Intensive care unit nurses knowledge, attitude, and self-awareness regarding telehealth and care quality: A cross-sectional study.
Abstract
Background
Intensive care unit nurses are central to patient safety and effective clinical care. Telehealth technologies have demonstrated potential to reduce mortality and length of hospital stay through real-time monitoring and protocol support. The successful implementation of these technologies depends on nurses' knowledge, attitudes, and self-awareness.
Aim
This study aimed to determine intensive care unit nurses' knowledge, attitudes, and self-awareness regarding telehealth and its associations with demographic characteristics.
Methods
This cross-sectional study was conducted in Iran in 2026 with 267 intensive care unit nurses recruited via proportionate stratified random sampling. Data were collected using a newly developed 35-item instrument with established content validity and internal consistency across three subscales. Content validity was confirmed using the Content Validity Ratio and Content Validity Index, and internal consistency was established through Cronbach's alpha (overall coefficient = 0.89). Non-parametric statistical methods and decision tree analysis were employed.
Results
Median scores on a 0-100 scale were 54.55 for knowledge, 54.55 for attitudes, and 36.11 for self-awareness. Knowledge and attitudes were significantly above the neutral threshold of 50 (p = 0.001), while self-awareness fell significantly below it (p = 0.001). Age was significantly associated with knowledge and self-awareness (p = 0.01) but not with attitude. Gender and marital status were associated only with attitude (p = 0.01). Educational attainment and clinical work experience were associated with all three domains (p = 0.01), with nurses having <10 years of experience scoring higher. Significant positive correlations were found among all three domains (r = 0.323-0.481, p = 0.008-0.012). CHAID analysis identified age as the sole predictor for knowledge and self-awareness.
Conclusion
Intensive care unit nurses demonstrated relatively favorable knowledge and positive attitudes toward telehealth; however, their practical self-awareness remained below average. Educational programs should move beyond theoretical instruction to include simulation-based and hands-on telehealth training, particularly targeting older nurses and those with longer clinical experience.