Analysis of the cognition, attitudes and willingness of island nurses toward “Internet + Nursing Service”

Background With the intensification of aging and the increasing burden of chronic diseases, the demand for home care is becoming increasingly urgent. Zhoushan city, as a typical island area, faces special challenges, such as a high degree of aging, a restricted geographical environment and transportation, and poor accessibility for residents seeking medical treatment. Traditional service models are unable to meet the needs of residents. Therefore, understanding the cognition, attitudes and willingness of nurses in this region toward this new service model is crucial for promoting the implementation of the service. Objective To investigate the current situation of nurses’ cognition, attitudes and participation intentions toward “Internet + Nursing Service” in the Zhoushan Island area, analyze the influencing factors, and provide references for optimizing the promotion of this model in the island region. Design Cross-sectional study. Methods By using stratified sampling, 3,000 clinically registered nurses who were employed in various medical units in Zhoushan city from November to December 2025 were selected. The nurses were surveyed via a self-designed general information questionnaire and an "Internet + Nursing Service" cognition, attitude and willingness questionnaire for nurses in island areas. A total of 2,662 questionnaires were recovered, with a recovery rate of 88.7%. Simple factor analysis and multiple regression analysis were used to determine the factors influencing the cognition and attitudes of island area nurses toward “Internet + Nursing Service”. Results The island nurses generally reported "high awareness, positive attitudes, and high willingness" toward “Internet + Nursing Service”. The score for the cognitive dimension was 11.58 ± 1.34, the score for the attitude dimension was 6.50 ± 1.31, and the overall willingness to participate reached 90%. Univariate analysis revealed that gender, marital status, number of children, having a specialized nurse qualification, the level of the institution where they work, and the employment form were significantly related to nurses' cognition ( P < 0.05), whereas age, years of service, professional title, and the level of the institution where they work were significantly related to nurses' attitudes ( P < 0.05). Multivariate linear regression analysis revealed that the cognitive level was significantly influenced by specialized nurse qualifications (β = 0.039, p = 0.041), the level of the institution (β = 0.07, p < 0.01), and the employment form (β = 0.11, p < 0.01), whereas the attitude was influenced mainly by the level of the institution (β = 0.05, p = 0.011). Conclusions Island-based nurses constitute the key group in the implementation of internet + Nursing services. Their high willingness has laid the foundation for the service's implementation. However, cognition and attitudes are influenced by various factors, such as individuals, organizations, and systems. The results suggest that the government and medical institutions should provide systematic and standardized training for nurses to ensure their professional safety, supplemented by intelligent platform support and a corresponding incentive mechanism, to effectively transform positive attitudes and high willingness among nurses into safe, high-quality, and sustainable island-based home care services.