Influence factors of guideline adherence based on the Cognitive Load Theory among clinical nurses: A cross-sectional...

This study aimed to explore the influencing factors of guideline adherence among clinical nurses, based on the Cognitive Load Theory.

A cross-sectional research design was employed. Clinical nurses from eight tertiary hospitals in Beijing were selected as the study participants between October 2023 and May 2024. A survey was conducted using a demographic information questionnaire, the Guideline Adherence Scale, the Task Complexity Assessment Scale, and the Cognitive Load Scale.

A total of 1,005 clinical nurses were included. Nurses self-reported relatively high task complexity, with a median total score of 35.00 (27.00, 41.00), cognitive load was moderate, with a median total score of 56.00 (50.00, 69.00), and relatively high guideline adherence with a median total score of 22.00 (17.00, 27.00). The multiple linear regression analyses revealed that the working experience (β = 0.056; P = 0.005), working pressure (β = -0.041; P = 0.043), extraneous cognitive load (β = -0.078; P < 0.001), germane cognitive load (β = 0.659; P < 0.001), and task complexity (β = 0.196; P < 0.001) are influencing factors of guidelines adherence among clinical nurses.

Clinical nurses in this study reported relatively high levels of guideline adherence. When assigning nursing tasks and developing targeted optimization strategies, nursing managers should focus on reducing unnecessary extraneous cognitive load and work pressure while actively enhancing germane cognitive load by strengthening nurses' understanding and internalization of clinical practice guidelines, thereby continuously improving their adherence to guidelines.