This multicenter, scenario-based cross-sectional study aims to examine the effect of operating room nurses' knowledge of medical device-related pressure injuries on their clinical decision-making skills. The study will be conducted with approximately 165 operating room nurses working in three different hospitals in Gaziantep, Türkiye. Data will be collected using a descriptive information form, a validated medical device-related pressure injury knowledge scale, and a scenario-based clinical decision-making assessment form. The study will evaluate the relationship between nurses' knowledge levels and their clinical decision-making performance, as well as identify factors influencing these outcomes. The findings are expected to contribute to improving patient safety, enhancing nursing education, and supporting evidence-based clinical decision-making in perioperative care.

Medical device-related pressure injuries (MDRPIs) are a significant and preventable patient safety issue, particularly in perioperative settings where prolonged immobility, decreased tissue perfusion due to anesthesia, and continuous contact with medical devices increase the risk of tissue damage. Studies have reported that the incidence of MDRPIs in surgical patients ranges widely and increases with the duration of surgery. Commonly affected areas include the nasal bridge, ears, lips, and other regions exposed to prolonged pressure from devices such as endotracheal tubes, masks, and fixation materials.

Operating room nurses play a critical role in preventing MDRPIs through appropriate device selection, positioning, skin assessment, and implementation of preventive interventions. International guidelines emphasize the importance of early risk identification and evidence-based clinical decision-making in reducing the occurrence of pressure injuries. However, existing literature indicates variability in nurses' knowledge levels regarding MDRPIs and suggests that this may affect their clinical decision-making processes. Despite the recognized importance of both knowledge and decision-making, studies examining the direct relationship between MDRPI knowledge and clinical decision-making skills among operating room nurses remain limited.

This multicenter, scenario-based cross-sectional study aims to evaluate the effect of operating room nurses' knowledge of MDRPIs on their clinical decision-making skills. The study will be conducted in three hospitals representing different levels of healthcare services in Gaziantep, Türkiye, including a university hospital, a city hospital, and a state hospital. Approximately 165 operating room nurses will be recruited based on predefined inclusion criteria.

Data will be collected using three instruments: a Descriptive Information Form, the Medical Device-Related Pressure Injury Knowledge Scale, and a Scenario-Based Clinical Decision-Making Form developed based on relevant literature and expert opinions. The scenario-based tool consists of multiple clinical situations designed to assess nurses' ability to make appropriate decisions in real-life perioperative contexts.

Data will be analyzed using appropriate statistical methods, including descriptive statistics, group comparisons, correlation analyses, and multiple linear regression to determine the predictive effect of knowledge on clinical decision-making skills. The study is expected to provide evidence on the relationship between knowledge and decision-making in the prevention of MDRPIs and to inform the development of targeted educational interventions aimed at improving perioperative nursing practices and patient safety outcomes.

Inclusion Criteria:

• Operating room nurses who have been working in operating rooms for at least one year Nurses who voluntarily agree to participate in the study Nurses who are able to understand and complete the data collection forms

Exclusion Criteria:

• Nurses who withdraw from the study at any stage after providing consent Incomplete or missing data in the questionnaires

The study population includes operating room nurses employed in three hospitals representing different levels of healthcare services (university, city, and state hospitals) in Gaziantep, Türkiye. Nurses with at least one year of operating room experience who meet the inclusion criteria and provide informed consent will be included in the study.