The Mediating Role of Self‐Efficacy in the Relationship Between Knowledge and Palliative Care Practices Among ICU Nurses in Timor‐Leste: A Cross‐Sectional Study

Background Access to palliative care remains limited in low‐ and middle‐income countries, including Timor‐Leste, where healthcare systems face structural and resource constraints. In intensive care units (ICUs), nurses play a critical role in delivering PC. However, the translation of knowledge into clinical practice remains inconsistent. Self‐efficacy has been proposed as a key psychological mechanism that may bridge this gap. Purpose This study aimed to examine the mediating role of self‐efficacy in the relationship between knowledge and palliative care practices among ICU nurses in Timor‐Leste. Methods A cross‐sectional study was conducted among 107 ICU nurses. Data were collected using convenience sampling with validated instruments: the Palliative Care Knowledge Test (PCKT), the Self‐Efficacy in Palliative Care Scale (PCSE‐S), and the Palliative Care Self‐Reported Practices Scale (PCPS). Rasch analysis was applied to transform ordinal data into interval‐level measures. Pearson correlation and regression‐based mediation analyses were performed using Jamovi. Results A total of 107 ICU nurses participated in this study. The mean Rasch person measures were 0.515 (SD = 0.985) for palliative care practice, 0.136 (SD = 1.210) for self‐efficacy, and −2.623 (SD = 0.973) for knowledge. Knowledge was significantly associated with self‐efficacy (β = 0.316, p < 0.001), while self‐efficacy was significantly associated with palliative care practice (β = 0.514, p < 0.001). In contrast, knowledge was not directly associated with palliative care practice (β = 0.0002, p = 0.998). Mediation analysis using bias‐corrected bootstrap confidence intervals demonstrated a significant indirect effect of knowledge on palliative care practice through self‐efficacy (β = 0.163, p = 0.003, 95% BC CI [0.0548, 0.365]), indicating that self‐efficacy significantly mediated the relationship between knowledge and palliative care practice. Conclusion Self‐efficacy may represent an important pathway linking palliative care knowledge with practice among ICU nurses. Interventions may consider strengthening both palliative care knowledge and self‐efficacy, particularly in resource‐limited ICU settings. Implications for Nursing Nursing education and clinical practice should incorporate strategies that strengthen nurses' self‐efficacy alongside palliative care knowledge. Practice‐based training, simulation, clinical mentoring, and supportive supervision may help nurses apply their knowledge more confidently in palliative care delivery, particularly in resource‐limited ICU settings.