“Knowing is not doing”: knowledge, misconceptions and perceived barriers to pressure ulcer prevention practice among nursing students at a tertiary institution in the United Arab Emirates

<title>Abstract</title> <p>Background Pressure ulcers are largely preventable, yet their burden across acute care in the UAE and the Gulf region is substantial and growing. Nursing students are the future workforce expected to prevent them, but it is unknown whether pre-registration education equips them to do so locally. This study assessed students’ knowledge of pressure ulcer prevention and the barriers they perceive in translating it into practice. Methods A cross-sectional study with an embedded qualitative component was conducted among 133 nursing students at a UAE health sciences college, using an adapted 31-item Pressure Injury Prevention Knowledge (PIPK) questionnaire and two open-ended questions on barriers and suggested improvements. Descriptive statistics, t-tests, ANOVA, chi-square tests and Spearman correlations were computed; reflexive thematic analysis was used to analyse while strategies for improvement responses were analysed through content analysis. Results Participants (mean age 21.9 ± 1.9 years; 99.2% Emirati) scored 19.9 ± 5.2 of 31 (64.1% ± 16.6%); 20.3% showed good knowledge (≥ 80%), 42.1% moderate and 37.6% poor (&lt; 60%). The five lowest-scoring items were all outdated practices students needed to reject: hyper-oxygenated fatty acids for moisture protection (14.3% correct), head-of-bed elevation of 30–45° (17.3%), heel bandaging (19.5%), a 48-hour admission skin assessment window (24.8%) and doughnut-shaped devices (36.8%). Knowledge correlated with year of study (ρ = 0.245, p = 0.006) and clinical placements (ρ = 0.220, p = 0.014). Thematic analysis of 112 barrier responses generated six themes, the largest (54%) a two-sided knowledge–practice gap; time scarcity (51%), workforce-capacity constraints (43%), equipment shortfalls (26%), communication breakdowns (13%) and patient complexity (12%) followed. Suggested improvements centred on regular training (58.9%), simulation (35.7%), and updated guidelines (22.3%). Conclusions Students knew affirmative recommendations considerably better than they could reject the outdated practices these replace and named this knowledge–practice gap as their leading barrier to future practice. Knowledge rose with clinical exposure but plateaued short of proficiency by the final year. Curricula that explicitly deconstruct legacy practice through simulation, paired with placements that reinforce teaching, offer facilitate from knowing to doing.</p>