Pressure injuries (PIs) remain a major concern in acute and critical care settings despite the availability of several preventive interventions (Edsberg et al., 2022). In a recent study of 1117 intensive care units (ICUs) and 13,254 adult patients in 90 countries across six continents, the overall prevalence of PIs was 26.6 %, with an ICU-acquired prevalence of 16.2 %. (Labeau et al., 2021). On the other hand, many devices are frequently used in patient care and treatment in these care settings in connection with the advances in science and technology, and they have become a significant source of PIs (Gefen et al., 2022). By 2016, the National Pressure Ulcer Advisory Panel (NPUAP) officially included medical device-related pressure injuries (MDRPIs) in its PI category, defining it as a PI resulting from the use of medical devices for diagnosis or treatment and that tends to take the pattern or shape of the device (Edsberg et al., 2016).

As an important indicator of PI management, MDRPIs attract increasingly more attention. MDRPIs account for more than 30 % of all hospital-acquired PIs, with a reported incidence of 28.1 % in acute care settings (Brophy et al., 2021, Pittman and Gillespie, 2020). A systematic review of 13 studies reporting the incidence and prevalence of MDRPI in patients admitted to the ICUs showed that the incidence ranged from 0.9 % to 41.2 % and the prevalence ranged from 1.4 % to 121 % (Barakat-Johnson et al., 2019). Compared to patients admitted to general wards, ICU patients have several additional risk factors for PIs, including low awareness and mobility; malnutrition; use of sedatives, inotropes, or muscle relaxants; and edema (Alderden et al., 2017, Coyer et al., 2022a, Coyer et al., 2022b). Furthermore, various devices such as arterial/venous catheters, gastrointestinal tubes, oxygen supply devices, and foley catheters, as well as mechanical ventilators (MV), renal replacement therapy, and extracorporeal membrane oxygenation systems (ECMO) are used simultaneously in ICU patients, which further increases the risk of MDRPIs (Black et al., 2010, Coyer et al., 2022a, Coyer et al., 2022b, Erbay Dallı et al., 2022, Erbay Dalli and Kelebek Girgin, 2022). The fact that all these devices and tools are necessary and unavoidable as a component of the patient's treatment process makes the prevention of such injuries more challenging than conventional PIs (Delmore and Ayello, 2017).

In addition to the common risk factors associated with hospital-acquired PIs, such as immobility, moisture, laceration, nutritional deficiencies, and poor oxygenation, the MDRPI has unique risk factors associated with the use of medical devices, which can cause pressure damage to both skin and mucosal tissues in any part of the body coming into contact with the device (Coyer et al., 2014, Liversedge, 2019, Lyu et al., 2023). In addition, existing PI assessment tools such as the Braden scale, Norton scale, etc. are inadequate in predicting and assessing MDRPIs because they focus on the immobility of the patient rather than the mobility of the device and show underperform when applied to ICU patients (Deschepper et al., 2022, Jackson et al., 2019). All of these factors highlight the need for particular attention and care for MDRPIs in terms of monitoring, staging, and prevention. Considering the significant impact of MDRPIs on the etiology of conventional PIs, it is critical to determine the awareness and training needs of healthcare professionals, especially nurses involved in the one-to-one care of patients, about MDRPIs. Although there is no national strategy for the prevention and management of both PIs and MDRPIs in Turkey, the Ministry of Health considers the prevalence of PIs as a quality indicator (Turkish General Directorate of Health Services, 2020). However, ICU nurses have problems with knowledge, monitoring, prevention, and recording of these injuries, indicating that the awareness about MDRPIs is very low in many general and acute care settings in Turkey. Studies also indicate that nurses need to know how to prevent and treat MDRPIs. In a study conducted with 142 ICU nurses in Turkey, the average rate of correctly answering the questions about MDRPIs was found to be 68.4 %, and the lowest rate of correct answers was found in the sub-themes of monitoring (50.8 %) and prevention (57.7 %) (Erbay Dalli and Kelebek Girgin, 2022, Erbay Dallı et al., 2022). In addition, 23 % of the nurses who participated in the study stated that they did not report MDRPIs; the most common reason (13.9 %) was that they “did not receive a warning/information about reporting them”. In another study with 355 nurses, the average rate of correctly answering the questions about MDRPIs was found to be 61.1 %; the lowest scores were obtained from the questions related to the “staging” of MDRPIs, and only 23.1 % of the nurses stated that they had general knowledge about MDRPIs (Sönmez and Bahar, 2022). Lack of awareness and knowledge about MDRPIs among nurses may lead to an increase in the incidence and prevalence of both MDRPIs and general PIs and negative patient outcomes due to failure to adopt early prevention strategies for MDRPIs. Indeed, studies in Turkey report somewhat high incidence rates for MDRPIs (between 27.2 % and 59.1 %) (Celik et al., 2023, Togluk Yiğitoğlu and Aydoğan, 2023). Although all these studies expose the need for conducting continuing education programs to increase knowledge on preventing and treating MDRPIs, there is a lack of information about the impact of educational programs based on the needs of ICU nurses on both nurses' knowledge levels and the MDRPI prevalence. Therefore, this study aimed to determine the effect of the training given to ICU nurses to prevent MDRPIs on nurses' knowledge levels, their prevention performance, and the point prevalence (PP) of MDRPIs.