Knowledge, Attitude and Self-Reported Practice of Delirium Among ICU Nurses in China: A Cross-Sectional Survey and...

Although ICU delirium is recognised as a significant independent predictor of long-term cognitive decline and mortality, its clinical management often remains fragmented. As frontline providers, ICU nurses play a pivotal role in early interventions; however, the psychological and professional determinants that underpin their clinical practice require clearer delineation.

The aim of this study was to assess the knowledge-attitude-practice (KAP) landscape regarding delirium among ICU nurses and to model the mediating role of professional attitudes in translating theoretical knowledge into clinical behaviours.

A cross-sectional survey was conducted in March 2025. Using convenience sampling, a validated KAP questionnaire was administered to ICU nurses via an online platform. The instrument evaluated three domains: Knowledge (10 items, total score range 10-40), Attitudes (10 items, total score range 10-40) and Practice (18 items, total score range 18-72), with higher scores indicating greater proficiency or more favourable orientations. Data were analysed using descriptive statistics, Pearson correlation and multiple linear regression, with mediation effects tested via path analysis.

Among 617 valid responses, the mean scores for knowledge, attitudes and practice were 2.58 ± 0.63, 3.42 ± 0.44 and 3.11 ± 0.51, respectively. Significant positive correlations were observed between all KAP dimensions (all p < 0.001). Regression analysis identified hospital grade and prior delirium training as key predictors of knowledge levels (p < 0.05). Both knowledge (β = 0.37) and attitudes (β = 0.36) were significantly associated with practice scores (p < 0.001). Mediation analysis confirmed that attitudes partially mediated the relationship between knowledge and practice (indirect effect = 0.06), accounting for 10.91% of the total effect.

ICU nurses demonstrate generally positive attitudes towards delirium management but exhibit notable knowledge deficits, particularly regarding delirium subtypes. Knowledge serves as the primary driver of practice, whereas professional attitudes function as a significant mediator that facilitates the translation of knowledge into action. Future interventions should transcend basic procedural instruction, prioritising tiered educational programmes and the cultivation of professional values to ensure sustained clinical improvements.

To enhance delirium care, multifaceted strategies are warranted: implementing systematic, tiered training to address specific knowledge gaps (e.g., hypoactive delirium); enhancing professional self-efficacy by emphasising the clinical impact of accurate assessment; and fostering a supportive unit culture that promotes evidence-based discussions and proactive intervention.