Knowledge,Practices,and Challenges in Deep Venous Thrombosis Prevention Among ICU Nurses: A Cross-Sectional Study

Abstract

Introduction

Intensive care unit patients are at increased risk for deep venous thrombosis, making prevention a key nursing responsibility. Evidence from Saudi Arabia remains limited, particularly regarding intensive care unit nurses’ challenges in implementing deep venous thrombosis prevention measures.

Objectives

To assess intensive care unit nurses’ knowledge, practices, and challenges related to deep venous thrombosis prevention in selected Saudi tertiary hospitals.

Methods

A descriptive-correlational, cross-sectional study was conducted among 89 intensive care unit nurses selected through convenience sampling. Data were collected using a self-administered structured questionnaire from March 17 to April 17, 2025. Data analysis employed descriptive and inferential statistical methods, including analysis of variance, Pearson’s correlation coefficient, and frequency and percentage distributions for the challenge items.

Results

Nurses demonstrated moderate knowledge of deep venous thrombosis prevention (M = 21.14, SD = 8.29), equivalent to 62.2% of the total possible knowledge score. Practice was generally favorable (M = 14.70, SD = 4.59), with 58.4% classified as having good practice. Knowledge and practice were positively associated (r = 0.486, p < .001). Commonly reported challenges included knowledge gaps, barriers to patient mobilization, resource constraints, and communication issues within the healthcare team.

Conclusion

Intensive care unit nurses demonstrated moderate knowledge and generally favorable practice regarding deep venous thrombosis prevention. Higher knowledge was associated with better practice. Targeted education and organizational support may help strengthen prevention in critical care settings.

Keywords

knowledge practice challenges intensive care unit nurses deep venous thrombosis Saudi Arabia

Introduction

Venous thromboembolism (VTE), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), remains an important and largely preventable cause of morbidity and mortality among hospitalized patients (Clapham et al., 2023; Nicolaides et al., 2024). VTE encompasses DVT and PE. DVT occurs when a thrombus forms in the deep venous system, most commonly in the lower extremities, whereas PE develops when part of the thrombus dislodges and travels to the pulmonary vasculature (Black & Choudhury, 2025). The pathophysiology of VTE is commonly explained by Virchow’s triad, which includes venous stasis, endothelial injury, and hypercoagulability (Schulman et al., 2024). In hospitalized and critically ill patients, these mechanisms may be triggered by prolonged immobility, invasive procedures, systemic inflammation, infection, and multiple comorbid conditions, thereby increasing the risk of thrombus formation and embolization (Schulman et al., 2024). Patients admitted to intensive care units (ICUs) are particularly vulnerable because critical illness, prolonged immobility, invasive devices, and multiple coexisting risk factors increase thrombotic risk (Yang et al., 2026). Contemporary guidance continues to emphasize systematic risk assessment and the timely use of pharmacologic and/or mechanical prophylaxis when indicated (Croke, 2022; Yang et al., 2026). Nurses are central to this process because they monitor patient risk, implement prescribed preventive measures, promote mobility, observe for early complications, and reinforce adherence to prevention protocols (Al-Mugheed & Bayraktar, 2023; Bartzak, 2025). Although nurses play a central role in DVT prevention, their contribution may be influenced by institutional protocols, multidisciplinary coordination, and the availability of structured support systems for VTE prophylaxis and reassessment (Abuzied et al., 2024).

Because ICU nurses provide continuous bedside care to high-risk patients, their knowledge and preventive practices are critical to the safe implementation of VTE or DVT prophylaxis (Al-Mugheed & Bayraktar, 2023; Croke, 2022). However, effective prevention may be compromised when nurses have incomplete knowledge of risk assessment or prophylaxis, when preventive practices are inconsistently applied, or when institutional barriers limit adherence to guidelines (Al-Mugheed & Bayraktar, 2023). Recent evidence further suggests that improving VTE prophylaxis requires staff engagement, multidisciplinary collaboration, and policy enhancement to ensure consistent and high-quality preventive care (Abuzied et al., 2024). For this reason, examining ICU nurses’ knowledge, practices, and challenges related to DVT prevention is important for strengthening patient safety and improving the quality of critical care.

Review of Literature

Recent literature has increasingly focused on nurses’ role in VTE prevention. A 2023 systematic review found that nurses’ knowledge, risk-assessment practices, self-efficacy, attitudes, and preventive behaviors related to VTE were variable across studies, highlighting persistent gaps in assessment and evidence-based prevention (Al-Mugheed & Bayraktar, 2023). In addition, a 2023 realist review of e-learning interventions reported that nurse education can translate into practice change when staff are supported by managers and given appropriate opportunities to complete learning activities (Dyke et al., 2023). Together, these findings suggest that both individual competence and organizational support are important for effective VTE prevention. Similarly, Abuzied et al. (2024) emphasized that improving VTE prophylaxis requires service integration, policy enhancement, and health informatics support, including electronic systems for prophylaxis assessment and reassessment. The authors further highlighted the importance of multidisciplinary engagement, particularly the involvement of nurses, pharmacists, and physical therapists, in standardizing prevention and management practices (Abuzied et al., 2024).

Evidence from Saudi Arabia also indicates that nurses’ preparedness for VTE prevention is mixed and influenced by contextual factors. In Hail, nurses generally demonstrated good VTE knowledge but also reported uncertainty and barriers related to the safety and underuse of anticoagulant strategies, with work area significantly associated with knowledge and barriers (Alshammari et al., 2023). In Jeddah, nurses showed adequate knowledge of DVT prevention, although reported practice was lower than knowledge; higher academic qualification, work unit, and prior DVT training were associated with better knowledge and practice (Alharazi et al., 2024). A 2024 multicenter study from the Riyadh region further showed satisfactory knowledge and favorable practice toward thromboprophylaxis among healthcare professionals, with better knowledge associated with awareness of VTE policies and anticoagulant availability, underscoring the importance of institutional resources and visible protocols (Almarshad et al., 2024).

Taken together, these studies show that DVT prevention is shaped not only by nurses’ knowledge, but also by training opportunities, policy visibility, resource availability (Almarshad et al., 2024; Alshammari et al., 2023), multidisciplinary collaboration, and institutional systems that support VTE assessment and reassessment (Abuzied et al., 2024). However, Saudi evidence remains relatively limited in studies focused specifically on ICU nurses, and the practical challenges nurses encounter during day-to-day DVT prevention are less commonly examined than knowledge or practice alone. Therefore, this study examined ICU nurses’ knowledge, practices, and challenges regarding DVT prevention in selected Saudi tertiary hospitals.

Objectives of the Study

1. To describe the socio-demographic and professional characteristics of ICU nurses.

2. To assess ICU nurses’ knowledge and practices related to DVT prevention.

3. To examine the association of sociodemographic and professional characteristics with knowledge and practice.

4. To determine the relationship between knowledge and practice.

5. To identify the challenges encountered in DVT prevention.

Methods

Design

A quantitative descriptive-correlational, cross-sectional study design. Cross-sectional designs provide a “snapshot” of a population at a single moment in time (Capili et al., 2021), thus providing a practical and convenient approach to address the study’s objectives. The STROBE checklist was used to report significant aspects of this investigation (Elm et al., 2025) (Supplementary file 1).

Participants

Inclusion Criteria

Registered nurses working in the intensive care units of the selected hospitals were eligible if they had at least a diploma in nursing or a higher nursing qualification, held a valid license from the Saudi Commission for Health Specialties, were directly involved in patient care, and were willing to participate in the study.

Exclusion Criteria

Nurses who were not assigned to the intensive care unit during the data collection period, were on leave, held purely administrative positions, or declined participation were excluded.

Study Settings

The study was conducted in two prominent healthcare facilities in Saudi Arabia: Prince Mutaib bin Abdulaziz Hospital and King Abdulaziz Specialist Hospital. Prince Mutaib bin Abdulaziz Hospital is a general hospital that is endowed with state-of-the-art facilities. It provides a comprehensive array of medical services to cater to a diverse patient population. In contrast, King Abdulaziz Specialist Hospital concentrates on the provision of specialized treatment for patients with complex medical conditions, utilizing advanced medical care across multiple specialties. The Saudi Ministry of Health supervises both hospitals, which are staffed by experienced healthcare professionals who are dedicated to providing critical care. This ensures that the hospitals adhere to high standards of care and safety protocols.

Sample Size

The total number of ICU nurses at Prince Mutaib bin Abdulaziz Hospital was 62 nurse and there were 53 nurses at King Abdulaziz Specialist Hospital. The total number was 115 nurses. According to the G* power program the total number of sample size was 89 at confidence level 95%.

Plan and Implementation Process

Convenience sampling technique was used. The critical care department was contact eligible participants for the study. Informed consent was obtained from participants to confirm their willingness to participate in the study, after they have been provided with the necessary information. The questionnaire was distributed online, via nurses’ emails, and through WhatsApp groups in collaboration with department supervisors and officials. The data collection period rolled out from March 17 to April 17, 2025.

Instrument

Data were collected using a self-administered structured questionnaire composed of three parts. The first part included researcher-prepared items on the participants’ demographic and professional characteristics, developed based on previous studies (Al-Mugheed & Bayraktar, 2018; Yohannes et al., 2022). The second part assessed ICU nurses’ knowledge and practices regarding deep venous thrombosis (DVT) prevention. These sections were adapted from the instrument originally developed by Al-Mugheed and Bayraktar (2018) and later used by Yohannes et al. (2022). The knowledge subscale consisted of 34 items with three response options: True = 1, False = 0, and I do not know = 0. The practice subscale consisted of 10 items rated on a three-point Likert scale: Always = 2, Sometimes = 1, and Never = 0. Knowledge scores were interpreted as poor (0-10), moderate (11-24), and good (25-34). Practice scores were categorized as poor (0-7), moderate (8-14), and good (15-20).

The third part assessed ICU nurses’ challenges related to DVT prevention and included close-ended statements on perceived barriers and management-related difficulties encountered while caring for patients at risk for or diagnosed with DVT. Participants were allowed to select more than one response based on the challenges they encountered in practice. These items were developed by the researchers based on relevant previous studies (Al-Mugheed & Bayraktar, 2018, 2023; Bartzak, 2025; Dyke et al., 2023; Yohannes et al., 2022).

With regard to the instrument’s methodological basis, the original questionnaire developed by Al-Mugheed and Bayraktar (2018) was pilot tested for clarity, although psychometric indices were not reported in the original publication. Subsequently, Yohannes et al. (2022), who used the same tool among Ethiopian nurses, reported acceptable reliability coefficients of 0.786 for the knowledge subscale and 0.760 for the practice subscale. In the present study, the questionnaire was pilot tested among 10 ICU nurses in its English version to assess clarity and contextual suitability in the Saudi setting. A result of 0.80 Cronbach alpha was obtained for its reliability. No further modifications were required following the pilot test. Therefore, the instrument in the present study should be understood as a previously published and pilot-tested questionnaire with supporting reliability evidence from later use, rather than as a fully psychometrically validated tool within the current study setting.

The Caprini Risk Assessment Model was not incorporated into the study instrument. Accordingly, the questionnaire did not assess nurses’ ability to assign formal VTE risk scores or classify patients according to Caprini risk categories. Instead, the instrument focused on ICU nurses’ general knowledge, preventive practices, and perceived challenges regarding DVT prevention.

Data Analysis

SPSS version 25.0 statistical analysis software was used for the analysis. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were used to summarize the participants’ demographic characteristics, as well as their knowledge and practice scores regarding deep venous thrombosis prevention. Analysis of variance (ANOVA) was used to examine differences in knowledge and practice levels according to selected sociodemographic characteristics. Pearson’s correlation coefficient was used to determine the relationship between ICU nurses’ knowledge and practice regarding deep venous thrombosis prevention. Responses to the challenge items were analyzed using frequencies and percentages, and the most commonly reported challenges were ranked accordingly. No qualitative data collection, coding, or thematic analysis was performed. A p-value of less than 0.05 was considered statistically significant.

Ethical Considerations

The study complied to the Code of Ethical Conduct for Research Involving Human Subjects outlined in the 2024 Declaration of Helsinki. Institutional Review Board approval was obtained from the Ethics Review Committee of University of Hail before the study begins (Protocol number: H-2025-624; Approval date: 17/02/2025). Informed consent was be obtained from all participants, and they were informed that participation is voluntary. Participant data was kept confidential and anonymous and will only be used for research purposes. Participants were informed that they are free to withdraw from the study at any time without penalty. Data was stored for at least five years in a secure location to ensure confidentiality and compliance with data protection legislation.

Results

Demographic Characteristics of Participants

Table 1 summarizes the demographic characteristics of the ICU nurses (n=89). Most participants were female (79.8%), 26 to 26 years old (46.1%), single (51.7%), and had a Bachelor’s nursing degree (69.7%).

Table 1.

Socio-Demographic Profile Characteristics of the Participants (n= 89)

Variables		N	%
Gender	Male	18	20.2
Gender	Female	71	79.8
Age	≤25 years	21	23.6
	26–30 years	41	46.1
	31–35 years	19	21.3
	≥36 years	8	9.0
Marital Status	Single	46	51.7
	Married	35	39.3
	Others	8	9.0
Educational Status	Diploma	5	5.6
	BSC degree	62	69.7
	Masters	18	20.2
	Doctorate	4	4.5

Level of Knowledge and Practices of ICU Nurses on DVT Prevention

The results further showed that ICU nurses demonstrated a moderate overall level of knowledge regarding DVT prevention, as reflected by a mean score of 21.14 out of 34 (Supplementary Table S1). This indicates that, on average, nurses answered about 62.2% of the knowledge items correctly. The highest proportion of correct responses was observed for items related to early ambulation after surgery and the use of heparin or low-molecular-weight heparin, both of which were answered correctly by 76.4% of respondents. In contrast, misconceptions were noted for items such as “Exercises may predispose to DVT” and “Low body mass index may predispose to DVT,” which were answered incorrectly by 57.3% and 52.8% of nurses, respectively. These findings indicate that although nurses were knowledgeable about some major preventive strategies, specific misunderstandings remain and may require targeted educational reinforcement.

The practice findings showed a generally favorable level of DVT prevention practice, with a mean score of 14.70 out of 20, which is close to the cutoff for the good practice category (Supplementary Table S2). More than half of the nurses (58.4%) were classified as having good practice, while 36.0% demonstrated moderate practice. The most frequently performed practices were monitoring anticoagulant side effects and educating patients on fluid intake, both reported as “always” by 60.7% of respondents. By contrast, the least consistently performed behaviors included encouraging early ambulation of surgical patients and educating patients to avoid injury, suggesting areas where practice standardization may still be needed.

Overall Level of Knowledge and Practice of ICU Nurses on DVT Prevention

Table 2 presents the overall levels of knowledge and practice among ICU nurses regarding DVT prevention. For knowledge, the mean score was 21.14 (SD = 8.29) out of a possible 34 points, which corresponds to approximately 62.2% of the total score and falls within the study’s predefined moderate knowledge category (11-24 points). Consistent with this mean score, 49.4% of the nurses were classified as having moderate knowledge, 40.4% had good knowledge, and 10.1% had poor knowledge. These findings suggest that although most nurses had at least an adequate understanding of DVT prevention, important knowledge gaps remain.

Table 2.

Overall Levels of Knowledge and Practice of ICU Nurses on DVT Prevention

Variable	N	%
Level of Knowledge
Poor Knowledge	9	10.1
Moderate Knowledge	44	49.4
Good Knowledge	36	40.4
	Mean=21.14, SD=8.29
Level of Practice
Poor Practice	5	5.6
Moderate Practice	32	36.0
Good Practice	52	58.4
	Mean=14.7, SD=4.59

For practice, the mean score was 14.70 (SD = 4.59) out of a possible 20 points. This score lies at the upper end of the moderate practice category (8-14 points) and close to the cutoff for good practice (15-20 points). In terms of distribution, 58.4% of the nurses were categorized as having good practice, 36.0% had moderate practice, and 5.6% had poor practice. Taken together, these results indicate that while the average practice score approached the threshold for good practice, more than half of the respondents were already classified in the good practice category.

Difference in the Level of Knowledge and Practices According to Socio-Demographic Profile Characteristics

The ANOVA showed differences in ICU nurses’ level of knowledge on DVT prevention according to socio-demographic characteristics (Table 3). Marital status showed a statistically significant difference in knowledge levels (F = 8.09). In contrast, gender (F = 0.048), age (F = 1.257), and educational status (F = 0.698) did not show statistically significant differences. Among the socio-demographic variables examined, only marital status was significantly associated with knowledge level.

Table 3.

Significant Difference in the Level of Knowledge and Practices According to Socio-Demographic Profile Characteristics

Variable	Level of knowledge	Level of practice
Gender	F=0.048	F=0.128
Age	F=1.257	F=0.762
Marital Status	F=8.09*	F=3.86*
Educational Statue	F=0.698	F=1.08

*Significant at p<0.05.

Similarly, Table 3 shows differences in ICU nurses’ level of practice on DVT prevention according to socio-demographic characteristics. Marital status showed a statistically significant difference in practice levels (F = 3.86). In contrast, gender (F = 0.128), age (F = 0.762), and educational status (F = 1.08) did not show statistically significant differences. Among the socio-demographic variables examined, only marital status was significantly associated with practice level.

Correlation Between Knowledge and Practice of ICU Nurses Regarding DVT Prevention

Table 4 presents the correlation between ICU nurses’ knowledge and practice regarding DVT prevention. The findings showed a statistically significant moderate positive correlation between knowledge and practice scores (r = 0.486, p < .001). This indicates that nurses with higher knowledge levels tended to report better DVT prevention practices.

Table 4.

Correlation Between Knowledge and Practice of ICU Nurses Regarding DVT Prevention

		Knowledge	Practice
Knowledge	Pearson Correlation	1	0.486^**
	p-value		<0.001
	N	89	89
Practice	Pearson Correlation	0.486^**	1
	p-value	<0.001
	N	89	89

Nurses’ Challenges (i.e.,Barriers and Management) in Caring for Patients Diagnosed With DVT

Table 5 shows that the most common barrier in managing patients with DVT are lack of resources (e.g., physical therapy support, equipment) (33.70%), inadequate knowledge and understanding of DVT prevention (28.10%), and delays in care delivery due to staffing issues and conflicting priorities (22.41%). Whereas ICU nurses nursing management of DVT focused mostly focused on anticoagulant therapy administration (33.70%), patient mobility and movement (28.10%), and use of compression devices (22.41%).

Table 5.

Nurses’ Challenges (i.e., Barriers and Management) in Caring for Patients Diagnosed With DVT (n=89)

Challenges	f	%	Rank
Barriers
Lack of resources (e.g., physical therapy support, equipment)	30	33.70%	1
Inadequate knowledge and understanding of DVT prevention	25	28.10%	2
Delays in care delivery due to staffing issues and conflicting priorities	20	22.41%	3
Concern about starting anticoagulant therapy correctly	15	16.85%	4
Lack of understanding about the use of compression devices	10	11.24%	5
Lack of communication among healthcare team members	8	8.99%	6
Patient reluctance to move or medical issues preventing mobility	4	4.49%	7
Emotional and psychological challenges of patients	2	2.25%	8
Nursing management
Focus on anticoagulant therapy administration	30	33.70%	1
Patient mobility and movement	25	28.10%	2
Use of compression devices	20	22.41%	3
Promoting early mobilization	10	11.24%	4
Emotional and psychological support for patients	4	4.49%	5

Discussion

This study examined ICU nurses’ knowledge, practices, and perceived challenges regarding DVT prevention in two large government hospitals in Saudi Arabia. Overall, the findings suggest a mixed pattern: nurses demonstrated moderate knowledge, generally favorable but not uniformly optimal practice, and a set of barriers that appear to reflect the realities of implementing prevention measures in demanding critical care environments. Rather than indicating a complete lack of awareness or effort, these findings suggest that DVT prevention in ICU settings may be constrained by uneven knowledge in specific content areas, variability in day-to-day practice, and operational challenges that affect the consistent delivery of preventive care.

The finding of moderate knowledge is broadly consistent with previous Saudi and international studies. Alharazi et al. (2024) reported comparable knowledge levels among nurses in Jeddah, while Yohannes et al. (2022) also found that nurses were generally aware of DVT as a clinical problem but still demonstrated important misconceptions regarding risk factors and prevention. Taken together, these findings suggest that basic awareness of DVT may be present, but more detailed and practice-relevant understanding remains inconsistent. In the ICU context, this distinction is important because prevention depends not only on general awareness, but also on accurate recognition of risk, timely implementation of preventive measures, and consistent reinforcement of evidence-based care. The present findings therefore support the need for more focused and context-specific educational initiatives, particularly those that address common misconceptions and strengthen the practical application of DVT prevention principles in critically ill patients.

Although more than half of the participants were categorized as having good practice, the overall pattern still suggests room for improvement in the consistency of implementation. This is important because favorable classification at the group level does not necessarily indicate that all recommended preventive measures are performed consistently across clinical situations. Alyousef et al. (2022) likewise reported encouraging levels of DVT-related practice, whereas Teichman et al. (2023) noted that awareness of preventive measures does not always translate into uniform protocol adherence. A possible interpretation is that nurses may perform more routine or protocol-driven tasks more consistently than preventive actions requiring coordination, patient engagement, or repeated reinforcement. In this sense, the present findings highlight the difference between knowing what should be done and ensuring that preventive measures are carried out consistently within the realities of ICU workflow.

The moderate positive correlation between knowledge and practice further supports this interpretation. Consistent with Hu et al. (2025), nurses with higher knowledge levels in the present study tended to report better preventive practices. However, because of the cross-sectional design, this relationship should be interpreted as an association rather than evidence of causality. Even so, the finding is meaningful because it suggests that strengthening nurses’ knowledge may be one important component of improving DVT prevention practice. At the same time, the correlation was only moderate, which also indicates that practice is shaped by factors beyond knowledge alone, including workflow demands, communication patterns, team coordination, and institutional reinforcement of prevention standards.

Marital status was significantly associated with knowledge levels among ICU nurses, but this finding should be interpreted with caution. Although a similar association was reported by Parveen et al. (2023), the present study was not designed to explain the mechanism underlying this relationship because a cross-sectional design cannot provide a causal interpretation. It is therefore possible that marital status may be acting as a proxy for other unmeasured personal, social, or professional factors, or that the finding may be incidental. For this reason, marital status should not be overemphasized as an explanatory factor unless supported by further research.

The challenges reported by ICU nurses provide important insight into why DVT prevention may remain difficult even when general awareness and some preventive practices are present. The reported barriers—including competing responsibilities, emotional and psychological demands, patient mobilization difficulties, and communication gaps within the healthcare team—suggest that DVT prevention is embedded within a broader clinical environment characterized by time pressure, competing priorities, and complex patient needs. Similar barriers have been described in previous studies, where workload pressures and practice-related constraints interfered with the consistent implementation of preventive measures (Han et al., 2024; Yesuf et al., 2021). These findings are important because they shift the interpretation away from viewing DVT prevention purely as an individual knowledge issue and toward understanding it as a practice process influenced by organizational and interdisciplinary factors.

The pattern of challenges identified in the present study also has implications for clinical practice and policy. Difficulties with mobilization and communication suggest that effective DVT prevention depends on stronger interdisciplinary coordination among nurses, physicians, and rehabilitation staff, rather than on isolated nursing action alone. Likewise, the finding that nurses often prioritized anticoagulant administration over other preventive measures is consistent with Kawaguchi (2024), who noted a tendency for clinicians to focus more heavily on pharmacological prevention than on other essential strategies. This may lead to an overly narrow understanding of prophylaxis, in which mobility support, patient education, hydration, surveillance, and reassessment receive less consistent attention. In the Saudi context, where VTE prophylaxis is already recognized as an important standard of care and supported by institutional frameworks (Alharazi et al., 2024; Alshammari et al., 2023), the issue may be less about the absence of resources and more about how prevention protocols are reinforced, coordinated, and operationalized in everyday ICU practice.

Finally, the emotional and psychological demands identified by participants should not be overlooked. Moss et al. (2023) emphasized the psychosocial burden associated with critical care practice, and the present findings suggest that such pressures may indirectly influence preventive care by reducing the cognitive and emotional capacity available for consistent attention to DVT prevention tasks. This highlights the importance of supportive work environments, practical continuing education, team communication, and realistic staffing strategies. Taken together, the findings of this study suggest that strengthening DVT prevention in ICU settings will likely require a multifaceted approach that combines education, workflow support, interdisciplinary collaboration, and institutional reinforcement of evidence-based prevention practices.

Implications for Nursing Practice

The present findings suggest that ICU nurses may benefit from continued educational support in DVT prevention, especially in specific areas where knowledge gaps were observed. While preventive practices were generally favorable, the findings also indicate that consistent implementation of DVT prevention measures remains an important practice consideration. The reported challenges related to mobilization, team communication, and competing demands further suggest that strengthening interdisciplinary collaboration and supporting routine preventive workflows may help improve DVT prevention efforts in critical care settings. Accordingly, the study may inform targeted and context-sensitive nursing practice improvement strategies.

Strengths and Limitations

This study has several strengths. It addresses a clinically important topic in a high-risk population and provides local evidence on ICU nurses’ knowledge, practices, and challenges regarding DVT prevention in selected Saudi tertiary hospitals. In addition, the sample size was adequate to provide acceptable statistical power, and the study used a previously published questionnaire to assess knowledge and practice levels.

However, several limitations should be considered when interpreting the findings. First, the cross-sectional design precludes any inference of causality among the study variables. Second, the use of convenience sampling may have introduced selection bias and reduced the generalizability of the findings beyond the participating hospitals. Third, the relatively small sample size may have limited the stability of subgroup comparisons and reduced the feasibility of more robust multivariate modeling. Fourth, the self-reported nature of the practice data may be subject to response bias or social desirability bias. Fifth, although the questionnaire was adapted from a previously published instrument, pilot tested for clarity, and supported by acceptable reliability in a later study, its original psychometric documentation was limited and formal validity testing was not conducted in the present setting. Finally, the questionnaire did not include a formal VTE risk assessment tool, such as the Caprini Risk Assessment Model; therefore, the study did not assess ICU nurses’ ability to perform standardized VTE risk stratification or assign formal risk scores.

Recommendations

The findings of this study suggest several directions for future research. First, future studies may investigate whether targeted educational interventions can strengthen ICU nurses’ knowledge and support more consistent DVT prevention practices, particularly in areas where knowledge gaps were identified. Second, because nurses reported barriers related to mobilization, communication, and competing responsibilities, future research may explore the effectiveness of interdisciplinary and context-specific strategies for improving the implementation of DVT prevention in critical care settings. Third, studies in other healthcare systems and cultural contexts may help determine the broader applicability of these findings. Finally, future research is also recommended to include larger and more representative samples, apply multivariate statistical approaches, and incorporate standardized VTE risk assessment tools such as the Caprini Risk Assessment Model to better examine nurses’ preparedness for risk-based thromboprophylaxis.

Conclusion

Among ICU nurses in the selected Saudi tertiary hospitals, moderate knowledge and generally favorable practice regarding DVT prevention were observed. However, important gaps in specific knowledge areas and challenges in the consistent application of preventive measures remain. The significant association between marital status and knowledge should be interpreted cautiously. These findings highlight the value of continued educational support and institutional reinforcement of evidence-based DVT prevention practices in critical care settings.

Supplemental Material

Supplemental material - Knowledge, Practices, and Challenges in Deep Venous Thrombosis Prevention Among ICU Nurses: A Cross-Sectional Study

Supplemental Material for Knowledge, Practices, and Challenges in Deep Venous Thrombosis Prevention Among ICU Nurses: A Cross-Sectional Study by Hazel Novela Villagracia, Reem Aladham Alruwaili, Rico William A. Villagracia, Bushra Alshammari, Salman Hamdan Alsaqri, Habib Alrashedi, Shaimaa Mohamed Nageeb, Awatif M. Alrasheeday, Mubarak Ashewi Eid Alshammari, Roger Robles Molina, Dolores I. Cabansag, Nazirah Omar Nouh, Khlood Hamdan Alblwei, Atheer Hamdan Albalawi, Daniel Joseph E. Berdida, Salwa Abd El Gawad Sallam in Sage Open Nursing

Supplemental Material

Supplemental material - Knowledge, Practices, and Challenges in Deep Venous Thrombosis Prevention Among ICU Nurses: A Cross-Sectional Study

Supplemental Material

Supplemental material - Knowledge, Practices, and Challenges in Deep Venous Thrombosis Prevention Among ICU Nurses: A Cross-Sectional Study

Footnotes

Acknowledgements

We acknowledge the invaluable participation of ICU nurses from Prince Mutaib bin Adbulaziz Hospital and King Abdulaziz Specialist Hospital. Also, our great appreciation to the Deanship of Scientific Research and Post Graduate at University of Ha’il, Saudi Arabia.

ORCID iDs

Hazel Novela Villagracia

Rico William A. Villagracia

Bushra Alshammari

Salman Hamdan Alsaqri

Habib Alrashedi

Shaimaa Mohamed Nageeb

Awatif M. Alrasheeday

Mubarak Ashewi Eid Alshammari

Roger Robles Molina

Dolores I. Cabansag

Nazirah Omar Nouh

Daniel Joseph E. Berdida

Salwa Abd El Gawad Sallam

Ethical Considerations

This study was approved by the University of Hail Research Ethics Committee (H-2025-624; Approval date:17/02/2025).

Author Contributions

Conceptualization: HNV, RAA, RWAV, BA, SHA, HA, SMN, AMA, MAEA, RRM, DIC, NON, KHA, AHA, DJEB, SAEGS.

Methodology: HNV, RWAV, BA, DJEB.

Software: HNV, MAEA, RAA, RWAV, BA, HA, SMN, AMA.

Validation: HNV, RAA, RWAV, BA, SHA, HA, SMN, AMA, MAEA, RRM, DIC, NON, KHA, AHA, DJEB, SAEGS.

Formal Analysis: HNV, MAEA, RAA, RWAV, NON, KHA, AHA, DJEB, SAEGS.

Data Curation: HNV, RAA, RWAV, BA, SHA, HA, SMN, AMA, MAEA, RRM, DIC, NON, KHA, AHA, DJEB, SAEGS.

Writing - Original Draft: HNV, RAA, RWAV, DJEB.

Writing - Review & Editing: HNV, RAA, RWAV, BA, SHA, HA, SMN, AMA, MAEA, RRM, DIC, NON, KHA, AHA, DJEB, SAEGS.

Visualization: HNV, MMA, RWAV, DJEB.

Supervision: HNV, RWAV.

Project administration: HNV, RWAV, RAA.

Funding acquisition: Not Applicable

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Conflicting Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data Availability Statement

The data supporting this study’s findings are available from the corresponding author upon reasonable request.*

Supplemental Material

Supplemental material for this article is available online.

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