This study aimed to introduction of a new assessment tool for China to evaluate the intention of ICU nurses to take measures to prevent deep vein thrombosis. To understand the factors influencing the intention of ICU nurses to take preventive measures against deep vein thrombosis (DVT), and to provide a reference for developing intervention strategies to strengthen the intention of ICU nurses to take preventive measures against DVT.

In this study, the electronic questionnaires on wjx.cn were first imported into WeChat, and then distributed and collected through the designated sharing of wjx.cn questionnaires on WeChat. Prior to the distribution of the electronic questionnaires, the research team obtained approval from the ethics committee of the investigated hospitals, and this study was approved and supported by the corresponding hospital leadership teams.

The study involving humans were approved by the Ethics Committee of the Hospital. Before conducting the survey, we fully explained the study objectives and survey instructions to the ICU nurses. ICU nurses could voluntarily participate in this study. If they agreed to participate, they signed an informed consent form, and they could withdraw from the study at any time. All questionnaires were completed anonymously, and the data collected were used solely for the purpose of this study. The basic information of the participating ICU nurses was kept confidential.

All the questionnaire data were analysed using SPSS 26.0 (IBM Corp., Armonk, NY, USA). For descriptive statistics, continuous variables (e.g., age) and categorical variables (e.g., gender) were expressed as frequencies and percentages. An independent samples t-test and one-way ANOVA were used to compare the differences based on general information (sex, education level, and previous training on knowledge of DVT) in terms of intention, and p < 0.05 was considered to indicate statistically significant difference. The total score of the C-NUDQ scale was used as the dependent variable, and the statistically significant variables in univariate analysis were used as the independent variables for multiple linear regression analysis.

In this study, we distributed 600 questionnaires and returned 575 questionnaires, with a return rate of 95.80%. Among all the participating nurses, 105 were male (18.26%), 470 were female (81.74%), 449 (78.09%) had a Bachelor’s degree or above, 34.26% of the nurses had worked in the ICU for 6–10 years, 50.44% of them were senior nurses, most of them were contract nurses (83.09%), and 79.3% of the nursing staff had received training on DVT (see Table 1).

This study strictly adhered to the framework of the Theory of Planned Behaviour (TPB), and measured the intention of ICU nurses to take DVT prevention measures, rather than directly observing their actual behaviours. The ICU nurses scored (19.24 ± 2.84) on the behavioural intention dimension to take preventive measures against DVT, (26.34 ± 3.37) on the behaviour attitude dimension, (25.28 ± 3.89) on the subjective norm dimension, and (22.46 ± 4.70) on the perceived behavioural control dimension. See Table 2 for details.

One-way ANOVA was performed with general information of ICU nurses, such as sex and age, as the independent variables, and the C-NUDQ total score as the dependent variable. Results showed that educational qualification, work experience in the ICU, the nurse was an ICU nurse specialist, the presence of prevention standards for DVT, and training had been received on DVT had influences on the intention to take preventive measures, with statistically significant differences (p < 0.05). See Table 3 for details.

Based to the results of independent samples t-test and one-way ANOVA, multivariate stepwise regression analysis was performed with the C-NUDQ score as the dependent variable, and five factors (educational qualification, work experience in the ICU, whether the nurse is an ICU nurse specialist, presence/absence of prevention standards for DVT, and whether the nurse had received training on DVT) as the independent variables. The significance levels for inclusion and exclusion of independent variables were α_in = 0.05, α_out = 0.10, respectively, and the specific values assigned to the independent variables are shown in Table 4. In the present study, the results indicated that educational qualification, work experience in the ICU, the nurse was an ICU nurse specialist, and with training on DVT had been received were the main factors influencing nurses’ intention to take DVT preventive measures. There were four variables included in the regression equation, which accounted for 54% of the variation in nurses’ intention to take preventive measures against DVT (F = 257, p = 00, R = 43, R² = 40). The details are shown in Tables 4, 5.

In terms of answers to the open-ended questions, nurses reported that the most common advantages of taking DVT preventive measures in critically ill patients included reducing the risk of pulmonary embolism, reducing the length of stay in the ICU, reducing the morbidity and mortality of cardiovascular diseases, and reducing medical costs. On the other hand, the nurses identified the possibility of bleeding, time-consuming nature of preventative measures, increased staff workload, and possible harm to patients as the most common disadvantages. In addition, some nurses answered that the use of an air pressure pump or elastic compression socks could help facilitate preventive measures against DVT in the ICU. Many nurses mentioned the importance of nurses’ knowledge and skills in preventing DVT, which is an important factor in enabling nurses to take preventive measures against DVT in the ICU. Moreover, 95 nurses (16.5%) expressed that training programs, workshops, and seminars would help prevent DVT; Eighty-seven nurses (15.1%) stated that they believed that patients being too ill, for example, patients with subarachnoid haemorrhage, lower limb surgeries, or fractures, was the main barrier to providing drug prophylaxis in the ICU. On the other hand, the patients being in a coma or with delirium would also limit the adoption of preventive measures. Ten head nurses (1.7%) expressed that their workload and staff shortages, coupled with emergency situations and the pressure of working in the ICU, also led to difficulties.

The survey results of 575 ICU nurses demonstrated a score of 19.24 ± 2.84 points on the dimension of behavioural intention to take preventive measures against DVT, suggesting a relatively strong intention to take preventive measures. Consistent with the results of the original authors (10). The score was 26.34 ± 3.37 for the behaviour attitude dimension, 25.28 ± 3.89 for the subjective norm dimension, and 22.46 ± 4.70 for the perceived behavioural control dimension. The results of this study revealed that educational qualification, work experience in the ICU, ICU nurse specialist, and the nurse had received training on DVT were the factors influencing nurses’ intention to take DVT preventive measures.

This study shows that the Bachelor’s degree score is 95.34 ± 8.79, Master’s degree and higher score is 105.00 ± 0.00. The results revealed that the higher the educational qualification of nurses, the stronger their intention to take preventive measures against DVT, which might be related to the fact that nurses with a relatively high educational qualification and richer work experience in the ICU had a broader knowledge base and more working experience. This is consistent with the research results of Li Jiaxin et al. (18). These nurses were relatively adept at professional skills, could better deal with complex clinical problems, and had a greater sense of confidence and self-efficacy. Generally, ICU nurses are more willing to engage in behaviours that they are interested in and capable of performing. Yao et al.’s survey results showed that the influence of educational level on the knowledge and prevention practice level of nurses regarding the risk of deep vein thrombosis (19). The reason might be that nurses with higher educational qualification have higher demands for self-development or professional growth and are more eager to improve their clinical nursing skills. Therefore, in future training or nursing management, we should pay attention to young nurses with relatively lower educational qualification and limited work experience in the ICU.

The results indicated that one of the positive influencing factors was that they were an ICU nurse specialist. ICU nurse specialists have more opportunities to receive relevant training, and they may have a stronger drive for autonomous learning and higher expectations. According to the theory of reasoned action, an individual’s positive experience in the past will strengthen their behavioural intention. Thus, the experiences of ICU nurse specialists in preventing DVT, and the skills and confidence established in preventing DVT, may promote their positive behavioural intention.

The results of this study indicated that having received insufficient training on DVT was a major barrier to the implementation of preventive measures. This is possibly because nurses who have received training have more knowledge and confidence in taking DVT preventive measures, and training has changed nurses’ knowledge, beliefs, and attitudes towards the prevention of DVT. The training can be delivered via a variety of methods, for example, a combination of online and offline instruction and team teaching. Guidelines for prevention of DVT should form the basis for the training. After the training, the training quality should be checked regularly to increase nurses’ awareness of taking preventive measures against thrombosis.

The findings of the open-ended questions showed that the ICU nurses endorsed a number of beliefs. For example, the attitudinal beliefs pertaining to the advantages of using DVT preventive measures reflected concerns about the reduced risks of pulmonary embolism, decreased length of ICU stay, decreased rates of morbidity and mortality, and improved cardiovascular benefits. Nurses believed that barriers preventing the use of DVT preventive measures in the ICU are the risks for some patients and instability of patients’ conditions. In addition, the ICU population includes patients with complex medical comorbidities, post-operative general surgical patients, poly-trauma, and neuro-intensive care as well as bariatric patients coupled with risk factors acquired during their ICU stays.

There are several limitations in our study. The main limitation is the use of convenience sampling in this study will affect the representativeness and generalizability of the findings. Second, the study focuses solely on intention and potential self-report, no data on actual DVT prevention practices, which may introduce social desirability bias or recall bias. To minimize the impact of bias to the greatest extent, we selected nurses from various regions in China (east, west, south, and north) to participate, and the participating group included nurses of different age groups, different educational backgrounds, and different ICU working experiences. Third, in the current study, the findings showed that the scale had good reliability and validity, but it was not validated in other countries and may need further testing and refinement. Fourth, the hypothesis that DVT-trained nurses would have more knowledge, confidence, etc. was not tested in this study. Fifth, we conducted the sample selection by surveying only the nursing staff in tertiary care hospitals and did not take other types of hospitals into consideration.

Future research should include larger sample sizes and test the applicability of the C-NUDQ scale among ICU nurses in different regions. At the same time, quantitative research can be conducted to understand the current implementation status and influencing factors of nurses’ measures to prevent deep vein thrombosis. Nursing managers should increase matching nursing staff, so that preventive measures can be effectively implemented, and establish a series of rules and regulations and evaluation mechanism in clinical, to ensure the rational operation of the system and norms, improve the intention of clinical nurses to take measures to prevent deep vein thrombosis, so that the prevention and treatment of deep vein thrombosis can be effective.