Delirium-care barriers among intensive care nurses based on the Capability, Opportunity, Motivation-Behaviour (COM-B) model: A cross-sectional study.

OBJECTIVES

To examine delirium-care difficulties among ICU nurses and, within the COM-B framework, explore associations with delirium knowledge, work environment and work motivation.

BACKGROUND

Delirium is common and serious in adult ICU patients, yet nurses struggle with recognising and managing it, and the determinants of these difficulties remain unclear.

DESIGN

Multicentre cross-sectional survey.

METHODS

From October to December 2025, a convenience sample of 898 ICU nurses from 35 tertiary hospitals in several provinces of China completed an anonymous questionnaire. Measures included delirium knowledge, nursing work environment, work motivation and delirium-care difficulty scales, and data were analysed using descriptive statistics, correlation, multiple linear regression and structural equation modelling.

RESULTS

ICU nurses reported moderate delirium knowledge and moderate-to-high delirium-care difficulties, particularly in delirium assessment, ensuring safety, coping with personal stress and using screening tools. A more favourable work environment and higher work motivation were moderately associated with fewer difficulties, whereas delirium knowledge showed no independent association. Work motivation partially mediated the relationship between work environment and delirium-care difficulties in the COM-B-based structural equation model.

CONCLUSION

ICU nurses in Chinese tertiary hospitals experience substantial difficulties in delirium care. Within the COM-B framework, opportunity (work environment) and motivation (work motivation) were more influential than capability (delirium knowledge), suggesting that improving the work environment and supporting nurses' autonomous motivation, alongside delirium education and protocols, may help alleviate delirium-care barriers.

IMPLICATIONS FOR CLINICAL PRACTICE: Routine assessment of delirium-care difficulties may help identify high-burden units and at-risk nurses. Behaviourally informed interventions that embed evidence-based delirium pathways into daily practice, optimise staffing and teamwork, and foster nurses' autonomous motivation could enhance the safety and person-centredness of delirium care in ICUs.