Identifying barriers to nursing management of postoperative stress hyperglycaemia in non-diabetic patients: a TDF-guided qualitative study in a Chinese tertiary hospital

BACKGROUND: Stress-induced hyperglycaemia (SIH) in non-diabetic surgical patients is under-recognised and is associated with infection, prolonged hospital stay, and adverse outcomes. Nurses play a central role in perioperative glucose monitoring, yet barriers to effective SIH management in routine surgical wards remain insufficiently understood. OBJECTIVE: To explore surgical nurses’ perceived barriers to postoperative SIH management in non-diabetic patients using the Theoretical Domains Framework (TDF). METHODS: We conducted a TDF-guided descriptive qualitative study in a tertiary hospital in Jiangsu, China. Semi-structured interviews were undertaken with 25 surgical nurses across six specialties. Data were analysed using a hybrid inductive–deductive approach: inductive coding procedures informed by Colaizzi’s analytic steps, followed by deductive mapping to the 14 TDF domains. Trustworthiness was supported through member checking, an audit trail, and reflexive journaling. RESULTS: Barriers clustered within nine TDF domains, including limited SIH-specific knowledge and skills, unclear professional roles and decision boundaries, low self-efficacy, fragmented interprofessional coordination, environmental and resource constraints, cognitive overload, lack of standardised protocols, and limited patient/family cooperation. Nurses described uncertainty about thresholds and targets for non-diabetic patients, challenges in interpreting glucose trends and supporting insulin-related care, and difficulty prioritising glycaemic concerns within busy ward workflows. CONCLUSION: Multiple interrelated barriers hinder the effective nursing management of SIH in non-diabetic patients. Interventions should target modifiable domains through training programs, standardised protocols, decision-support systems, and collaborative care models. Addressing these barriers may improve timely recognition and escalation of postoperative dysglycaemia, supporting patient safety and postoperative recovery.