Diabetes nutrition care among nurses in West Bank hospitals, Palestine: a multicenter assessment of knowledge, attitudes, and practices

Background Nutritional management is central to diabetes care, and nurses contribute to nutritional assessment, patient education, and self-management support. Evidence on nurses’ knowledge, attitudes, and practices regarding diabetes nutrition in Palestine remains limited. This study aimed to assess nurses’ knowledge, attitudes, and practices regarding the nutritional management of diabetes mellitus in hospitals across the West Bank, Palestine. Methods A cross-sectional study included 400 hospital-based nurses recruited through approximately 20 governmental and non-governmental hospitals between May 1 and July 1, 2026, using convenience sampling. A structured questionnaire assessed knowledge using 20-item knowledge, 15-item attitude, and 15-item practice questionnaires. Scores were primarily standardized to 0–100 using min–max normalization, with percentage-of-maximum scoring examined in a sensitivity analysis. Non-parametric tests were used for bivariate analyses, and multivariable generalized linear models with robust standard errors identified associated factors. Results The median knowledge score was 16.0 (IQR: 14.0–17.0) (mean standardized score: 76.20 ± 12.76). High knowledge was observed in 80.5% of nurses, while 18.8% had moderate and 0.8% had poor knowledge. The mean attitude score was 52.27 ± 9.60/75 (standardized score: 62.12 ± 15.99); 56.3% had positive, 35.8% moderate, and 8.0% poor attitudes. The mean standardized practice score was 39.47 ± 21.52; 13.0% had good, 51.0% moderate, and 36.0% poor practice. These categorical distributions were sensitive to standardization; under percentage-of-maximum scoring, 77.3% had positive attitudes and 8.8% had poor practice. Greater monthly diabetes patient volume and previous counseling were associated with higher knowledge. Longer nursing experience and greater perceived competence were associated with more favorable attitudes. Practice was positively associated with attitude and consistent use of the Initial Nursing Assessment Sheet guideline, whereas older age and higher monthly diabetes patient volume were associated with lower practice. Knowledge was not independently associated with attitude or practice. Overall, 88.5% were interested in working as diabetes link nurses. Conclusion Nurses working in West Bank hospitals demonstrated high knowledge and generally favorable attitudes, while self-reported practice scores were comparatively lower; however, categorical descriptions of attitude and practice were sensitive to the score-standardization method and should be interpreted cautiously.