Clinical nurses’ knowledge, attitudes and practices regarding incontinence-associated dermatitis: A cross-sectional study from China

To explore the current status of knowledge, attitudes, and practices (KAP) regarding incontinence-associated dermatitis (IAD) among clinical nurses in China and identify factors influencing these three aspects, this study adopted a cross-sectional design and was conducted in a tertiary hospital in Fujian Province, China, with 1,153 nurses completing the questionnaire. Primary outcome measures included nurses' IAD-related knowledge, attitude, and practice scores, with scoring rates of 70.6%, 90.9%, and 69.9% respectively; key low-scoring items in knowledge were "IAD care products" (2.04 ± 1.019) and "IAD assessment tools" (2.12 ± 0.923), while low-scoring practice items included "actively participating in IAD seminars" (60%) and "using IAD assessment tools" (66%). Demographic and professional information collected included gender, age, highest educational attainment, work experience, job position, job grade, department, wound/ostomy/incontinence (W/O/I) team membership, and participation in W/O/I care training. Results showed that clinical nurses had insufficient IAD knowledge (only 15.3% with high knowledge levels) and inadequate practices, but held positive attitudes (75.4% with positive attitudes). Notably, male nurses demonstrated more comprehensive IAD knowledge than female nurses (p < 0.05), though no significant gender difference was observed in practice (p = 0.883); this knowledge difference may be associated with male nurses' more frequent assignment to IAD-high-incidence departments (e.g., ICUs) and higher participation in W/O/I training. Factors influencing nurses' IAD-KAP included: 1) Common factors across KAP: job position (specialist nurses and head nurses performed better) and W/O/I team membership; 2) Dimension-specific factors: department affiliation (ICU nurses outperformed general ward nurses in knowledge and practice), participation in W/O/I training (improved knowledge and practice), gender (influencing knowledge only), and work experience (longer tenure correlated with more positive attitudes). Highest educational attainment was not a significant influencing factor, possibly due to inconsistent quality of part-time continuing education for nurses. In conclusion, participating nurses exhibited insufficient IAD knowledge and inadequate practices despite positive attitudes, presenting a notable "attitude-practice gap". Nursing administrators should develop targeted training (e.g., scenario-based training on IAD assessment tools and care products) and encourage female nurses to rotate in high-incidence departments (e.g., ICUs), strengthen resource allocation (e.g., ensuring supply of IAD care products) and promote W/O/I team construction, and optimize continuing education quality to address knowledge disparities, thereby enhancing nurses' understanding of IAD prevention and improving their related practices.