Background/Objectives: Continuous renal replacement therapy (CRRT) is a critical intervention for managing acute kidney injury (AKI) in critically ill patients. Critical care nurses (CCNs) play a pivotal role in its implementation, requiring adequate knowledge, a positive attitude, and practice proficiency. This study aimed to assess the levels and factors affecting CCNs’ knowledge, attitudes, and practices (KAPs) regarding the care of patients receiving CRRT in Hail Hospitals, Saudi Arabia. Methods: A cross-sectional study was conducted with 190 registered CCNs from the critical care units of Hail Hospitals, Saudi Arabia, from March to May 2025. Data were collected using a sociodemographic characteristics sheet and the knowledge, attitudes, and practices questionnaire on CRRT. Non-parametric statistical tests (Mann–Whitney U, Kruskal–Wallis, and Spearman’s correlation tests) were used to determine the relationships between variables. A multiple linear regression analysis was used to explore the factors affecting the study variables. Results: The majority of CCNs had a high level of knowledge regarding CRRT management (66.3%), followed by moderate (21.1%) and low (16.6%) levels. Additionally, the majority had a high level of attitude regarding CRRT management (74.7%), followed by moderate (18.4%) and low (6.9%) levels. The majority of CCNs had a high level of practice regarding CRRT management (66.8%), followed by low (23.7%) and moderate (9.5%) levels. There was a significant positive correlation between CCNs’ knowledge, attitudes (rs = 0.230, p < 0.001), and practices (rs = 0.192, p < 0.001). Additionally, there was a significant positive correlation between CCNs’ attitudes and practices (r = 0.419, p < 0.001). Multiple linear regression revealed a significant model (p < 0.001) when sociodemographic and work-related factors were analyzed as predictors of CCNs’ levels of knowledge, attitudes, and practices regarding CRRT: Having more experience, working with a nurse-to-patient ratio of 1:2, and frequently using CVVHDF as a CRRT modality were significant factors for higher knowledge levels when compared to the reference categories. In addition, having a bachelor’s degree and frequently using CVVHD, CVVHDF, or SCUF as a CRRT modality were significant factors for higher attitude levels regarding CRRT when compared to the reference categories. Having a bachelor’s degree and frequently using CVVHD or CVVHDF as a CRRT modality were significant factors for higher practice levels regarding CRRT when compared to the reference categories. Conclusions: CCNs in Hail Hospitals self-reported high levels of knowledge, attitudes, and practices regarding CRRT management, followed by moderate levels. Targeted educational programs, standardized protocols, and organizational support are recommended to improve CCN care for CRRT and to optimize patient outcomes.

Background/Objectives: While previous research has explored the effects of moral distress and the work environment separately, there is limited evidence on how these two factors are associated with nurses’ turnover intention. Therefore, in this study, we assessed the mediating role of moral distress in the correlation between nurses’ work environments and turnover intention. Methods: This study employed a multicenter cross-sectional design of emergency nurses from April to June 2025. The Measure of Moral Distress—Healthcare Professionals, Practice Environment Scale of the Nursing Work Index (PES-NWI), and Turnover Intention Scale were used to collect data. The mediating effect was analyzed using Hayes’ PROCESS macro (Model 4, Version 4.2) software with the bootstrap technique (5000 repetitions, 95% bias-corrected confidence interval). Statistical significance was set at a threshold of p < 0.05. Results: Mediation analysis revealed that work environment had a significant negative effect on moral distress (β = −0.251, B = −45.293, 95% CI [−70.376, −20.210], p < 0.001). Moral distress significantly increased nurse turnover (β = 0.202, B = 0.008, 95% CI [0.003, 0.012], p = 0.003), while the work environment had a significant negative direct effect on turnover (β = −0.391, B = −2.629, 95% CI [−3.507, −1.751], p < 0.001). The total effect of work environment on nurse turnover was also significant (β = −0.442, B = −2.970, 95% CI [−3.837, −2.102], p < 0.001). Bootstrapping confirmed a significant indirect effect of moral distress (β = −0.051, 95% CI [−0.092, −0.016]), indicating partial mediation. Conclusions: This study revealed that nurses’ work environment was significantly associated with turnover intention, both directly and indirectly, through moral distress. Moral distress acted as a statistically significant but modest partial mediator of the association between the work environment and turnover intention, suggesting that it may partially explain this relationship. Strategies by healthcare organizations should be organized to optimize proactive work environments and mitigate moral distress among nurses.

Background: Yemen’s long-standing armed conflict has decimated the health system and subjected nurses to unprecedented levels of occupational and conflict-related stress. The role of nurses is pivotal, yet little is known about their mental health in Yemen, limiting the evidence available to inform nursing leadership and workforce protection strategies. Methods: A multicenter cross-sectional study was carried out between January and December 2025, involving 800 registered nurses from 24 health facilities across eight conflict-affected Yemeni governorates using a multistage sampling strategy with probability-based selection of facilities and nurses within accessible governorates. Validated Arabic PHQ-9 and GAD-7 questionnaires (cut-off ≥ 10) were used to assess depression and anxiety. Burnout was assessed using a single-item self-rated measure with pilot validation against the Maslach Burnout Inventory emotional exhaustion subscale (r = 0.82), selected for pragmatic feasibility in a highly stressed population. Mixed-effects logistic regression was used to account for clustering at the facility level. Exploratory supplementary analyses examined associations involving self-rated burnout and reported availability of psychological support. Results: 52.0% (95% CI: 48.5–55.5) of nurses experienced moderate-to-severe depressive symptoms, while 47.0% (95% CI: 43.5–50.5) experienced moderate-to-severe anxiety symptoms. High self-rated burnout was prevalent in 34.0% (95% CI: 30.7–37.4), and 54.8% (95% CI: 51.2–58.3) reported their intention to leave within 12 months. Psychological distress was independently associated with displacement (AOR = 2.31, 95% CI: 1.68–3.17), workplace violence (AOR = 2.84, 95% CI: 2.03–3.97), inadequate income (AOR = 2.53, 95% CI: 1.80–3.56), nurse-to-patient ratios ≥ 1:20 (AOR = 1.68, 95% CI: 1.07–2.63), and frequent night shifts (AOR = 1.26, 95% CI: 1.17–1.36 per additional shift). Not all expected associations were significant; nurse-to-patient ratios of 1:15, facility type, and type of employment showed no consistent associations. Sampling-weighted prevalence estimates were very similar to the unweighted estimates (absolute differences < 1 percentage point), supporting the robustness of the findings against differential selection probabilities across governorates. Conclusions: Armed conflict and structural workforce stressors were associated with a substantial mental health burden among nurses in southern, central, and eastern governorates in Yemen. Because the most heavily conflict-affected northern governorates were inaccessible for security reasons, the findings are generalizable only to accessible areas, and the direction of difference in burden in inaccessible areas cannot be determined from these data. While the cross-sectional design precludes causal inference, the findings identify potential targets for intervention. Mental health support, workplace violence prevention, and safe staffing in nursing leadership and humanitarian workforce strategies may be relevant to workforce resilience strategies in fragile health systems, but these are implications consistent with observed associations rather than evidence of intervention effectiveness. Findings should be interpreted given the cross-sectional design, limited geographical access, and the use of a single-item self-rated burnout measure that does not capture the multidimensional nature of burnout. Future longitudinal studies should include multidimensional burnout instruments and trauma-related assessment.