The study was led by Hyung-Ju Na, a wound, ostomy, and continence nurse at Seoul Metropolitan Dongbu Hospital, together with Sung-Hee Yoo of the College of Nursing at Chonnam National University. Rather than simply cataloging gaps in practice, the researchers anchored their investigation in the Information–Motivation–Behavioral Skills model, or IMB model, a framework originally developed to explain health behavior change and later adapted to clinical performance. The model proposes that behavior is driven by three interacting ingredients: accurate information, motivation to act, and the behavioral skills needed to translate intention into action. In this study, those ingredients were mapped onto pressure injury care knowledge, attitudes and institutional support, and self-efficacy, respectively.

Pressure injuries develop when sustained pressure, often combined with shear and moisture, compromises blood flow to the skin and underlying tissue, particularly over bony prominences such as the sacrum, heels, and hips. In frail, elderly residents who may be immobile, incontinent, or malnourished, the risk escalates dramatically. Once a deep injury forms, it can take months to heal, exposes the patient to infection and pain, and signals a breakdown in preventive care. That is why pressure injury management is widely treated as a critical indicator of nursing quality in long-term care facilities, and why understanding its determinants carries weight well beyond the ward.

To probe those determinants, the team conducted a descriptive, cross-sectional survey of 200 nurses working at five long-term care facilities in Seoul. Data were collected between June 1 and December 1, 2020, using a self-administered questionnaire that measured four domains: knowledge of pressure injury care, attitudes and perceived institutional support, self-efficacy, and actual performance of evidence-based pressure injury care. The researchers then used hierarchical stepwise regression, a statistical technique that adds predictor variables in stages to see how much additional explanatory power each contributes, while first accounting for the nurses’ general characteristics such as age, experience, and education level.

The headline finding was sobering but instructive. The mean item score for evidence-based pressure injury care performance was 3.89 out of 5, with a standard deviation of 0.61. In other words, nurses in these facilities were performing reasonably well but not at the near-perfect level that evidence-based prevention ideally demands. The regression analysis then identified four significant factors, ranked by the strength of their influence. Knowledge of pressure injury care came first, with a standardized beta coefficient of 0.38 and a p-value below 0.001. Self-efficacy followed at 0.23 (p = 0.001), then the provision of annual pressure injury care education at 0.22 (p = 0.003), and finally education level at 0.17 (p = 0.003). Together, these variables explained 38.3 percent of the total variance in performance, a substantial share for a complex clinical behavior measured in a real-world setting.

The prominence of knowledge is perhaps the most striking result. In the IMB framework, information is the foundation upon which motivation and skills build, and the data here bear that out: nurses who scored higher on pressure injury knowledge were markedly more likely to perform evidence-based care. This matters because clinical knowledge is not static. Pressure injury prevention guidelines evolve, covering topics such as risk assessment tools, repositioning schedules, support surfaces, skin moisture management, and nutrition. Nurses whose training predates current recommendations may be applying outdated techniques without realizing it, which makes periodic knowledge updating a genuine safety issue rather than an administrative box-tick.

Yet knowledge alone did not carry the story. Self-efficacy, the confidence a nurse has in her own ability to execute the required behaviors, emerged as the second strongest predictor. This aligns with a large body of behavioral science showing that people who believe they can perform an action are more likely to persist at it, especially when the action is effortful or the environment is challenging. Preventing pressure injuries in a busy long-term care ward is exactly that kind of effortful behavior: it requires vigilance, coordination with aides, advocacy for equipment, and repeated reassessment. A nurse who knows what to do but doubts her capacity to do it amid competing demands may quietly let best practice slip.

The third significant factor, the provision of annual pressure injury care education, shifts the lens from the individual to the organization. This is a notable finding because it demonstrates that institutional support contributes to performance independently of nurses’ personal educational backgrounds. A facility that commits to yearly training is, in effect, doing two things at once: refreshing the knowledge base of its staff and signaling that pressure injury prevention is a priority worth the organization’s time and resources. The authors conclude that enhancing care quality requires systematic, multi-level interventions that focus on updating clinical knowledge and bolstering nurses’ self-efficacy through sustained organizational commitment, not one-off lectures or posters in the break room.

Even the weakest predictor in the model, education level, carries practical implications. Its significance suggests that nurses with higher formal qualifications tend to perform better evidence-based care, but the fact that it ranked last—behind knowledge, self-efficacy, and annual training—implies that targeted continuing education can compensate for differences in academic credentials. For long-term care facilities, which often struggle to recruit highly credentialed nurses, this is an encouraging message: investment in structured, recurring in-service education may narrow the gap that degrees alone cannot.

The study does have boundaries worth noting. It was cross-sectional, capturing a single moment in time, so it can identify associations but cannot prove that boosting knowledge or self-efficacy causes better performance. The sample comprised 200 nurses from five facilities in a single city, and data were self-reported, which introduces the possibility of response bias. The researchers also note that the work received no specific grant from any funding agency, and the study was approved by the Institutional Review Board of Chonnam National University with written informed consent from all participants, conducted in accordance with the Declaration of Helsinki. Still, by grounding the analysis in a tested behavioral model and quantifying the relative weight of each factor, the study offers long-term care administrators a concrete roadmap: audit and refresh staff knowledge, build confidence through skills-based training and supportive supervision, and institutionalize annual pressure injury education. In a field where a single deep wound can mean months of suffering for a vulnerable resident, those levers may prove among the most cost-effective tools available.

Subject of Research: Determinants of evidence-based pressure injury care performance among nurses in long-term care facilities using the Information–Motivation–Behavioral Skills model

Article Title: Factors associated with evidence-based pressure injury care among nurses in long-term care facilities: an information–motivation–behavioral skills model-based study

Article References: Na, H.-J., & Yoo, S.-H. (2026). Factors associated with evidence-based pressure injury care among nurses in long-term care facilities: an information–motivation–behavioral skills model-based study. BMC Nursing. https://doi.org/10.1186/s12912-026-05472-4

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05472-4

Keywords: pressure injury, bedsores, long-term care facilities, nursing, evidence-based practice, IMB model, self-efficacy, nurse education, cross-sectional study, South Korea, wound care, nursing quality

Inhalation injury is one of the most feared complications of major burns. Hot gases and toxic smoke damage the delicate lining of the airway, causing swelling, secretions, and progressive respiratory failure that can develop over hours. For these patients, an artificial airway, typically a tube placed through the mouth or nose into the trachea, or a surgical opening in the neck, is often a life-saving necessity. But the tube itself introduces new risks: it can become blocked by thick secretions, dislodged, or colonized by bacteria leading to ventilator-associated pneumonia. The quality of day-to-day airway management, from humidification and suctioning to cuff pressure monitoring and secure fixation, therefore has a direct bearing on survival and recovery.

The research team, led by Fangfang Xia and colleagues in the hospital’s Department of Burns and Plastic Surgery, set out to measure how well artificial airway management was actually being delivered in their burn intensive care unit, and to identify which patient characteristics and staff-related factors predicted lapses in quality. They combined two complementary data streams. First, they performed a retrospective analysis of clinical records from all 223 patients admitted to the burn ICU between January and December 2025 who had burn injuries combined with inhalation injuries. The variables they extracted included sex, age, the total body surface area burned (TBSA), whether the patient developed acute respiratory distress syndrome (ARDS), the timing of artificial airway establishment, and any airway-related complications that occurred during the stay.

Second, recognizing that airway management is fundamentally a nursing-delivered intervention, the team surveyed 49 nursing staff members about their clinical experience, whether they had received formal airway management training, how often they attended training sessions each year, and how they documented their care. This dual approach, pairing patient outcomes with staff characteristics, allowed the investigators to look beyond the bedside and ask whether the structure of the care team itself shaped the quality of what patients received. The study was approved by the hospital’s institutional ethics committee and adhered to the principles of the Declaration of Helsinki, with all participants providing informed consent.

The headline numbers reveal a system that performs reasonably well but leaves meaningful room for improvement. The timely airway establishment rate, meaning the proportion of patients who received an artificial airway within the clinically appropriate window, stood at 82.1 percent. Overall quality compliance, a measure of how consistently management met established standards, reached 73.5 percent. In other words, roughly one in four patients did not receive airway care that fully met quality benchmarks, and nearly one in five did not have their airway established in a timely fashion. For a population in which respiratory compromise can escalate within hours, those gaps are clinically significant.

To move from description to explanation, the researchers performed multivariable logistic regression, a statistical technique that estimates the independent effect of each factor while holding the others constant. Five factors emerged as significant independent predictors of suboptimal airway management quality, all with P values below 0.05. Three were patient-related: a total body surface area burned of 60 percent or more, the concurrent development of ARDS, and delayed establishment of the artificial airway. Two were staff-related and, crucially, modifiable: nursing experience of less than three years, and an annual training frequency of fewer than two sessions.

The patient-related predictors make physiological sense. Patients with burns covering 60 percent or more of their body surface face massive fluid shifts, profound inflammatory responses, and prolonged immobility, all of which complicate airway care and increase the burden of secretions and edema. Those who develop ARDS require prolonged mechanical ventilation with high pressures and oxygen concentrations, which stresses every component of airway maintenance. And delayed airway establishment is both a marker of deteriorating physiology and a contributor to it: a patient whose swollen airway is intubated late may be harder to intubate safely, may accumulate aspirated secretions, and may start the course of artificial airway care from a worse baseline.

It is the two staff-related findings, however, that carry the clearest practical message, because they are the ones an institution can change. Nurses with less than three years of experience were significantly more likely to be involved in suboptimal airway management, suggesting that the skills required, precise suctioning technique, correct cuff pressure management, early recognition of tube obstruction or displacement, and sound clinical judgment about secretion load, are accumulated through years of bedside practice. Equally telling, nurses who attended fewer than two training sessions per year were at higher risk of suboptimal care. The message is that competency in artificial airway management is not a one-time credential but a perishable skill that decays without regular reinforcement.

The authors also observed that where quality fell short, it tended to manifest as inconsistent protocol adherence and incomplete documentation, rather than as dramatic single-point failures. This pattern is common in intensive care: the difference between adequate and excellent care often lies in the accumulation of small, unglamorous tasks performed correctly and recorded properly, shift after shift. Documentation matters not only for continuity between clinicians but also as a quality-control signal, since gaps in the record make it harder for teams to detect drifting practice standards before they produce complications.

Based on their findings, the researchers recommend a package of institutional reforms: risk stratification frameworks that flag patients with extensive burns or evolving ARDS for intensified airway surveillance; standardized assessment tools that make protocol adherence measurable rather than assumed; tiered, competency-based training programs that ensure less experienced nurses receive structured skill-building and that all staff receive training at least twice a year; and strengthened multidisciplinary collaboration between burn surgeons, intensivists, and nursing teams. The study, funded by Ningxia Medical University, is retrospective and conducted at a single center, so the authors’ results describe one institution’s experience rather than a universal benchmark. But the structure of the findings, that injury severity sets the stage while training and timing determine execution, offers a concrete, testable template for other burn units. In a field where the airway is quite literally the difference between breathing and not, the suggestion that two of the five decisive factors are as simple as experience and regular training is a conclusion worth acting on.

Subject of Research: Quality of artificial airway management and its modifiable predictors in burn patients with inhalation injury

Article Title: Quality of artificial airway management and its modifiable predictors in burn patients with inhalation injury: a retrospective cohort study

Article References: Xia, F., You, X., Zhou, X., Yao, M., & Yan, R. (2026). Quality of artificial airway management and its modifiable predictors in burn patients with inhalation injury: a retrospective cohort study. BMC Nursing. https://doi.org/10.1186/s12912-026-05433-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05433-x

Keywords: burn injury, inhalation injury, artificial airway management, nursing quality, ARDS, TBSA, nurse training, retrospective cohort study, burn intensive care, airway complications, protocol adherence, documentation