Knowledge, attitudes, and practices regarding enteral nutrition interruption management in intensive care units: a multicenter cross-sectional study predominantly among nurses.

BACKGROUND

Enteral nutrition (EN) is essential for critically ill patients, yet enteral nutrition interruption (ENI) is common in intensive care unit (ICU) and compromises nutrient delivery. ENI reflects clinical conditions, workflows, team collaboration, and bedside implementation, but how knowledge, attitudes, and practices (KAP) interact remains unclear.

OBJECTIVE

To assess ENI-related knowledge, attitudes, and practices among ICU healthcare professionals, predominantly nurses, and examine their interrelationships and associations with training, demographic, and organizational factors.

METHODS

This multicenter cross-sectional survey included 478 ICU healthcare professionals from 14 hospitals in Shandong and Henan, China, between December 2025 and February 2026; 93.5% were nurses. Self-reported KAP were assessed using a validated questionnaire. Descriptive statistics, Spearman correlation, multiple linear regression, and observed-variable path analysis were conducted.

RESULTS

Self-assessed knowledge scores were lower than attitude and practice scores, particularly for items related to the operational definitions of ENI. The three KAP domains were positively correlated, with the strongest correlation between knowledge and practice (ρ = 0.738, p < 0.001). Path analysis suggested that knowledge was associated with both attitudes and practices and that attitudes were also associated with practices. Bootstrap analysis further indicated a possible indirect association between knowledge and practice through attitudes (indirect effect = 0.339, 95% CI 0.246-0.438). EN-related training was associated with higher scores across all three domains, whereas EN team membership was associated with higher knowledge and practice scores. Several demographic and hospital characteristics showed domain-specific associations. The regression models explained a modest proportion of the observed variance (adjusted R 2 = 0.054-0.141).

CONCLUSION

Among ICU healthcare professionals, predominantly nurses, self-reported ENI management practices were associated with knowledge and attitudes, with attitudes potentially playing an intermediary role. EN-related training was also associated with more favorable KAP scores, while organizational and workflow factors may contribute to the observed variation. These findings may help identify potential targets for future intervention development and evaluation but do not establish causal relationships or improvements in actual ENI management, nutrient delivery, or patient outcomes.