Knowledge, attitudes, and behaviors of ICU nurses for enteral nutrition-related diarrhea management: a...

Enteral nutrition (EN) is essential for ICU patients, but EN-associated diarrhea (ENAD) affects 48.6-89.0% of them, increasing complications and healthcare costs. ICU nurses' knowledge, attitudes, and behavior in ENAD management significantly influence patient outcomes.

We evaluated ICU nurses' knowledge, attitudes, and behavior in ENAD management and explored their interrelationships using a social cognitive and behavior change framework.

From June 2022 to March 2023, 371 ICU nurses from 11 Chinese ICUs completed a validated questionnaire. We analyzed data using descriptive statistics, regression, and structural equation modeling.

Knowledge (mean = 63.57, SD = 15.04), attitudes (mean = 44.19, SD = 4.76), and behaviors (mean = 56.32, SD = 9.15) were moderate. Knowledge was positively correlated with attitudes (ρ = 0.42, p < 0.001) and behaviors (ρ = 0.58, p < 0.001), and attitudes strongly correlated with behaviors (ρ = 0.65, p < 0.001). Attitudes mediated the knowledge-behavior relationship (β = 0.14, 95% CI [0.08, 0.21], p < 0.001). Master's Degree (β = 0.10, p = 0.049), training participation (β = 0.18, p = 0.002), and frequent training (4 times/year, β = 0.22, p < 0.001) predicted better knowledge, while training and age (31-35 years) enhanced attitudes (p < 0.05).

Knowledge gaps hinder ICU nurses' ENAD management, with attitudes critically mediating the translation of knowledge into practice. Targeted interventions, such as quarterly workshops and scenario-based simulations, are recommended to enhance knowledge, foster positive attitudes, and standardize behaviors, thereby improving patient care quality.