{"id":"https://openalex.org/W7224515997","doi":"https://doi.org/10.1155/jonm/7066240","title":"Nurse Competencies, Patient Characteristics, and Pain Management Protocol Adherence in Intensive Care Units: A Multicenter Cross\u2010Sectional Study Accounting for ICU Clustering","display_name":"Nurse Competencies, Patient Characteristics, and Pain Management Protocol Adherence in Intensive Care Units: A Multicenter Cross\u2010Sectional Study Accounting for ICU Clustering","publication_year":2026,"publication_date":"2026-01-01","ids":{"openalex":"https://openalex.org/W7224515997","doi":"https://doi.org/10.1155/jonm/7066240","pmid":"https://pubmed.ncbi.nlm.nih.gov/42952193","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13717227"},"language":"en","primary_location":{"id":"doi:10.1155/jonm/7066240","doi":"https://doi.org/10.1155/jonm/7066240","is_oa":true,"landing_page_url":"https://doi.org/10.1155/jonm/7066240","pdf_url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1155/jonm/7066240","source":{"id":"https://openalex.org/S172540258","display_name":"Journal of Nursing Management","issn_l":"0966-0429","issn":["0966-0429","1365-2834"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["abdc-c","anvur-scientific","cwts-core","dongbi-b","doyens","fnege-4","jufo-3","ki-jl-1","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320595","host_organization_name":"Wiley","host_organization_lineage":["https://openalex.org/P4310320595"],"host_organization_lineage_names":["Wiley"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Nursing Management","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1155/jonm/7066240","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5160114920","display_name":"Yasaman Shafie Motlagh Kashani","orcid":"https://orcid.org/0009-0003-7944-3073","observed_orcids":["https://orcid.org/0009-0003-7944-3073"]},"institutions":[{"id":"https://openalex.org/I70640408","display_name":"Tehran University of Medical Sciences","ror":"https://ror.org/01c4pz451","country_code":"IR","type":"education","lineage":["https://openalex.org/I70640408"]}],"countries":["IR"],"is_corresponding":false,"raw_author_name":"Yasaman Shafie Motlagh Kashani","raw_affiliation_strings":["Department of Critical Care Nursing School of Nursing and Midwifery Tehran University of Medical Sciences  Tehran Iran  tums.ac.ir"],"raw_orcid":"https://orcid.org/0009-0003-7944-3073","affiliations":[{"raw_affiliation_string":"Department of Critical Care Nursing School of Nursing and Midwifery Tehran University of Medical Sciences  Tehran Iran  tums.ac.ir","institution_ids":["https://openalex.org/I70640408"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5080350501","display_name":"Mahboobeh Shali","orcid":"https://orcid.org/0000-0003-4094-8878","observed_orcids":["https://orcid.org/0000-0003-4094-8878"]},"institutions":[{"id":"https://openalex.org/I70640408","display_name":"Tehran University of Medical Sciences","ror":"https://ror.org/01c4pz451","country_code":"IR","type":"education","lineage":["https://openalex.org/I70640408"]}],"countries":["IR"],"is_corresponding":true,"raw_author_name":"Mahboubeh Shali","raw_affiliation_strings":["Department of Critical Care Nursing School of Nursing and Midwifery Tehran University of Medical Sciences  Tehran Iran  tums.ac.ir"],"raw_orcid":"https://orcid.org/0000-0003-4094-8878","affiliations":[{"raw_affiliation_string":"Department of Critical Care Nursing School of Nursing and Midwifery Tehran University of Medical Sciences  Tehran Iran  tums.ac.ir","institution_ids":["https://openalex.org/I70640408"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5061275660","display_name":"Maryam Chamari","orcid":"https://orcid.org/0000-0001-7040-0868","observed_orcids":["https://orcid.org/0000-0001-7040-0868"]},"institutions":[{"id":"https://openalex.org/I70640408","display_name":"Tehran University of Medical Sciences","ror":"https://ror.org/01c4pz451","country_code":"IR","type":"education","lineage":["https://openalex.org/I70640408"]}],"countries":["IR"],"is_corresponding":false,"raw_author_name":"Maryam Esmaieli","raw_affiliation_strings":["Department of Critical Care Nursing School of Nursing and Midwifery Tehran University of Medical Sciences  Tehran Iran  tums.ac.ir"],"raw_orcid":"https://orcid.org/0000-0001-7040-0868","affiliations":[{"raw_affiliation_string":"Department of Critical Care Nursing School of Nursing and Midwifery Tehran University of Medical Sciences  Tehran Iran  tums.ac.ir","institution_ids":["https://openalex.org/I70640408"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5089948630","display_name":"Shima Haghani","orcid":"https://orcid.org/0000-0002-1334-975X","observed_orcids":["https://orcid.org/0000-0002-1334-975X","https://orcid.org/0000-0001-8226-279X"]},"institutions":[{"id":"https://openalex.org/I161106909","display_name":"Iran University of Medical Sciences","ror":"https://ror.org/03w04rv71","country_code":"IR","type":"education","lineage":["https://openalex.org/I161106909"]}],"countries":["IR"],"is_corresponding":false,"raw_author_name":"Shima Haghani","raw_affiliation_strings":["Department of Biostatistics Iran University of Medical Sciences  Tehran Iran  iums.ac.ir"],"raw_orcid":"https://orcid.org/0000-0002-1334-975X","affiliations":[{"raw_affiliation_string":"Department of Biostatistics Iran University of Medical Sciences  Tehran Iran  iums.ac.ir","institution_ids":["https://openalex.org/I161106909"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5080350501"],"corresponding_institution_ids":["https://openalex.org/I70640408"],"apc_list":{"value":2700,"currency":"USD","value_usd":2700},"apc_paid":{"value":2700,"currency":"USD","value_usd":2700},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.87785685,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"2026","issue":"1","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11199","display_name":"Pain Management and Opioid Use","score":0.8779000043869019,"subfield":{"id":"https://openalex.org/subfields/2703","display_name":"Anesthesiology and Pain Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11199","display_name":"Pain Management and Opioid Use","score":0.8779000043869019,"subfield":{"id":"https://openalex.org/subfields/2703","display_name":"Anesthesiology and Pain Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10508","display_name":"Patient Safety and Medication Errors","score":0.02329999953508377,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11744","display_name":"Health Sciences Research and Education","score":0.021199999377131462,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/nursing-competencies","display_name":"nursing competencies","score":0.7710000276565552},{"id":"https://openalex.org/keywords/intensive-care-nurses","display_name":"intensive care unit nurses","score":0.7260000109672546},{"id":"https://openalex.org/keywords/nursing-knowledge","display_name":"nursing knowledge","score":0.7099999785423279},{"id":"https://openalex.org/keywords/self-efficacy","display_name":"self-efficacy","score":0.8610000014305115},{"id":"https://openalex.org/keywords/nurse-attitudes","display_name":"nurse attitudes","score":0.8560000061988831},{"id":"https://openalex.org/keywords/patient-characteristics","display_name":"patient characteristics","score":0.9829999804496765},{"id":"https://openalex.org/keywords/substance-use-history","display_name":"substance use history","score":0.7570000290870667},{"id":"https://openalex.org/keywords/glasgow-coma-scale","display_name":"Glasgow Coma Scale","score":0.8650000095367432},{"id":"https://openalex.org/keywords/mechanical-ventilation","display_name":"mechanical ventilation","score":1.0},{"id":"https://openalex.org/keywords/organizational-support","display_name":"organizational support","score":0.75},{"id":"https://openalex.org/keywords/intensive-care-unit","display_name":"intensive care unit","score":0.7110000252723694},{"id":"https://openalex.org/keywords/tehran","display_name":"Tehran","score":0.46000000834465027},{"id":"https://openalex.org/keywords/evidence-based-practice","display_name":"evidence-based practice","score":0.48399999737739563},{"id":"https://openalex.org/keywords/guideline-adherence","display_name":"guideline adherence","score":0.5519999861717224}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7953000068664551},{"id":"https://openalex.org/C2779343474","wikidata":"https://www.wikidata.org/wiki/Q3109175","display_name":"Context (archaeology)","level":2,"score":0.6222000122070312},{"id":"https://openalex.org/C2780385302","wikidata":"https://www.wikidata.org/wiki/Q367158","display_name":"Protocol (science)","level":3,"score":0.5928999781608582},{"id":"https://openalex.org/C2776376669","wikidata":"https://www.wikidata.org/wiki/Q5094647","display_name":"Intensive care unit","level":2,"score":0.5895000100135803},{"id":"https://openalex.org/C104709138","wikidata":"https://www.wikidata.org/wiki/Q1671540","display_name":"Intraclass correlation","level":3,"score":0.5763999819755554},{"id":"https://openalex.org/C2987404301","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care","level":2,"score":0.49059998989105225},{"id":"https://openalex.org/C2780344248","wikidata":"https://www.wikidata.org/wiki/Q2084130","display_name":"Nursing management","level":2,"score":0.4851999878883362},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.4392000138759613},{"id":"https://openalex.org/C203915360","wikidata":"https://www.wikidata.org/wiki/Q352454","display_name":"Critical care nursing","level":3,"score":0.4147999882698059},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.37070000171661377},{"id":"https://openalex.org/C2777921204","wikidata":"https://www.wikidata.org/wiki/Q66104672","display_name":"Knowledge translation","level":2,"score":0.3596999943256378},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.35749998688697815},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.33329999446868896},{"id":"https://openalex.org/C2984889486","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing care","level":2,"score":0.3287000060081482},{"id":"https://openalex.org/C2777080012","wikidata":"https://www.wikidata.org/wiki/Q3766250","display_name":"Mechanical ventilation","level":2,"score":0.2904999852180481},{"id":"https://openalex.org/C142052008","wikidata":"https://www.wikidata.org/wiki/Q954027","display_name":"Cross-sectional study","level":2,"score":0.2786000072956085},{"id":"https://openalex.org/C39896193","wikidata":"https://www.wikidata.org/wiki/Q380344","display_name":"Descriptive statistics","level":2,"score":0.2743000090122223},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.2578999996185303}],"mesh":[{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002983","descriptor_name":"Clinical Competence","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true},{"descriptor_ui":"D002983","descriptor_name":"Clinical Competence","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D003430","descriptor_name":"Cross-Sectional Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007362","descriptor_name":"Intensive Care Units","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":false},{"descriptor_ui":"D007362","descriptor_name":"Intensive Care Units","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D007492","descriptor_name":"Iran","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008875","descriptor_name":"Middle Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D009726","descriptor_name":"Nurses","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true},{"descriptor_ui":"D009726","descriptor_name":"Nurses","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D011795","descriptor_name":"Surveys and Questionnaires","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D019983","descriptor_name":"Guideline Adherence","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true},{"descriptor_ui":"D019983","descriptor_name":"Guideline Adherence","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D059408","descriptor_name":"Pain Management","qualifier_ui":"Q000379","qualifier_name":"methods","is_major_topic":true},{"descriptor_ui":"D059408","descriptor_name":"Pain Management","qualifier_ui":"Q000451","qualifier_name":"nursing","is_major_topic":true},{"descriptor_ui":"D059408","descriptor_name":"Pain Management","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true},{"descriptor_ui":"D059408","descriptor_name":"Pain Management","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true}],"locations_count":3,"locations":[{"id":"doi:10.1155/jonm/7066240","doi":"https://doi.org/10.1155/jonm/7066240","is_oa":true,"landing_page_url":"https://doi.org/10.1155/jonm/7066240","pdf_url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1155/jonm/7066240","source":{"id":"https://openalex.org/S172540258","display_name":"Journal of Nursing Management","issn_l":"0966-0429","issn":["0966-0429","1365-2834"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["abdc-c","anvur-scientific","cwts-core","dongbi-b","doyens","fnege-4","jufo-3","ki-jl-1","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320595","host_organization_name":"Wiley","host_organization_lineage":["https://openalex.org/P4310320595"],"host_organization_lineage_names":["Wiley"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Nursing Management","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13717227","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13717227/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13717227/pdf/JONM-2026-7066240.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"J Nurs Manag","raw_type":"Text"},{"id":"pmid:42952193","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42952193","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of nursing management","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.1155/jonm/7066240","doi":"https://doi.org/10.1155/jonm/7066240","is_oa":true,"landing_page_url":"https://doi.org/10.1155/jonm/7066240","pdf_url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1155/jonm/7066240","source":{"id":"https://openalex.org/S172540258","display_name":"Journal of Nursing Management","issn_l":"0966-0429","issn":["0966-0429","1365-2834"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["abdc-c","anvur-scientific","cwts-core","dongbi-b","doyens","fnege-4","jufo-3","ki-jl-1","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320595","host_organization_name":"Wiley","host_organization_lineage":["https://openalex.org/P4310320595"],"host_organization_lineage_names":["Wiley"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Nursing Management","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":1.0,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7224515997.pdf","grobid_xml":"https://content.openalex.org/works/W7224515997.grobid-xml"},"referenced_works_count":26,"referenced_works":["https://openalex.org/W2002846329","https://openalex.org/W2020155291","https://openalex.org/W2070208538","https://openalex.org/W2128770955","https://openalex.org/W2134049139","https://openalex.org/W2136608905","https://openalex.org/W2801354279","https://openalex.org/W2885896746","https://openalex.org/W3014862601","https://openalex.org/W3088337919","https://openalex.org/W3140655848","https://openalex.org/W3210650930","https://openalex.org/W4220919766","https://openalex.org/W4294904623","https://openalex.org/W4308001749","https://openalex.org/W4385708289","https://openalex.org/W4392553304","https://openalex.org/W4400864670","https://openalex.org/W4402332547","https://openalex.org/W4411034573","https://openalex.org/W4411117155","https://openalex.org/W4417114020","https://openalex.org/W7114781975","https://openalex.org/W7117325858","https://openalex.org/W7135027030","https://openalex.org/W7164509630"],"related_works":["https://openalex.org/W1768271528","https://openalex.org/W7084754707","https://openalex.org/W4402609145","https://openalex.org/W7135027030","https://openalex.org/W7166471333","https://openalex.org/W4415679364","https://openalex.org/W2983438930","https://openalex.org/W4287981777","https://openalex.org/W2168437401","https://openalex.org/W3013427551"],"abstract_inverted_index":{"AIM(S):":[0],"To":[1],"examine":[2],"the":[3,179,259,266,310,319,358],"associations":[4],"between":[5],"nurse":[6,110],"competencies":[7,41,281],"(knowledge,":[8],"self-efficacy,":[9],"and":[10,14,108,198,244,282,333,352,371],"attitude),":[11],"patient":[12,94,283],"characteristics,":[13],"pain":[15,32,289,349],"management":[16,33,290,350],"protocol":[17,118,168,291],"adherence":[18,119,157,169,207,292,314],"in":[19,64,87,261,293,315,336,374],"adult":[20],"intensive":[21],"care":[22],"units,":[23],"while":[24],"accounting":[25],"for":[26,44,97,117,167],"between-ICU":[27],"clustering.":[28,177],"BACKGROUND:":[29],"Adherence":[30],"to":[31,139,227,272],"protocols":[34],"remains":[35,73],"suboptimal":[36],"despite":[37],"available":[38],"guidelines.":[39],"Nurse":[40,280,344],"are":[42,285,309,330,369],"essential":[43],"evidence-based":[45],"practice,":[46],"yet":[47],"their":[48],"translation":[49],"into":[50],"clinical":[51],"performance":[52],"may":[53,346],"depend":[54],"on":[55],"contextual":[56],"factors.":[57],"ICU-level":[58,100],"organizational":[59,101,328],"context":[60,147],"has":[61],"been":[62],"described":[63],"recent":[65],"reviews,":[66],"but":[67],"empirical":[68],"examination":[69],"of":[70,258,313,322,361],"these":[71,367],"relationships":[72],"limited.":[74],"METHOD(S):":[75],"This":[76],"multicenter":[77,295],"cross-sectional":[78],"study":[79],"included":[80],"525":[81],"ICU":[82,131,183,296,323,362],"nurses":[83],"from":[84,122,270],"seven":[85,267],"hospitals":[86],"Tehran,":[88],"Iran":[89],"(July-October":[90],"2025).":[91],"One":[92],"index":[93],"was":[95,120,137,148,158,170,300],"assessed":[96,104],"each":[98],"nurse.":[99],"characteristics":[102,213,284],"were":[103],"through":[105],"unit":[106],"observation":[107],"head":[109],"interviews.":[111],"The":[112,165,253],"intraclass":[113],"correlation":[114],"coefficient":[115],"(ICC)":[116],"computed":[121],"an":[123],"empty":[124],"mixed":[125],"model.":[126],"Multivariable":[127],"linear":[128],"regression":[129],"with":[130,144,182,206,288,355],"entered":[132],"as":[133,150,184],"a":[134,151,185],"fixed":[135,186],"effect":[136,187],"used":[138],"identify":[140],"individual-level":[141,307],"factors":[142,308],"associated":[143,205,287],"adherence.":[145,262],"Organizational":[146,263],"retained":[149],"descriptive":[152,331],"variable":[153],"only.":[154],"RESULTS:":[155],"Protocol":[156],"moderate":[159],"(mean":[160],"8.5/12;":[161],"32.4%":[162],"good":[163],"adherence).":[164],"ICC":[166],"0.02":[171],"(95%":[172],"CI:":[173],"0.001-0.15),":[174],"indicating":[175],"minimal":[176,301],"In":[178],"multivariable":[180],"model":[181,255],"(18":[188],"predictors),":[189],"knowledge":[190],"(\u03b2":[191,195,200,220,229,238,247],"=":[192,196,201,221,224,230,233,239,242,248,251,303,326,365],"0.311),":[193],"self-efficacy":[194],"0.290),":[197],"attitude":[199],"0.276)":[202],"remained":[203,214],"independently":[204,286],"(all":[208],"p":[209,223,232,241,250],"<":[210,236],"0.001).":[211],"Patient":[212],"significantly":[215],"associated:":[216],"substance":[217],"use":[218],"history":[219],"-0.138,":[222],"0.016),":[225],"inability":[226],"communicate":[228],"-0.148,":[231],"0.010),":[234],"GCS":[235],"9":[237],"-0.160,":[240],"0.008),":[243],"mechanical":[245],"ventilation":[246],"-0.121,":[249],"0.028).":[252],"full":[254],"explained":[256],"53.4%":[257],"variance":[260],"support":[264],"across":[265],"ICUs":[268],"ranged":[269],"1":[271],"5":[273],"(weighted":[274],"mean":[275],"3.42":[276],"\u00b1":[277],"1.15).":[278],"CONCLUSION(S):":[279],"this":[294,316],"sample.":[297,317],"Between-ICU":[298],"clustering":[299],"(ICC":[302],"0.02),":[304],"suggesting":[305],"that":[306],"primary":[311],"correlates":[312],"Given":[318,357],"small":[320,359],"number":[321,360],"clusters":[324,363],"(n":[325,364],"7),":[327,366],"findings":[329],"only":[332],"require":[334,372],"confirmation":[335],"larger":[337,375],"multilevel":[338,376],"studies.":[339,377],"IMPLICATIONS":[340],"FOR":[341],"NURSING":[342],"MANAGEMENT:":[343],"managers":[345],"consider":[347],"competency-based":[348],"education":[351],"regular":[353],"audits":[354],"feedback.":[356],"recommendations":[368],"hypothesis-generating":[370],"validation":[373]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-10-30T00:00:00"}
