J Clin Nurs. 2025 Jul 14. doi: 10.1111/jocn.70034. Online ahead of print.
ABSTRACT
AIM: To examine the impact of critical care nurses’ delirium knowledge, self-efficacy and clinical reasoning competency on delirium care difficulties based on the information-motivation-behavioural (IMB) skills model from a behavioural perspective.
DESIGN: Cross-sectional study.
METHODS: A total of 440 critical care nurses from five hospitals in China were selected using convenience sampling and invited to complete an online questionnaire for measurement. Data were collected in November 2024 and analysed using SPSS/AMOS with descriptive statistics, Pearson’s correlation coefficient and multiple regression. Structural equation modelling was constructed to test the hypothesised relationships among the variables, with bootstrapping to assess mediation effects.
RESULTS: The level of delirium care difficulties was moderated. Delirium care difficulties were negatively correlated with delirium knowledge, self-efficacy and clinical reasoning competency. Clinical reasoning competency partly mediated delirium knowledge and self-efficacy with regard to delirium care difficulties.
CONCLUSION: Delirium knowledge, self-efficacy and clinical reasoning competency are essential for improving critical care nurses’ delirium care competencies. The role of clinical reasoning competency in the relationship between the other two variables and delirium care difficulties was highlighted. Establishing multifaceted innovative delirium education programmes, emphasising individuals’ sense of competence and enhancing clinical reasoning competency as behavioural skills were supported. Exploring these pathways using a nurse behaviour change-based perspective is critical.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Critical care managers should value nurses’ delirium care competencies. Enhancing continuing professional development through system-level support with high reliability and multiform professional education, including innovative theoretical and practical training; advancing policies that increase work motivation and self-planning to stimulate self-efficacy; and exercising critical and reflective thinking to improve clinical reasoning competency may enhance nurses’ delirium recognition and care competencies, including prioritisation, potentially improving delirium care dilemmas and patient outcomes.
REPORTING METHOD: The STROBE checklist was used as a guideline.
PATIENT OR PUBLIC CONTRIBUTION: Nurses completed questionnaires.
TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400092177). https://www.chictr.org.cn/bin/project/edit?pid=249216.
PMID:40654168 | DOI:10.1111/jocn.70034
