Knowledge, Attitude, and Practice Levels of Nurses in Primary Hospitals Regarding Elderly Subsyndromal Delirium: Assessment and Development of a Network-Based Tiered Training Program

<b>Aims/Background</b> Subsyndromal delirium (SSD) in elderly patients can lead to prolonged hospital stays, reduced quality of life, and cognitive decline. Evidence suggests that nursing interventions play a key role in mitigating SSD risk by facilitating early identification as well as timely and effective interventions. This study aimed to assess the knowledge, attitude, and practice (KAP) levels of nurses in primary hospitals regarding elderly SSD, identify factors influencing these levels, and construct a network-based tiered training program. <b>Methods</b> A literature review and Delphi expert consultation method, based on the KAP theory, were utilized to develop a questionnaire to assess the KAP levels of nurses regarding elderly SSD in primary hospitals. A pilot study was conducted to determine the reliability and validity of the questionnaire. From January 2024 to June 2024, a stratified cluster sampling method was employed to survey nurses from six secondary or higher-level primary hospitals in Shaoxing, China. The self-developed questionnaire was used to evaluate the KAP levels of primary hospital nurses regarding elderly SSD assessment and analyze factors influencing their scores. Based on the findings, a network-based tiered training program was constructed. <b>Results</b> A total of 615 questionnaires were distributed, of which 600 were valid, with an effective response rate of 97.56%. The mean total KAP score for nurses in primary hospitals regarding elderly SSD assessment was 98.11 ± 12.23, with an overall scoring rate of 61.32%. The mean scoring rates for KAP were 48.35%, 81.29%, and 68.84% respectively. Significant differences in KAP scores regarding elderly SSD for nurses in primary hospitals with different characteristics were observed based on age, educational level, years of experience, and professional title (<i>p</i> < 0.001). Multiple linear regression analysis showed that years of experience and professional title (nurse in charge or deputy senior nurse practitioner and above) were significant predictors of total KAP scores (<i>p</i> < 0.05). <b>Conclusion</b> The overall KAP level of primary hospital nurses regarding elderly SSD assessment was suboptimal. While attitudes towards SSD were generally positive, knowledge and practice levels required considerable improvement. A network-based tiered training program was developed to enhance the capacity of primary hospital nurses for timely and accurate identification of SSD risks in elderly patients.