Study quality was assessed using the Joanna Briggs Institute (JBI) checklist, and data were analyzed using a random-effects model. Results: A total of 12 studies were included in the final analysis. The pooled knowledge score of Iranian nurses regarding pressure ulcers was 55% (95% CI: 40–70; I² = 99.8%). The pooled attitude score was 46% (95% CI: 33–59; I² = 96.0%). In addition, 52% of nurses (95% CI: 31–73; I² = 98.0%) had participated in pressure ulcer training programs. Meta-regression analysis indicated a linear association between study quality, sample size, year of publication, and the knowledge and attitude scores. Conclusion: The knowledge and attitudes of Iranian nurses toward pressure ulcers are suboptimal, with approximately half lacking adequate knowledge and appropriate attitudes in this area. Therefore, implementing structured educational programs is essential to enhance nurses’ competencies in pressure ulcer prevention and management.