Intensive Care Nurses' Self-Reported Adherence to Evidence-Informed Microaspiration-Prevention Practices and Potential Implementation Determinants: A Multicenter Cross-Sectional Study.

Abstract

Aim: To assess intensive care nurses' self-reported adherence to recommended microaspiration-prevention practices and explore potential implementation determinants.

Design: Multicentre, cross-sectional.

Methods: From December 2024 to February 2025, nurses in 31 intensive care units at 17 hospitals in Henan Province, China, completed a questionnaire on 22 preventive practices and 43 implementation-related items informed by the Theoretical Domains Framework. Bivariate analyses, a fully adjusted three-level mixed-effects model accounting for unit and hospital clustering, and generalised estimating equation sensitivity analyses examined associations.

Results: Of 510 respondents, 476 were analysed. Mean adherence was 77.17/110 (70.15% of maximum), with basic care scoring highest (73.6%) and risk management lowest (67.2%). After adjustment, adherence was lower in units with 10-14, 15-19 and ≥ 20 beds than in those with < 5 beds; the 5-9-bed group did not differ. Both training exposures were associated with higher adherence in the primary analysis; only evidence-based practice training remained significant in the 14-item analysis. The lowest-scoring items concerned near-term implementation intention (3.10), competing priorities (3.21), and professional responsibility (3.29); the highest concerned time efficiency (4.19), workflow compatibility (4.15) and interest (3.94).

Conclusion: Self-reported adherence varied across practices and domains. Intensive care unit bed capacity and training exposure were associated with adherence, and implementation-related findings identified potential areas for further investigation.

Implications for nursing practice: Findings may guide intensive care unit nurses, nurse managers, and educators in strengthening targeted microaspiration-prevention training, clarifying responsibilities, integrating preventive practices into routine workflows, and reinforcing bedside supervision, particularly in units with 10-14, 15-19, or ≥ 20 beds.

Reporting method: The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were followed. Patient or Public Contribution: None.