Knowledge, attitude, and practice of Chinese ICU nurses regarding ICU delirium: a nationwide cross-sectional study

BACKGROUND: Intensive care unit (ICU) delirium is highly prevalent and has profound impacts on patient outcomes. ICU nurses are ideally positioned to implement delirium prevention and management strategies. However, the effectiveness of these interventions is significantly influenced by nurses' knowledge, attitude, and practice regarding delirium. Currently, there is a lack of large-scale investigations into Chinese ICU nurses' knowledge, attitude, and practice status concerning ICU delirium. AIMS AND OBJECTIVES: This study aimed to evaluate the current status of knowledge, attitude, and practice regarding ICU nurses in China. DESIGN: A nationwide cross-sectional survey study was conducted. METHODS: An 82-item questionnaire was developed to evaluate ICU nurses' knowledge, attitude, and practice regarding delirium.It included a self-rated knowledge item (0-100 scale), 26 objective knowledge questions (scored 0-26, converted to percentages), 27 attitude items, and 20 practice items (both on 5-point Likert scales). Data were collected via an online survey platform. Descriptive statistics, including percentages, medians, and interquartile ranges, are reported. Univariate and multivariate analyses were used to identify factors affecting knowledge, attitude, and practice scores. The primary outcomes of this study were ICU nurses' scores of knowledge, attitude, and practice of ICU delirium. Secondary outcomes comprised factors associated with these primary outcomes. This study adhered to the STROBE reporting guidelines. RESULTS: Of the 5,476 responses, 5,146 (94.0%) were included. The sample comprised 4,369 females (84.9%), and 60.5% of participants had received delirium-related training. Nurses' self-assessed knowledge score (76.1 ± 15.5, out of 100) was significantly higher than their objective knowledge score (63.2 ± 13.3, converted to a percentage; t = 48.202, P < 0.01). Using a threshold of ≥ 60% for moderate and ≥ 80% for excellent performance, 49.3% of nurses achieved moderate knowledge scores and 12.4% achieved excellent scores. For the attitude dimension, 71.6% scored in the excellent range, whereas practice scores were notably lower, with only 9.0% achieving excellence.Multivariable regression analyses revealed the following significant factors: Knowledge scores were significantly associated with hospital level (B = 1.810, 95% CI: 0.733 to 2.887), educational background (B = 3.617, 95% CI: 2.673 to 4.562), professional title (B = 2.335, 95% CI: 1.698 to 2.972), ICU type (B = 1.477, 95% CI: 1.050 to 1.904), and prior delirium training (B = 2.991, 95% CI: 2.271 to 3.710) (all P < 0.01).Attitude scores were independently associated only with prior delirium training (B = 4.720, 95% CI: 3.762 to 5.678, P < 0.01).Practice scores were significantly associated with professional title (B = 1.394, 95% CI: 0.701 to 2.087), ICU type (B = -0.874, 95% CI: -1.574 to -0.175), and prior delirium training (B = -8.524, 95% CI: -9.702 to -7.346) (all P < 0.01). Total KAP scores were significantly associated with educational background (B = 4.234, 95% CI: 2.349 to 6.120), professional title (B = 4.207, 95% CI: 2.929 to 5.484), and years of ICU experience (B = -2.262, 95% CI: -3.716 to -0.808) (all P < 0.01). CONCLUSIONS: ICU nurses demonstrated moderate knowledge levels regarding delirium and overestimated their actual knowledge. While they exhibit positive attitudes toward delirium care, their clinical practice remains suboptimal. Nursing administrators and educators should implement stratified training programs tailored to nurses' levels, establish comprehensive ICU delirium care standards, and increase nurses' willingness and capability in practice.