Healthcare Professionals' Knowledge, Attitudes, and Practices Regarding Respiratory Support

doi:10.21203/rs.3.rs-4612229/v1

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Healthcare Professionals' Knowledge, Attitudes, and Practices Regarding Respiratory Support

https://doi.org/10.21203/rs.3.rs-4612229/v1

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Background

To investigate healthcare professionals' knowledge, attitudes, and practices (KAP) regarding the application of respiratory support.

Method

A cross-sectional study was conducted from November 15,2023 to December 14,2023 at Multiple hospitals. Demographic information, alongside scores measuring knowledge and attitudes, was gathered through the dissemination of questionnaires.

Results

A total of 517 valid questionnaires were enrolled, including 284 (54.9%) nurses, and 269 (52%) had worked for less than 10 years. The median of knowledge, attitude, and practice were 20 (possible range: 11–22), 26 (possible range: 7–35), and 38 (possible range: 9–45), respectively. Multivariate logistic regression showed that lower than 20 of knowledge score (OR = 0.441, 95% CI: [0.297, 0.657], P < 0.001), lower than 26 of attitude score (OR = 0.493, 95% CI: [0.335, 0.724], P < 0.001), lower than 40 of MBI-GS Scale score (OR = 1.857, 95% CI: [1.256, 2.746], P = 0.002), aged 40 years and above (OR = 0.470, 95% CI: [0.264, 0.837], P = 0.010), being nurse (OR = 0.627, 95% CI: [0.424, 0.928], P = 0.020), and no training in respiratory support in the last six months (OR = 0.590, 95% CI: [0.403, 0.866], P = 0.007) were independently associated with practice.

Conclusions

Healthcare professionals had sufficient knowledge, positive attitudes, and proactive practices regarding the application of respiratory support. Healthcare institutions should prioritize continuous education and training programs focusing on respiratory support, especially for nurses and older professionals, to enhance clinical practice and patient outcomes.

respiratory support

healthcare professional

knowledge

attitude

practice

Reducing mortality from respiratory illnesses is critically dependent on effective respiratory support strategies[1]. These strategies encompass a range of techniques from oxygen therapy to both invasive and non-invasive mechanical ventilation. Noninvasive respiratory support (NIRS), which includes standard oxygen therapy (SOT), high-flow oxygen therapy (HFOT), continuous positive airway pressure (CPAP), and noninvasive ventilation (NIV), plays a pivotal role in the early management of patients with acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS)[2, 3]. When NIRS proves insufficient, particularly in cases where the respiratory demand overwhelms the system's capacity, transitioning to invasive mechanical ventilation (IMV) is key[4, 5]. IMV not only facilitates physiological gas exchange but also provides lung and diaphragm protection, thereby allowing time for the lungs to recover and preventing the progression of patient self-inflicted lung injury. However, it is imperative to carefully manage the transition between noninvasive and invasive respiratory support, as neglecting the underlying physiology of the respiratory system can lead to the exacerbation of lung injury[6].

The Knowledge-Attitude-Practice (KAP) model is foundational in understanding and influencing health behaviors, serving as a crucial framework within health literacy to evaluate the knowledge, attitudes, and practices prevalent among specific populations, particularly in the healthcare sector[7]. Utilizing the KAP questionnaire, researchers can thoroughly assess the knowledge levels, attitudes, and practical approaches of target groups towards health-related topics, further analyzing the demand for and acceptance of pertinent information[8]. Central to this model is the principle that increased knowledge positively affects attitudes, which in turn, shape behaviors and practices[9]. In the realm of healthcare, the emphasis on healthcare professionals is paramount, given their role as primary decision-makers in clinical environments. Their decisions significantly affect the choice, deployment, and oversight of respiratory support techniques, making their knowledge and perspectives crucial for the implementation of evidence-based practices and the safeguarding of patient safety. Recognizing and addressing any gaps in their understanding or misconceptions becomes a pathway to targeted educational measures that enhance patient care quality. Consequently, exploring the KAP concerning respiratory support among healthcare professionals is instrumental in refining clinical protocols, enhancing educational programs, and optimizing patient care, potentially decreasing the mortality and morbidity associated with respiratory diseases.

Despite the critical importance of such an inquiry, research specifically targeting the KAP of healthcare professionals in the application of respiratory support has been conspicuously absent. This gap underscores the need for this study, which aims to explore the KAP of healthcare professionals regarding respiratory support. This investigation not only seeks to illuminate the current state of professional understanding and application of respiratory support techniques but also to identify opportunities for improving healthcare delivery and outcomes for patients with respiratory conditions.

Study Design and Participants

This cross-sectional study, conducted between November 15,2023 and December 14,2023 at Multiple hospitals. Demographic information, alongside scores measuring knowledge and attitudes, was gathered through the dissemination of questionnaires, focused on healthcare professionals. Ethical approval was obtained from the Ethics Committee of Taihe County People's Hospital, and informed consent was obtained from all participants prior to questionnaire administration.

Inclusion criteria comprised individuals aged 18 years or older who were healthcare professionals specializing in emergency, respiratory, cardiology, and critical care disciplines. Additionally, participants were required to complete the questionnaire in its entirety and provide informed consent. Exclusion criteria encompassed completion times of less than 90 seconds and duplicate questionnaire submissions.

The study employed convenience sampling and involved ten trained medical research assistants in questionnaire collection and organization. Questionnaires were distributed via WeChat workgroups of various departments at Taihe County People's Hospital, Anhui Medical University First Affiliated Hospital, Fuyang People's Hospital, Taihe County Huayuan Hospital, and Taihe County Second People's Hospital. These groups targeted pre-hospital emergency physicians, emergency department physicians, intensivists, cardiologists, and respiratory physicians. Participants completed the questionnaires online using the Wenjuanxing platform (https://www.wjx.cn/app/survey.aspx).

Questionnaire Introduction

The questionnaire design was guided by pertinent guidelines and literature. Following the initial development phase, feedback was solicited from two experts: Dr. Jun Chen, Deputy Chief Physician of the Respiratory Department at the First Affiliated Hospital of the University of Science and Technology of China, and Dr. Min Shao, Director of the Intensive Care Medicine Department at the First Affiliated Hospital of Anhui Medical University. Subsequently, incorporating their input, a pilot study was conducted, yielding a Cronbach's α coefficient of 0.809 for the pre-test feedback questionnaire, indicating commendable internal consistency.

The final questionnaire encompassed four dimensions: demographic information, knowledge, attitude, and practice. The knowledge dimension comprised 11 questions, with correct responses earning 2 points, and incorrect or uncertain responses earning 1 point, resulting in a score range of 11–22 points. The attitude dimension comprised 7 questions, utilizing a five-point Likert scale ranging from "Strongly Agree" (5 points) to "Strongly Disagree" (1 point), yielding a score range of 7–35 points. Similarly, the practice dimension comprised 9 questions, employing a five-point Likert scale ranging from "Always" (5 points) to "Never" (1 point), with a score range of 9–45 points. Achievement of scores surpassing 70% of the maximum in each segment indicated satisfactory knowledge, favorable attitude, and proactive practice[10]. The Chinese version of the Maslach Burnout Inventory General Survey (MBI-GS) [11]. For the assessment of occupational burnout, the MBI-GS Occupational Burnout Scale employed a 7-point Likert scale ranging from "Always" (6 points) to "Never" (0 points). Standardized scoring involved the summation of total scores divided by 15, then multiplied by 20. Higher scores indicated more pronounced occupational burnout.

Statistical Analysis

Statistical analysis was conducted using SPSS 26.0 (IBM Corp., Armonk, N.Y., USA). Continuous variables were described using median (25th percentile, 75th percentile), and between-group comparisons were performed using Wilcoxon-Mann-Whitney tests or Kruskal-Wallis analysis of variance. Categorical variables were presented as n (%). Spearman correlation analysis was employed to assess the correlations between knowledge, attitude, and practice scores. In multivariate analysis, median score was used as the cut-off value. Univariate variables with P < 0.1 were enrolled in multivariate regression. Hypotheses were validated using structural equation modeling (SEM). Two-sided p < 0.05 were considered statistically significant in this study.

Initially, a total of 550 questionnaires were collected, excluding 20 questionnaires that took less than 90 seconds or more than 1,800 seconds to fill in, and 13 incomplete questionnaires, leaving 517 valid questionnaires with a validity rate of 94%. The Cronbach's α coefficient for the formal experiment feedback questionnaire was 0.812; the Kaiser-Meyer-Olkin (KMO) value for the self-made questionnaire was 0.886; and the KMO value for the MBI-GS Occupational Burnout Scale was 0.932.

Out of 517 participants, 245 (47.4%) were aged 30–39 years, 284 (54.9%) were nurses, 328 (63.4%) were females, 328 (63.4%) had Bachelor's Degree, 326 (63.1%) were working in public tertiary hospitals, 269 (52%) had worked for less than 10 years, 211 (40.8%) had a frequency of respiratory support for 0–20% of their patients, and 316 (61.1%) had received training related to respiratory support in the last six months. The median (25th percentile, 75th percentile) of knowledge, attitude, practice, and MBI-GS scores were 20 (19, 21) (possible range: 11–22), 26 (23, 28) (possible range: 7–35), 38 (35, 44) (possible range: 9–45), and 40 (18.7, 53.3) (possible range: 0–120), separately. Participants with different age, education, nature of institution, years of work experience, department/ward, frequency of respiratory support for patients, and availability of respiratory support related training were more likely to have different knowledge scores. Participants with different education, nature of institution, position, and department/ward were more likely to have different attitude scores. Those with different education, position, and availability of respiratory support related training were more likely to have different knowledge scores were more likely to have different practice scores. Moreover, those with different age, education, nature of institution, years of work experience, and frequency of respiratory support for patients were more likely to have different MBI-GS Scale score (P < 0.005) (Table 1).

Table 1

Basic information of participants and KAP score
	N(%)	Knowledge (K)			Practice (P)			MBI-GS Scale
		Median (25th percentile, 75th percentile)	P	Median (25th percentile, 75th percentile)	P	Median (25th percentile, 75th percentile)	P	Median (25th percentile, 75th percentile)	P
Total		20(19, 21)		26(23, 28)		38(35, 44)		40(18.7, 53.3)
Age			0.001		0.821		0.088		0.002
Below 30 years	180(34.8)	20(19, 21)		26(23, 28)		39(34, 45)		44(21.3, 56)
30–39 years	245(47.4)	21(19, 21)		26(23, 29)		38(36, 44)		41.3(20, 54.7)
40 years and above	92(17.8)	19(18, 21)		26(24, 28)		36(35, 41.5)		30(12.7, 42.7)
Gender			0.112		0.766		0.120		0.962
Male	189(36.6)	21(19, 21)		26(23, 28)		38(36, 45)		41.3(18.7, 53.3)
Female	328(63.4)	20(19, 21)		26(23, 28.5)		37.5(35, 44)		40(18.7, 54.7)
Marital status			0.105		0.170		0.587		0.172
Married	374(72.3)	20(19, 21)		26(23, 29)		38(35, 44)		40(18.7, 52)
Other	143(27.7)	21(19, 21)		26(23, 28)		37(34, 45)		44(20, 54.7)
Education			<0.001		0.002		0.049		<0.001
College	139(26.9)	20(18, 21)		25(23, 28)		36(34, 42)		29.3(10.7, 49.3)
Bachelor’s degree	346(66.9)	20(19, 21)		26(23, 29)		38(35, 45)		41.3(20, 54.7)
Master’s degree and above	32(6.2)	21(20, 21)		26(24.5, 29)		38.5(36, 43.5)		48(36, 62.7)
Professional title			0.112		0.104		0.651		0.667
No title	34(6.6)	19(17, 21)		26.5(23, 29)		39.5(31, 43)		38.7(18.7, 50.7)
Junior	239(46.2)	21(19, 21)		26(23, 28)		37(35, 45)		37.3(17.3, 54.7)
Intermediate	209(40.4)	20(19, 21)		27(23, 29)		38(35, 44)		41.3(20, 53.3)
Senior	35(6.8)	21(19, 21)		27(24, 28)		37(34, 44)		40(18.7, 50.7)
Nature of institution			<0.001		0.008		0.286		<0.001
Public tertiary	326(63.1)	21(19, 21)		27(23, 29)		38(36, 45)		42.7(22.7, 56)
Public secondary	154(29.8)	19.5(18, 21)		26(23, 28)		36(34, 43)		29.3(10.7, 48)
Public primary	19(3.7)	18(17, 21)		24(23, 29)		40(34, 44)		28(16, 44)
Private hospital	18(3.5)	20(19, 21)		24(22, 26)		38.5(33, 44)		50.7(41.3, 62.7)
Years of work experience			<0.001		0.633		0.353		0.008
Less than 10 years	269(52)	21(19, 21)		26(23, 29)		39(35, 45)		42.7(18.7, 56)
10–19 years	183(35.4)	20(19, 21)		26(23, 28)		37(35, 44)		40(21.3, 53.3)
20 years and above	65(12.6)	19(18, 21)		26(24, 27)		36(35, 42)		29.3(13.3, 42.7)
Position			0.542		0.018		0.008		0.593
Physician	233(45.1)	20(19, 21)		27(23, 29)		39(36, 45)		41.3(18.7, 54.7)
Nurse	284(54.9)	20(19, 21)		26(23, 28)		37(34.5, 44)		38.7(18.7, 52)
Department/Ward			<0.001		0.005		0.665		0.056
Emergency Department	261(50.5)	20(19, 21)		26(23, 28)		38(35, 45)		38.7(17.3, 52)
Respiratory Department	76(14.7)	21(19, 21)		26(24, 29)		37(35, 43)		42.7(26.7, 56)
Cardiology Department	100(19.3)	20(18, 21)		25(23, 27)		36.5(35, 43)		37.3(13.3, 53.3)
Intensive Care Unit	80(15.5)	21(20, 21)		27(24, 29.5)		39(36, 43.5)		42.7(30.7, 53.3)
Frequency of Respiratory Support for Patients			<0.001		0.179		0.703		<0.001
No contact	78(15.1)	19(17, 21)		25(23, 28)		37(34, 45)		26(10.7, 46.7)
0–20%	211(40.8)	20(19, 21)		26(23, 28)		38(36, 44)		40(18.7, 52)
21–50%	88(17)	20(19, 21)		26(24, 28)		37.5(35, 43.5)		40(18.7, 54.7)
More than 50%	140(27.1)	21(20, 21)		26(23, 29)		38(34.5, 44)		46.7(28.7, 56)
Respiratory Support Related Training in the Past Six Months			0.012		0.414		<0.001		0.082
Yes	316(61.1)	21(19, 21)		26(23, 28)		40(36, 45)		40(17.3, 52)
No	201(38.9)	20(18, 21)		26(23, 28)		36(34, 43)		41.3(24, 54.7)

The distribution of knowledge dimensions shown that the two knowledge items with the highest correctness rates were "Respiratory support techniques include oxygen therapy, non-invasive mechanical ventilation, and invasive mechanical ventilation." (K2) with 95.6% and "Patients with acute left heart failure accompanied by significant hypoxemia and respiratory distress (especially with peripheral oxygen saturation < 90%) should receive oxygen therapy early." (K4) with 93.8%. However, 36.6% of participants were unsure how to adjust the parameters of non-invasive ventilation for patients with severe pancreatitis (K12) (Table S1).

Responses to the attitude items showed that 76.8% strongly agreed that it is important to consider the choice of respiratory support techniques based on the patient's specific condition (A1), and 37.3% agreed that patients' wishes and preferences often lead to unnecessary distress and influence medical decision-making (A4). Regarding whether guidelines and criteria for respiratory support techniques are confusing and challenging to implement, 34.2% were neutral (A5). On the other hand, 41.8% disagreed that the choice of respiratory support technique can significantly impact outcomes, especially for patients with chronic illnesses (A2) (Table S2).

Participants' overall practice was proactive and positive, specifically, 54.2% adhered to choosing respiratory support techniques based on the patient's condition and prognosis (P1), 49.9% adhered to adjusting ventilator parameters based on the patient's oxygenation and ventilation indexes (P3), and 48.9% always analyzed the choice of ventilator based on the patient's specific condition (P8) (Table S3).

Responses to the burnout scale showed that 37.7% always care about whether their work makes a contribution (M9) and 35.4% never doubt the significance of the work they do (M8). 35.6% believed that they were very good at what they did on a daily basis (M12) and 35.0% were always very happy when they accomplished something at their work (M13). However, it is worth noting that also 35.0% occasionally feel that the whole day's work is really stressful for them (M4), and 34.4% occasionally feel that their work makes them feel physically and mentally exhausted (M1) (Table S4).

Correlation analysis showed that knowledge (r = 0.252, P<0.001) and attitude (r = 0.235, P<0.001) were positively correlated with practice, while attitude (r = -0.289, P<0.001) and practice (r = -0.206, P<0.001) were negatively correlated with MBI-GS Scale score (Table 2).

Table 2

Correlation analysis of KAP scores.
	Knowledge	Attitude	Practice	MBI-GS Scale
Knowledge	1.000	0.086(P = 0.051)	0.252(P<0.001)	0.010(P = 0.817)
Attitude	0.086(P = 0.051)	1.000	0.235(P<0.001)	-0.289(P<0.001)
Practice	0.252(P<0.001)	0.235(P<0.001)	1.000	-0.206(P<0.001)
MBI-GS Scale	0.010(P = 0.817)	-0.289(P<0.001)	-0.206(P<0.001)	1.000

Multivariate logistic regression showed that lower than 20 of knowledge score (OR = 0.441, 95% CI: [0.297, 0.657], P < 0.001), lower than 26 of attitude score (OR = 0.493, 95% CI: [0.335, 0.724], P < 0.001), lower than 40 of MBI-GS Scale score (OR = 1.857, 95% CI: [1.256, 2.746], P = 0.002), aged 40 years and above (OR = 0.470, 95% CI: [0.264, 0.837], P = 0.010), being nurse (OR = 0.627, 95% CI: [0.424, 0.928], P = 0.020), and no training in respiratory support in the last six months (OR = 0.590, 95% CI: [0.403, 0.866], P = 0.007) were independently associated with practice (Table 3).

Table 3

Univariable and multivariable logistic regression.
Cutoff value: ≥38 /<38		Univariable		Multivariable (P<0.1)		Multivariable (P<0.25)
	No.	OR(95%CI)	P	OR(95%CI)	P	OR(95%CI)	P
Knowledge score
High (≥ 20)	197/336	ref.		ref.		ref.
Low (<20)	66/181	0.405(0.279, 0.588)	<0.001	0.441(0.297, 0.657)	<0.001	0.441(0.297, 0.657)	<0.001
Attitude score
High (≥ 26)	176/293	ref.		ref.		ref.
Low (<26)	87/224	0.422(0.296, 0.603)	<0.001	0.493(0.335, 0.724)	<0.001	0.493(0.335, 0.724)	<0.001
MBI-GS Scale score
High (≥ 40)	116/267	ref.		ref.		ref.
Low (<40)	147/250	1.858(1.310, 2.634)	0.001	1.857(1.256, 2.746)	0.002	1.857(1.256, 2.746)	0.002
Age
Below 30 years	96/180	ref.		ref.		ref.
30–39 years	133/245	1.039(0.706, 1.528)	0.846	0.999(0.661, 1.510)	0.996	0.999(0.661, 1.510)	0.996
40 years and above	34/92	0.513(0.307, 0.858)	0.011	0.470(0.264, 0.837)	0.010	0.470(0.264, 0.837)	0.010
Gender
Male	99/189	ref.
Female	164/328	0.909(0.635, 1.301)	0.602
Marital status
Married	193/374	ref.
Other	70/143	0.899(0.612, 1.322)	0.589
Education
College	57/139	ref.
Bachelor’s degree	188/346	1.712(1.149, 2.550)	0.008
Master’s degree and above	18/32	1.850(0.851, 4.018)	0.120
Professional title
No title	18/34	ref.
Junior	118/239	0.867(0.422, 1.780)	0.697
Intermediate	112/209	1.026(0.496, 2.122)	0.944
Senior	15/35	0.667(0.258, 1.723)	0.403
Nature of institution
Public tertiary	175/326	ref.
Public secondary	68/154	0.682(0.464, 1.003)	0.052
Public primary	10/19	0.959(0.380, 2.421)	0.929
Private hospital	10/18	1.079(0.415, 2.802)	0.877
Years of work experience
Less than 10 years	145/269	ref.
10–19 years	91/183	0.846(0.581, 1.232)	0.383
20 years and above	27/65	0.608(0.351, 1.052)	0.075
Position
Physician	128/233	ref.		ref.		ref.
Nurse	135/284	0.743(0.525, 1.052)	0.094	0.627(0.424, 0.928)	0.020	0.627(0.424, 0.928)	0.020
Department/Ward
Emergency Department	132/261	ref.
Respiratory Department	36/76	0.880(0.527, 1.467)	0.623
Cardiology Department	48/100	0.902(0.569, 1.431)	0.662
Intensive Care Unit	47/80	1.392(0.838, 2.311)	0.201
Frequency of Respiratory Support for Patients
No contact	35/78	ref.
0–20%	110/211	1.338(0.794, 2.254)	0.274
21–50%	44/88	1.229(0.667, 2.264)	0.509
More than 50%	74/140	1.377(0.790, 2.402)	0.259
Respiratory Support Related Training in the Past Six Months
Yes	179/316	ref.		ref.		ref.
No	84/201	0.549(0.384, 0.786)	0.001	0.590(0.403, 0.866)	0.007	0.590(0.403, 0.866)	0.007

After adjustment, the fit Indices reached the target interval, showing that an ideal model was achieved (Fig. 1, from model 1 to model 2). The SEM results show that knowledge directly affected attitude (β = 0.475, P = 0.010) and attitude directly affected practice (β = 0.775, P = 0.010). Concurrently, knowledge has an indirect effect on practice through attitude (β = 0.368, P = 0.010), and the MBI-GS Scale also has an indirect effect on practice (β = -0.099, P = 0.037) (Table 4 and Fig. 1).

Table 4

Bootstrap analysis of mediating effect significance test for the final mode.
Pre-adjustment model	Standardized direct effects	P	95%CI		Standardized indirect effects	P	95%CI
Pre-adjustment model	Standardized direct effects	P	LLCI	ULCI	Standardized indirect effects	P	LLCI	ULCI
K-A	0.410	0.010	0.244	0.535	/	/	/	/
K-P	0.008	0.980	-0.116	0.111	0.270	0.010	0.153	0.383
M-K	-0.073	0.313	-0.213	-0.067	/	/	/	/
A-P	0.660	0.010	0.558	0.787	/	/	/	/
M-A	-0.120	0.032	-0.232	-0.015	-0.030	0.240	-0.097	0.023
M-P	-0.104	0.090	-0.200	0.006	-0.100	0.018	-0.169	-0.024
Post-adjustment model	Standardized direct effects	P	95%CI		Standardized indirect effects	P	95%CI
Post-adjustment model	Standardized direct effects	P	LLCI	ULCI	Standardized indirect effects	P	LLCI	ULCI
K-A	0.475	0.010	0.265	0.622	/	/	/	/
K-P	-0.109	0.162	-0.314	0.027	0.368	0.010	0.185	0.575
M-K	-0.073	0.351	-0.227	0.064	/	/	/	/
A-P	0.775	0.010	0.656	0.963	/	/	/	/
M-A	-0.103	0.065	-0.223	0.005	-0.035	0.352	-0.123	0.024
M-P	-0.092	0.204	-0.198	0.042	-0.099	0.037	-0.194	-0.012

Healthcare professionals demonstrate sufficient knowledge, positive attitudes, and proactive practices regarding respiratory support. Given the observed correlations and associations, interventions targeting continuous education, particularly for nurses and older professionals, alongside addressing burnout through targeted interventions, could further enhance the implementation of personalized respiratory support in clinical settings.

Age emerged as a significant factor influencing both knowledge and burnout, with younger professionals displaying higher levels of knowledge and lower burnout scores compared to older counterparts. This finding aligns with previous studies indicating that healthcare professionals may experience declines in knowledge retention and increased burnout due to prolonged exposure to stressors in the workplace[12]. Besides, the association between higher educational attainment and better knowledge, more positive attitudes, and enhanced practices, coupled with increased burnout levels among healthcare professionals in personalized respiratory support, reveals a multifaceted dynamic within professional development and workplace stressors. Professionals with advanced degrees often exhibit a deeper understanding of theoretical concepts and possess advanced skills pertinent to respiratory care, fostering positive attitudes and proactive engagement in their practice. However, the pursuit of higher education may entail additional academic and professional responsibilities, leading to heightened workload and stress levels. Additionally, individuals in roles requiring advanced degrees may face greater expectations for leadership, decision-making, and research, intensifying job-related pressures.

Moreover, the institutional setting was found to significantly influence knowledge, attitudes, and burnout levels, with professionals in public tertiary institutions scoring higher across these domains compared to those in other settings. This could be attributed to differences in resources, organizational culture, and support systems available in various types of healthcare institutions. Additionally, years of work experience exhibited a negative correlation with knowledge and burnout, indicating a potential decline in competencies and increased susceptibility to burnout over time, which resonates with the findings of previous study[13]. Furthermore, differences in attitudes and practices between physicians and nurses were evident, with physicians generally exhibiting more positive attitudes and practices. This finding underscores the importance of considering professional roles and responsibilities when designing interventions aimed at improving respiratory support practices and addressing burnout among healthcare professionals.

Correlation analysis and SEM results provide valuable insights into the relationships among healthcare professionals' knowledge, attitudes, practices, and burnout levels regarding personalized respiratory support. The positive correlations observed between knowledge, attitudes, and practices, as well as the negative correlations between attitudes/practices and burnout levels among healthcare professionals in personalized respiratory support, stem from a complex interplay of individual, organizational, and environmental factors within the healthcare context. Professionals who possess a deeper understanding of personalized respiratory support are more likely to demonstrate positive attitudes toward their work, viewing it as meaningful and impactful. This positive mindset often translates into proactive practices, as they feel empowered to apply their knowledge effectively. Conversely, healthcare professionals experiencing burnout may exhibit negative attitudes characterized by emotional exhaustion and reduced personal accomplishment, leading to a decline in their engagement with their work and subsequent practices. Furthermore, the findings from the SEM analysis corroborate previous research highlighting the mediating role of attitudes in the relationship between knowledge and practice. This underscores the importance of fostering positive attitudes towards evidence-based practices to enhance implementation in clinical settings. Moreover, the SEM results indicating the indirect effect of burnout on practice align with existing literature on the impact of burnout on healthcare professionals' performance and patient care outcomes. For instance, previous studies demonstrated a significant association between burnout and lower quality of care, highlighting the detrimental effects of burnout on healthcare delivery[14, 15].

In examining healthcare professionals' understanding of respiratory support techniques, it's evident that there are areas requiring further clarification and reinforcement. While there is generally a good grasp of fundamental concepts such as oxygen therapy and non-invasive positive pressure ventilation, certain nuanced aspects, such as the appropriateness of mechanical ventilation in specific clinical scenarios, warrant attention. To bridge these knowledge gaps, targeted educational initiatives should be implemented, focusing on case-based learning and scenario simulations. These sessions could involve multidisciplinary discussions, drawing insights from real-life experiences and clinical guidelines to enhance professionals' confidence and competence in decision-making regarding respiratory support interventions[16, 17].

Healthcare professionals' attitudes play a pivotal role in patient care, particularly in decision-making processes. While there is a positive inclination towards patient-centered care and recognizing the impact of respiratory support techniques on outcomes, challenges persist in navigating clinical guidelines effectively. To address this, healthcare organizations should prioritize creating supportive environments that foster shared decision-making and continuous learning. Implementing regular interdisciplinary case reviews and providing access to updated guidelines and decision-support tools can empower professionals to make informed choices aligned with patients' preferences and clinical evidence, ultimately enhancing the quality and patient-centeredness of care delivery[18–20].

In translating knowledge and attitudes into practice, it's essential to ensure alignment with evidence-based recommendations and patient-centered principles. While professionals demonstrate a willingness to engage in shared decision-making and pursue ongoing education, gaps exist in applying advanced airway management techniques during urgent situations. To enhance practice, healthcare institutions should invest in comprehensive training programs that integrate simulation-based learning and crisis resource management[21, 22]. These initiatives should prioritize hands-on skill development in emergency airway management, fostering confidence and competence among practitioners in delivering timely and effective respiratory support interventions, ultimately improving patient outcomes and safety[23, 24].

The prevalence of burnout symptoms among healthcare professionals underscores the urgent need for proactive strategies to support workforce well-being. Chronic stress and exhaustion not only jeopardize individual health but also compromise patient care quality and safety. To mitigate burnout, organizations should adopt a holistic approach that addresses both individual and systemic factors contributing to workplace stress. Implementing regular staff well-being assessments and providing access to confidential counseling services can empower professionals to prioritize self-care and seek support when needed[25, 26]. Moreover, fostering a culture of appreciation and recognition, alongside workload optimization strategies and opportunities for professional development, can cultivate a resilient workforce capable of delivering high-quality care while maintaining personal well-being[27–29].

Limitation

This study had limitations. Firstly, the study's cross-sectional design restricts the establishment of causal relationships between variables, limiting the ability to determine temporal sequences or causality. Secondly, the study was conducted at a single area, potentially limiting the generalizability of findings to broader healthcare settings. Lastly, reliance on self-reported measures through questionnaires may introduce response bias or social desirability bias, potentially influencing the accuracy and reliability of the collected data.

In conclusion, healthcare professionals exhibited satisfactory levels of knowledge, positive attitudes, and proactive practices regarding the application of respiratory support. To further enhance the quality of care and mitigate burnout risks, targeted interventions such as regular training sessions focusing on personalized respiratory support should be implemented, particularly for older healthcare professionals and nurses, to ensure sustained competence and well-being in clinical practice.

SOT, standard oxygen therapy

NIRS, Noninvasive respiratory support

HFOT, high-flow oxygen therapy

CPAP, continuous positive airway pressure

NIV, noninvasive ventilation

AHRF, acute hypoxemic respiratory failure

ARDS, acute respiratory distress syndrome

IMV, invasive mechanical ventilation

KAP, Knowledge-Attitude-Practice

MBI-GS, Maslach Burnout Inventory General Survey

SEM, structural equation modeling

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Taihe County People's Hospital, and informed consent was obtained from the participants for the study through an online questionnaire. All methods were performed in accordance with the relevant guidelines and regulations.

Consent for publication

Not applicable

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information file.

Competing interests

The authors declare that they have no competing interests

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions

CT and LJ carried out the studies, participated in collecting data, and drafted the manuscript. CB and YCW performed the statistical analysis and participated in its design. HYL and BCF participated in acquisition, analysis, or interpretation of data and draft the manuscript. All authors read and approved the final manuscript.

Acknowledgements

Not applicable

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No competing interests reported.

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Healthcare Professionals' Knowledge, Attitudes, and Practices Regarding Respiratory Support

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Background

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