Barriers and Facilitators to Delirium Management Among ICU Nurses in Two Tertiary Hospitals in Chongqing, China: A Qualitative Study Using the COM-B Framework

Background: Delirium management remains inconsistently implemented in intensive care units (ICUs), and existing studies provide limited insight into how assessment capability, organisational opportunity, and emotional motivation interact in Chinese tertiary care settings. Aim: To explore ICU nurses’ perceived barriers and facilitators to delirium assessment and management using the Capability, Opportunity and Motivation model of Behaviour (COM-B). Methods: A qualitative descriptive exploratory study was conducted with 14 registered ICU nurses from two tertiary hospitals in Chongqing, China, between December 2025 and February 2026. Purposive sampling captured variation in clinical experience, educational background, and ICU type. The first author conducted face-to-face interviews in Mandarin Chinese and completed the initial coding. COM-B informed both the interview guide and the deductive organisation of the analysis, while six themes and 33 lowest-level factors were developed within the three domains. During revision, the fixed analytic structure was audited against all 14 Mandarin transcripts, and the second author independently applied the fixed codebook to five complete transcripts selected for maximum variation; disagreements were resolved by returning to the original Mandarin context and predefined coding boundaries. Results: Eighteen barriers and fifteen facilitators were identified across six themes within the COM-B domains. Capability was strengthened by clinical experience, senior nurses’ intuitive pattern recognition, and conversational assessment, but constrained by difficulty recognising hypoactive delirium, uncertainty when assessing older adults, inconsistent use of CAM-ICU, and insufficient targeted training. Opportunity was enhanced by staffing, environmental control, peer support, family engagement, and physician collaboration, but restricted by fragmented visibility, sensory overstimulation, workload, restrictive visiting, and delayed medical responses. Motivation reflected the tension between professional duty and accountability for safety on one hand and emotional burden, verbal abuse, and violence on the other. Cross-domain accounts showed that opportunity constraints could amplify anxiety and safety-first motivation, narrowing feasible behaviour toward containment, whereas social support could sustain relational care. Conclusions: Delirium management was shaped by interacting behavioural, organisational, and emotional conditions. Strengthening assessment capability alone is unlikely to produce consistent practice without staffing, workflow, environmental, and interprofessional support. Mapping the findings to Behaviour Change Wheel intervention functions highlighted training, environmental restructuring, enablement, and modelling as priority candidate functions for prospective evaluation; education alone was unlikely to be sufficient. Reporting Method: This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Patient or Public Contribution: No patient or public contribution was involved in the design, conduct or reporting of this study. Participants were registered intensive care unit nurses.