Does Nurses' Fatigue Level Affect Their Self-Efficacy in Pressure Injury Management? A Multi-Center Cross-Sectional Study

Abstract

To investigate the impact of nurses' occupational fatigue and exhaustion levels on their self-efficacy in managing pressure injuries. A descriptive cross-sectional study. The data were collected from 682 nurses employed at three institutions from May 15 to July 31, 2023. Occupational fatigue and exhaustion were assessed using the OFER scale, while self-efficacy in pressure injury (PI) management was evaluated using the PUM-SES. Correlation and multiple linear regression methods were used for data analysis. The STROBE checklist was used in the study. The study included 682 nurses, 85.3% female. The average age was 29.99 years, with a mean work experience of 7.52 years. Most participants (70.7%) worked in public training and research hospitals, with 327 nurses working mixed day-night shifts and 358 nurses managing 1–5 patients per shift. Fatigue levels, measured using the OFER, showed a mean score of 67.54 (22.89) for chronic fatigue. Self-efficacy in pressure ulcer management, assessed using the PUMSES, had a mean score of 48.39 (24.87). Higher PUMSES scores were found among nurses with certification in stoma and wound care (p < 0.001) and those who had attended relevant training (p < 0.001). Significant correlations were identified between OFER recovery scores, professional characteristics and PUMSES scores. This study revealed that nurses experience moderate-to-high levels of occupational fatigue and low levels of self-efficacy in PI management. Although no significant relationship was found between fatigue and self-efficacy, occupational factors such as poor sleep quality, long working hours and irregular shift patterns were associated with increased fatigue. In contrast, higher educational attainment, greater knowledge about PI and participation in professional training significantly enhanced nurses' self-efficacy in PI management. This study offers some early data on the possible role of occupational fatigue and PI preventive practices. © 2025 Elsevier B.V., All rights reserved.