Attitudes, knowledge and practices concerning delirium among paediatric intensive care unit nurses: A multisite cross-sectional study in Sichuan, China

Attitudes, knowledge and practices concerning delirium among paediatric intensive care unit nurses: A multisite cross-sectional study in Sichuan, China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Attitudes, knowledge and practices concerning delirium among paediatric intensive care unit nurses: A multisite cross-sectional study in Sichuan, China YueEr Zhang, JingYing Xie, MengLin Tang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3800409/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Apr, 2024 Read the published version in BMC Nursing → Version 1 posted 10 You are reading this latest preprint version Abstract Background Delirium is an acute mental state associated with poor outcomes. The incidence of delirium is high, especially in the paediatric intensive care unit (PICU). It is important for staff, particularly nurses, to understand delirium and implement interventions to prevent it. We performed a survey with the aim of evaluating and analysing the factors influencing the knowledge, attitudes and behaviour of PICU nurses towards delirium. Methods This cross-sectional descriptive study included 215 PICU nurses in 6 PICUs from five Grade 3A hospitals in Sichuan Province, China. Nurses were surveyed regarding their knowledge, attitudes/beliefs, and practices related to delirium care. The data were analysed using descriptive statistics; differences between groups were compared using t tests, ANOVA and rank-sum tests. Variables with a significance level of 0.05 in the univariate analysis were entered into the multivariable regression analysis to identify predictors. Results Only 14.4% of the nurses had a good understanding of delirium, and 40.9% had received relevant training. The mean knowledge score was 9.01 ± 3.86, and the overall passing rate of knowledge was 49.8%. The mean attitude and behaviour scores were 40.95 ± 5.62 and 40.33 ± 8.01, respectively. Among the hospitals, different delirium assessments for children and specific training were performed, explaining approximately 10% of the variability in knowledge scores (F = 6.152), approximately 10% of the variability in attitude/belief scores (F = 5.908), and approximately 17% of the variability in practice scores (F = 10.767). Conclusions PICU nurses have poor knowledge of delirium, particularly regarding its clinical manifestations, influencing factors and medications used, and they have adequate attitudes and confidence and good behaviour regarding delirium in children. To better prevent delirium, we suggest that PICU departments routinely assess delirium and conduct delirium training for nurses. Trial registration Not applicable Paediatric delirium Nurses KAP Risk factors BACKGROUND Delirium is a syndrome characterized by the acute onset of cerebral dysfunction accompanied by a change or fluctuation in baseline mental status, inattention, or either disorganized thinking or an altered level of consciousness [ 1 ]. Delirium can be classified into four clinical subtypes: hyperactive, hypoactive, mixed and unclassifiable [ 2 ]. The incidence of delirium in hospitalized children ranges from 4.5–65.9%, and the incidence of delirium ranges from 22%-44% in the paediatric intensive care unit (PICU)[ 3 , 4 ]. A diagnosis of delirium adds to the cost of caring for critically ill children and places them at risk for adverse outcomes, including mortality and morbidity. Critically ill children with delirium experience prolonged mechanical ventilation and may experience posttraumatic stress disorder (PTSD) after hospitalization [ 5 – 7 ], which means that delirium exacerbates the condition of children, prolongs hospitalization time and increases hospitalization costs. In addition, children with delirium require resource-intensive care, further increasing hospitalization costs. One study showed that delirium increases the length of hospital stay and duration of ventilation in paediatric intensive care units (PICUs) by 2–3 days and increases the cost of hospitalization by more than 4 times[ 8 ]. Early detection and aggressive treatment can reverse delirium [ 9 ], and guidelines, including assessment, identification, prevention and treatment [ 10 ], have recommended effective management of delirium in children. Nurses in intensive care units play an important role in delirium treatment; nurses have an innate advantage in the early recognition and prevention of delirium because they care for children at the bedside for long periods and provide knowledgeable care. In addition, the environment in the intensive care units(ICU) is an important factor contributing to delirium incidence, and nurses who regularly assess the impact of environmental factors and take steps to minimize the impact of these factors may reduce delirium in patients and improve outcomes. In addition, nurses play a role in educating children’s family members [ 11 ]. Delirium management should be a routine task in the PICU, but a survey showed that delirium management in the PICU is not sufficient and varies widely, which may be related to a lack of awareness of the importance of delirium among professionals, a lack of delirium-related knowledge, low confidence in the use of delirium screening tools, and fear of adverse events [ 12 – 14 ]. It is necessary to explore nurses’ abilities to manage delirium and to make delirium management a routine and effective task. Knowledge-attitude-practice (KAP) theory states that targeted groups acquire relevant health or professional knowledge, form strong beliefs, and subsequently adopt positive attitudes to change their behaviours. Researchers often use KAP theory as a guide to develop questionnaires to understand the knowledge, attitudes and beliefs of a population in a certain area and use the results to develop interventions to improve behaviour. Studies have been conducted to investigate delirium knowledge, attitudes and practices among health care workers, but recent investigations in this area have focused on adult ICU nurses [ 12 , 14 ], with a lack of investigations involving PICU nurses. Gesin et al. [ 13 ] investigated only the knowledge of delirium among PICU nurses without evaluating their beliefs and behaviours or influencing factors. The aims of the survey were to 1) evaluate the knowledge, attitudes and behaviour of PICU nurses regarding delirium in Sichuan Province and 2) analyse the influential factors affecting the knowledge, beliefs and behaviour of PICU nurses regarding delirium. METHODS Design A convenience sampling method was used to select PICU nurses from five Grade 3A hospitals (West-China Hospital of Sichuan University, Nanchong Central Hospital, Chengdu Women's and Children's Hospital, Second Affiliated Hospital of West China Hospital of Sichuan University, and Sichuan Women's and Children's Hospital) from November 2021 to January 2022 as survey respondents. The inclusion criteria were as follows: (1) registered nurses and (2) nurses working in the PICU for ≥ 3 months. The exclusion criteria were as follows: (1) nurses on leave or interns and (2) nurses who were unwilling to participate in this survey. Sample size In this study, a brief calculation method was adopted, and the number of independent variables was expected to be 9; this value was calculated according to the requirement that the required sample size be 5–10 times the number of independent variables. Considering 20% attrition, the sample size should be at least 54–108 patients[ 15 ]. Development and content of the survey The intervention model divides the relevant behaviours into three main parts: "acquiring knowledge", "generating beliefs", and "forming behaviours". The three components are continuous in time, and the results of each component are progressive. Based on this theoretical framework and the previously published ICU delirium-related questionnaire [ 16 – 18 ], the study questionnaire(Supplementary Appendix1) consisted of four parts: 1) demographic and delirium training information: sex, age, education level, title, length of time in the PICU, and delirium training information; and 2) the Paediatric Delirium Knowledge Questionnaire, which consisted of 20 multiple-choice questions, including basic concepts of delirium, clinical manifestations of paediatric delirium, assessment tools, risk factors, and prevention and treatment options. Each question had three answer options (right/wrong/unclear), and each correct answer received a score of 1, while incorrect or unclear answers received a score of 0. The total possible score was 20 points. The higher the score was, the more PICU nurses knew about paediatric delirium. 3) Attitudes towards dealing with paediatric delirium: To investigate the confidence and attitudes of PICU nurses regarding intervention treatment and medical care cooperation for paediatric delirium patients, we designed 10 questions and used a 5-point Likert scale. The answer options strongly agree, agree, uncertain, disagree and strongly disagree were assigned values of 5, 4, 3, 2 and 1, respectively. The higher the score was, the greater the confidence and attitudes of nurses towards dealing with paediatric delirium. 4) Behaviour in dealing with paediatric delirium: To investigate the behaviour of PICU nurses in dealing with paediatric delirium, including prevention, intervention, medical and nursing cooperation and self-learning about delirium, a 5-point Likert scale was used, with answer options of always, often, occasionally and never (5, 4, 3, 2 and 1, respectively). With a total score ranging from 10–50, higher scores indicate better management behaviours of nurses in response to delirium in children. Validity Based on relevant guidelines and articles, five experts (three PICU physicians and two nurse managers, all with a title of associate senior or above) were consulted to design the questionnaire. This questionnaire was presurveyed in 20 patients and evaluated by 5 experts. The content validity was calculated as the proportion of experts who scored 4 points (important) or 5 points (very important) for the evaluation item. The content validity index (I-CVI) of each item was 0. 85 ~ 1. 00, the content validity index (S-CVI) of the total scale was 0.891, and the Cronbach's ɑ values of the three subquestionnaires were 0.907, 0.878, and 0.910, respectively. Ethical issues and survey methodology The study protocol was reviewed and approved by the ethics committee of West China Hospital, Sichuan University (IRB number: 2023 − 886). All participants provided informed consent after they were informed about the study overview. An electronic survey was also conducted among the PICU nurses. Nurses could use cell phones or computers to complete the survey, and only one questionnaire could be completed and submitted for each IP address, which prevented them from filling out the questionnaires repeatedly and ensured the quality of the survey. Before sending out the link, we communicated with PICU nurse managers, explaining the purpose of this survey and obtaining permission. Then, we determined the survey time and survey person in charge. Before the patients were distributed the electronic questionnaires, we provided uniform guidelines through the WeChat platform to explain how to answer the questionnaires in detail. The questionnaires were reviewed in a timely manner after being collected by a computer to eliminate invalid questionnaires. A total of 300 questionnaires were distributed, and 231 questionnaires were collected. After deleting invalid questionnaires, 215 valid questionnaires remained. Data analysis Descriptive statistics included frequencies and percentages of demographic data. Knowledge/Attitude/Behaviour scores are expressed as the mean scores and mean percentages as previously defined. Differences between groups (e.g., knowledge scores) were compared using t tests, ANOVA and rank-sum tests. Variables with a significance level of 0.05 in the univariate analysis were subsequently entered into the multivariable regression analysis to identify predictors. All analyses were performed using SPSS v 22. A p value < 0.05 was considered to indicate statistical significance. RESULTS General characteristics A total of 300 questionnaires were distributed in this study, and 215 valid questionnaires were returned, for a rate of 71.7%. Table 1 shows the general profile of the PICU nurses who participated in the survey. There were 209 (97.2%) females and 6 (2.8%) males aged 22–53 years, with an average age of 30.60 ± 5.93 years, and the majority (54.0%) were aged < 30 years. Seventy-nine percent of the nurses had a bachelor's degree. A total of 58.1% of the nurses had the title of nurse practitioner; 33.0% of the nurses had 10–20 years of experience; 36.3% of the nurses' units did not routinely perform delirium assessment in children; and 53.5% of the nurses had cared for children with delirium. Only 40.9% of the nurses had received training in childhood delirium, and only 14.4% felt that they had a good understanding of the topic. Table 1 Characteristics and factors influencing delirium knowledge, attitudes and practices among PICU nurses (n = 215) Characteristic Group Frequency Knowledge Attitudes/Beliefs Practice Median(IQR) Z/H Mean ± SD t/F Median(IQR) Z/H Sex Male 6 8.5(5.5,11.5) -0.464 40.33 ± 4.67 -0.275 37.5(35.25,42) -1.028 Female 209 10(7,12) 40.97 ± 5.66 42(35,47) Age ≤ 30 116 10(7,13) 3.541 40.92 ± 5.78 0.027 42(35,47) 0.780 31–40 86 9.5(6, 11.25) 41.04 ± 5.57 41.5(35,47) ＞40 13 9(4.5,10.5) 40.69 ± 4.87 41(32.5,45) Hospital Nanchong Central Hospital 82 11(7,13) 15.740 * 41.75 ± 6.20 4.538 * 42.5(40,49) 27.889 ** West China hospital 58 9.5(7,11) 41.94 ± 4.86 43.5(34,45) Second Affiliated Hospital of West China Hospital 21 10(9,11) 40.66 ± 4.52 39.0(34,45) Chengdu Women's and Children's Hospital 26 8.0(4,10) 36.92 ± 5.23 34.5(31,39) Chengdu Women's and Children's Hospital 28 8.5(6,10) 40.53 ± 4.99 40.0(31.5,45) Highest Level of Education Associate degree 36 9(7,13) 1.110 40.86 ± 7.71 0.054 41.5(30.25,48.75) 4.673 Bachelor’s Degree 171 10(7,12) 41.00 ± 5.29 42(36,47) Master’s Degree and PhD 8 10(6.75,13.5) 40.37 ± 5.37 34(30.75,41.75) Job Title Nurse 44 9.5(7,12) 3.386 40.54 ± 5.88 0.762 42.5(37.25,49.75) 7.019 Senior Nurse 125 10(7,13) 41.37 ± 5.76 42(36,48) Supervisor Nurse and above 46 9(6,11) 40.21 ± 4.96 38(32.75,44.25) Years of work as a registered nurse ＜1 9 10(9,12.5) 7.112 41.00 ± 4.41 0.081 44(35.5,50) 3.649 1–5 66 10(8,13) 40.84 ± 5.77 41(35.75,47.25) 6–10 56 9.5(6.25,12.75) 41.30 ± 5.66 44(35.5,47) 10–20 71 9(5,11) 40.85 ± 5.82 40(33,47) ＞20 13 9(4.5,10.5) 40.53 ± 4.96 41(32.5,43) Does the department perform delirium assessment? Yes 137 10(7.5,12.5) -2.795 * 41.92 ± 4.94 3.204 * 43(39,48) -4.580 ** No 78 9(5,11) 39.25 ± 6.34 35(30,45) Have cared for a child with delirium Yes 115 9(6,11) 7.384 * 40.86 ± 5.35 0.050 41(35,47) 0.882 No 86 10.5(7.75,13) 41.10 ± 5.74 42(34,49) Not clear 14 8.5(6.5,10.25) 40.78 ± 7.33 42(33.75,44.25) Somewhat 157 9(6.5,12) 40.88 ± 5.41 40(35,47) Do not know 27 7(2,12) 37.29 ± 5.97 35(30,45) Received specific training Yes 88 10(8,13) -3.353 ** 42.61 ± 4.39 3.915 ** 43(39,48) -3.328 ** No 127 9(6,11) 39.81 ± 6.10 39(32,46) *: p < 0.05; **: p ≤ 0.001 Attitudes, knowledge and practices regarding delirium among PICU nurses The highest score for PICU nurses' knowledge of delirium in children was 17 points, with no nurses receiving a perfect score and only 49.8% (107/215) of the nurses scoring more than 12 points. Only 4.2% of the nurses knew that "children usually remember delirium". In addition, the nurses' scores regarding the factors influencing delirium, such as family history (history of dementia), clinical manifestations (duration, symptoms of hyperactivity), and medications used to treat delirium, were also very low. A total of 71.6% of the nurses believed that benzodiazepines were helpful in treating delirium. A total of 29.3% of the nurses believed that children with delirium always presented with a hyperactive, confused state. (Table 3 ) A perfect score regarding the confidence and attitudes of nurses regarding delirium was given by 8.8% (19/215) of the nurses, and 98.6% (212/215) of the nurses received a passing score (≥ 30 points) (Table 2 ). The three questions with the lowest mean scores are shown in Table 3 , where the mean score is "If asked, are you confident that you can provide an accurate definition of delirium?" was 3.32 ± 1.03, with only 16.3% of the nurses being very confident that they could provide an accurate definition of delirium. This was followed by "You are able to use at least two interventions to prevent and reduce the duration of delirium in PICU patients", with a mean score of 3.66 ± 0.97 and 21.8% of the nurses being very confident in the use of the two interventions. In addition, the mean score for "You are confident in communicating concerns about the presence or risk of delirium to the child's bedside physician" was 3.83 ± 0.97, with 28.4% of the nurses being very confident in communicating delirium prevention and recognition to the physician. Of the nurses' behaviours in response to delirium, 15.8% (34/215) received a perfect score, and 91.6% (196/215) received a passing score (≥ 30) (Table 2 ). The three questions with the lowest mean scores are shown in Table 3 . The mean score for "encourage family companionship as much as possible when appropriate" was 3.69 ± 1.22, and only 34.4% of the nurses strongly agreed that family companionship should be encouraged. The mean score for "Actively learn about delirium in children" was 3.72 ± 1.15, with 34% of the nurses always actively learning about delirium in children. In addition, the mean score for "Frequently use ICU delirium assessment tools in clinical work" was 3.77 ± 1.36, with 41.4% of the nurses always using delirium assessment tools. Table 2 Knowledge, attitudes and practices regarding delirium among PICU nurses (n = 215) Score range Mean ± SD Passing Percentage Knowledge 0–17 9.01 ± 3.86 49.8% Attitudes/Beliefs 25–50 40.95 ± 5.62 98.6% Practice 10–50 40.33 ± 8.01 91.2% Table 3 The 3 knowledge, attitudes and practice dimensions with the lowest scores among PICU nurses (n = 215) Item Correct rate/ average score Knowledge Children generally don’t remember being delirious (FALSE) 9(4.2%) A family history of dementia predisposes a patient to delirium (FALSE) 17(8.0%) Delirium usually lasts several hours (FALSE) 22(10.2%) Attitude/Belief If asked, are you confident that you can provide an accurate definition of delirium 3.32 ± 1.03 There are at least two interventions you can use to prevent and reduce the time to delirium in PICU 3.66 ± 0.97 You are confident that you can communicate concerns about the presence or risk of delirium to doctor 3.83 ± 0.97 Practice You can encourage family companionship as much as possible if appropriate 3.69 ± 1.22 You take the initiative to learn about delirium in children in general 3.72 ± 1.15 You frequently use the ICU Delirium Assessment Tool in your clinical work 3.77 ± 1.36 Factors associated with PICU nurse attitudes, knowledge and practices concerning delirium We learned from the test analysis that the departments conducting delirium assessments, caring for children with delirium, ensuring an understanding of delirium, and providing delirium training affected PICU nurses' knowledge of delirium in children; nurses in different hospitals scored differently, in addition to nurses whose departments conducted delirium assessments, cared for children with delirium, ensured an understanding of delirium information, and provided delirium training with higher delirium knowledge scores. The departments that conduct delirium assessments, ensure an understanding of delirium, and provide delirium training affect PICU nurses' beliefs and behaviours regarding delirium in children. Nurses whose departments conducted delirium assessments, ensured an understanding of delirium information, and provided delirium training had higher delirium confidence and coping behaviour scores (Table 1 ). In addition, delirium behaviour scores differed among nurses with different titles, with nurses with lower titles having higher delirium behaviour scores. We subsequently included all the factors in a multiple regression analysis, which showed that not receiving specific training had the greatest impact on knowledge scores. The departments did not perform delirium assessments, and not receiving specific training had an impact on nurses' delirium beliefs. Different hospitals and not performing delirium assessments had an impact on nurses' delirium beliefs and behaviours (Table 4 ). Table 4 Multivariable regression analysis of delirium knowledge, attitudes and practices among PICU nurses (n = 215) Predictor Knowledge Attitudes/Beliefs Practice β (95% CI) Hospital -0.103 -0.136 -0.189* (-0.672 to 0.115) (-0.111 to 0.003) (-0.185 to -0.28) Does the department perform delirium assessment? -0.151 -0.155* -0.310** (-2.437 to 0.025) (-1.360 to -0.289) (-0.762 to -0.270) Have cared for a child with delirium 0.104 / / (-0.310 to 1.605) / / 0.184 / / Received specific training -0.194* -0.163* -0.078 (-2.770 to -0.266) (-0.369 to -0.003) (-0.377 to 0.124) F 6.152** 5.908** 10.767** R 2 0.105 0.101 0.170 *: p < 0.05; **: p ≤ 0.001 DISCUSSION The most important findings of this multicentre survey on delirium among PICU nurses are summarized as follows: 1) PICU nurses have poor knowledge of delirium in children, especially regarding clinical manifestations, some influencing factors and medications used; 2) PICU nurses have adequate beliefs and confidence and good behaviour regarding delirium in children; and 3) It is important to conduct delirium training for PICU nurses. In this study, 49.8% of the PICU nurses received a passing score for delirium knowledge, and the delirium knowledge of the PICU nurses was poor, which has been mentioned in numerous previous studies [ 19 – 20 ]. The attitude/belief and practice scores of the PICU nurses were 98.6% and 91.2%, respectively, indicating that the nurses had a certain awareness of delirium and paid attention to it. However, considering that knowledge of delirium is poor, nurses may not be able to carry out effective delirium management. Knowledge deficiencies are considered major obstacles to the implementation of delirium guidelines, and there is a need to strengthen continuing education to equip nurses with the latest knowledge of delirium care [ 21 ]. According to the 3 dimensions of the KAP scale, which had the lowest scores (Table 2 ), we found that PICU nurses were aware of the importance of delirium management but did not have the confidence to manage delirium well; for example, they could implement preventive measures and conduct delirium assessments and subsequently performed poorly on delirium management behaviours. This finding confirms those of Eastwood et al. [ 22 ] and Devlin et al. [ 23 ], who reported that different ICUs assess delirium in different ways and that 85% of nurses do not use assessment tools, which may be related to nurses' lack of understanding of delirium assessment tools and the fact that the assessment tools are complex and require additional time and effort. Analysis of the factors affecting the delirium knowledge and belief behaviour of PICU nurses revealed that age, sex, years of experience, education level and title had no effect on the delirium knowledge or belief behaviour of nurses. In contrast, some studies have shown that nurses with low seniority and education levels have relatively low delirium knowledge [ 17 , 20 ]. In addition, we explored whether the units assessed delirium had an effect on PICU nurses' delirium knowledge and belief behaviour. KAP theory states that improving cognition improves the ability to act. Accordingly, it is necessary to establish a delirium assessment program in PICU departments to influence nurses' understanding of the management of this disease and improve their ability to care for delirium. Finally, training is an important and effective measure for improving the knowledge, attitudes and behaviour of PICU nurses regarding delirium. The current study showed that while nurses often care for patients with delirium, most nurses report a lack of educational experience, and there are no delirium assessment tools or manuals available in their departments [ 24 ]. However, one study showed that after nurse training, the incidence of delirium decreased by 54.29% [ 25 ]. Therefore, it is necessary to develop an education and training program that reflects the needs identified in this study so that hospital nurses can develop the knowledge, skills, and attitudes needed for delirium care. Limitations This study has several limitations. First, the generalizability of our study results to other contexts is limited because we targeted hospital nurses working at five hospitals in Sichuan Province, China, by convenience sampling. Second, the questionnaire used in this study was self-designed, and although it was reviewed by experts, it was not validated by additional psychometric indices and was used on a large scale. Furthermore, the potential for selection bias should be accounted for because of the 71.7% response rate. Implications for practice Considering the importance of delirium care and the ripple effect of delirium care on patients, it is necessary to enhance nurses' competency in delirium care. To improve nurses' competency in delirium care, it is necessary to develop delirium training programs to improve nurses' knowledge and attitudes regarding delirium. In addition, it is necessary for management to formulate corresponding delirium management strategies, such as stipulating the frequency of delirium assessment and providing assessment tools in the ward. However, further research is needed to determine the effects of training programs and management strategies on the improvement of the delirium care competency of hospital nurses. CONCLUSIONS Preventing delirium in high-risk patients is easier than providing treatment after delirium has occurred. PICU nurses are in a unique position to care for patients at the bedside for long periods and are an important part of the early identification and prevention of delirium. In addition, due to the special environment of the PICU, the absence of family members and the weak expression abilities of children, it is necessary for nurses to improve their understanding and attitudes regarding delirium. Our study indicated that PICU nurses lack knowledge and practical abilities regarding delirium. It is necessary to strengthen education regarding the awareness, confidence and attitudes of PICU nurses to better manage delirium in children. Abbreviations PICU Paediatric Intensive Care Unit ICU Intensive Care Unit KAP Knowledge-Attitude-Practice ANOVA Analysis of variance SPSS Statistical Product and Service Solutions IRB Institutional Review Board Declarations Ethics approval and consent to participate The study protocol was reviewed and approved by the ethics committee of West China Hospital, Sichuan University (IRB number: 2023-886). All participants provided informed consent after they were informed about the study overview. Consent for publication Not applicable Availability of data and materials The datasets used during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding Funding was obtained from the Development Special Fund Project Sichuan University (Grant No. 18HXFH042), which helped design the study, collect the data and write the manuscript. This study was supported by the Major Program of the National Natural Science Foundation of Sichuan (Grant No. 2023YFG0019). This funding helped analyse and interpret the data. Authors' contributions YueEr Zhang and MengLing Tang designed the study and performed the experiments; YueEr Zhang and JingYing Xie performed the experiments, analysed the data, and wrote the manuscript. Acknowledgements Not applicable Authors' information YueEr Zhang Department of Pain, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China JingYing Xie West China Stomatological Hospital of Sichuan University, Chengdu, China Meng Lin Tang West China Hospital, Sichuan University/Department of Cardiovascular Surgery, Chengdu, China References Schieveld JN, Janssen NJ, Van Cauteren YJ. On the cornell assessment for pediatric delirium and both the diagnostic and statistical manual, 5th edition, and international classification of diseases, 11th revision: quo vadis? Crit Care Med. 2014;42:751-2. Morandi A, Jackson JC. Delirium in the intensive care unit: a review. Neurol Clin. 2011;29:749–63. Meyburg J, Dill ML, Von Haken R, Picardi S, Westhoff JH, Silver G, et al. Risk factors for the development of postoperative delirium in pediatric intensive care patients. Pediatr Crit Care Med. 2018;19:e514–21. Patel AK, Biagas KV, Clarke EC, Gerber LM, Mauer E, Silver G, et al. Delirium in children after cardiac bypass surgery. Pediatr Crit Care Med. 2017;18:165–71. Traube C, Mauer EA, Gerber LM, Kaur S, Joyce C, Kerson A, et al. Cost associated with pediatric delirium in the ICU. Crit Care Med. 2016;44:e1175–9. Traube C, Silver G, Gerber LM, Kaur S, Mauer EA, Kerson A, et al. Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Crit Care Med. 2017;45:891–8. Colville G, Kerry S, Pierce C. Children's factual and delusional memories of intensive care. Am J Respir Crit Care Med. 2008;177:976–82. Silver GH, Kearney JA, Bora S, De Souza C, Giles L, Hrycko S, et al. A clinical pathway to standardize care of children with delirium in pediatric inpatient settings. Hosp Pediatr. 2019;9:909–16. Bettencourt A, Mullen JE. Delirium in children: identification, prevention, and management. Crit Care Nurse. 2017;37:e9–18. Smith HAB, Besunder JB, Betters KA, Johnson PN, Srinivasan V, Stormorken A, et al. 2022 society of critical care medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatr Crit Care Med. 2022;23:e74–110. Berutti T, Brink E, Strohler B, Fuchs DC, Ely EW, Pandharipande PP, et al. Pediatric critical care perceptions on analgesia, sedation, and delirium. Semin Respir Crit Care Med. 2013;34:244–61. Forsgren LM, Eriksson M. Delirium–awareness, observation and interventions in intensive care units: a national survey of Swedish ICU head nurses. Intensive Crit Care Nurs. 2010;26:296–303. Gesin G, Russell BB, Lin AP, Norton HJ, Evans SL, Devlin JW. Impact of a delirium screening tool and multifaceted education on nurses' knowledge of delirium and ability to evaluate it correctly. Am J Crit Care. 2012;21:e1–11. Van Den Boogaard M, Pickkers P, Van Der Hoeven H, Roodbol G, Van Achterberg T, Schoonhoven L. Implementation of a delirium assessment tool in the ICU can influence haloperidol use. Crit Care. 2009;13:R131. Xia Wan. (2019). Graphical exploration of sample size calculation for linear regression and logistic regression models [D]. Chongqing Medical University. https://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CMFD&filename=1019659599.nh Flaigle MC, Ascenzi J, Kudchadkar SR. Identifying barriers to delirium screening and prevention in the pediatric ICU: evaluation of PICU staff knowledge. J Pediatr Nurs. 2016;31:81–4. Li YB, Hu YL, Liu XY, Ning Y. Knowledge, attitude and behavior of 194 ICU nurses in delirium of critically ill patients. J Nurs. 2017;24:42–5. Zhang S, Han Y, Wu Y. Preparation of delirium knowledge level questionnaire in ICU and its reliability and validity test. Chin J Nurs Manag. 2020;20. 10.3969/j.issn.1672-756.2020.01.025 . Abusaad F, Mostafa M, Ibraheim A. Learning needs assessment of pediatric nurses regarding delirium and its barriers of screening at intensive care units. Am J Nurs Res. 2017;5:70–8. Yang X, Xu JJ. Investigation on knowledge and practice of nurses in ICU delirium. J Nurs Sci. 2017;32:61–4. Trogrlić Z, Ista E, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, et al. Attitudes, knowledge and practices concerning delirium: a survey among intensive care unit professionals. Nurs Crit Care. 2017;22:133–40. Eastwood GM, Peck L, Bellomo R, Baldwin I, Reade MC. A questionnaire survey of critical care nurses' attitudes to delirium assessment before and after introduction of the CAM-ICU. Aust Crit Care. 2012;25:162–9. Devlin JW, Bhat S, Roberts RJ, Skrobik Y. Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight states. Ann Pharmacother. 2011;45:1217–29. Lee G, Roh YS. Knowledge, barriers, and training needs of nurses working in delirium care. Nurs Crit Care. 2023;28:637–44. Speed G. The impact of a delirium educational intervention with intensive care unit nurses. Clin Nurse Spec. 2015;29:89–94. Additional Declarations No competing interests reported. Supplementary Files supplementarymaterialquestionnaire.docx Cite Share Download PDF Status: Published Journal Publication published 29 Apr, 2024 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 20 Mar, 2024 Reviews received at journal 18 Mar, 2024 Reviewers agreed at journal 13 Mar, 2024 Reviews received at journal 11 Feb, 2024 Reviewers agreed at journal 01 Feb, 2024 Reviewers agreed at journal 05 Jan, 2024 Reviewers invited by journal 05 Jan, 2024 Editor assigned by journal 01 Jan, 2024 Submission checks completed at journal 01 Jan, 2024 First submitted to journal 24 Dec, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3800409","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":264617202,"identity":"a34f4b43-a348-42ce-9c3a-af9e006bfd55","order_by":0,"name":"YueEr Zhang","email":"","orcid":"","institution":"Sichuan University, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"YueEr","middleName":"","lastName":"Zhang","suffix":""},{"id":264617203,"identity":"3004f2c0-adff-4907-ad6b-de9207a7a423","order_by":1,"name":"JingYing Xie","email":"","orcid":"","institution":"West China Stomatological Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"JingYing","middleName":"","lastName":"Xie","suffix":""},{"id":264617204,"identity":"bd1868c4-8641-40d0-aa0b-2dec3bf1537f","order_by":2,"name":"MengLin Tang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYBACAxDxwMDGjnH+4YMPEipqiNHCzMCQUJCWzDyDLdngwZljxGr5cJixfQaPmuTDFmbCWswl8o9uSDBgZuad3cNWkdjAxsDf3p2AV4tlz2G2GwkGbHySc84eu5G4Q4ZB4szZDfgddrwZpIWH2bAhL+1G4hk2BgOJXAJaDjODtEgw7j+QY1aQ2MZMhBaILQaMjTNyzBiI03LmsBlQS0IyY8+xZImEM8d4CPvlRuKzGx/+/LdjbG8++PFHRY0cf3svfi0YgIc05aNgFIyCUTAKsAIA2atO8DSsZ70AAAAASUVORK5CYII=","orcid":"","institution":"Sichuan University, Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"MengLin","middleName":"","lastName":"Tang","suffix":""}],"badges":[],"createdAt":"2023-12-24 12:29:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3800409/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3800409/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-024-01956-3","type":"published","date":"2024-04-29T23:24:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":55693867,"identity":"daee2ff5-2fc5-4d68-a9d7-d76dcd9a4420","added_by":"auto","created_at":"2024-05-02 00:38:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":648434,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3800409/v1/b23e3ceb-0cb6-49f1-be7d-357172eb174b.pdf"},{"id":49101464,"identity":"02228930-eccd-4a8c-a21a-d5932bb5856d","added_by":"auto","created_at":"2024-01-03 05:57:29","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20236,"visible":true,"origin":"","legend":"","description":"","filename":"supplementarymaterialquestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-3800409/v1/6ac897b319d4c9883b9bba98.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Attitudes, knowledge and practices concerning delirium among paediatric intensive care unit nurses: A multisite cross-sectional study in Sichuan, China","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eDelirium is a syndrome characterized by the acute onset of cerebral dysfunction accompanied by a change or fluctuation in baseline mental status, inattention, or either disorganized thinking or an altered level of consciousness [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Delirium can be classified into four clinical subtypes: hyperactive, hypoactive, mixed and unclassifiable [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The incidence of delirium in hospitalized children ranges from 4.5\u0026ndash;65.9%, and the incidence of delirium ranges from 22%-44% in the paediatric intensive care unit (PICU)[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A diagnosis of delirium adds to the cost of caring for critically ill children and places them at risk for adverse outcomes, including mortality and morbidity. Critically ill children with delirium experience prolonged mechanical ventilation and may experience posttraumatic stress disorder (PTSD) after hospitalization [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], which means that delirium exacerbates the condition of children, prolongs hospitalization time and increases hospitalization costs. In addition, children with delirium require resource-intensive care, further increasing hospitalization costs. One study showed that delirium increases the length of hospital stay and duration of ventilation in paediatric intensive care units (PICUs) by 2\u0026ndash;3 days and increases the cost of hospitalization by more than 4 times[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly detection and aggressive treatment can reverse delirium [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and guidelines, including assessment, identification, prevention and treatment [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], have recommended effective management of delirium in children. Nurses in intensive care units play an important role in delirium treatment; nurses have an innate advantage in the early recognition and prevention of delirium because they care for children at the bedside for long periods and provide knowledgeable care. In addition, the environment in the intensive care units(ICU) is an important factor contributing to delirium incidence, and nurses who regularly assess the impact of environmental factors and take steps to minimize the impact of these factors may reduce delirium in patients and improve outcomes. In addition, nurses play a role in educating children\u0026rsquo;s family members [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Delirium management should be a routine task in the PICU, but a survey showed that delirium management in the PICU is not sufficient and varies widely, which may be related to a lack of awareness of the importance of delirium among professionals, a lack of delirium-related knowledge, low confidence in the use of delirium screening tools, and fear of adverse events [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It is necessary to explore nurses\u0026rsquo; abilities to manage delirium and to make delirium management a routine and effective task.\u003c/p\u003e \u003cp\u003eKnowledge-attitude-practice (KAP) theory states that targeted groups acquire relevant health or professional knowledge, form strong beliefs, and subsequently adopt positive attitudes to change their behaviours. Researchers often use KAP theory as a guide to develop questionnaires to understand the knowledge, attitudes and beliefs of a population in a certain area and use the results to develop interventions to improve behaviour. Studies have been conducted to investigate delirium knowledge, attitudes and practices among health care workers, but recent investigations in this area have focused on adult ICU nurses [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], with a lack of investigations involving PICU nurses. Gesin et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] investigated only the knowledge of delirium among PICU nurses without evaluating their beliefs and behaviours or influencing factors.\u003c/p\u003e \u003cp\u003eThe aims of the survey were to 1) evaluate the knowledge, attitudes and behaviour of PICU nurses regarding delirium in Sichuan Province and 2) analyse the influential factors affecting the knowledge, beliefs and behaviour of PICU nurses regarding delirium.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eA convenience sampling method was used to select PICU nurses from five Grade 3A hospitals (West-China Hospital of Sichuan University, Nanchong Central Hospital, Chengdu Women's and Children's Hospital, Second Affiliated Hospital of West China Hospital of Sichuan University, and Sichuan Women's and Children's Hospital) from November 2021 to January 2022 as survey respondents. The inclusion criteria were as follows: (1) registered nurses and (2) nurses working in the PICU for \u0026ge;\u0026thinsp;3 months. The exclusion criteria were as follows: (1) nurses on leave or interns and (2) nurses who were unwilling to participate in this survey.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eIn this study, a brief calculation method was adopted, and the number of independent variables was expected to be 9; this value was calculated according to the requirement that the required sample size be 5\u0026ndash;10 times the number of independent variables. Considering 20% attrition, the sample size should be at least 54\u0026ndash;108 patients[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDevelopment and content of the survey\u003c/h2\u003e \u003cp\u003eThe intervention model divides the relevant behaviours into three main parts: \"acquiring knowledge\", \"generating beliefs\", and \"forming behaviours\". The three components are continuous in time, and the results of each component are progressive. Based on this theoretical framework and the previously published ICU delirium-related questionnaire [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], the study questionnaire(Supplementary Appendix1) consisted of four parts: 1) demographic and delirium training information: sex, age, education level, title, length of time in the PICU, and delirium training information; and 2) the Paediatric Delirium Knowledge Questionnaire, which consisted of 20 multiple-choice questions, including basic concepts of delirium, clinical manifestations of paediatric delirium, assessment tools, risk factors, and prevention and treatment options. Each question had three answer options (right/wrong/unclear), and each correct answer received a score of 1, while incorrect or unclear answers received a score of 0. The total possible score was 20 points. The higher the score was, the more PICU nurses knew about paediatric delirium. 3) Attitudes towards dealing with paediatric delirium: To investigate the confidence and attitudes of PICU nurses regarding intervention treatment and medical care cooperation for paediatric delirium patients, we designed 10 questions and used a 5-point Likert scale. The answer options strongly agree, agree, uncertain, disagree and strongly disagree were assigned values of 5, 4, 3, 2 and 1, respectively. The higher the score was, the greater the confidence and attitudes of nurses towards dealing with paediatric delirium. 4) Behaviour in dealing with paediatric delirium: To investigate the behaviour of PICU nurses in dealing with paediatric delirium, including prevention, intervention, medical and nursing cooperation and self-learning about delirium, a 5-point Likert scale was used, with answer options of always, often, occasionally and never (5, 4, 3, 2 and 1, respectively). With a total score ranging from 10\u0026ndash;50, higher scores indicate better management behaviours of nurses in response to delirium in children.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eValidity\u003c/h2\u003e \u003cp\u003e Based on relevant guidelines and articles, five experts (three PICU physicians and two nurse managers, all with a title of associate senior or above) were consulted to design the questionnaire. This questionnaire was presurveyed in 20 patients and evaluated by 5 experts. The content validity was calculated as the proportion of experts who scored 4 points (important) or 5 points (very important) for the evaluation item. The content validity index (I-CVI) of each item was 0. 85\u0026thinsp;~\u0026thinsp;1. 00, the content validity index (S-CVI) of the total scale was 0.891, and the Cronbach's ɑ values of the three subquestionnaires were 0.907, 0.878, and 0.910, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEthical issues and survey methodology\u003c/h2\u003e \u003cp\u003e The study protocol was reviewed and approved by the ethics committee of West China Hospital, Sichuan University (IRB number: 2023\u0026thinsp;\u0026minus;\u0026thinsp;886). All participants provided informed consent after they were informed about the study overview. An electronic survey was also conducted among the PICU nurses. Nurses could use cell phones or computers to complete the survey, and only one questionnaire could be completed and submitted for each IP address, which prevented them from filling out the questionnaires repeatedly and ensured the quality of the survey. Before sending out the link, we communicated with PICU nurse managers, explaining the purpose of this survey and obtaining permission. Then, we determined the survey time and survey person in charge. Before the patients were distributed the electronic questionnaires, we provided uniform guidelines through the WeChat platform to explain how to answer the questionnaires in detail. The questionnaires were reviewed in a timely manner after being collected by a computer to eliminate invalid questionnaires. A total of 300 questionnaires were distributed, and 231 questionnaires were collected. After deleting invalid questionnaires, 215 valid questionnaires remained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics included frequencies and percentages of demographic data. Knowledge/Attitude/Behaviour scores are expressed as the mean scores and mean percentages as previously defined. Differences between groups (e.g., knowledge scores) were compared using t tests, ANOVA and rank-sum tests. Variables with a significance level of 0.05 in the univariate analysis were subsequently entered into the multivariable regression analysis to identify predictors. All analyses were performed using SPSS v 22. A p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eGeneral characteristics\u003c/h2\u003e \u003cp\u003eA total of 300 questionnaires were distributed in this study, and 215 valid questionnaires were returned, for a rate of 71.7%. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the general profile of the PICU nurses who participated in the survey. There were 209 (97.2%) females and 6 (2.8%) males aged 22\u0026ndash;53 years, with an average age of 30.60\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93 years, and the majority (54.0%) were aged\u0026thinsp;\u0026lt;\u0026thinsp;30 years. Seventy-nine percent of the nurses had a bachelor's degree. A total of 58.1% of the nurses had the title of nurse practitioner; 33.0% of the nurses had 10\u0026ndash;20 years of experience; 36.3% of the nurses' units did not routinely perform delirium assessment in children; and 53.5% of the nurses had cared for children with delirium. Only 40.9% of the nurses had received training in childhood delirium, and only 14.4% felt that they had a good understanding of the topic.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics and factors influencing delirium knowledge, attitudes and practices among PICU nurses (n\u0026thinsp;=\u0026thinsp;215)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eAttitudes/Beliefs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian(IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ/H\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003et/F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMedian(IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eZ/H\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.5(5.5,11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-0.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e37.5(35.25,42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-1.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(7,12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.97\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42(35,47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(7,13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42(35,47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5(6, 11.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.04\u0026thinsp;\u0026plusmn;\u0026thinsp;5.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41.5(35,47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e＞40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(4.5,10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.69\u0026thinsp;\u0026plusmn;\u0026thinsp;4.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41(32.5,45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNanchong Central Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(7,13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e15.740\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.75\u0026thinsp;\u0026plusmn;\u0026thinsp;6.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e4.538\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42.5(40,49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e27.889\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWest China hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5(7,11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.94\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43.5(34,45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond Affiliated Hospital of West China Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(9,11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.66\u0026thinsp;\u0026plusmn;\u0026thinsp;4.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39.0(34,45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChengdu Women's and Children's Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.0(4,10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e34.5(31,39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChengdu Women's and Children's Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.5(6,10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40.0(31.5,45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHighest Level of Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssociate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(7,13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.86\u0026thinsp;\u0026plusmn;\u0026thinsp;7.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41.5(30.25,48.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e4.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(7,12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42(36,47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u0026rsquo;s Degree and PhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(6.75,13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.37\u0026thinsp;\u0026plusmn;\u0026thinsp;5.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e34(30.75,41.75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eJob Title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5(7,12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.54\u0026thinsp;\u0026plusmn;\u0026thinsp;5.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42.5(37.25,49.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e7.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(7,13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.37\u0026thinsp;\u0026plusmn;\u0026thinsp;5.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42(36,48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupervisor Nurse and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(6,11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.21\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38(32.75,44.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eYears of work as a registered nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e＜1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(9,12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e7.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44(35.5,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e3.649\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(8,13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41(35.75,47.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5(6.25,12.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44(35.5,47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(5,11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.85\u0026thinsp;\u0026plusmn;\u0026thinsp;5.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40(33,47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e＞20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(4.5,10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41(32.5,43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDoes the department perform delirium assessment?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(7.5,12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-2.795\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.204\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43(39,48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-4.580\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(5,11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35(30,45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHave cared for a child with delirium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(6,11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e7.384\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.86\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41(35,47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.5(7.75,13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.10\u0026thinsp;\u0026plusmn;\u0026thinsp;5.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42(34,49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot clear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.5(6.5,10.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.78\u0026thinsp;\u0026plusmn;\u0026thinsp;7.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42(33.75,44.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSomewhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(6.5,12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.88\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40(35,47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo not know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(2,12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37.29\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35(30,45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReceived specific training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(8,13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-3.353\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42.61\u0026thinsp;\u0026plusmn;\u0026thinsp;4.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.915\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43(39,48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-3.328\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(6,11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39.81\u0026thinsp;\u0026plusmn;\u0026thinsp;6.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39(32,46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e*: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **: p\u0026thinsp;\u0026le;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes, knowledge and practices regarding delirium among PICU nurses\u003c/h2\u003e \u003cp\u003eThe highest score for PICU nurses' knowledge of delirium in children was 17 points, with no nurses receiving a perfect score and only 49.8% (107/215) of the nurses scoring more than 12 points. Only 4.2% of the nurses knew that \"children usually remember delirium\". In addition, the nurses' scores regarding the factors influencing delirium, such as family history (history of dementia), clinical manifestations (duration, symptoms of hyperactivity), and medications used to treat delirium, were also very low. A total of 71.6% of the nurses believed that benzodiazepines were helpful in treating delirium. A total of 29.3% of the nurses believed that children with delirium always presented with a hyperactive, confused state. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA perfect score regarding the confidence and attitudes of nurses regarding delirium was given by 8.8% (19/215) of the nurses, and 98.6% (212/215) of the nurses received a passing score (\u0026ge;\u0026thinsp;30 points) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The three questions with the lowest mean scores are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, where the mean score is \"If asked, are you confident that you can provide an accurate definition of delirium?\" was 3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03, with only 16.3% of the nurses being very confident that they could provide an accurate definition of delirium. This was followed by \"You are able to use at least two interventions to prevent and reduce the duration of delirium in PICU patients\", with a mean score of 3.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97 and 21.8% of the nurses being very confident in the use of the two interventions. In addition, the mean score for \"You are confident in communicating concerns about the presence or risk of delirium to the child's bedside physician\" was 3.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97, with 28.4% of the nurses being very confident in communicating delirium prevention and recognition to the physician.\u003c/p\u003e \u003cp\u003eOf the nurses' behaviours in response to delirium, 15.8% (34/215) received a perfect score, and 91.6% (196/215) received a passing score (\u0026ge;\u0026thinsp;30) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The three questions with the lowest mean scores are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The mean score for \"encourage family companionship as much as possible when appropriate\" was 3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22, and only 34.4% of the nurses strongly agreed that family companionship should be encouraged. The mean score for \"Actively learn about delirium in children\" was 3.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15, with 34% of the nurses always actively learning about delirium in children. In addition, the mean score for \"Frequently use ICU delirium assessment tools in clinical work\" was 3.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36, with 41.4% of the nurses always using delirium assessment tools.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge, attitudes and practices regarding delirium among PICU nurses (n\u0026thinsp;=\u0026thinsp;215)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePassing Percentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.01\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitudes/Beliefs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e40.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e40.33\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe 3 knowledge, attitudes and practice dimensions with the lowest scores among PICU nurses (n\u0026thinsp;=\u0026thinsp;215)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrect rate/\u003c/p\u003e \u003cp\u003eaverage score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChildren generally don\u0026rsquo;t remember being delirious (FALSE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA family history of dementia predisposes a patient to delirium (FALSE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(8.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelirium usually lasts several hours (FALSE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(10.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude/Belief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf asked, are you confident that you can provide an accurate definition of delirium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThere are at least two interventions you can use to prevent and reduce the time to delirium in PICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou are confident that you can communicate concerns about the presence or risk of delirium to doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou can encourage family companionship as much as possible if appropriate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou take the initiative to learn about delirium in children in general\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou frequently use the ICU Delirium Assessment Tool in your clinical work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with PICU nurse attitudes, knowledge and practices concerning delirium\u003c/h2\u003e \u003cp\u003eWe learned from the test analysis that the departments conducting delirium assessments, caring for children with delirium, ensuring an understanding of delirium, and providing delirium training affected PICU nurses' knowledge of delirium in children; nurses in different hospitals scored differently, in addition to nurses whose departments conducted delirium assessments, cared for children with delirium, ensured an understanding of delirium information, and provided delirium training with higher delirium knowledge scores. The departments that conduct delirium assessments, ensure an understanding of delirium, and provide delirium training affect PICU nurses' beliefs and behaviours regarding delirium in children. Nurses whose departments conducted delirium assessments, ensured an understanding of delirium information, and provided delirium training had higher delirium confidence and coping behaviour scores (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In addition, delirium behaviour scores differed among nurses with different titles, with nurses with lower titles having higher delirium behaviour scores. We subsequently included all the factors in a multiple regression analysis, which showed that not receiving specific training had the greatest impact on knowledge scores. The departments did not perform delirium assessments, and not receiving specific training had an impact on nurses' delirium beliefs. Different hospitals and not performing delirium assessments had an impact on nurses' delirium beliefs and behaviours (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable regression analysis of delirium knowledge, attitudes and practices among PICU nurses (n\u0026thinsp;=\u0026thinsp;215)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAttitudes/Beliefs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.189*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(-0.672 to 0.115)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(-0.111 to 0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(-0.185 to -0.28)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDoes the department perform delirium assessment?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.155*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.310**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(-2.437 to 0.025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(-1.360 to -0.289)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(-0.762 to -0.270)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHave cared for a child with delirium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(-0.310 to 1.605)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReceived specific training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.194*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.163*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(-2.770 to -0.266)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(-0.369 to -0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(-0.377 to 0.124)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.152**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.908**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.767**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **: p\u0026thinsp;\u0026le;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe most important findings of this multicentre survey on delirium among PICU nurses are summarized as follows:\u003c/p\u003e \u003cp\u003e1) PICU nurses have poor knowledge of delirium in children, especially regarding clinical manifestations, some influencing factors and medications used;\u003c/p\u003e \u003cp\u003e2) PICU nurses have adequate beliefs and confidence and good behaviour regarding delirium in children; and\u003c/p\u003e \u003cp\u003e3) It is important to conduct delirium training for PICU nurses.\u003c/p\u003e \u003cp\u003eIn this study, 49.8% of the PICU nurses received a passing score for delirium knowledge, and the delirium knowledge of the PICU nurses was poor, which has been mentioned in numerous previous studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The attitude/belief and practice scores of the PICU nurses were 98.6% and 91.2%, respectively, indicating that the nurses had a certain awareness of delirium and paid attention to it. However, considering that knowledge of delirium is poor, nurses may not be able to carry out effective delirium management. Knowledge deficiencies are considered major obstacles to the implementation of delirium guidelines, and there is a need to strengthen continuing education to equip nurses with the latest knowledge of delirium care [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the 3 dimensions of the KAP scale, which had the lowest scores (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), we found that PICU nurses were aware of the importance of delirium management but did not have the confidence to manage delirium well; for example, they could implement preventive measures and conduct delirium assessments and subsequently performed poorly on delirium management behaviours. This finding confirms those of Eastwood et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and Devlin et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], who reported that different ICUs assess delirium in different ways and that 85% of nurses do not use assessment tools, which may be related to nurses' lack of understanding of delirium assessment tools and the fact that the assessment tools are complex and require additional time and effort.\u003c/p\u003e \u003cp\u003eAnalysis of the factors affecting the delirium knowledge and belief behaviour of PICU nurses revealed that age, sex, years of experience, education level and title had no effect on the delirium knowledge or belief behaviour of nurses. In contrast, some studies have shown that nurses with low seniority and education levels have relatively low delirium knowledge [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In addition, we explored whether the units assessed delirium had an effect on PICU nurses' delirium knowledge and belief behaviour. KAP theory states that improving cognition improves the ability to act. Accordingly, it is necessary to establish a delirium assessment program in PICU departments to influence nurses' understanding of the management of this disease and improve their ability to care for delirium. Finally, training is an important and effective measure for improving the knowledge, attitudes and behaviour of PICU nurses regarding delirium. The current study showed that while nurses often care for patients with delirium, most nurses report a lack of educational experience, and there are no delirium assessment tools or manuals available in their departments [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, one study showed that after nurse training, the incidence of delirium decreased by 54.29% [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Therefore, it is necessary to develop an education and training program that reflects the needs identified in this study so that hospital nurses can develop the knowledge, skills, and attitudes needed for delirium care.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, the generalizability of our study results to other contexts is limited because we targeted hospital nurses working at five hospitals in Sichuan Province, China, by convenience sampling. Second, the questionnaire used in this study was self-designed, and although it was reviewed by experts, it was not validated by additional psychometric indices and was used on a large scale. Furthermore, the potential for selection bias should be accounted for because of the 71.7% response rate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eImplications for practice\u003c/h2\u003e \u003cp\u003eConsidering the importance of delirium care and the ripple effect of delirium care on patients, it is necessary to enhance nurses' competency in delirium care. To improve nurses' competency in delirium care, it is necessary to develop delirium training programs to improve nurses' knowledge and attitudes regarding delirium. In addition, it is necessary for management to formulate corresponding delirium management strategies, such as stipulating the frequency of delirium assessment and providing assessment tools in the ward. However, further research is needed to determine the effects of training programs and management strategies on the improvement of the delirium care competency of hospital nurses.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003ePreventing delirium in high-risk patients is easier than providing treatment after delirium has occurred. PICU nurses are in a unique position to care for patients at the bedside for long periods and are an important part of the early identification and prevention of delirium. In addition, due to the special environment of the PICU, the absence of family members and the weak expression abilities of children, it is necessary for nurses to improve their understanding and attitudes regarding delirium. Our study indicated that PICU nurses lack knowledge and practical abilities regarding delirium. It is necessary to strengthen education regarding the awareness, confidence and attitudes of PICU nurses to better manage delirium in children.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePICU Paediatric Intensive Care Unit\u003c/p\u003e \u003cp\u003eICU Intensive Care Unit\u003c/p\u003e \u003cp\u003eKAP Knowledge-Attitude-Practice\u003c/p\u003e \u003cp\u003eANOVA Analysis of variance\u003c/p\u003e \u003cp\u003eSPSS Statistical Product and Service Solutions\u003c/p\u003e \u003cp\u003eIRB Institutional Review Board\u003c/p\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the ethics committee of West China Hospital, Sichuan University (IRB number: 2023-886).\u0026nbsp;All participants provided informed consent after they were informed about the study overview.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding was obtained from the Development Special Fund Project Sichuan University (Grant No. 18HXFH042), which helped design the study, collect the data and write\u003c/p\u003e\n\u003cp\u003ethe manuscript. This study was supported by the Major Program of the National Natural Science Foundation of Sichuan (Grant No. 2023YFG0019). This funding helped analyse and interpret the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYueEr\u003c/strong\u003e \u003cstrong\u003eZhang\u003c/strong\u003eand \u003cstrong\u003eMengLing\u003c/strong\u003e \u003cstrong\u003eTang\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003edesigned the study and performed the experiments; \u003cstrong\u003eYueEr\u003c/strong\u003e \u003cstrong\u003eZhang\u003c/strong\u003e and \u003cstrong\u003eJingYing\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eXie\u003c/strong\u003e performed the experiments, analysed the data, and wrote the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; information\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eYueEr\u003c/u\u003e\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003cu\u003eZhang\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDepartment of\u0026nbsp;\u003c/u\u003e\u003cu\u003ePain, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eJingYing\u003c/u\u003e\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003cu\u003eXie\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eWest China Stomatological Hospital of Sichuan University, Chengdu, China\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMeng Lin\u003c/u\u003e\u003cu\u003e\u0026nbsp;Tang\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eWest China Hospital, Sichuan University/Department of\u0026nbsp;\u003c/u\u003e\u003cu\u003eCardiovascular Surgery, Chengdu, China\u003c/u\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSchieveld JN, Janssen NJ, Van Cauteren YJ. On the cornell assessment for pediatric delirium and both the diagnostic and statistical manual, 5th edition, and international classification of diseases, 11th revision: quo vadis? Crit Care Med. 2014;42:751-2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorandi A, Jackson JC. Delirium in the intensive care unit: a review. Neurol Clin. 2011;29:749\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyburg J, Dill ML, Von Haken R, Picardi S, Westhoff JH, Silver G, et al. Risk factors for the development of postoperative delirium in pediatric intensive care patients. Pediatr Crit Care Med. 2018;19:e514\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel AK, Biagas KV, Clarke EC, Gerber LM, Mauer E, Silver G, et al. Delirium in children after cardiac bypass surgery. Pediatr Crit Care Med. 2017;18:165\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTraube C, Mauer EA, Gerber LM, Kaur S, Joyce C, Kerson A, et al. Cost associated with pediatric delirium in the ICU. Crit Care Med. 2016;44:e1175\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTraube C, Silver G, Gerber LM, Kaur S, Mauer EA, Kerson A, et al. Delirium and mortality in critically ill children: epidemiology and outcomes of pediatric delirium. Crit Care Med. 2017;45:891\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColville G, Kerry S, Pierce C. Children's factual and delusional memories of intensive care. Am J Respir Crit Care Med. 2008;177:976\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilver GH, Kearney JA, Bora S, De Souza C, Giles L, Hrycko S, et al. A clinical pathway to standardize care of children with delirium in pediatric inpatient settings. Hosp Pediatr. 2019;9:909\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBettencourt A, Mullen JE. Delirium in children: identification, prevention, and management. Crit Care Nurse. 2017;37:e9\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith HAB, Besunder JB, Betters KA, Johnson PN, Srinivasan V, Stormorken A, et al. 2022 society of critical care medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Pediatr Crit Care Med. 2022;23:e74\u0026ndash;110.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerutti T, Brink E, Strohler B, Fuchs DC, Ely EW, Pandharipande PP, et al. Pediatric critical care perceptions on analgesia, sedation, and delirium. Semin Respir Crit Care Med. 2013;34:244\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForsgren LM, Eriksson M. Delirium\u0026ndash;awareness, observation and interventions in intensive care units: a national survey of Swedish ICU head nurses. Intensive Crit Care Nurs. 2010;26:296\u0026ndash;303.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGesin G, Russell BB, Lin AP, Norton HJ, Evans SL, Devlin JW. Impact of a delirium screening tool and multifaceted education on nurses' knowledge of delirium and ability to evaluate it correctly. Am J Crit Care. 2012;21:e1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Den Boogaard M, Pickkers P, Van Der Hoeven H, Roodbol G, Van Achterberg T, Schoonhoven L. Implementation of a delirium assessment tool in the ICU can influence haloperidol use. Crit Care. 2009;13:R131.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXia Wan. (2019). Graphical exploration of sample size calculation for linear regression and logistic regression models [D]. Chongqing Medical University. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CMFD\u0026amp;filename=1019659599.nh\u003c/span\u003e\u003cspan address=\"https://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CMFD\u0026amp;filename=1019659599.nh\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlaigle MC, Ascenzi J, Kudchadkar SR. Identifying barriers to delirium screening and prevention in the pediatric ICU: evaluation of PICU staff knowledge. J Pediatr Nurs. 2016;31:81\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi YB, Hu YL, Liu XY, Ning Y. Knowledge, attitude and behavior of 194 ICU nurses in delirium of critically ill patients. J Nurs. 2017;24:42\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang S, Han Y, Wu Y. Preparation of delirium knowledge level questionnaire in ICU and its reliability and validity test. Chin J Nurs Manag. 2020;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3969/j.issn.1672-756.2020.01.025\u003c/span\u003e\u003cspan address=\"10.3969/j.issn.1672-756.2020.01.025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbusaad F, Mostafa M, Ibraheim A. Learning needs assessment of pediatric nurses regarding delirium and its barriers of screening at intensive care units. Am J Nurs Res. 2017;5:70\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang X, Xu JJ. Investigation on knowledge and practice of nurses in ICU delirium. J Nurs Sci. 2017;32:61\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrogrlić Z, Ista E, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, et al. Attitudes, knowledge and practices concerning delirium: a survey among intensive care unit professionals. Nurs Crit Care. 2017;22:133\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEastwood GM, Peck L, Bellomo R, Baldwin I, Reade MC. A questionnaire survey of critical care nurses' attitudes to delirium assessment before and after introduction of the CAM-ICU. Aust Crit Care. 2012;25:162\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDevlin JW, Bhat S, Roberts RJ, Skrobik Y. Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight states. Ann Pharmacother. 2011;45:1217\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee G, Roh YS. Knowledge, barriers, and training needs of nurses working in delirium care. Nurs Crit Care. 2023;28:637\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpeed G. The impact of a delirium educational intervention with intensive care unit nurses. Clin Nurse Spec. 2015;29:89\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Paediatric delirium, Nurses, KAP, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-3800409/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3800409/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDelirium is an acute mental state associated with poor outcomes. The incidence of delirium is high, especially in the paediatric intensive care unit (PICU). It is important for staff, particularly nurses, to understand delirium and implement interventions to prevent it. We performed a survey with the aim of evaluating and analysing the factors influencing the knowledge, attitudes and behaviour of PICU nurses towards delirium.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional descriptive study included 215 PICU nurses in 6 PICUs from five Grade 3A hospitals in Sichuan Province, China. Nurses were surveyed regarding their knowledge, attitudes/beliefs, and practices related to delirium care. The data were analysed using descriptive statistics; differences between groups were compared using t tests, ANOVA and rank-sum tests. Variables with a significance level of 0.05 in the univariate analysis were entered into the multivariable regression analysis to identify predictors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOnly 14.4% of the nurses had a good understanding of delirium, and 40.9% had received relevant training. The mean knowledge score was 9.01\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86, and the overall passing rate of knowledge was 49.8%. The mean attitude and behaviour scores were 40.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.62 and 40.33\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01, respectively. Among the hospitals, different delirium assessments for children and specific training were performed, explaining approximately 10% of the variability in knowledge scores (F\u0026thinsp;=\u0026thinsp;6.152), approximately 10% of the variability in attitude/belief scores (F\u0026thinsp;=\u0026thinsp;5.908), and approximately 17% of the variability in practice scores (F\u0026thinsp;=\u0026thinsp;10.767).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePICU nurses have poor knowledge of delirium, particularly regarding its clinical manifestations, influencing factors and medications used, and they have adequate attitudes and confidence and good behaviour regarding delirium in children. To better prevent delirium, we suggest that PICU departments routinely assess delirium and conduct delirium training for nurses.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"Attitudes, knowledge and practices concerning delirium among paediatric intensive care unit nurses: A multisite cross-sectional study in Sichuan, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-03 05:57:24","doi":"10.21203/rs.3.rs-3800409/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-20T10:57:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-18T15:59:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"cd9bb07d-658c-4289-8311-3445fe5fe2f2","date":"2024-03-13T09:45:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-02-11T17:33:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"f2f69504-ba33-4604-a17b-6fbf07fb0fe8","date":"2024-02-01T18:11:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"a106292c-19da-41b4-b9b4-f9ff025bcad7","date":"2024-01-05T17:50:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-01-05T17:37:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-01-01T12:34:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-01T12:34:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2023-12-24T12:26:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ad645753-080a-445e-aade-c82e799c168a","owner":[],"postedDate":"January 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-01T23:24:50+00:00","versionOfRecord":{"articleIdentity":"rs-3800409","link":"https://doi.org/10.1186/s12912-024-01956-3","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2024-04-29 23:24:50","publishedOnDateReadable":"April 29th, 2024"},"versionCreatedAt":"2024-01-03 05:57:24","video":"","vorDoi":"10.1186/s12912-024-01956-3","vorDoiUrl":"https://doi.org/10.1186/s12912-024-01956-3","workflowStages":[]},"version":"v1","identity":"rs-3800409","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3800409","identity":"rs-3800409","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}