Guideline familiarity emerges as strongest driver of nurses’ wound care confidence in Iran

Wound care is one of the most technically demanding responsibilities in nursing, blending anatomy and physiology knowledge, hands-on dressing technique, infection control, and patient education into a single clinical task. Yet how confident nurses actually feel when performing it has rarely been measured at scale in Iran. A new cross-sectional analytical study published in BMC Nursing has now quantified wound care self-efficacy among 948 Iranian nurses, and the results point to a striking conclusion: the single strongest predictor of confidence was not seniority, not specialization, and not even direct wound care experience, but how familiar nurses were with clinical practice guidelines for wound management.

The research team, led by Mohsen Mollahadi of the Nursing Care Research Center at Baqiyatallah University of Medical Sciences in Tehran, distributed a 43-item Wound Care Self-Efficacy Questionnaire, or WCSEQ, to nurses across Iran through internal social messaging applications. Of those who started the survey, 84 percent completed it, yielding 948 full responses with a mean completion time of just 15 minutes. The questionnaire breaks self-efficacy into four domains: Anatomy and Physiology, Care of Chronic and Acute Wounds, Wound Management and Evaluation, and Values and Attitudes. Each domain probes a different facet of the psychological construct of self-efficacy, the belief in one’s own capability to organize and execute the courses of action required to manage a clinical situation.

The overall mean WCSEQ score came in at 209.08 with a standard deviation of 40.60, out of a maximum possible 301 points. That translates to 69.4 percent of the ceiling, which the study’s descriptive benchmarks classify as moderate-to-high self-efficacy. In other words, Iranian nurses generally believe they can handle wound care competently, but there is clear room for improvement, particularly given that chronic wounds, diabetic ulcers, pressure injuries, and surgical site complications are rising across aging populations worldwide.

Breaking the total down by subscale reveals where confidence is strongest and weakest. The Anatomy and Physiology domain averaged 34.89 out of a possible 49, the Care of Chronic and Acute Wounds domain averaged 104.23 out of 147, the Wound Management and Evaluation domain averaged 43.16 out of 63, and the Values and Attitudes domain averaged 26.79 out of 42. The pattern suggests that nurses feel reasonably assured about the technical execution of dressing changes and wound assessment, but the foundational science and the attitudinal components sit slightly lower, hinting that continuing education could target basic physiology and professional attitudes as much as procedural technique.

Before running any multivariable model, the researchers used non-parametric group comparisons with Bonferroni-corrected post-hoc pairwise tests, having first assessed normality with the Shapiro-Wilk statistic. These univariate analyses showed significantly higher total WCSEQ scores among nurses who held a wound or stoma care specialization, who had attended a wound care workshop, who had accumulated longer workshop durations, who performed wound care directly, who carried higher monthly patient caseloads, who worked where a wound clinic was available, who collaborated with wound clinics, and who reported greater familiarity with clinical guidelines. Every one of these comparisons reached statistical significance at p less than 0.05.

The multivariable linear regression then isolated which factors held up independently. The full model explained 29.2 percent of the variance in total WCSEQ scores, with an R-squared of 0.292, an adjusted R-squared of 0.272, and an F statistic of 14.58 on 26 and 920 degrees of freedom, p less than 0.001. Guideline familiarity dominated the model, with standardized beta coefficients ranging from 0.211 to 0.431 relative to nurses reporting very low familiarity, all p values below 0.001. That is a substantial effect size for a survey-based predictor, and it dwarfs the contributions of every other variable in the equation.

Several other factors remained independently significant after adjustment. Direct wound care experience carried a standardized beta of 0.120, p less than 0.001. Cumulative years of experience carried a beta of 0.114, p less than 0.001. Wound and stoma care specialization carried a beta of 0.104, p equal to 0.005. Collaboration with a wound clinic carried a beta of 0.073, p equal to 0.029, and willingness to participate in more workshops carried a beta of 0.059, p equal to 0.039. Interestingly, workshop duration longer than 30 hours was independently associated with higher scores in two specific domains, Anatomy and Physiology and Wound Management and Evaluation, but not with the total score, suggesting that extended training shapes foundational knowledge and evaluative skill more than it moves overall confidence.

The authors are careful about interpretation, and rightly so. Because the design is cross-sectional and the sampling is convenience-based, the findings reflect associations rather than causation. Nurses who feel more confident may seek out guidelines, or guideline exposure may build confidence, or both directions may operate simultaneously. The study also relies on self-reported self-efficacy rather than observed clinical performance, so it measures perceived capability, not necessarily actual wound care quality. Still, the consistency of the guideline familiarity signal across both univariate and multivariable analyses makes it a compelling target for intervention research.

The practical implications are considerable for health systems far beyond Iran. If structured continuing education programs, interprofessional clinic collaboration, and the integration of national wound care guidelines into routine clinical workflows were tested in longitudinal and interventional studies, health systems could determine whether boosting self-efficacy translates into better wound outcomes, fewer complications, and lower costs. Chronic wound management already consumes enormous healthcare resources globally, and nursing confidence sits at the front line of every dressing change, every pressure injury risk assessment, and every patient conversation about healing. The study, approved by the Institutional Review Board of Baqiyatallah University of Medical Sciences under approval number IR.BMSU.BAQ.REC.1404.086 and adhering to the Declaration of Helsinki with electronic written informed consent, offers a rigorous baseline for that next phase of research, and its message is clear: putting evidence-based guidelines directly into nurses’ hands may be the most efficient lever for building the confidence that quality wound care depends on.

Subject of Research: Nursing Research

Article Title: Wound care self-efficacy among nurses in Iran: a cross-sectional analytical study

Article References: Mollahadi, M., Shabani, S. M. H. K. S., Dehi, M., Jamshidi, Z., Jafari-Oori, M., & Raei, M. (2026). Wound care self-efficacy among nurses in Iran: a cross-sectional analytical study. BMC Nursing. https://doi.org/10.1186/s12912-026-05548-1

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05548-1

Keywords: wound care, self-efficacy, nurses, WCSEQ, clinical guidelines, Iran, nursing education, cross-sectional study, BMC Nursing, continuing education, Wound, care