Beyond knowledge: Nurses’ attitudes, emotional involvement, and care strategies in Alzheimer's disease: A cross-sectional mixed-methods study

Background: Alzheimer's disease (AD) poses significant challenges to nursing practice, particularly due to behavioural and psychological symptoms of dementia (BPSD), which contribute to care complexity, professional burden, and safety risks for both patients and healthcare professionals. Nurses play a central role in dementia care across hospital, residential, and community settings; however, variability in care strategies, including communication-based and relational approaches as well as training-informed practices, attitudes, and dementia-specific knowledge, remains a critical issue. Aim: To examine nurses’ care management of people with AD, focusing on perceived challenges, care strategies, emotional involvement and attitudes towards dementia, and their associations with professional and training-related characteristics. Methods: A cross-sectional mixed-methods study was conducted among Italian nurses working in hospital, residential, and community settings. Data were collected online using a structured questionnaire including sociodemographic variables, professional experience, care strategies and the Dementia Attitudes Scale (DAS). The items on care challenges and management strategies also included free-text fields, which provided the qualitative data. Quantitative data were analysed descriptively and inferentially, while free-text responses were analysed through qualitative content analysis. Quantitative and qualitative findings were then integrated at the interpretation stage to provide a more comprehensive understanding of nurses’ experiences and attitudes. Results: A total of 187 nurses participated. Most had experience caring for people with AD, although specific experience was often limited. BPSD, particularly agitation and aggression, were identified as the main care challenges. Nonpharmacological approaches, especially communication strategies and family involvement, were most frequently adopted. The DAS showed good internal consistency and sampling adequacy. Higher dementia knowledge was associated with specific training and broader clinical experience, whereas emotional involvement was mainly related to greater relational comfort. Conclusions: despite good relational comfort, relevant gaps in dementia-specific knowledge persist among nurses. Structured education and organisational support are needed to enhance evidence-based nursing care for people with AD.