Search Results (430)

Background/Objectives: Nurses working in Anaesthesia and Intensive Care Units (AICUs) face high job demands that may negatively affect their well-being and increase turnover intention. In healthcare systems experiencing workforce shortages, such as Romania, understanding these mechanisms is essential for developing effective retention strategies. This study examined the relationship between job demands and turnover intention among Romanian AICU nurses, focusing on the mediating roles of professional fatigue and depressive symptoms. Methods: A cross-sectional survey was conducted among 1001 nurses from the AICUs of 68 Romanian public hospitals. Job demands were measured using a composite index including night shifts, long working hours, schedule changes, exposure to aggressive patients, calls from home, and alarm-related stress. Professional fatigue was assessed as subjective exhaustion after work, depressive symptoms with the Patient Health Questionnaire-9, and turnover intention as the intention to leave the workplace within 12 months. Mediation analyses were performed using PROCESS macro (Model 4) with logistic regression. Results: Job demands were positively associated with turnover intention. Higher job demands predicted increased professional fatigue and depressive symptoms, both significantly associated with turnover intention. Mediation analyses demonstrated significant indirect associations through both professional fatigue and depressive symptoms, indicating partial mediation. Conclusions: Job demands are related to turnover intention among Romanian AICU nurses both directly and indirectly through professional fatigue and depressive symptoms. Retention strategies should address not only workload reduction, but also prevention and coping interventions targeting fatigue and psychological distress. Full article

Background: Cardiac arrest is a life-threatening event that requires early recognition and timely intervention. In-hospital cardiac arrest (IHCA) may be preceded by clinical deterioration, making competent monitoring, escalation, and resuscitation response essential. Cardiopulmonary resuscitation (CPR) is a key life-saving intervention, but CPR knowledge and skills may decline when healthcare professionals have limited opportunities for practice or exposure to real CPR events. Aim: This study aimed to evaluate CPR competency retention and compare knowledge and skills outcomes between nurses working in critical care and general care units. Methods and Results: A prospective comparative observational cohort study was conducted among 265 registered nurses. All participants were assessed immediately after BLS training, and each participant was reassessed once at an assigned post-training interval of 1, 3, or 6 months. Therefore, the findings represent subgroup comparisons across reassessment intervals rather than individual longitudinal trajectories across all time points. Knowledge was analyzed as a percentage score, while practical skills were analyzed categorically as Pass or Needs Remediation. Lower knowledge scores were observed at the assigned post-training reassessment intervals than at the immediate post-training assessment in both clinical groups, with clearer differences across reassessment intervals in the general care group. Skills competency also showed a higher proportion of nurses needing remediation at later intervals, particularly in the general care group. Conclusions: The findings suggest that CPR competency retention may vary across clinical settings and post-training reassessment intervals. The results support targeted refresher strategies, while acknowledging that causal explanations and individual longitudinal trajectories cannot be inferred from this design. Full article

Background: Postoperative pain is a significant continuous clinical problem for patients in surgical units. This study aimed to examine surgical nurses’ attitudes toward the use of non-pharmacological techniques in postoperative pain management and to identify factors associated with these attitudes. Methods: This descriptive and cross-sectional study was conducted between October 2025 and February 2026 with 200 nurses working in the surgical clinics of a private hospital in Türkiye. Data were collected through digital forms by using the Socio-Demographic Data Form and the Attitude Scale Toward Non-Pharmacological Techniques in Postoperative Pain Management. Descriptive statistics, independent samples t-test, and one-way ANOVA were used for data analysis (p < 0.05). Results: Approximately 59% of the nurses were aged 20–29 years, and 65.5% were female. 68% of the nurses used both pharmacological and non-pharmacological techniques in postoperative pain management, and 80% of them believed that non-pharmacological methods were effective. The mean total score obtained from the scale was 48.42 ± 9.70, indicating that nurses had a positive attitude toward the use of non-pharmacological techniques. Mean scores related to non-pharmacological techniques differed significantly according to gender, marital status, educational level, professional experience, and department (p < 0.05). Conclusions: Surgical nurses demonstrated positive attitudes toward non-pharmacological postoperative pain management. Non-pharmacological techniques should be integrated into clinical practice by nurses in pain management. Full article

Background. Sleep fragmentation and frailty are interrelated yet underexplored determinants of adverse outcomes in critically ill patients, and no published model has combined objective nocturnal fragmentation metrics with administrative frailty indices to predict adverse outcomes at ICU admission. Methods. Using 31,139 first ICU admissions from the MIMIC-IV (v3.1) database, we developed and compared five supervised machine learning models to predict a composite outcome of 30-day mortality, prolonged mechanical ventilation (>7 days), or discharge to a skilled nursing or rehabilitation facility (outcome prevalence 56.1%). Predictors were drawn exclusively from routinely available admission-time data, including nocturnal chartevent frequency, nighttime RASS scores, the Hospital Frailty Risk Score (HFRS), comorbidity and severity indices, and standard demographic variables. Results. The three gradient boosting models achieved statistically equivalent discrimination (ROC AUC ≈ 0.82–0.83) with strong calibration. SHAP analysis of the best-performing model (CatBoost) identified age, HFRS, nocturnal chartevent count, and nighttime RASS as the most influential predictors, confirming that frailty and sleep fragmentation contribute independently to risk. Conclusions. These findings show that EHR-derived frailty signals and nocturnal monitoring intensity, available without additional assessment burden, provide clinically actionable risk stratification at ICU admission and a viable foundation for embedded decision-support tools. Full article

Medical device-related pressure injuries (MDRPIs) represent a significant subset of hospital-acquired pressure injuries, yet nurses’ knowledge regarding their prevention remains inadequately characterized. MDRPIs are a critical yet often overlooked patient safety issue in acute-care settings. This study aimed to evaluate the knowledge levels of nurses regarding MDRPI risk factors in a hospital located in Eastern Türkiye. A descriptive cross-sectional study was conducted with 284 nurses working in intensive care, palliative care, surgical, and internal medicine units between October and December 2024. Data were gathered through a structured questionnaire assessing knowledge of risk factors, evidence-based prevention strategies, and device-specific clinical competencies. Statistical analysis included descriptive statistics, ANOVA, and multiple regression modeling. Results revealed moderate overall MDRPI knowledge levels with significant variation by clinical unit, years of experience, prior training exposure, and frequency of medical device use. Regression analysis identified prior education on pressure injury prevention as the strongest predictor of knowledge scores. Nurses in intensive care units demonstrated higher knowledge and prevention competency compared to those in palliative care and general medical-surgical units (p < 0.001). These findings underscore the need for targeted, device-specific educational interventions and standardized training protocols to enhance nurses’ competency in MDRPI prevention across diverse clinical settings. Strengthening in-service training protocols is essential to reduce preventable patient harm and improve clinical outcomes in regional healthcare facilities. Full article

Background and Objectives: Malnutrition and frailty affect 30–55% of intensive care unit (ICU) patients, yet formal nutritional screening remains inconsistently implemented in routine ICU admission workflows. The APACHE II score, the standard measure of acute physiological severity, does not capture pre-existing nutritional status or functional reserve. The Norton scale, routinely recorded by nursing staff for pressure-ulcer screening, could serve as a pragmatic proxy for the nutritional-functional axis. We assessed its independent prognostic value at admission for in-hospital and post-ICU mortality. Materials and Methods: Retrospective cohort study of 5775 consecutive adult patients admitted to a Spanish tertiary polyvalent ICU between 2012 and 2019, with APACHE II and Norton scores recorded at admission. The Norton was analysed as continuous and categorised (minimal >14, medium 13–14, high 10–12, very high 5–9). Discrimination was assessed by AUC and DeLong’s test, predictive improvement by IDI and NRI, and internal validity by bootstrap resampling (B = 200). Results: Hospital mortality was 12.8% (n = 738), rising from 7.7% in patients with minimal-risk Norton to 34.5% in very high risk. After adjustment for APACHE II, each additional Norton point reduced the odds of death by 7.7% (adjusted OR = 0.923; 95% CI 0.903–0.943). Adding the Norton to APACHE II improved discrimination (AUC 0.865 → 0.872; DeLong p = 0.003; IDI = 0.011; continuous NRI = 0.30). In the highest APACHE II quartile, the absolute mortality difference between minimal and very high Norton categories reached 23.2 percentage points. The Norton’s prognostic effect was approximately twice as large for post-ICU mortality (ΔAUC +0.011) as for overall in-hospital mortality (ΔAUC +0.006). Conclusions: The Norton scale at admission improves the prognostic capacity of APACHE II in critically ill patients, particularly for post-ICU mortality. Its widespread availability without additional patient-level data collection positions it as a pragmatic candidate for routine prognostic assessment and for guiding targeted nutritional screening. Full article

Background: Effective nurse–patient communication is fundamental to quality care delivery, yet language barriers pose significant challenges in multicultural healthcare environments. In Saudi Arabia’s diverse healthcare landscape, nurses frequently encounter patients who do not speak Arabic, potentially compromising care quality and patient safety. Objective: To explore multilevel factors influencing communication between Saudi nurses and non-Arabic-speaking patients, using Bronfenbrenner’s ecological systems theory as a conceptual framework. Design: A qualitative descriptive study employing semi-structured interviews analyzed through reflexive thematic analysis. Setting: Four healthcare facilities (two governmental and two private hospitals) across Saudi Arabia. Participants: Eighteen Saudi registered nurses with experience caring for non-Arabic-speaking patients, recruited through purposive sampling. Methods: Semi-structured interviews (n = 18) were conducted in Arabic or English between November 2025 and February 2026. Data were analyzed using Braun and Clarke’s reflexive thematic analysis, organized within Bronfenbrenner’s ecological levels. Collaborative reflexive coding and member-checking with six participants supported analytical rigor. Results: Five main themes emerged: (1) Individual-level competencies and preparedness (microsystem), (2) Interpersonal dynamics and cultural sensitivity (microsystem), (3) Unit-level resources and organizational support (mesosystem), (4) Institutional policies and language services (exosystem), and (5) Healthcare system and societal influences (macrosystem). Participants identified language proficiency gaps, cultural misunderstandings, inadequate interpreter services, and systemic barriers as primary challenges affecting communication quality. Conclusions: Communication between Saudi nurses and non-Arabic-speaking patients is influenced by complex, interconnected factors across multiple ecological levels. Interventions should address individual competency development, organizational support systems, and policy-level changes to ensure equitable, safe, and effective communication for all patients. Full article

Background/Objectives: Acute ischemic stroke (AIS) care depends on rapid, coordinated workflows. This study compared two real-world in-hospital stroke models—a neurohospitalist-led model and a stroke practitioner-led multidisciplinary model—in terms of time metrics, radiological outcomes, and 3-month clinical outcomes in patients undergoing reperfusion therapy. Methods: This retrospective, single-center cohort study evaluated patients across two sequential workflow periods. In the practitioner-led model, trained non-neurologist clinicians coordinated care with a stroke nurse under neurologist supervision. Time metrics included door-to-needle time (DNT) and door-to-puncture time (DPT). Clinical outcomes included intensive care unit (ICU) transfer and 3-month functional outcomes assessed by the modified Rankin Scale (mRS). Multivariable logistic regression analyses were performed to explore variables associated with achievement of DNT < 60 min and ICU transfer. Results: A total of 573 patients were included (284 neurohospitalist-led, 289 practitioner-led). Baseline NIHSS scores were similar between groups. Among patients receiving intravenous thrombolysis, the proportion achieving DNT < 60 min did not differ significantly between periods (77.9% vs. 72.5%, p = 0.124), while mean DNT and DPT were comparable. Early radiological outcomes at 24 h were similar between groups. ICU transfer rates were significantly lower in the practitioner-led period (17.6% vs. 28.2%, p = 0.002). In multivariable analyses, the stroke practitioner-led period was not independently associated with achieving DNT < 60 min among thrombolysed patients, but remained independently associated with a lower likelihood of ICU transfer. Three-month mRS outcomes did not differ significantly. Conclusions: A structured, practitioner-led multidisciplinary workflow was associated with lower ICU transfer rates, while no statistically significant differences were detected in DNT target achievement among thrombolysed patients, safety outcomes, or functional outcomes compared with the neurohospitalist-led period. The observed associations between workflow organization and ICU utilization highlight the potential importance of system-level factors in AIS care delivery. Full article

Background: Patients with severe chronic anemia often require frequent blood transfusions. Many are elderly with comorbidities and limited mobility, making regular hospital visits burdensome. In some cases, patients may receive transfusions despite hemoglobin levels being above the clinical threshold due to logistical challenges, leading to unnecessary exposure to risks, inefficient use of blood units, and resource strain. This study aims to evaluate the use of point-of-care (POC) hemoglobin measurements under controlled outpatient clinic conditions, as an initial step toward potential future home-based monitoring by the patients or their caregivers, with the goal of optimizing transfusion timing, aiming to reduce unnecessary hospital visits while maintaining patient safety. Methods: A total of 127 patients from a hemato-oncology outpatient clinic at Carmel Medical Center were evaluated using a nurse-operated POC device to sample capillary blood, with 236 paired measurements concurrently analyzed via venous blood in the laboratory. Demographic and clinical data were assessed to evaluate factors associated with agreement between POC and laboratory measurements. Statistical analysis included Bland–Altman plots and Pearson correlation coefficients. Results: The POC device showed a moderate correlation with laboratory results (r = 0.73, p < 0.001), with a mean difference of 1.20 g/dL (SD = 1.94 g/dL) but wide limits of agreement (−3.20 to 5.50 g/dL). No significant differences were observed across demographic or clinical subgroups. Notably, all 156 paired measurements with POC-measured hemoglobin >7 g/dL were confirmed by laboratory testing. Conclusions: Although POC hemoglobin devices are not suitable as standalone tools for routine monitoring of chronic anemia, the high negative predictive value observed at the 7 g/dL threshold suggests that they may be useful for ruling out severe anemia. If validated in larger multicenter and home-use studies, POC Hb devices might contribute to reducing unnecessary hospital visits and transfusions. Full article

Background: Nurse–patient communication is a nurse-associated, interprofessionally delivered care-process indicator captured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), but its hospital-level association with hospital-wide readmission after structural and case-mix adjustment remains incompletely characterized. Methods: We conducted a cross-sectional secondary analysis of publicly available Centers for Medicare and Medicaid Services (CMS) Hospital Compare data. The exposure was the HCAHPS nurse communication composite (April 2024–March 2025), and the outcome was the Hybrid Hospital-Wide All-Cause 30-day Readmission measure (July 2023–June 2024). The primary model adjusted for ownership and US Census region. Robustness was assessed using a six-model hierarchy, including linkage to Provider of Services and HCRIS data to account for teaching intensity, staffing density, and Disproportionate Share Hospital percentage. Additional sensitivity analyses examined survey weighting, survey-volume restriction, lagged HCAHPS scores, HCAHPS-domain specificity, CMS star-rating adjustment, non-linearity, regional interaction, health-system clustering, and alternative functional forms. Findings are interpreted as cross-sectional ecological associations, not causal or predictive effects. Results: Among 2844 acute care hospitals, each 10-percentage-point higher patient-perceived nurse communication score was associated with a 0.289 percentage-point lower 30-day readmission rate (95% CI −0.341 to −0.236; p < 0.001) in the primary model. The association was consistent across sensitivity analyses, although it was attenuated after additional adjustment for linked structural hospital characteristics. Among HCAHPS domains, discharge information showed the largest association with readmission. These findings indicate a modest but consistent hospital-level association rather than evidence of causality. Conclusions: Hospitals with higher patient-perceived nurse communication tended to have lower 30-day readmission rates, although the association was attenuated after adjustment for structural hospital characteristics. Patient-perceived nurse communication may therefore be a useful nurse-associated process indicator for readmission-related benchmarking, although it reflects interprofessional care and residual organizational confounding remains plausible. Longitudinal or interventional studies are needed to determine whether improving nurse communication can reduce readmissions. Full article

Background: Implant supply strategy in spine surgery affects operative workflow, resource utilization, and packaging-related material use, yet has received limited systematic investigation. This study evaluates single-sterile implants versus multipack implants using a hospital-based Health Technology Assessment (HB-HTA) framework. Methods: A non-randomized, mixed-methods comparative study was conducted at a tertiary academic spine center. Time measurements were recorded during eight posterior fusion procedures (four per supply type; n = 18 single-pack screws, n = 20 multipack screws) across three process steps: implant retrieval, sterile transfer, and instrument preparation. Time measurements were recorded per packaging unit; per-implant comparisons were additionally derived for operational interpretation. Packaging volume, weight, and packaging-related CO₂-equivalent estimates were calculated per implant. Standardized questionnaires were distributed to operating-room (OR) nurses (n = 14/21; 66.7%) and institutional surgeons (n = 11/11; 100%). Manufacturer-provided descriptive process and cost data were analyzed. Results: Multipack implants were associated with consistently shorter handling times across all measured process steps. Mean retrieval time per packaging unit was 25.4 s (multipack) versus 58.7 s (single-pack); retrieval time was significantly shorter for multipack units on the Mann–Whitney U test (p = 0.004), a result that was robust to supply-related outlier events (p = 0.001 after their post hoc exclusion). Packaging-normalized sterile-transfer burden per implant was reduced by a factor of 4.76. Instrument preparation was faster with multipack systems (15.6 s vs. 25.2 s). Packaging volume per implant was reduced by a factor of 5.6, and packaging weight by a factor of 2. Packaging-related CO₂-equivalent estimates were lower for multipack implants (0.017 kg vs. 0.026 kg per implant). Survey responses indicated predominantly positive evaluations of workflow and handling efficiency. A trade-off was identified regarding the potential disposal of unused implants (noted by 73% of institutional surgeons). Manufacturer-provided descriptive data suggested scale effects in packaging and sterilization processes. Conclusions: Under high-volume academic conditions, multipack implants were associated with shorter implant-handling process times, favorable staff perceptions, and reduced packaging-related material burden while introducing trade-offs that require local evaluation. These exploratory findings suggest that the implant supply strategy is an underexplored but potentially relevant dimension of surgical process optimization in spine surgery. Full article

Background/Objectives: Initiation of empiric antibiotic therapy for neonatal early-onset sepsis (EOS) is prudent to prevent morbidity and mortality, particularly in low- and middle-income countries (LMICs). Inappropriate or prolonged antibiotic exposure in neonates is associated with poor clinical outcomes. Antimicrobial stewardship programs (ASPs) have been shown to optimize antibiotic use, but data from LMICs are limited. In this study, we aimed to evaluate adherence to a locally developed and adopted guideline for antibiotic use in EOS. Methods: We conducted a retrospective before-and-after study during the pre- (June 2024–January 2025) and post-implementation (May–December 2025) of ASP guideline for EOS. The intervention involved consolidating best practices—previously shared verbally and applied variably into a locally united written guideline, then provide training to neonatologists, pharmacists, and nurses. Adherence to best practices was evaluated by indication, dosing, timing, and duration of antibiotic therapy. Results: In a cohort of 388 neonates with EOS (i.e., 205 pre- and 183 post-implementation), the median gestational age was 38 (IQR: [37–39]) weeks, with the median birthweight of 3000 (IQR: [2800–3400]) grams, and 63% were male. The total adherence improved from 2.0% to 65.6% (p < 0.001) from pre- to post-implementation of ASP. In the post period, adherence rates were 96.7% for empiric antibiotics indication, 95.6% for antibiotics indication after culture results are obtained, 88.5% for antibiotic dosing, 83.1% for timely antibiotic initiation, and 89.1% for appropriate discontinuation of antibiotics. The median days of therapy and length of therapy significantly decreased by 139 per 1000 patient-days, from 1806 (IQR: [1556–2083] to 1667 (IQR: [1400–2000]; p < 0.001)] patient-days; and from 1000 (IQR: [875–1000]) to 875 (IQR: [769–1000]; p < 0.001) patient-days in the pre- versus the post-implementation, respectively. Median length of hospitalization of 8 [7–12] days and recovery (~93%) from EOS were similar pre- and post-implementation. Conclusions: The results support the effectiveness of ASP implementation in improving guideline adherence and reducing antibiotic exposure among neonates with EOS in low-resource settings. In-hospital clinical outcomes, including mortality at discharge, were similar between periods; however, further studies with longer follow-up are needed to better evaluate clinical outcomes. Full article

Background/Objectives: Retention of healthcare professionals in the workforce, their employment, and the improvement of working conditions largely depend on identifying the factors that influence their departure and their health. The study was conducted during the period from January to June 2021. This study aimed to examine the association between specific work-related stressors and work ability. The initial hypothesis was that general and specific occupational stressors negatively associate with work ability among healthcare professionals in emergency medical intervention teams. Methods: The study was designed as a cross-sectional comparative study. It was conducted among nurses and physicians in pre-hospital emergency medical services, employed full-time in intervention teams, while the control group consisted of employees from dispatch and call-receiving units. The study was conducted on the 840 participants, representing 43.3% of all healthcare professionals employed in pre-hospital emergency medical services in the Republic of Croatia. In addition to questions on participants’ personal characteristics, the following instruments were used: 1. a validated Questionnaire on Workplace Stressors among hospital healthcare professionals; and 2. the international standardized Work Ability Index (WAI) questionnaire for assessing work ability. Participants completed the questionnaires in paper form. Results: On average, the participants demonstrated lower levels of stress compared to reference values, both for overall stress and for individual stress factors, while their work ability, assessed using the Work Ability Index (WAI), ranged from very good to excellent. The control group showed higher levels of stress across all factors and lower work ability. However, the control group was older on average, generally had lower levels of education, and consisted more often of women—personal characteristics that may influence the examined variables. Lower stress levels and better work ability were associated with job satisfaction, ambition, and the fact that participants were working in their desired profession. Frequent sick leave (absenteeism) was highly correlating with both higher stress levels and poorer work ability. Conclusions: Greater job satisfaction and higher motivation have a positive impact on stress levels and employees’ work ability. The study results can serve as a starting point for institutional management in designing feasible decisions aimed at improving satisfaction, health, the work environment, and the work ability of emergency medical service personnel, as well as making these institutions more attractive for recruitment and retention of employees both in their positions and within the profession. Full article

Background/Objectives: The rising prevalence of multimorbid and complex chronically ill young and middle-aged adults necessitates the implementation of innovative care models and the creation of roles that can meet the complex healthcare needs of this patient group. Advanced Practice Nurses (APNs) can play a crucial role in the care of multimorbid and complex chronically ill young and middle-aged adults in APN-led clinics; however, in Switzerland, these roles are still evolving. The aim of this study was to explore APNs’ perspectives on the planned development of their roles in an APN-led clinic. Methods: To gain insights into the experiences of APNs in caring for this patient group, a qualitative study design was chosen. Data were collected through interviews with APNs from Switzerland, the USA, and Canada. In total, 19 APNs (12 from Switzerland and 7 from the United States and Canada) participated in the study. The data were collected through semi-structured online interviews. These data were analyzed using reflective thematic analysis in accordance with the approach presented by Braun and Clarke. Results: The analysis identified 10 themes that describe the competencies, components, and framework conditions required for the work of APNs in an APN-led clinic for multimorbid and complex chronically ill young and middle-aged adults within the Swiss clinical context. Required competencies include direct clinical practice, guidance and coaching, collaboration, and psychosocial support. Essential components include person-centered care, transitional care, and continuity of care. Key framework conditions include regulations of the legal and regulatory framework and eligibility for reimbursement of services, resources, and extended competencies and scope of practice. Conclusions: The perspectives of the APNs involved in this study show that multimorbid and complexly chronically ill young and middle-aged adults require complex and long-term care that extends beyond the hospital setting. The findings of this study show that Swiss APNs may be well positioned to contribute to this role. Full article

Background: Pressure injuries (PIs) remain a major and escalating global patient safety concern, affecting 12.8% of hospitalized patients worldwide and contributing to rising prevalence and mortality rates from 5.63 to 8.18 and 0.31 to 0.47 per 100,000 population, respectively. The economic burden of PIs is substantial, amounting to $26.8 billion annually in the United States and $9608 per patient in the Kingdom of Saudi Arabia (KSA). However, adherence toward pressure injury prevention (PIP) guidelines among registered nurses (RNs) remains critically inconsistent. Objectives: The aim of this study was to examine whether attitude and practice function as parallel mediators in the relationship between knowledge and adherence to PIP guidelines among RNs, adjusting for age and years of experience. This aim was addressed through three-fold objectives: to assess RNs’ knowledge, attitude, practice (KAP) and adherence to PIP guidelines, evaluate the direct knowledge–adherence relationship, and quantify the two mediated pathways. Methods: A cross-sectional mediation study recruited 166 RNs from 52 clinical units at Prince Sultan Military Medical City in Riyadh, KSA, using convenience sampling with data collected from 5 to 15 March 2026. Validated instruments assessed KAP and adherence to PIP guidelines. Pearson correlations, multiple linear regression, and parallel mediation (Hayes PROCESS macro, model 4; 5000 bootstrap resamples) were performed with age and years of experience as covariates. Results: Mean scores indicated low knowledge (7.31/25; 29.2%), negative attitude (28.20/52; 54.2%), poor practice (36.10/110; 32.8%), and low adherence (28.40/90; 31.6%). Regression explained 36.8% of the variance in adherence to PIP guidelines (Adjusted R² = 0.35), with knowledge (β = 0.22; p < 0.003), attitude (β = 0.30; p < 0.001), practice (β = 0.20; p = 0.006), and years of experience (β = 0.12; p = 0.04) emerging as significant predictors. Both attitude (unstandardized indirect effect = 0.40; 95% Boot CI [0.20, 0.64]) and practice (indirect effect = 0.30; [0.10, 0.60]) significantly mediated the knowledge–adherence relationship, while knowledge retained a significant direct effect (B = 0.70, p = 0.003), indicating partial mediation. Conclusions: This study was the first to employ a parallel mediation analysis to examine KAP as concurrent predictors of adherence toward PIP guidelines within a tertiary military healthcare setting in the KSA. The mediating roles of attitude and practice, together with the direct effect of knowledge, indicated that adherence to PIP guidelines is shaped by interconnected cognitive and behavioral mechanisms. Persistently low KAP levels and low adherence, along with the predictive influence of all KAP domains and RNs’ years of experience, underscored the urgent need for integrated interventions that strengthen KAP to improve adherence and prevent PIs. Full article