Exploring neurosurgical nurses’ insights: a multicenter study on knowledge, attitude, and practice in external ventricular drain management

BACKGROUND: External ventricular drain (EVD) management is a critical aspect of neurosurgical nursing practice. Nurses play a central role in monitoring patients, identifying early signs of complications, and preventing EVD-related infections. Understanding their knowledge, attitude, and practice (KAP) regarding EVD management is therefore critical to improving care quality and patient safety. METHODS: A multicenter cross-sectional study was conducted in accordance with the STROBE guidelines. This study recruited neurosurgical nurses from 10 hospitals in Hubei Province, China, between May and June 2024. Data were collected online using a self-administered questionnaire assessing KAP toward EVD management. Descriptive statistics and the rank-sum test were used to describe the knowledge, attitude, and practice. Bootstrapping mediation analysis was performed to examine the associations among the knowledge, attitude and practice. RESULTS: A total of 398 nurses participated. The median (interquartile range) scores for knowledge, attitudes and practices were 8 (1.25), 50 (9) and 55 (5), respectively. Nurses with prior EVD-related training demonstrated significantly higher knowledge and practice scores (p < 0.001; p < 0.001). Furthermore, holding a senior professional title, having EVD-related training experience, possessing longer years of general or neurosurgical nursing experience, and older age were associated with more positive attitudes. Mediation analysis revealed that attitude significantly mediated the relationship between knowledge and practice, accounting for 38.27% of the total effect. CONCLUSION: Neurosurgical nurses demonstrated positive attitudes and good practice towards EVD management. However, their knowledge required further improvement. Attitudes played a key mediating role in bridging theoretical knowledge and clinical practice in EVD management. The findings suggested that training programs should focus not only on knowledge dissemination but also on fostering positive professional attitudes to effectively improve clinical practice. TRIAL REGISTRATION: Not applicable.