# Patient Safety and Quality Improvement in Nursing Practice: Associations Among Workload, Occupational Coping Self-Efficacy and Medical Device-Related Pressure Injury Prevention

## TL;DR

This study finds that nurses' workload affects their ability to prevent medical device-related pressure injuries through their coping self-efficacy.

## Contribution

The study identifies occupational coping self-efficacy as a key mediator linking workload and MDRPI prevention performance.

## Key findings

- Higher workload is associated with lower occupational coping self-efficacy.
- Occupational coping self-efficacy mediates the relationship between workload and MDRPI prevention performance.
- Organizational strategies to improve coping self-efficacy may enhance patient safety.

## Abstract

Background/Objectives: Medical device-related pressure injury (MDRPI) is a significant patient safety issue associated with increased morbidity, prolonged hospitalization, and healthcare costs. Although evidence-based guidelines for MDRPI prevention exist, nurses’ prevention performance remains suboptimal, and the mechanisms linking workload to preventive practice remain insufficiently elucidated. Within a patient safety and quality improvement framework, this study aimed to examine whether occupational coping self-efficacy (OCSE) is statistically consistent with an indirect association linking nurses’ workload and MDRPI prevention performance across the nursing practice continuum. Methods: This descriptive correlational study used a mediation model with data from 181 registered nurses working in intensive care units, general wards, and integrated nursing care wards in South Korea. Workload, OCSE, and MDRPI prevention performance were measured using validated instruments. Mediation was tested using hierarchical regression and bootstrapped analysis (PROCESS macro Model 4, 5000 resamples), controlling for demographic and work-related variables. Results: Higher workload was associated with lower OCSE, while higher OCSE was associated with better MDRPI prevention performance. When OCSE was included in the model, the direct association between workload and prevention performance was no longer significant. Bootstrapping confirmed a significant indirect association through OCSE, consistent with a full mediation pattern. Conclusions: Nurses’ workload appears to be indirectly associated with MDRPI prevention performance through OCSE. These findings suggest that strengthening nurses’ coping self-efficacy, alongside organizational strategies, may be essential for sustainable MDRPI prevention and patient safety improvement.