Direct and Indirect Statistical Associations Between Knowledge, Attitudes, and Behaviours Regarding Subsyndromal Delirium in Psychiatric Nurses: A Cross-Sectional Study.

AIM: To examine the indirect association between subsyndromal delirium knowledge and clinical behaviour among psychiatric nurses, with attitude as a linking factor. DESIGN: A cross-sectional survey design. RESULTS: The mean scores for SSD self-perceived knowledge, attitudes, and practices were 17.32 ± 6.66, 32.55 ± 4.54, and 30.11 ± 6.08, respectively. All three variables showed positive correlations (p < 0.01). Attitudes exhibited a significant association within the knowledge-practice relationship. The direct association between knowledge and behaviour (81.0%) proved to be more robust than the indirect association (19.0%). The moderating role of professional title was not statistically significant (p = 0.058). Given the cross-sectional design, the direct and indirect comparisons are descriptive only and should not be interpreted causally. CONCLUSION: Attitude showed a relatively small indirect association with SSD knowledge and behaviour among psychiatric nurses, though the direct association was considerably more robust. Despite favourable attitudes, self-perceived knowledge levels remained notably low. The findings suggest that system-level behavioural triggers (e.g., electronic health record prompts, standardized handover checklists) and knowledge education both offer potentially promising directions for future intervention research, though their relative effectiveness requires further investigation. However, the convenience sample was predominantly composed of tertiary hospital nurses (73.2%), limiting generalizability to primary-level settings. Due to the cross-sectional nature of this study, the findings indicate associations and necessitate longitudinal validation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The direct knowledge-behaviour association suggests that system-level workflow factors may be relevant intervention targets. Low self-perceived knowledge scores also indicate a continued need for knowledge education as a complementary goal. IMPACT: The predominance of the direct knowledge-behaviour association over the attitudinal pathway suggests that system-level workflow factors may play a key role in sustaining clinical practices, whereas self-perceived knowledge deficits point to the continued need for knowledge education. These findings provide empirical support for considering both system-level and educational approaches in SSD nursing care. REPORTING METHOD: This study adhered to the STROBE guidelines for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.