Analysis of ICU nurses' CRRT downtime management knowledge, attitude, and practice status and influencing factors based on latent profiles and chain mediation analysis: a multicenter, cross-sectional survey.

Abstract

Background: Downtime is a prevalent issue in Continuous Renal Replacement Therapy (CRRT), often arising from various causes and adversely impacting its effectiveness and safety. Throughout the CRRT treatment process, nurses play a pivotal role. Therefore, this study aims to assess ICU nurses' current knowledge, attitudes, and practices regarding CRRT downtime management, identify influencing factors, and determine whether individual heterogeneity exists among them.

Methods: We conducted a cross-sectional survey in China, targeting ICU nurses from 42 ICUs across six provinces. Data was collected using an online questionnaire, including the CRRT Downtime Management Knowledge, Attitude, and Practice Questionnaire and the Self-Efficacy Assessment Scale. Statistical methods, such as latent profile analysis and multiple linear regression, were employed to analyze heterogeneity and influencing factors. Chain mediation analysis was also used to verify the relationship between self-efficacy and nurses' knowledge, attitudes, and practices.

Results: Of the 515 nurse questionnaires analyzed, the study could not establish latent profile types for ICU nurses' CRRT downtime management. Scores for knowledge, attitude, and practice dimensions were above average, with total scores averaging 149.56 ± 21.769. Factors such as nurse type, higher income, more experience, longer CRRT implementation duration, participation in downtime management training, and higher self-efficacy positively impacted nurses' knowledge, attitude, and practice (P<0.05). The maximum number of CRRT patients cared for in one shift positively influenced knowledge scores (P<0.05), while age negatively correlated with total scores (P<0.05). The mediating effect of self-efficacy is significant, accounting for 59% of the total effect. Therefore, self-efficacy can directly or indirectly affect the practice behavior of ICU nurses in CRRT downtime management. However, this study cannot determine the potential profile types of ICU nurses' CRRT downtime management.

Conclusion: ICU nurses generally demonstrate positive management of CRRT downtime, with above-average knowledge, attitude, and practice scores. Self-efficacy plays a crucial role in influencing their behavior. However, our study found no evidence of heterogeneous characteristics among ICU nurses in this regard.

Relevance to clinical practice: The deficiency in ICU nurses' knowledge regarding CRRT interruption management may compromise both the efficacy and safety of this therapeutic modality. Assessing their KAP (Knowledge, Attitude, Practice) competencies is crucial for identifying gaps and optimizing CRRT care quality. This finding underscores the need for nursing administrators to implement targeted interventions-such as specialized training programs incorporating self-efficacy enhancement modules, standardized protocols for machine downtime management, or structured curricula addressing technical skills development-thereby fostering clinician confidence and ultimately elevating standards of CRRT delivery.

Patient or public contribution: Thanks to the nurses who provided responses to the questionnaire.