The purpose of this study was to examine Brazilian nursing

students’ knowledge of pressure ulcers. Third- and fourth-

year undergraduate baccalaureate students at a public uni-

versity in Brazil (N = 83) were asked to provide demograph-

ic information, identify extracurricular activities (eg, read-

ing journals and articles and using the Internet to enhance

comprehension of pressure ulcer care), and complete the

Pressure Ulcer Knowledge Test. Students correctly answered

67.7% of the Pressure Ulcer Knowledge Test items. Students

who participated in extracurricular activities and used the

Internet had significantly higher Knowledge Test scores than

those who did not. Readings did not significantly impact the

Knowledge Test score. Generally, the students were found to

have low pressure ulcer knowledge, but that educational pro-

grams and the Internet have the potential to positively

impact nursing students’ knowledge of pressure ulcers.

Ostomy/Wound Management 2003:49(3):54-63

Globally, maintaining skin integrity and prevent-

ing pressure ulcers have traditionally been the

responsibility of nurses. The presence of pres-

sure ulcers in hospitalized patients has been identified

as a quality indicator in healthcare.1 Prevention

requires a systematic evaluation of the patient for the

risk of developing pressure ulcers and adoption of

appropriate preventive measures. Gray2 stated that it

was the responsibility of educational institutions to

ensure that nursing students obtain the necessary

knowledge for practice while they are still completing

their undergraduate program. Therefore, nursing edu-

cational programs need to ensure that students receive

the necessary knowledge for pressure ulcer prevention,

staging, and description. The purpose of this study was

to examine Brazilian nursing students’ knowledge of

pressure ulcers.

Literature ReviewInternationally, various researchers have investigated

the knowledge and clinical practice of nurses and nurs-

ing students concerning the prevention and treatment

of pressure ulcers. Several studies have been conducted

in the United States. Moody and colleagues3 presented

an intensive educational program about the pathogene-

sis, assessment, treatment, and prevention of pressure

ulcers to nurses and physicians. This program resulted

in a decrease in pressure ulcers, decreased use of spe-

cialty beds, and cost savings. Bostrom and Kenneth4

surveyed staff nurses about their knowledge of pressure

54 OstomyWound Management

KNOWLEDGE OF PRESSUREULCERS BY UNDERGRADUATENURSING STUDENTS IN BRAZIL– Maria Helena Larcher Caliri, DNS, RN; Margareth Yuri Miyazaki, RN; and Barbara Pieper, PhD,

RN, FAAN, CWOCN

Ms. Caliri is Associate Professor and Ms. Miyazaki is a former BSN nursing student, Ribeirao Preto School of Nursing,University of Sao Paulo, Ribeirao Preto, Brazil. Dr. Pieper is a Professor/Nurse Practitioner, College of Nursing, Wayne StateUniversity, Detroit, Mich. Please address correspondence to: Maria Helena Larcher Caliri, DNS, RN, Assistant Professor,Ribeirao Preto School of Nursing, University of Sao Paulo, Ribeirao Preto, SP 14040-902, Brazil; email: mhcaliri@eerp.usp.br.

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ulcer risk factors, interventions for maintaining skin

integrity, and factors that hinder preventive care. They

reported a high knowledge of risk factors, but found

that nurses lacked interest and gave prevention a low

priority in care. Lack of staffing and costs were identi-

fied as additional barriers to pressure ulcer preventive

care. Hayes, Wolf, and McHugh5 examined the impact

of a pressure ulcer educational program on nurses’

knowledge of risk, assessment, and treatment. Nurses in

the pressure ulcer knowledge program versus a control

group improved their knowledge. Beitz and colleagues6

identified that professional and nonprofessional nurs-

ing staff members were poorly informed in several

basic aspects of pressure ulcer care. Nursing staff

desired more wound care information. Pieper and

Mott7 noted that the more recently nurses had heard a

lecture or read an article, the higher (significantly) their

knowledge about pressure ulcers. Knowledge scores

were not related to nurses’ educational background,

age, or years of work experience.

In Britian, Hill8 observed nurses providing patient

care and subsequently tested them about pressure

ulcer prevention. Nurses were knowledgeable about

dressings and nutritional assessment, but failed to

implement their knowledge of pressure ulcer risk

assessment. Hill8 recommended educating nursing

students about pressure ulcers and updating nurses’

knowledge. Russell9 queried nurses from two patient

care units about their pressure ulcer knowledge and

practice. She identified gaps in knowledge, such as

capillary pressures and pressure ulcer staging, and

recommended more post-basic education about

pressure ulcer prevention and treatment.

Maylor and Torrance10 surveyed nurses

about their knowledge and attitude about

pressure ulcers. They could not identify a

knowledge deficit. The failure to prevent

pressure ulcers was suggested as a prob-

lem with individual or organizational

motivation. In contrast, Gerrish and col-

leagues’11 survey and audit of the knowl-

edge of risk assessment and its documen-

tation noted deficiencies in both.

Mockridge and Anthony12 noted nurses’

knowledge of pressure ulcer treatment

and healing was higher for those ranked

at the senior versus junior level.

A study of 34 nurses in Hong Kong examined

knowledge and practice of preventing and treating

pressure ulcers in the elderly.13 Nurses had sound

knowledge of prevention and treatment, but inconsis-

tencies occurred in practice. In the Netherlands,

researchers studied the extent to which pressure ulcer

preventive methods were used and nurses’ knowledge

and beliefs regarding the usefulness of these methods.14

The study was based on a consensus committee report.

Nurses reported using many preventive methods that

the consensus committee had judged as not useful and

not using those judged as useful. The authors conclud-

ed that a knowledge deficit existed with regard to the

information from the consensus committee.14 A

Swedish study examined nurses’ knowledge of pressure

ulcer risk, prevention, and treatment for patients with

hip fractures.15 Nurses primarily used repositioning,

lotion, and pressure reducing surfaces; whereas, nutri-

tional support, reduction of shear and friction, and

patient education were only employed to a small

extent. The authors concluded that nursing staff knowl-

edge and documentation could be improved.15

Few studies could be found about nursing students.

Gould16 surveyed nursing schools about pressure ulcer

education. Faculty believed that pressure ulcer content

received a low priority. It tended to be presented at the

beginning of a student’s program and rarely updated or

discussed again. Although the textbooks in the study

have been revised since the study was published,

Vogelpohl and Dougherty17 noted that nursing text-

books tended to present pressure ulcer content sparse-

ly; at times, it was incomplete and inaccurate. They

March 2003 Vol. 49 Issue 3 55

KEY POINTS• The results of this study, conducted in Brazil, confirm that knowl-

edge of pressure ulcer prevention and care and dissemination ofresearch findings remains a global concern.

• In addition to the well-known traditional barriers faced by manypracticing clinicians, language and resource barriers are commonin many countries.

• The results of this study are encouraging, however; the availabilityof special programs and resources, including the Internet, made adifference in student knowledge.

• Because pressure ulcer prevention and care are important nursingfunctions, educators all over the world must find ways to bridgethe apparent knowledge-research gap and provide up-to-date basicand continuing education.

Ostomy/Wound Management 2003;49(3):54–63

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concluded that students were dependent upon clinical

experience, self-study, and the faculty to enhance their

background regarding pressure ulcer risk, prevention,

and treatment.

In Brazil, Rabeh and Caliri18 conducted a study to

identify the teaching-learning experiences of 31 stu-

dents in the last term of the undergraduate nursing

program in a private school. In that sample, 97% of

students cared for patients with pressure ulcers, hav-

ing acquired their skills in their Fundamentals of

Nursing course. The measure most frequently used for

prevention was postural alignment. They also

employed practices that are ill-advised, such as the

ring cushion, local massage, and soap and povidone

iodine for wound cleansing. The authors concluded

that students’ knowledge about pressure ulcer preven-

tion and treatment was low and care, at times, inap-

propriate.18 The above findings were similar to

Pearson and colleagues,19 who reported pressure ulcer

prevention and treatment varied, ranging from turn-

ing the patient and using occlusive dressings to sun-

shine exposure and airing the wound. The authors

concluded that despite years of attention to pressure

ulcer prevention and treatment, pressure ulcers

remained a significant problem in Australia.19

Rangel and colleagues20 interviewed 33 nursing stu-

dents at a university in Brazil about their pressure ulcer

care. Less than half of the students (48%) had delivered

prevention or treatment to patients at risk for pressure

ulcers or with pressure ulcers; 33% had never provided

this care; and 18% had only observed the care. The stu-

dents who performed pressure ulcer prevention and

treatment care cited an average of 10.2 pressure ulcer

care measures for these patients; whereas, those who

had never provided the care or only observed proce-

dures cited an average of one measure. Among the

measures utilized for treatment, 21% were considered

to be inadequate according to standardization in scien-

tific literature. The authors concluded that nursing

practice impacted students’ knowledge of pressure ulcer

prevention and treatment.20

In summary, findings about nurses’ knowledge about

pressure ulcers vary. Nurses first learn about pressure

ulcers in their educational programs. A few authors

conclude that knowledge is appropriate, but implemen-

tation of care is weak; others have identified low

knowledge or misconceptions about pressure ulcers. A

common thread is that continued education is neces-

sary. Knowledge for students can be achieved through

theoretical and practical teaching in undergraduate

nursing programs; by participating informally in

optional courses, lectures, and extracurricular activities,

and/or by reading articles and information on the

Internet and the like.

Worldwide, nurses are concerned about knowledge

of pressure ulcer prevention and treatment as evi-

denced by national studies of nurses and development

of consensus statements. Since 1998 in Brazil, the

guideline, Pressure Ulcers in Adults: Prediction and

Prevention21 has been available in Portuguese on the

website of the University of São Paulo at Ribeirão Preto

College of Nursing. The document is also disseminated

during classes, courses, and lectures. The purpose of

this study was to examine Brazilian nursing students’

knowledge of pressure ulcer prevention, staging, and

wound description. The following research questions

were examined:

1. What is nursing students’ knowledge about

pressure ulcers?

2. Is nursing students’ knowledge associated with

other learning methods such as extracurricular

activities, reading, or use of the Internet?

MethodSubjects and setting. The study was completed

with students (N = 83) at the end of their third or

fourth years of the undergraduate baccalaureate nurs-

ing education at a public university in São Paulo

State, Brazil. A sample of 83 has the power of .87 to

detect a large effect, 2-tail alpha = .05. All students in

the third and fourth years (N = 166) were invited to

participate. Fifty-three students from the third year

(63.9% of the class) and 30 students from the fourth

year (36.1% of the class) agreed to participate. The

difference in participant numbers between the third-

year and fourth-year students was due to difficulties

locating the latter because they were in a full-time

period of clinical training in different healthcare

institutions, often far from where data were collected.

Because the students had studied the pressure ulcer

curriculum during the second year of their education

and did not differ in their total score on the Pressure

Ulcer Knowledge Test, students were considered as a

total group for statistical analyses.

56 OstomyWound Management

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58 OstomyWound Management

The research

project was eval-

uated and

approved by the

institution’s

Committee of

Regulations and

Ethics. The study

was explained to

the students and

signed consent

was obtained.

Participation or

nonparticipation

did not affect the

students’ grades.

Data collection

occurred during

the last week of

class in

December 2000.

Instrument. The Pressure Ulcer Prevention Survey

was adapted from the instrument developed by

Pieper7,22 for use in this study. The instrument consisted

of demographic questions, questions about extracurric-

ular activities undertaken to learn about pressure

ulcers, and the Pressure Ulcer Knowledge Test. The

demographic items included sex, age, race, and acade-

mic year classification. In addition, information was

obtained about participation in extracurricular learn-

ing activities, such as attending conferences or special

lectures about pressure ulcers, reading articles and/or

books about pressure ulcers in addition to materials

assigned by the faculty, and using the home page about

pressure ulcer prevention and treatment. The Pressure

Ulcer Knowledge Test7,22 was translated and adapted to

Portuguese. After the initial translation, it was re-trans-

lated to English to validate that the items were the same

as the translation. To examine the instrument for clari-

ty and comprehension, eight students who did not par-

ticipate in the study completed the instrument. These

students reported no difficulty in reading or under-

standing the items. Content of the test was considered

basic care for nursing practice. In its adaptation to

Portuguese, 46 of the original 47 questions were main-

tained. The item related to vascular boots was deleted

because this product was not used in Brazil. The item

about heel protectors was modified to reflect the prac-

tice in Brazilian hospitals of placing water-filled gloves

on the heels. Water-filled gloves are viewed as an inex-

pensive method to decrease heel pressure. However,

Williams23 tested gloves filled with 260 mL of water and

found heel pressures were higher on the gloves than

resting on a mattress.

The 46 questions on the Pressure Ulcer Knowledge

Test included seven items about pressure ulcer staging,

seven items about wound description, and 32 items

about pressure ulcer risk. The items were answered as

true or false; items the students did not know were

considered incorrect. Because the goal of the study was

to examine total knowledge, items were tabulated for a

total correct score. The coefficient alpha value for all

students for the total score was .63.

Procedures. The students present at the teaching

institution on the dates established for data collection

were invited to participate. They were assured that their

identities would be kept secret and that the informa-

tion provided would be confidential. Data collection

proceeded with the students’ completion of the instru-

ment, which took approximately 20 minutes. The data

were submitted to analysis after they had been tran-

scribed to electronic tables using the EXCEL and EPI-

INFO applications.

Data analysis. The sample of students and number

of correct responses for an item were described using

percentages and frequencies. The Mann-Whitney U test

was performed to examine difference between groups.

ResultsSubjects. From the 83 subjects comprising the sam-

ple, 53 (63.9%) were in the third year and 30 (36.1%)

were in the fourth year of the undergraduate program

(see Table 1). Most participants (38.6%) were 21 years

old or younger (75.9% of the total number of students

were 23 years old or younger), Caucasian (89.2%), and

female (96.4%). Only two students had work experi-

ence as nurses in the position of a nurse auxiliary or

technician. Third- and fourth-year students did not dif-

fer by age or sex.

Pressure ulcer knowledge. The first research ques-

tion examined students’ knowledge about pressure

ulcers. Students correctly answered 67.7% of the

Pressure Ulcer Knowledge Test items (M = 31.16, SD =

4.19, range 20 to 41). No items were answered correctly

TABLE 1DESCRIPTION OF

STUDENTPARTICIPANTS (N = 83)

Characteristic

Age in Years<22 22 – 23

24 - 2526 – 27> 27

SexFemaleMale

RaceWhite Other (Asian;African American)

n

3231135 2

803

749

%

38.637.315.76.02.4

96.43.6

89.210.8

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60 OstomyWound Management

or missed by all stu-

dents. Of the 46

items, only 26

(56.5%) were

answered correctly

by 71.1% to 98.8%

of students. Items

with 90% correct

responses (a high

knowledge level)

included content

about pressure edu-

cational programs,

incontinence, docu-

mentation, and

nutrition, to name a

few (see Table 2). In

contrast, 20 items

(43.5%) were

answered correctly

by 60.2% to 13.3%

of participants.

Items with the low-

est correct scores

(poor knowledge,

with less than 50%

of students respond-

ing correctly)

included many time-

related items about

repositioning (see

Table 3).

Extracurricularlearning activities,reading, and use ofthe pressure ulcerknowledge website.The second research

question examined

the impact of

extracurricular

learning activities,

reading, and use of

the Internet on the

students’ pressure

ulcer knowledge.

Sixty-three (63,

TABLE 2PRESSURE ULCER KNOWLEDGE TEST ITEMS ANSWERED

CORRECTLY BY 90% OR GREATER OF THE STUDENTS (N = 83)

For persons who have incontinence, skin cleaning should occur at the time ofsoiling and routine intervals. (T)

Educational programs may reduce the incidence of pressure ulcers. (T)All care given to prevent or treat pressure ulcers must be documented. (T)Bony prominences should not have direct contact with one another. (T)An adequate dietary intake of protein and calories should be maintained dur-

ing illness. (T)Risk factors for development of pressure ulcers are immobility, incontinence,

impaired nutrition, and altered level of consciousness. (T)All individuals should be assessed on admission to a hospital for risk of pres-

sure ulcer development. (T)Every person assessed to be at risk for developing pressure ulcers should be

placed on a pressure-reducing bed surface. (T)Stage IV pressure ulcers are a full-thickness skin loss with extensive destruc-

tion, tissue necrosis, or damage to muscle, bone, or supporting structure. (T)A turning schedule should be written and placed at the bedside. (T)Skin, macerated from moisture, tears more easily. (T)A blister on the heel is nothing to worry about. (F)Friction may occur when moving a person up in bed. (T)

nItem

82

82818181

81

80

80

80

79787875

%

98.8

98.897.697.697.6

97.6

96.4

96.4

96.4

95.29494

90.4

TABLE 3PRESSURE ULCER KNOWLEDGE TEST ITEMS ANSWERED

CORRECTLY BY 50% OR LESS OF THE STUDENTS (N = 83)

The head of the bed should be maintained at the lowest degree of elevation(hopefully, no higher than a 30 degree angle) consistent with the medical con-dition. (T)

Undermining is the destruction that occurs under the skin. (T)Donut devices/rings cushions help to prevent pressure ulcers. (F)A low humidity environment may predispose a person to pressure ulcers. (T)Slough is yellow or creamy necrotic tissue on a wound bed. (T)Stage II pressure ulcers are full-thickness skin loss. (F)Persons confined to bed should be repositioned every 3 hours. (F)It is important to massage bony prominences. (F)All individuals at risk for pressure ulcers should have a systematic skin inspection

at least once a week. (F)In a side lying position, a person should be at a 30 degree angle with the bed. (T)Heel protection with water filled gloves relieves pressure on the heels. (F)The incidence of pressure ulcers is so high that countries appoint panels to

study risk, prevention, and treatment. (T)A person who cannot move self should be repositioned while sitting in a chair

every two hours. (F)A low Braden score is associated with increased pressure ulcer risk. (T)Persons, who can be taught, should shift their weight every 30 minutes while sit-

ting in a chair. (F)

n

40

3837363534333231

272014

11

1111

%

48.2

45.844.643.442.241

39.838.637.3

32.524.116.9

13.3

13.313.3

Activity

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75.9%) students participated in extracurricular activities related to pressure

ulcers. Examples of extracurricular activities are presented in Table 4. Sixty-

five (65, 78.3%) students had read articles, texts, or books on pressure

ulcers during their undergraduation studies. Among the material cited were

texts provided in courses and journal club, dissertations or theses, bandag-

ing manuals, and medical and surgical nursing textbooks. Twenty-one stu-

dents (21, 25.3%) utilized the website on the prevention and treatment of

pressure ulcers; 17 of the students used it two to five times.

Students who participated (M = 31.71, SD = 4.37) in extracurricular

activities had significantly higher Pressure Ulcer Knowledge scores than

those who had not (M = 29.4, SD = 3.05; Mann-Whitney non-parametric z

= -3.83, P < .001). The higher number of correct answers on the Pressure

Ulcer Knowledge Test was associated with use of the website (M = 33, SD =

4.74) as opposed to those who had not used the Internet (M = 30.9, SD =

3.69; Mann-Whitney non-parametric z = -2.29; P = .02) (M = 33, SD =

4.1). In contrast, students who had read textbook or journal articles about

pressure ulcers did not have significantly higher Pressure Ulcer Knowledge

Test scores compared to those who had not consulted these sources.

Students’ comments. Forty-nine students provided comments about par-

ticipation in the study. Students considered taking the Pressure Ulcer

Knowledge Test an important way to evaluate their theoretical and clinical

practice knowledge about pressure ulcers. They stated that knowledge tests

such as this may contribute to the improvement of undergraduate nursing

education programs. They commented that attending extracurricular lec-

tures and seminars about pressure ulcers enhanced their knowledge.

Students did not write comments about the Internet as a learning tool.

DiscussionThis study examined Brazilian nursing students’ knowledge of pressure

ulcers and practices that may enhance this knowledge. Generally, students

were found to have low Pressure Ulcer Knowledge Test scores. Students’

scores were higher if they had participated in extracurricular activities

about pressure ulcers or used the website about pressure ulcers. The test

included pressure ulcer nursing care practices that were clearly outdated

and incorrect and which are still used by nurses in Brazilian hospitals and

prescribed by physicians. Students are novice practitioners; learning in

environments that espouse proper care is important. Lamond and Farnell24

studied expert and novice nurses’ decisions about the treatment of pressure

ulcers. Nurses were given a photograph of a pressure ulcer along with

descriptive information. Experts were more accurate in their choice of

treatment and focused on specific information to make the decision.

Possibly, the low scores of these students reflect their novice level of knowl-

edge. Nevertheless, the low knowledge level about pressure ulcers is a con-

cern. Fernandes25 stated that the success of pressure ulcer prevention in hos-

pitalized patients greatly depends on the education of healthcare profes-

sionals, patients, and their relatives for the adoption of and adherence to

adequate measures. Although in its infancy in Brazil, this statement also

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62 OstomyWound ManagementOstomyWound Management

holds true for home care, because many patients at risk

for developing ulcers or who have ulcers are presently

receiving care from relatives at home. Nurses in the

basic (community) health units must provide guidance

to these family members.

Nurses must be able to seek relevant information

about pressure ulcer prevention and care. Textbooks

may not be up-to-date because of the potential delay

between writing and publishing. In addition, content

ages as students use the books over time.

Thirteen nursing journals are published in Brazil

with articles written in Portuguese. Because of the cost

of paper and printing, these journals are limited in size

and numbers of issues per year. This limits the venue

for nurses to obtain new information. Universities sub-

scribe to many international nursing journals, but

Brazilian nursing students primarily speak and read

Portuguese; thus, limiting available information.

Information in journals and textbooks needs to be use-

ful for the decisions made about pressure ulcer preven-

tion and treatment, and currently available research

does not appear to reach the nurses who make deci-

sions about patient care at the bedside. Gould26 noted

nurses’ failure to implement research results and related

this to the failure of nursing faculty to include relevant

materials in educational programs. Globally, the lack of

research implementation also must be examined in

terms of language and resource barriers.

Attending extracurricular activities such as special

lectures and courses requires motivation. Students at

this university in Brazil had opportunities to participate

in special courses and lectures about wound care and

pressure ulcers. These programs featured local and

international experts in pressure ulcer and wound care.

Students selected these programs because of a special

interest in the topic; they paid a fee to attend these pro-

grams. They were active participants in the learning

process. Students who attended these programs had a

higher level of pressure ulcer knowledge, underscoring

the fact that education about pressure ulcer prevention

and wound care is a life-long effort, requiring active

engagement of the learner.

The Internet provides worldwide information to stu-

dents. Web-based instruction requires transformation

from traditional teaching strategies to directed inde-

pendent learning.27 Teikmanis and Armstrong28 used an

online discussion board to teach pathophysiology to

baccalaureate nursing students. Their results suggested

that this assignment promoted greater participation

and feedback among students. Because of the cost,

computers are not generally owned by Brazilian nurs-

ing students, but they are available at university

libraries. Internet sites expose students to a variety of

information because of links within the system. The

student is an active participant in making decisions

about the depth and breath of the content presented.

The most recent literature also can be examined.

Although few students (n = 21) used the Internet, those

who did had higher knowledge scores. The Internet will

probably continue to evolve as an important education-

al tool for pressure ulcer information.

LimitationsThis study had limitations. The sample size was

small and students from only one university were par-

ticipants. The Pressure Ulcer Knowledge Test needs

further testing with students in Portuguese because

the reliability was .63. This may be a reflection of the

nature of items on the test or the way it was adminis-

tered. Students may not have considered items care-

fully because the test did not affect their course grade.

The study needs to be replicated with a larger and

more diverse sample. Examining students’ nursing

practice with knowledge is critical. These graduates

primarily direct patient care provided by other levels

of nursing personnel in Brazil. If they lack the neces-

sary knowledge about pressure ulcer prevention,

assessment and care, the information they give to oth-

ers will be insufficient.

TABLE 4EXTRACURRICULAR ACTIVITIES

COMPLETED BY STUDENTS (N = 83)

Course about pressure ulcers and otherchronic wounds

Some combination of course, lecture,journal club, honors program

Lecture about pressure ulcers and otherchronic wounds

Course and lecture togetherNone

nItem

24

18

16

520

%

28.9

21.7

19.3

624.1

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March 2003 Vol. 49 Issue 3 63

ConclusionNursing professionals must be educated to intervene

positively in the process to prevent and treat pressure

ulcers. To that end, knowledge and skills both for direct

care to the patient and management of human

resources and materials are necessary; hence, the

importance of quality theoretical and practical teach-

ing. Knowledge about pressure ulcer prevention and

treatment must be achieved in undergraduate educa-

tional programs where students must gain knowledge

and skill to provide safe patient care in regard to main-

taining skin integrity. Pressure ulcer risk assessment

based on knowledge of risk factors, prevention, and

early intervention is crucial to decreasing pressure

ulcers.29 Research-based nursing practice is frequently

stressed in educational endeavors. Research utilization

activities with students about pressure ulcers may lead

to positive outcomes in pressure ulcer prevention, just

as it has in clinical settings.30 Continuing educational

programs and use of the Internet have the potential to

positively impact nursing students’ knowledge. - OWM

AcknowledgmentsThe authors wish to thank Dr. Cláudia B. dos Santos

for the statistical analysis of the data and Dr. Miyeko

Hayashida for her assistance in the use of the EPI-

INFO program.

This study was partially supported by grants from

Fundação de Amparo à Pesquisa do Estado de Sao

Paulo - FAPESP (Proc. No. 2000/05458-5) and

Conselho Nacional de Desenvolvimento Científico -

CNPq (PIBIC/USP).

References1. Maklebust J, Sieggreen M. Pressure Ulcer: Guidelines for

Prevention and Nursing Management, 2nd ed. Springhouse, Pa.:Springhouse Corporation; 1996.

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