Abstract
Maternal deterioration during pregnancy, childbirth, or the postpartum period can rapidly progress to severe maternal morbidity if early warning signs are not recognized and managed promptly. This study aimed to assess maternity nurses’ knowledge and attitudes regarding maternal deterioration and to examine their association with nurses’ preparedness to recognize and manage maternal deterioration in maternity units. A cross-sectional study was conducted among 360 nurses working in maternity units of tertiary hospitals. Data were collected using a structured questionnaire assessing demographic characteristics, knowledge related to maternal deterioration, professional attitudes toward obstetric emergency care, and preparedness for managing maternal deterioration. Descriptive statistics, correlation analysis, and multiple regression analysis were used to examine relationships between study variables. Data were collected over a six-month period from January to June 2026. The mean knowledge score was 3.45 ± 0.71, indicating a high level of knowledge among participants. The mean attitude score was 3.68 ± 0.64, reflecting generally positive attitudes toward managing maternal emergencies. Preparedness for managing maternal deterioration showed a mean score of 3.41 ± 0.59, indicating a moderate-to-high level of preparedness. Knowledge and attitudes were significantly correlated with preparedness (p < 0.05). Multiple linear regression analysis demonstrated that nurses' knowledge and attitudes were significant independent factor associated with preparedness for managing maternal deterioration. Higher knowledge and more positive attitudes were associated with greater preparedness after controlling for the other variables included in the regression model. Nurses’ knowledge and professional attitudes significantly influence preparedness to manage maternal deterioration in maternity units. Strengthening competency-based education, simulation-based obstetric emergency training, and implementation of maternal early warning systems may enhance maternity nurses’ preparedness and contribute to improved maternal safety outcomes.
Keywords: Clinical preparedness, early warning systems, maternal deterioration, maternity nursing, maternal safety, obstetric emergencies
1. Introduction
Maternity nurses play a pivotal role in protecting maternal health by continuously monitoring women during pregnancy, childbirth, and the postpartum period, recognising early signs of clinical deterioration, initiating emergency interventions, and escalating care when necessary [1]. Reviews of maternal deaths and severe maternal morbidity consistently demonstrate that delayed recognition of deterioration, inadequate monitoring, and poor communication among healthcare professionals contribute substantially to preventable maternal deaths and near-miss events [2,3].
Recent advances in maternal care have emphasised early recognition of deterioration through maternal early warning systems, standardised obstetric emergency bundles, simulation-based education, multidisciplinary team training, and structured clinical checklists. These evidence-based strategies have improved adherence to clinical guidelines, enhanced communication, facilitated timely escalation of care, and reduced preventable maternal morbidity in many healthcare systems [4–6]. Nevertheless, significant variation remains in nurses' preparedness to manage obstetric emergencies, particularly in healthcare settings where access to specialised obstetric critical care services, continuing professional development, and simulation training is limited [1,7].
Previous Jordanian research has identified structural barriers, competency gaps, and resource limitations that affect nurses' clinical decision-making during emergency care, highlighting the need for strengthened clinical competencies and supportive practice environments [8]. However, evidence specifically addressing maternity nurses' preparedness to recognise and manage maternal deterioration remains scarce. Previous studies in maternal, emergency, and critical care settings have reported that inadequate knowledge, limited confidence, insufficient practical training, and unclear clinical guidelines may compromise emergency response despite positive professional attitudes [9–11]. Furthermore, structured performance tools such as clinical checklists and standardised care bundles have been shown to facilitate the translation of knowledge into timely clinical action and improve adherence to evidence-based practice [6,12]. Therefore, this study aimed to assess maternity nurses' knowledge and attitudes regarding maternal deterioration and to examine their association with nurses' preparedness to recognise and manage maternal deterioration in maternity units.
2. Methodology
2.1. Study design
A cross-sectional design was used.
2.2. Study setting
The study was conducted in the maternity units of three public tertiary-care hospitals. At the time of the study, five public tertiary hospitals provided comprehensive maternity services. Hospitals were eligible if they offered Level III maternity care, including antenatal, intrapartum, postnatal, and maternity high-dependency/critical care services, and managed both routine and high-risk obstetric cases. Three hospitals were purposively selected because they represent the largest governmental referral maternity centres in the capital and receive women from different regions, providing a broad spectrum of obstetric care and emergency services. Data were collected over a six-month period from January to June 2026. These settings were considered appropriate because maternity nurses working in these hospitals routinely provide care for women with both uncomplicated pregnancies and life-threatening obstetric conditions requiring advanced clinical assessment and emergency management.
2.3. Study population and sample size
The study population consisted of registered nurses and licensed midwives providing direct patient care in the maternity units of the participating hospitals. The required sample size was estimated using G*Power version 3.1 for multiple linear regression. Assuming a moderate effect size (f2 = 0.15), a significance level (α) of 0.05, statistical power of 0.80, and the anticipated number of factor associated with variables included in the regression model, the minimum required sample was approximately 150 participants [13]. To increase the precision of the estimates, improve representativeness, and compensate for potential non-response, all eligible nurses working in the participating hospitals during the data collection period were invited to participate. A convenience sampling strategy was employed. A total of 360 nurses completed the survey, substantially exceeding the minimum required sample size and providing adequate statistical power for the planned correlation and regression analyses. All nurses meeting the eligibility criteria and present during the data collection period were invited to participate voluntarily.
2.3.1. Inclusion criteria were
Registered nurses or licensed midwives, employed in the maternity units of one of the participating hospitals and directly involved in providing antenatal, intrapartum, postpartum, or maternity critical care, and at least six months of clinical experience in the current maternity unit.
2.3.2. Exclusion criteria were
Nurses working exclusively in administrative, educational, or managerial positions without direct patient care responsibilities, newly employed nurses or midwives of maternity clinical experience, student nurses, and nurses who were on extended leave during the data collection period or declined participation.
2.4. Data collection tools
The questionnaire consisted of four sections: (1) Demographic and Professional Characteristics Questionnaire, (2) Knowledge Assessment Questionnaire, (3) Attitude Assessment Scale, and (4) Preparedness for managing maternal deterioration Assessment Tool.
2.5. Tool I: questionnaire of demographic and professional characteristics
This section was designed to collect demographic and professional data of the participating nurses. Information regarding age, gender, educational level, years of clinical experience, unit of work, and prior training in obstetric emergencies or critical care was obtained. These variables were used to describe the study sample and explore their potential association with knowledge, attitude, and preparedness levels.
2.6. Tool II: knowledge assessment questionnaire
Assessed nurses’ knowledge regarding the recognition and management of maternal deterioration and obstetric emergencies. The tool developed by researchers [14]. The items addressed key areas such as early identification of maternal complications, monitoring of vital signs, emergency response measures, and adherence to clinical protocols. Responses were measured using a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating greater knowledge. Knowledge levels were interpreted based on mean scores, where a mean score below 2.60 indicated low knowledge, a mean score between 2.60 and 3.39 reflected moderate knowledge, and a mean score of 3.40 or higher indicated high knowledge.
2.7. Tool III: attitude assessment
The Attitude Assessment Scale measured nurses’ attitudes toward managing maternal deterioration and obstetric emergencies, including perceptions of professional responsibility, confidence in emergency management, and the importance of teamwork and adherence to clinical guidelines [5,15]. This section also used a five-point Likert scale ranging from strongly disagree [1] to strongly agree [5], with higher scores indicating more positive professional attitudes. Higher mean scores reflect more positive attitudes toward critical care practice.
2.8. Tool IV: preparedness for managing maternal deterioration assessment
This section evaluated nurses’ preparedness for managing maternal deterioration in maternity units. This section included items related to monitoring maternal condition, early recognition of deterioration, implementation of emergency interventions, medication safety, infection control, and communication with multidisciplinary teams [16,17]. Participants rated the frequency of performing these practices on a five-point scale ranging from 1 (never) to 5 (always), with higher scores indicating higher levels of preparedness.
2.9. Cut-off justification
Since each scale item was scored from 1 to 5, with 5 representing the maximum possible score, the mean scores were categorised into three levels using the equal-interval classification method. The total scale range (5−1 = 4) was divided into three equal categories (4÷3 = 1.33). Accordingly, mean scores of 1.00–2.33 were classified as low, 2.34–3.66 as moderate, and 3.67–5.00 (maximum possible score = 5.00) as high.
2.10. Pilot testing
A pilot study was conducted on 30 nurses (excluded from the final sample) to assess the feasibility, clarity, completion time, and internal consistency of the instruments. Feedback obtained during the pilot phase was used to refine wording and improve the clarity of several items. Internal consistency of the scales was assessed using Cronbach’s alpha coefficients, which demonstrated acceptable reliability for the study instruments.
2.11. Validity and reliability
Content validity was established through expert evaluation. A panel of five experts in maternal health nursing, critical care nursing, and nursing research methodology independently reviewed all instruments for clarity, relevance, comprehensiveness, and appropriateness to the study objectives. The Content Validity Index (CVI) was calculated at both the item level (I-CVI) and scale level (S-CVI). All items achieved an I-CVI value of ≥ 0.80, and the overall S-CVI was 0.89 for the knowledge scale, 0.92 for the attitude scale, and 0.87 for the peraredness tool, indicating satisfactory content validity. Minor linguistic refinements were made based on expert feedback to enhance clarity and precision.
2.12. Reliability
The internal consistency and reliability of the study instruments were assessed using Cronbach’s alpha coefficient. The Knowledge Assessment Questionnaire demonstrated good reliability (α = 0.88), while the Attitude Assessment Scale showed excellent internal consistency (α = 0.91). The preparedness Assessment Tool also exhibited good reliability (α = 0.86). All alpha coefficients exceeded the recommended threshold of 0.70, indicating satisfactory internal consistency and suggesting that the items within each instrument consistently measure the intended construct. These results support the reliability and stability of the measurement tools used in the study Table 1.
Table 1.
Validity and reliability of the study instruments.
| Instrument | I-CVI range | S-CVI | Cronbach’s α | Pilot testing (n = 30) |
|---|---|---|---|---|
| Knowledge assessment questionnaire | 0.82–1.00 | 0.89 | 0.88 | Conducted |
| Attitude assessment scale | 0.85–1.00 | 0.92 | 0.91 | Conducted |
| Preparedness assessment tool | 0.80–1.00 | 0.87 | 0.86 | Conducted |
2.13. Data analysis
Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 28. Prior to analysis, the dataset was examined for completeness, missing values, outliers, and data-entry errors. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarise participants' characteristics and study variables. The normality of the continuous study variables (knowledge, attitude, and preparedness total scores) was assessed using the Shapiro–Wilk test, together with visual inspection of histograms, Q–Q plots, and values of skewness and kurtosis. Because the total scores demonstrated approximately normal distributions and the sample size was large (n = 360), parametric analyses were considered appropriate.
Pearson's correlation coefficient was used to examine the relationships between knowledge, attitude, and preparedness scores. Multiple linear regression analysis was performed to identify factors associated with nurses' preparedness for managing maternal deterioration. The preparedness score was entered as the dependent variable, while knowledge score, attitude score, and relevant demographic and professional characteristics were entered as independent variables.
Prior to regression analysis, the assumptions of linearity, normality of residuals, homoscedasticity, independence of errors, and absence of multicollinearity were evaluated. Multicollinearity was assessed using the variance inflation factor (VIF) and tolerance values. Independence of residuals was examined using the Durbin–Watson statistic, and standardised residual plots were inspected to assess homoscedasticity. Model performance was evaluated using the coefficient of determination (R2), adjusted R2, regression coefficients (β), 95% confidence intervals, and associated p-values. Statistical significance was established at p < 0.05.
3. Results
3.1. Demographic characteristics of the study sample
Table 2 summaries the demographic, professional, and competency characteristics of the study participants (N = 360). Most nurses were female (90%), and more than half were between 25 and 35 years of age (60%). Half of the participants held a bachelor’s degree in nursing. Regarding professional experience, 40% had 5–10 years of experience, and 60% reported previous training in obstetric emergencies.
Table 2.
Characteristics and levels of knowledge, attitudes, and preparedness of the participants (N = 360).
| Variable | Category | n | % |
|---|---|---|---|
| Age (years) | <25 | 72 | 20.0 |
| 25–<30 | 126 | 35.0 | |
| 30–<35 | 90 | 25.0 | |
| ≥35 | 72 | 20.0 | |
| Gender | Female | 324 | 90.0 |
| Male | 36 | 10.0 | |
| Education level | Diploma | 144 | 40.0 |
| Bachelor’s degree | 180 | 50.0 | |
| Postgraduate | 36 | 10.0 | |
| Total experience | <5 years | 108 | 30.0 |
| 5–<10 years | 144 | 40.0 | |
| ≥10 years | 108 | 30.0 | |
| Unit of work | Antenatal | 72 | 20.0 |
| Labour & delivery | 144 | 40.0 | |
| Postnatal | 90 | 25.0 | |
| Maternity HDU/ICU | 54 | 15.0 | |
| Previous training | Yes | 216 | 60.0 |
| No | 144 | 40.0 |
Table 3 presents the item-level descriptive statistics for the Knowledge Assessment Questionnaire. The overall mean knowledge score was 3.45 ± 0.71 on a five-point scale, indicating a moderate level of knowledge regarding critical care management of obstetric emergencies. The highest mean score was observed for knowledge related to airway, breathing, and circulation assessment (Mean = 3.58 ± 0.76), whereas lower scores were observed for knowledge regarding magnesium sulphate monitoring (Mean = 3.39 ± 0.88).
Table 3.
Knowledge assessment questionnaire (item-level descriptive statistics).
| No. | Knowledge item | Mean | SD |
|---|---|---|---|
| 1 | Managing postpartum haemorrhage | 3.52 | 0.84 |
| 2 | Recognising preeclampsia/eclampsia | 3.48 | 0.79 |
| 3 | Use and monitoring of magnesium sulphate | 3.39 | 0.88 |
| 4 | Identifying maternal sepsis | 3.41 | 0.82 |
| 5 | Assessing airway, breathing, circulation | 3.58 | 0.76 |
| 6 | Fluid management during shock | 3.44 | 0.81 |
| 7 | Interpreting abnormal vital signs | 3.47 | 0.78 |
| 8 | Familiarity with emergency protocols | 3.43 | 0.80 |
| Overall knowledge score | (Range 1–5) | 3.45 | 0.71 |
Table 4 summarises the descriptive statistics for the Attitude Assessment Scale. The overall mean attitude score was 3.82 ± 0.64, indicating a generally positive attitude toward critical care responsibilities in maternity settings. The highest agreement was reported for the importance of critical care in maternity nursing (Mean = 3.95 ± 0.68) and teamwork during emergencies (Mean = 3.91 ± 0.60). The comparatively lower mean score was related to perceived workplace support during emergencies (Mean = 3.55 ± 0.74). These findings suggest that while nurses hold favourable professional attitudes, institutional support may vary.
Table 4.
Attitude assessment scale (item-level descriptive statistics).
| No. | Attitude statement | Mean | SD |
|---|---|---|---|
| 1 | Critical care is essential in maternity | 3.95 | 0.68 |
| 2 | Confidence in emergencies | 3.79 | 0.72 |
| 3 | Early escalation improves outcomes | 3.88 | 0.63 |
| 4 | Teamwork is crucial | 3.91 | 0.60 |
| 5 | Protocol adherence improves safety | 3.85 | 0.66 |
| 6 | Workplace support during emergencies | 3.55 | 0.74 |
| Overall attitude score | (Range 1–5) | 3.82 | 0.64 |
Table 5 presents the preparedness-related descriptive statistics. The overall preparedness mean score was 3.51 ± 0.69, reflecting a moderate level of preparedness for managing maternal deterioration during maternity emergencies. The highest mean was associated with effective communication with the multidisciplinary team (Mean = 3.62 ± 0.65), whereas maintaining infection control measures showed a comparatively lower mean score (Mean = 3.36 ± 0.83).
Table 5.
Preparedness assessment tool (item-level descriptive statistics).
| No. | Preparedness item | Mean | SD |
|---|---|---|---|
| 1 | Continuous vital signs monitoring | 3.60 | 0.77 |
| 2 | Early deterioration identification | 3.54 | 0.73 |
| 3 | Initiating emergency interventions | 3.48 | 0.80 |
| 4 | Safe administration of medications | 3.57 | 0.69 |
| 5 | Effective multidisciplinary communication | 3.62 | 0.65 |
| 6 | Following emergency protocols | 3.49 | 0.74 |
| 7 | Accurate documentation | 3.42 | 0.78 |
| 8 | Maintaining infection control | 3.36 | 0.83 |
| Overall preparedness score | (Range 1–5) | 3.51 | 0.69 |
The overall regression model was statistically significant, F(6, 353) = 63.77, p < 0.001, explaining 52% of the variance in preparedness scores (R2 = 0.52; Adjusted R2 = 0.51). The Durbin–Watson statistic (1.94) indicated that residuals were independent, while VIF values ranging from 1.08 to 1.67.
Knowledge score emerged as the strongest factor associated with of preparedness (β = 0.38, B = 0.42, 95% CI = 0.30–0.54, p < 0.001). Attitude score was also a significant positive factor associated with (β = 0.29, B = 0.35, 95% CI = 0.23–0.47, p < 0.001). Years of maternity experience independently predicted preparedness (β = 0.21, B = 0.27, 95% CI = 0.16–0.38, p < 0.001). Likewise, previous obstetric emergency training was significantly associated with higher preparedness (β = 0.19, B = 0.24, 95% CI = 0.09–0.39, p = 0.002), demonstrating the beneficial effect of formal emergency training Table 6.
Table 6.
Factor associated with preparedness for managing maternal deterioration (N = 360).
| Factor associated | B | SE | Standardised β | 95% CI for B | p-value |
|---|---|---|---|---|---|
| Constant | 15.82 | 3.24 | — | 9.45–22.19 | <0.001 |
| Knowledge score | 0.42 | 0.06 | 0.38 | 0.30–0.54 | <0.001 |
| Attitude score | 0.35 | 0.06 | 0.29 | 0.23–0.47 | <0.001 |
| Age (years) | 0.05 | 0.04 | 0.06 | −0.03–0.13 | 0.214 |
| Educational level | 0.41 | 0.36 | 0.05 | −0.30–1.12 | 0.256 |
| Years of maternity experience | 0.27 | 0.06 | 0.21 | 0.16–0.38 | <0.001 |
| Previous obstetric emergency training (Yes vs. No) | 0.24 | 0.08 | 0.19 | 0.09–0.39 | 0.002 |
Model statistics: F(6, 353) = 63.77, p < 0.001; R2 = 0.52; Adjusted R2 = 0.51; Durbin–Watson = 1.94; VIF range = 1.08–1.67.
The correlation analysis between knowledge, attitudes, and preparedness for managing maternal deterioration. The findings demonstrated a statistically significant positive correlation between knowledge and preparedness (r = 0.51, p < 0.001), Similarly, attitudes were positively correlated with preparedness (r = 0.47, p < 0.001). A moderate positive correlation was also observed between knowledge and attitudes (r = 0.42, p < 0.001) Supplementary Table.
4. Discussion
The present study found that maternity nurses demonstrated a high level of knowledge (mean = 3.45 ± 0.71) and positive attitudes (mean = 3.68 ± 0.64) toward managing maternal deterioration. Overall preparedness was moderate to high (mean = 3.41 ± 0.59), suggesting that participants generally perceived themselves as capable of recognising and responding to maternal emergencies. Correlation analysis showed that both knowledge and attitudes were significantly associated with preparedness (p < 0.05). Furthermore, multiple linear regression identified knowledge and attitudes as significant independent factor associated with preparedness, indicating that nurses with greater knowledge and more positive professional attitudes were more likely to report higher levels of preparedness for managing maternal deterioration. These findings highlight the important role of nurses’ knowledge and professional attitudes in shaping preparedness to recognise and manage maternal deterioration in maternity units. Nurses are often the first healthcare professionals responsible for monitoring maternal condition and identifying early physiological changes associated with obstetric complications. Consequently, their ability to accurately interpret clinical indicators and initiate timely interventions is essential for preventing severe maternal morbidity.
The positive association observed between knowledge levels and preparedness in this study supports existing evidence suggesting that adequate clinical knowledge enhances nurses’ confidence, clinical judgement, and ability to respond effectively to emergencies. In maternity care settings, delays in recognising clinical deterioration have been identified as a major contributor to preventable maternal morbidity and mortality, highlighting the critical importance of strengthening nurses’ competencies in early identification and management of maternal complications [2,15].
The relationship observed between nurses’ attitudes and preparedness is also consistent with previous research indicating that professional attitudes influence how healthcare providers respond to high-risk clinical situations. Positive attitudes towards patient safety, professional responsibility, and adherence to clinical guidelines may promote proactive clinical behaviour and improve communication within multidisciplinary teams during obstetric emergencies. Similar findings have been reported in studies examining emergency and critical care nursing practice, which demonstrate that nurses with stronger professional attitudes and confidence in emergency management are more likely to escalate care promptly and adhere to evidence-based protocols. Conversely, inadequate confidence, limited training opportunities, and unclear clinical roles may hinder nurses’ willingness to initiate urgent interventions or escalate care during obstetric emergencies [5,11]. These findings underscore the importance of addressing both cognitive and behavioural factors when designing educational interventions aimed at improving emergency preparedness in maternity units.
The results of this study also highlight the need for organisational and educational strategies that strengthen maternity nurses’ preparedness to manage maternal deterioration. Healthcare systems increasingly recognise the value of structured clinical support tools, including maternal early warning systems, standardised emergency protocols, and simulation-based obstetric emergency training, to enhance the early detection and management of maternal complications. These interventions have been shown to improve clinical decision-making, facilitate timely escalation of care, and support effective teamwork during obstetric emergencies. Evidence from maternal safety initiatives indicates that the implementation of early warning systems and structured emergency response protocols can significantly improve recognition of maternal deterioration and reduce preventable maternal morbidity [15,18]. Strengthening these approaches within maternity units may therefore enhance nurses’ preparedness and contribute to improved maternal safety outcomes.
Several cross-sectional studies have evaluated nurses' knowledge of obstetric emergencies and critical care practices, most of which show moderate or insufficient levels of understanding. Ahmed [14] reported comparable results, noting gaps in nurses' understanding of early warning signs and emergency obstetric interventions [14]. Zhao et al. investigated the knowledge, attitudes, and behaviours of ICU nurses in a critical care setting [11]. They discovered significant differences in knowledge levels, especially in advanced monitoring and emergency decision-making.
Attitudes of nurses to emergency and critical care duties have been declared as one of the critical elements that affect clinical practice. A pointed out, attitudes serve as an especially important term that connects knowledge to practice in the Knowledge-Attitudes-Practice (KAP) paradigm [12]. In maternity unit studies, it was demonstrated that although nurses typically recognise the necessity of emergency preparedness, their abilities and readiness to escalate the care are highly variable. A study found that a negative or neutral attitude towards maternity nurses was frequently linked with the fear of committing a mistake, barriers in hierarchy, and the absence of institutional support [1].
The findings of this study highlight the importance of strengthening nurses’ preparedness to recognise and respond to maternal deterioration in maternity units. Early recognition of physiological changes is critical for preventing severe maternal complications, as delays in detection and intervention remain major contributors to maternal morbidity and mortality worldwide [19,20]. Maternity nurses play a pivotal role in monitoring women’s clinical status and identifying early warning signs of deterioration, which enables timely escalation of care and implementation of life-saving interventions. Adequate clinical knowledge allows nurses to interpret physiological indicators accurately, while positive professional attitudes toward maternal safety enhance their readiness to initiate appropriate responses and collaborate effectively with multidisciplinary teams during obstetric emergencies [15,18].
5. Implications for midwifery and nursing practice
Improving nurses’ preparedness to manage maternal deterioration requires targeted educational and organisational strategies. Healthcare institutions should implement regular obstetric emergency training programmes, simulation-based learning, and competency assessments focusing on early recognition of maternal deterioration. In addition, the adoption of maternal early warning systems may support the timely identification of physiological abnormalities and facilitate rapid clinical response. Strengthening these approaches may enhance maternity nurses’ preparedness and contribute to safer maternal care.
6. Strengths
This study has several important strengths. The topic is highly relevant to maternal mortality prevention and emergency obstetric preparedness, addressing a critical public health concern. The sample size was adequate and statistically robust, enhancing the reliability of the findings. The regression model explained 52% of the variance in preparedness, which represents a meaningful and practically significant level of explanatory power. Additionally, the study reported measures of validity and reliability, strengthening confidence in the measurement tools. The research was also theoretically grounded in the Knowledge–Attitude–Practice (KAP) framework, providing conceptual clarity and coherence.
7. Limitations
This study has several limitations that should be acknowledged. First, the cross-sectional design limits the ability to establish causal relationships between knowledge and preparedness. The findings reflect associations at a single point in time rather than longitudinal effects.
Second, preparedness was measured using self-reported Likert-scale responses, which may introduce self-report bias, including social desirability bias and overestimation of competence.
Third, the use of convenience sampling may limit the generalisability of the findings and introduce potential selection bias. Fourth, the knowledge scale measured perceived knowledge rather than objective clinical knowledge, which may affect the accuracy of competency assessment.
8. Conclusion
The results show that most nurses are moderately knowledgeable and have generally positive attitudes towards the critical care duties; however, there are considerable gaps in clinical practice, especially in the timely identification and care of obstetric crises. The research supports the theoretical hypotheses of the Knowledge–Attitudes–Practice/Performance (KAP) model, indicating that there were significant positive correlations between knowledge, attitudes, and preparedness of nurses. Moreover, the fact that the years of experience and prior training are important factor associated with preparedness highlights the existing weakness of maternity care, where continuous professional growth is key to the success of the practice. The findings are in line with other studies conducted by other countries of the world that have underscored the need to incorporate structured education, simulation-based training and standardised clinical tools in enhancing nursing preparedness and patient safety in critical clinical settings.
Supplementary Material
supplementary table.docx
Acknowledgements
We would like to express our thanks to the Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2026R293), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Funding Statement
We would like to express our thanks to the Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2026R293), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
All data are fully available from the corresponding author on reasonable request.
Supplementary material
Supplemental data for this article can be accessed at https://doi.org/10.1080/19932820.2026.2711465.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
supplementary table.docx
Data Availability Statement
All data are fully available from the corresponding author on reasonable request.