Knowledge, attitudes, practices among intensive care nurses in perioperative sepsis management: a structural equation modeling analysis

Sepsis burden in Chinese intensive care units (ICUs) highlights nurses’ critical knowledge, attitudes, and practices (KAP) challenges. This study aims to assess the KAP of ICU nurses and to examine the structural relationships among these components using structural equation modeling (SEM) of ICU nurses regarding perioperative management of patients with sepsis. This cross-sectional survey was conducted among ICU nurses at the Second Hospital of Hebei Medical University between February and March 2025. The study assessed participants’ KAP using a structured questionnaire. Additionally, SEM was employed to investigate direct and indirect relationships between knowledge, attitudes, and practice. A subgroup analysis was also conducted to compare KAP scores between nurses working in general ICUs and those in specialized ICUs. This study included 373 ICU nurses, of whom 73.19% (n = 273) were female, 71.85% (n = 268) worked in general ICUs, and 76.68% (n = 286) reported working 40–50 h weekly. Mean scores for knowledge (range: 0–16), attitude (range: 10–50), and practice (range: 6–30) were 9.64 ± 2.30, 40.36 ± 3.86, and 26.16 ± 3.01, respectively. SEM analysis showed that knowledge was positively associated with attitude (β=0.268, P༝0.007), and attitude was positively associated with practice (β༝0.824, P༝0.008). Knowledge was also indirectly associated with practice through attitude (β༝0.221, P༝0.006). Subgroup analysis revealed that nurses in general ICUs had slightly higher knowledge scores (mean: 9.80 vs. 9.22) and practice scores (mean: 26.27 vs. 25.89) compared to those in specialized ICUs. ICU nurses demonstrated moderate levels of knowledge but generally positive attitudes and practices toward the perioperative management of sepsis patients. Our findings suggest that attitude is a key factor associated with practice, and may mediate the relationship between knowledge and practice. Targeted educational interventions that enhance both knowledge and attitudes may help support better clinical practice among ICU nurses managing perioperative sepsis care. Not applicable.