Background <p>Despite preventive nursing efforts, pressure injuries remain a significant clinical challenge, with a high incidence. The adoption of advanced technologies is therefore essential for more effective prevention.</p> Aims <p>To evaluate the effectiveness of real-time pressure mapping-based nursing interventions in preventing pressure injuries and improving caregiver outcomes.</p> Methods <p>A randomized controlled trial was conducted in which the intervention group received seven days of nursing care using real-time pressure mapping, allowing for safe, minimal repositioning based on real-time visual pressure distribution data and a nursing protocol. The control group received standard care. Skin condition was assessed three times daily, and caregiver burden and satisfaction were evaluated before and after the intervention.</p> Results <p>Sixty-eight participants completed the study. The intervention group demonstrated significantly lower pressure injury incidence and caregiver burden than the control group.</p> Conclusions <p>The findings support the use of real-time pressure mapping as an effective tool for preventing pressure injuries and suggest its broader applicability in intervention programs.</p> Trial registration <p>The study was registered in CRIS (KCT0009366; registration date: 23 April 2024; retrospectively registered).</p>