Nurses’ knowledge of prehospital and in-hospital management of traumatic hypovolemic shock: a national observational study

Introduction: traumatic hypovolemic shock is one of the leading causes of preventable death following major trauma. Its management relies on evidence-based resuscitation strategies and requires a time-sensitive, integrated approach across the prehospital and in-hospital settings. Nurses play a pivotal role in the early recognition and initial management of these patients. The objective of the study was to assess nurses' knowledge of traumatic hypovolemic shock management and to explore the association between recent trauma training, the availability of clinical care algorithms, and performance in clinical scenarios.

Materials and Methods: a national cross-sectional observational study was conducted between July 1 and July 31, 2025, among 170 nurses affiliated with ANIARTI (Italian Association of Critical Care Nurses). Data were collected using a purpose-designed questionnaire that underwent content validation (S-CVI = 0.95). The questionnaire included socio-demographic and professional characteristics, information on trauma training and the availability of clinical care algorithms, and six clinical scenarios assessing knowledge of traumatic hypovolemic shock management. Descriptive statistics and bivariate comparisons using Welch's t-test were performed. Results. The mean total knowledge score was 3.12 out of 6 (52%). Correct response rates ranged from 49% to 83% across the six clinical scenarios. Participants who had attended recent trauma training achieved higher mean scores than those without recent training (3.60 vs 1.96). Higher mean scores were also observed in settings where integrated clinical care algorithms were available.

Conclusions: nurses' knowledge of traumatic hypovolemic shock management was overall moderate. This exploratory study suggests that recent trauma training and the availability of structured clinical care algorithms may be associated with better performance in clinical scenarios. Given the use of a purpose-designed questionnaire that underwent content validation only, these findings should be interpreted as an exploratory assessment rather than as a definitive measure of nurses' knowledge. Periodic trauma education programmes and the implementation of shared clinical care algorithms may contribute to improving consistency in trauma care and supporting patient safety across emergency settings.