ASSESSMENT OF ICU-ACQUIRED WEAKNESS IN NABLUS HOSPITALS: NURSE RECOGNITION, INTERVENTIONS, AND OUTCOMES COMPARED TO INTERNATIONAL STANDARDS – A DESCRIPTIVE CROSS-SECTIONAL AND PROSPECTIVE STUDY

Abstract

Background: Intensive care unit-acquired weakness (ICU-AW) is associated with delayed recovery, prolonged mechanical ventilation and ICU stay, persistent functional impairment, and reduced quality of life. ICU nurses are central to early recognition and prevention, yet evidence regarding their knowledge and bedside practice in Palestine is limited. This study assessed ICU nurses’ knowledge, recognition and assessment practices, preventive interventions, and perceived barriers related to ICU-AW in Nablus hospitals. Methodology: A descriptive cross-sectional study with a prospective observational component was conducted. All 150 eligible ICU nurses were invited; 140 completed the researcher-developed questionnaire (response rate = 93.3%), and 47 were included in direct observation. The questionnaire assessed demographics, knowledge, recognition and assessment, preventive interventions, and perceived barriers. The observational checklist assessed routine bedside practices. Content and face validity were established through expert review, and internal consistency was acceptable (Cronbach’s α = 0.749). Data were analyzed using SPSS, with p < 0.05 considered statistically significant. Results: Nurses demonstrated moderate overall knowledge (M = 14.14/24, SD = 3.99). Knowledge was strongest for general concepts and risk factors and weakest for diagnosis and recognition. Although 86.4% correctly identified the definition of ICU-AW, only 34.3% identified the MRC-SS as the principal bedside assessment tool and 12.9% identified its diagnostic threshold. None had received previous ICU-AW training. In the observational subsample, direct adherence averaged 4.66/12 (38.8%), whereas the self-reported practice score was 6.44/11 (58.5%). Higher education and longer ICU experience were significantly associated with greater knowledge. The most frequently reported barriers were workload, staff shortage, lack of training, limited diagnostic resources, restricted access to physiotherapy, and absence of standardized protocols. Conclusions: ICU nurses had moderate ICU-AW knowledge but important gaps in diagnostic recognition, standardized assessment, and bedside implementation. The difference between reported and observed practice indicates a knowledge-to-practice gap. Structured education, standardized ICU-AW protocols, multidisciplinary collaboration, and stronger institutional support are recommended.