Knowledge, attitudes, and practices of emergency nurses regarding sepsis nutritional management: a multicenter cross-sectional study

Abstract

Nutritional management is an important component of supportive care for patients with sepsis, but its implementation in emergency settings may be challenging alongside other time-critical priorities. This study assessed emergency department (ED) nurses’ knowledge, attitudes, and practices (KAP) regarding nutritional management in patients with sepsis. This multicenter cross-sectional study was conducted among ED nurses from hospitals in Jiangsu Province, China, between January and May 2026. A structured Chinese questionnaire with satisfactory internal consistency was used to assess KAP, with KAP levels descriptively classified using modified Bloom’s cut-off criteria. Multivariable linear regression was performed to identify factors associated with KAP scores, and structural equation modeling (SEM) was used to further evaluate the direct and indirect relationships among KAP domains. A total of 630 valid questionnaires were analyzed, including 558 female nurses (88.6%). The median knowledge, attitude, and practice scores were 9.00 (9.00, 15.00), 40.50 (36.00, 45.00), and 29.00 (22.25, 36.00), respectively, out of possible ranges of 0–18, 9–45, and 9–45. In multivariable analyses, nurses without recent training had significantly lower knowledge scores (β = −4.676, 95% CI: −5.386 to −3.965, p  < 0.001) and practice scores (β = −3.014, 95% CI: −4.296 to −1.732, p  < 0.001). Higher knowledge scores were independently associated with more positive attitudes (β = 0.419, 95% CI: 0.337 to 0.501, p  < 0.001) and better practices (β = 0.860, 95% CI: 0.723 to 0.997, p  < 0.001), while higher attitude scores were also independently associated with better practices (β = 0.415, 95% CI: 0.294 to 0.537, p  < 0.001). SEM demonstrated that knowledge had significant direct effects on attitude (β = 0.470, 95% CI: 0.404–0.536, p  < 0.001) and practice (β = 0.512, 95% CI: 0.432–0.589, p  < 0.001), and also had an indirect effect on practice through attitude (β = 0.100, 95% CI: 0.061–0.140, p  < 0.001). ED nurses showed insufficient knowledge, positive attitudes and moderate practice toward nutritional management in patients with sepsis. The observed associations of knowledge with both attitude and practice support the potential value of targeted, practice-oriented training, together with standardized documentation and workflow-based support.