A structural equation model of the relationship among occupational stress, coping styles, and mental health of pediatric nurses in China: a cross-sectional study

A questionnaire on the current situation of resignation intention of nurses in intensive care units in China - A descriptive quantitative study

AIM

This study analysed and summarized the correlation between various indicators of ICU nurses' personal lives, hospital work situation, social opinion, psychological assessment, and their intention to resign.

DESIGN

A descriptive quantitative study.

METHODS

This study was a multicentre questionnaire on factors influencing intensive care unit (ICU) nurses' intention to resign. This study was completed through the Critical Care E Institute (CCEI) and China Calm Therapy Research Group Academic Organization (CNCSG) by contacting ICU nurses in three hospitals in 34 provinces in China. The questionnaire was in the form of a cell phone WeChat scan code. The survey included 22 indicators, including basic information about nurses (marital and child status, personal income, etc.), hospital work (weekly working hours, night shift, hospital environment, etc.), and psychological symptoms.

RESULTS

A total of 1904 nurses were included in this study. Among them, 1060 (55.67%) had the intention to resign. In this study, among the 22 indicators involved, 16 factors, including hospital work hours, job title, satisfaction with current income, having children, and evaluation of the hospital, significantly impact nurses' intentions to resign (all p < 0.05). Logistic regression analysis showed that six indicators influenced nurses' choice of resignation intention (all p < 0.05), including hospital work time, professional title, income satisfaction, hospital work pride, satisfaction of nurses with the compassion and care given to them by their hospitals, and career vision score. The ROC curve showed that all six indicators were <0.70, but the model receiver operating characteristic (ROC) curve constructed for the indicators was 0.756. In China, increasing the income of ICU nurses, fostering pride in hospital work, reducing working hours, ensuring smooth promotion processes, and enhancing career prospects can all decrease their likelihood of choosing to resign. Absorbing practical nursing management and work experience from other countries will help decrease the intention to resign within this group.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Psychometric Evaluation of the Brief-COPE Inventory and Exploration of Factors Associated with Perceived Stress among Peruvian Nurses

BACKGROUND

This study aimed to analyze the psychometric properties of the Brief-COPE Inventory and to determine its concurrent validity by examining its association with perceived stress among Peruvian nurses.

METHODS

A psychometric study was conducted with 434 Peruvian nurses to evaluate the psychometric properties of the Brief-COPE Inventory through confirmatory factor analysis. Three stepwise variable selection regression models were implemented.

RESULTS

The three-factor model of the Brief-COPE Inventory demonstrated adequate fit indices (root mean square error of approximation = 0.052, standardized root mean square residual = 0.068, and both the comparative fit index and the Tucker-Lewis index = 0.95). Additionally, the factors were significantly correlated (p < 0.001), and the reliability was adequate (ω = 0.90). Nurses reported a medium level of perceived stress, with associated factors including having received stress management training, fear of COVID-19, and problem-focused coping strategies (p < 0.05).

CONCLUSION

This study confirms that the Brief-COPE Inventory is a valid tool for measuring coping strategies among Peruvian nurses due to its good model fit, excellent reliability, and concurrent validity with perceived stress. However, further research is needed to assess its validity in the specific areas of performance perceived by nursing professionals.

Correlation analysis of occupational stress and metabolic syndrome among employees of a power grid enterprise in China

BACKGROUND

Being in a state of high occupational stress may disrupt the metabolic balance of the body, thus increasing the risk of metabolic diseases. However, the evidence about the relationship between occupational stress and metabolic syndrome was limited.

OBJECTIVES

To explore the association between occupational stress and metabolic syndrome (MetS) in employees of a power grid enterprise.

METHODS

A total of 1091 employees were recruited from a power grid enterprise in China. Excluding those who failed to complete the questionnaire and those who had incomplete health check-ups, 945 subjects were included in the study. Assessment of occupational stress was used by job demand-control (JDC) and effort-reward imbalance (ERI) questionnaires, respectively. The information on body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were collected. The levels of high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and fasting blood glucose (FBG) in the fasting venous blood samples were measured. Logistic regression analysis and multiple linear regression methods were used to analyze the correlation between JDC and ERI models of occupational stress, metabolic syndrome, and its components, respectively.

RESULTS

The prevalence of MetS was 8.4% and 9.9% in JDC and ERI model high occupational stress employees, respectively. ERI model occupational stress and smoking are significantly associated with the risk of MetS. ERI ratio was significantly associated with lower HDL-C levels. Gender, age, marital status, smoking, high-temperature and high-altitude work were significantly associated with metabolic component levels.

CONCLUSION

Our study revealed a high detection rate of occupational stress in both JDC and ERI models among employees of a power grid enterprise. ERI model occupational stress, demanding more attention, was associated with the risk of MetS as well as its components such as HDL-C.

Influencing factors associated with mental workload among nurses: A latent profile analysis

Objective

This study aimed to examine the latent profile of nurses' mental workload (MWL) and explore the influencing factors via a person-centred approach.

Methods

From March to July 2023, a quantitative cross-sectional study was carried out to investigate 526 Chinese clinical nurses from five tertiary hospitals in Sichuan Province, China, by using demographic information, the Perceived Social Support Scale, Simplified Coping Skill Questionnaire, and NASA-Task Load Index. Latent profile analyses were performed using Mplus 7.3 software. Pearson's chi-squared and logistic regression analysis was done using SPSS 24.0 software.

Results

Three profiles of mental workload were identified based on the nurses' responses to the mental workload assessment, designated as "low MWL-high self-rated (n = 70, 13.3%)", "moderate MWL (n = 273, 51.9%)", and "high MWL-low self-rated (n = 183, 34.8%)". Based on the analysis of the three subtypes, nurses with working years < 5 years (χ 2  = 12.135, P < 0.05), no children (χ 2  = 16.182, P < 0.01), monthly income < 6000 (χ 2  = 55.231, P < 0.001), poor health status (χ 2  = 39.658, P < 0.001), no psychological training in the past year (χ2 = 56.329, P < 0.001) and suffering from workplace violence (χ 2  = 19.803, P < 0.001) were significantly associated with MWL. Moreover, the multivariate logistic regression analysis showed that negative coping styles (OR = 1.146, 95% CI: 1.060-1.238, P = 0.001) were accompanied by higher MWL while negatively associated with perceived social support (OR = 0.927, 95% CI: 0.900-0.955, P < 0.001).

Conclusion

Our results showed that the MWL of nurses could be classified into three subtypes. Monthly income, health status, psychological training, workplace violence, negative coping style, and perceived social support were the factors influencing MWL. Managers can employ personalised intervention strategies according to the individual characteristics of different subgroups to reduce nurses' MWL.

Moral distress, moral resilience, and job embeddedness among pediatric nurses

BACKGROUND

Nurses often face ethical issues in their daily work that can have an impact on their level of job embeddedness. And positive job embeddedness is essential to reduce burnout among nurses and improve professional retention in the medical industry. However, few studies have focused on the relationship between moral distress, moral resilience, and job embeddedness.

OBJECTIVES

To investigate the relationship between moral distress, moral resilience, and job embeddedness, and explore the mediating role of moral resilience between moral distress and job embeddedness among nurses.

DESIGN

A quantitative, cross-sectional study.

METHODS

Nurses from a number of tertiary general hospitals in central China were surveyed and assessed using the Moral Distress Scale, the Nurse Moral Resilience Scale, and the nurse job embeddedness Scale from February to March 2023. The study was conducted in line with the 1964 Declaration of Helsinki.

ETHICAL CONSIDERATION

All study procedures were approved by the Ethics Committee of Hunan Normal University (No. 2023-313).

FINDINGS

Moral distress was positively correlated with moral resilience (β = 0.525, p < 0.01) and negatively correlated job embeddedness (β = -0.470, p < 0.01). Moral resilience partially mediated the relationship between moral distress with job embeddedness (β = -0.087, p < 0.01).

DISCUSSION

The findings reveal a relationship between moral distress, job embeddedness, and moral resilience among nurses.

CONCLUSION

Moral distress and moral resilience are important correlates of job embeddedness in nurses. Interventions to reduce moral distress and increase moral resilience may have potential benefits for improving nurses' job embeddedness. It is recommended that clinical nursing administrators create a favorable ethical atmosphere, educate nurses about ethics, and increase nurses' moral resilience.

The mediating role of perceived social support on the relationship between lack of occupational coping self-efficacy and implicit absenteeism among intensive care unit nurses: a multicenter cross‑sectional study

BACKGROUND

Implicit absenteeism is very common among nurses. Poor perceived social support of intensive care unit nurses has a negative impact on their mental and physical health. There is evidence that lack of occupational coping self-efficacy can promote implicit absenteeism; however, the relationship between lack of occupational coping self-efficacy in perceived social support and implicit absenteeism of intensive care unit nurses is unclear. Therefore, this study aimed to evaluate the role of perceived social support between lack of occupational coping self-efficacy and implicit absenteeism of intensive care unit nurses, and to provide reliable evidence to the management of clinical nurses.

METHODS

A cross-sectional study of 517 intensive care unit nurses in 10 tertiary hospitals in Sichuan province, China was conducted, of which 474 were valid questionnaires with a valid recovery rate of 91.6%. The survey tools included the Chinese version of Implicit Absenteeism Scale, the Chinese version of Perceived Social Support Scale, the Chinese version of Occupational Coping Self-Efficacy Scale and the Sociodemographic characteristics. Descriptive analysis and Pearson correlation analysis were performed using SPSS version 22.0, while the mediating effects were performed using AMOS version 24.0.

RESULTS

The average of intensive care unit nurses had a total implicit absenteeism score of (16.87 ± 3.98), in this study, the median of intensive care unit nurses' implicit absenteeism score was 17, there were 210 intensive care unit nurses with low implicit absenteeism (44.3%) and 264 ICU nurses with high implicit absenteeism (55.7%). A total perceived social support score of (62.87 ± 11.61), and a total lack of occupational coping self-efficacy score of (22.78 ± 5.98). The results of Pearson correlation analysis showed that implicit absenteeism was negatively correlated with perceived social support (r = -0.260, P < 0.001) and positively correlated with lack of occupational coping self-efficacy (r = 0.414, P < 0.001). In addition, we found that perceived social support plays a mediating role in lack of occupational coping self-efficacy and implicit absenteeism [β = 0.049, 95% CI of (0.002, 0.101)].

CONCLUSIONS

Intensive care unit nurses had a high level of implicit absenteeism with a moderate level of perceived social support and lack of occupational coping self-efficacy. Nursing managers should pay attention to the nurses those who were within low levels of social support and negative coping strategies, and take measures to reduce intensive care unit nurses' professional stress, minimize implicit absenteeism.

Influence of Self-Perceived Burden on Quality of Life in Patients with Urostomy Based on Structural Equation Model: The Mediating Effects of Resilience and Social Support

Objective

To investigate the current situation of self-perceived burden in patients with urostomy, analyze the correlation between self-perceived burden and quality of life, and explore the intermediary role of resilience and social support.

Methods

The convenience sampling method was used to select 303 patients with urostomy of outpatient departments of the three tertiary hospitals in Yinchuan, Ningxia region, China, from April 1, 2020, to October 1, 2020, who then completed a survey questionnaire. The survey questionnaire contained a general data questionnaire and self-perceived burden scale, city of hope-quality of life-ostomy questionnaire, Connor-Davidson resilience scale, and social support rating scale.

Results

Self-perceived burden was present among 89.8% patients with urostomy; the quality of life of patients with urostomy is low. The results showed that the self-perceived burden and quality of life, resilience, and social support are related in pairs; self-perceived burden was significantly negatively correlated with quality of life，resilience, and social support; there was a significant positive correlation between quality of life, resilience, and social support; resilience and social support were parallel mediators.

Conclusions

Patients with urostomy had a heavy self-perceived burden and low quality of life. Reducing the self-perceived burden of patients with urostomy by improving the level of resilience and social support, could raise the level of quality of life. This study could provide empirical basis for nurses to take continuous nursing intervention measures in order to reduce the self-perceived burden of patients with urostomy and ultimately to improve the quality of life.

Stressors, coping strategies and intention to leave the nursing profession: A cross-sectional nationwide study in China

AIMS

This study aims to investigate the association between stressors, coping strategies and intention to leave the nursing profession among nurses.

BACKGROUND

Job stressors and coping strategies are believed to affect turnover intention among nurses, but no large-scale study has been conducted on these associations in China yet.

METHOD

A cross-sectional secondary analysis was conducted among 51,406 nurses from 1858 hospitals. Univariable and multivariable logistic regression analyses were carried out, and odds ratios were reported.

RESULTS

Overall, 49.58% nurses had an intention to leave the profession. It is found that stress from health condition, family, occupational injuries, nurse-patient tension, high job demands, strict leaders and colleague relationships were significantly associated with higher intention to leave. Coping strategies such as talking to family and friends, talking to leaders, doing outdoor activities, engaging in hobbies and attending on-the-job training were significantly associated with lower intention, but social gathering, psychological counselling and suffering in silence had an opposite effect.

CONCLUSIONS

Our study provides new insights into the association between stressors, coping strategies and turnover intention among nurses in China.

IMPLICATIONS FOR NURSING MANAGEMENT

Evidence from this study indicates that policies promoting a safe and supportive work environment should be developed to help nurses cope with stress.