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Effects of burnout and work engagement in the relationship between self‐efficacy and safety behaviours—A chained mediation modelling analysis

October 2023
Journal of Advanced Nursing 80(4):n/a-n/a

October 2023
80(4):n/a-n/a

Authors:

Aims To explore the current situation, influencing factors and pathways of safety behaviour of nurses in tumour specialized hospitals, in order to provide a theoretical basis for managers to manage and train nurses, improve their safety behaviour level and ensure medical safety. Design An anonymous cross‐sectional survey. Method A total of 2147 nurses from Grade A cancer hospitals in 15 provinces of China were selected by a convenient sampling method. Questionnaires were collected through the Questionnaire Star platform. Nurses' safety behaviour was measured using the nurse Safety Behaviour Scale, Self‐efficacy by the General Self‐efficacy Scale, and nurses' occupational burnout was measured by the occupational Burnout Scale, and work engagement through the the Work Engagement Scale. Structural equation modelling was used to test the relationship among nurses' safety behaviour, general self‐efficacy, occupational burnout and work engagement. SPSS25.0 software was used to test the relationship among the safety behaviour of nurses, general self‐efficacy, occupational burnout and work engagement. Results The total score of safety behaviour of nurses was 55.45 ± 6.879, the total score of general self‐efficacy was 31.39 ± 5.729, the total score of occupational burnout was 44.99 ± 26.587, and the total score of work engagement was 38.48 ± 13.433; the scores of the Nurse Safety Behaviour Scale, Self‐Efficacy Scale, and Work Engagement Scale were positively correlated (all p < .001); the occupational burnout scale was negatively correlated with the scores of self‐efficacy scale, work engagement scale and nurse safety behaviour scale (all p < .001); Structural equation model analysis shows that self‐efficacy and work engagement have a direct positive impact on nurse safety behaviour(β = .103, β = .096, all p < .001); Occupational burnout has a direct negative impact on self‐efficacy, work engagement and nurse safety behaviour(β = −.371, β = −.413, β = −.328 all p < .001). Bootstrap analysis showed that occupational burnout and job involvement had a significant chain mediating effect between self‐efficacy and the safety behaviour of nurses (95% CI: 0.148–0.21). The total effect of self‐efficacy on the safety behaviour of nurses was 0.283 (p < .001, 95% CI: 0.225–0.301), the direct effect was 0.096 (p < .001, 95% CI: 0.042–0.15), and the indirect effect was 0.179 (p < .001, 95% CI: 0.085–0.215), The mediating effect accounted for 63.3% of the total effect size. Conclusion Occupational burnout and work engagement play a partial mediating role between self‐efficacy and nurse safety behaviour. It is necessary to strengthen training on nurse safety culture awareness, improve the nurse self‐efficacy and work engagement, reduce nurse occupational burnout, and thereby improve the level of nurses' safety behaviour.

Structural equation model for the chain‐mediating effect.

…

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J Adv Nurs. 2024;80:1473–1483. wileyonlinelibrary.com/journal/jan

Received: 27 July 2023

Revised: 5 October 2023

Accepted: 18 October 2023

DOI: 10.1111/jan.15925

E M P I R I C A L R E S E A R C H Q U A N T I T A T I V E

Effects of burnout and work engagement in the relationship

between self-efficacy and safety behaviours—A chained

mediation modelling analysis

Man Liu, L u Liu and Zhuohe ng Lv are co-first au thors.

Department of Thoracic Surgery, National

Cancer Center/National Clinical Research

Center for Cancer (NCRCC), C ancer

Hospital, Chinese Academy of Medical

Sciences & Peking Union Medical College,

Beijing, China

Correspondence

Yan Liu, Department of Thoracic Surgery,

National Cancer Center/National Clinical

Research Center for Cancer (NCRCC),

Cancer Hospital, Chinese Academy of

Medical Sciences & Peking Union Medical

College, Paniiayuannanli No 17. Chaoyang

District, Beijing 100021, China.

Email: 18332056673@126.com

Funding information

Administrative Research Fund, Grant/

Award Number: CHCAMS(LC2022D05)

Abstract

Aims: To explore the current situation, influencing factors and pathways of safety

behaviour of nurses in tumour specialized hospitals, in order to provide a theoretical

basis for managers to manage and train nurses, improve their safety behaviour level

and ensure medical safety.

Design: An anonymous cross-sectional survey.

Method: A total of 2147 nurses from Grade A cancer hospitals in 15 provinces of

China were selected by a convenient sampling method. Questionnaires were col-

lected through the Questionnaire Star platform. Nurses' safety behaviour was meas-

ured using the nurse Safety Behaviour Scale, Self-efficacy by the General Self-efficacy

Scale, and nurses' occupational burnout was measured by the occupational Burnout

Scale, and work engagement through the the Work Engagement Scale. Structural

equation modelling was used to test the relationship among nurses' safety behaviour,

general self-efficacy, occupational burnout and work engagement. SPSS25.0 soft-

ware was used to test the relationship among the safety behaviour of nurses, general

self-efficacy, occupational burnout and work engagement.

Results: The total score of safety behaviour of nurses was 55.45 ± 6.879, the total

score of general self-efficacy was 31.39 ± 5.729, the total score of occupational burn-

out was 44.99 ± 26.587, and the total score of work engagement was 38.48 ± 13.433;

the scores of the Nurse Safety Behaviour Scale, Self-Efficacy Scale, and Work

Engagement Scale were positively correlated (all p < .001); the occupational burn-

out scale was negatively correlated with the scores of self-efficacy scale, work en-

gagement scale and nurse safety behaviour scale (all p < .001); Structural equation

model analysis shows that self-efficacy and work engagement have a direct positive

impact on nurse safety behaviour(β = .103, β = .096, all p < .001); Occupational burn-

out has a direct negative impact on self-efficacy, work engagement and nurse safety

behaviour(β = −.371, β = −.413, β = −.328 all p < .001). Bootstrap analysis showed that

occupational burnout and job involvement had a significant chain mediating effect

between self-efficacy and the safety behaviour of nurses (95% CI: 0.148–0.21). The

total effect of self-efficacy on the safety behaviour of nurses was 0.283 (p < .001,

Working Conditions and Quality of Life in Healthcare: Mediating Roles of Burnout and Engagement, Moderated by Resilience and Self-Efficacy.

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This study addresses the influence of working conditions on Work-Related Quality of Life (WRQOL) among Spanish healthcare professionals. The research seeks to elucidate the mediating roles of job engagement and burnout, and the moderating effects of resilience and self-efficacy, in this relationship. Methods: The study included 374 healthcare workers from Spain, encompassing physicians, nurses, and nursing assistants. It employed a methodological approach using validated instruments to assess psychosocial risks, work-life quality, job engagement, burnout, and resilience. Data were gathered through self-reported questionnaires. Results: Key findings indicate a negative association between working conditions and WRQOL. Job engagement and burnout significantly mediated this relationship, accounting for 19% to 33% of the variance in WRQOL. Notably, lack of support emerged as a strong negative factor for work-related quality of life. Additionally, resilience moderated the relationship between lack of support and burnout. Conclusions: The study concludes that improving working conditions could increase WRQOL. Interventions aimed at enhancing engagement and addressing burnout may be effective. The moderating role of resilience suggests that strategies to enhance resilience could also be beneficial. These findings hold significant implications for policy formulation and human resources planning in healthcare, emphasizing the need for enhanced workplace support and the development of resilience among health workers.

Examining the influence of work engagement on the relationship between self-efficacy, job satisfaction, and professional goals of special education teachers in China

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Teachers play an essential role in the lives of their students, and they influence society as a whole. Special education teachers (SETs) have a crucial role in promoting both all-encompassing and fair educational environments for pupils with various requirements. Therefore, understanding the factors that affect the professional goals (PG) of SETs is essential for effective teacher development and student success. The purpose of the current study is to determine the PG of Chinese SETs. A random sampling technique was used to collect data from 400 Chinese SETs through a questionnaire method. The gathered data were analyzed using PLS-SEM. The study’s findings reveal work engagement (WE) plays a mediating role in linking self-efficacy (SE) to job satisfaction (JS) among SET in China. The novelty of the study lies in investigating how WE influence the relationship between Chinese teachers’ SE and JS. The analysis findings demonstrate that the relationship between SE and the PG of SET in China is mediated by WE. The research findings clarify that the dedication of particular education educators to their jobs is positively correlated with their intentions. The study results suggest that by promoting positive WE, teachers’ JS and SE are likely to be positively influenced, ultimately leading to improved educational outcomes over pupils who require personalized instruction.

Effectiveness of mindfulness-based interventions on burnout and self-compassion among critical care nurses caring for patients with COVID-19: a quasi-experimental study

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Background Workloads in intensive care units (ICUs) have increased and extremely challenging ethical dilemmas were generated by the coronavirus disease 2019 (COVID-19) pandemic. ICU nurses experience high-stress levels and burnout worldwide. Egyptian studies on the effectiveness of mindfulness-based intervention (MBI) among ICU nurses are limited, although MBI has been shown to reduce stress and burnout. Methods This quasi-experimental study included 60 nurses working in three hospitals in El-Beheira, Egypt. Participants were randomly allocated to one of the two groups: intervention or control (30 participants per group). The participants in the intervention group (MBI) received 8 MBI sessions, whereas the control group received no intervention. The Maslach Burnout Inventory, the Five-Facet Mindfulness Questionnaire (FFMQ), and the Self-Compassion Scale were used to assess the outcomes. Additionally, demographic and workplace data were collected. Results The post-test score of emotional exhaustion after MBI for 8 weeks significantly decreased in the MBI group to 15.47 ± 4.44 compared with the control group with 32.43 ± 8.87 (p < 0.001). The total Self-Compassion Scale significantly increased because of the mindfulness sessions 94.50 ± 3.83 for the MBI group vs. 79.00 ± 4.57 for the control group (p < 0.001). The post-test score of the FFMQ significantly increased to 137.03 ± 5.93, while the control group’s score decreased to 114.40 ± 7.44, following the MBI sessions (p < 0.001). As determined by Cohen’s d test, the effect size of MBI training is quite large, on the three burnout scale dimensions (emotional exhaustion, depersonalization, and personal achievement), as well as the total score of the mindfulness and self-compassion scales. Conclusion This study provides preliminary evidence that MBI sessions were effective in reducing emotional exhaustion and depersonalization and increasing levels of mindfulness and self-compassion among critical care nurses.

Resilience and stress as predictors of work engagement: the mediating role of self-efficacy in nurses

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Background Nurses face high levels of stress and work demands, which can affect their work engagement and psychological well-being. Resilience and self-efficacy have been identified as important resources to improve nurses’ adaptation and work engagement. Objective This study aimed to evaluate the mediating role of self-efficacy in the relationship between resilience and stress on work engagement in Peruvian nurses. Methods A cross-sectional design was used, and data were collected from a sample of 459 nurses. Self-report questionnaires were administered to measure self-efficacy, resilience, stress, and work engagement. SEM analyses were performed to examine the relationship between these variables, and a mediation analysis was conducted to evaluate the role of self-efficacy as a mediator in the relationship between resilience, stress, and work engagement. Results The results indicated a positive relationship between resilience, self-efficacy, and work engagement, as well as a negative relationship between stress and work engagement. Additionally, self-efficacy mediated the relationship between resilience and work engagement, as well as the relationship between stress and work engagement in nurses. Conclusion Personal resources such as self-efficacy are a key factor in the relationship between resilience (work resources), stress (work demands), and work engagement of Peruvian nurses. Strengthening self-efficacy and resilience can improve work engagement and personal satisfaction of nurses. Hospital administrators and nursing managers should consider the importance of resilience, stress, work engagement, and self-efficacy in registered nurses and develop effective strategies to improve them. This can have a positive impact on the quality of care provided to patients and on the job satisfaction of nurses.

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Background Unsafe health practices are one of the leading causes of disability and even death. Competent nurses are crucial to ensure safe and high-quality healthcare services. The patient safety culture is concerned with internalizing safety beliefs, values, and attitudes, translating them into healthcare practices, and committing to maintaining an error-free health environment. A high level of competence ensures the achievement and compliance with the safety culture goal. This systematic review aims to identify the relationship between the level of nursing competence and the safety culture score and perception among nurses at their workplace. Methods Four international online databases were searched to find relevant studies published between 2018 and 2022. Peer-reviewed articles using quantitative methods, targeting nursing staff, and written in English were included. After reviewing 117 identified studies, 16 full-text studies were included. The PRISMA 2020 checklist for systematic reviews was used. Results Evaluation of the studies indicates safety culture, competency, and perception were assessed using various instruments. Safety culture was generally perceived as positive. No unique and standard tool has been developed to investigate the effect of safety competency on the perception of the safety culture in a standardized way. Conclusions Existing research provides evidence of a positive correlation between nursing competence and patient safety score. Future research is recommended to investigate ways to measure the effect of nursing competency level on safety culture in healthcare institutions.

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Background Burnout occurs frequently in nurses and seems more common in nurses providing palliative care. However, to our knowledge, there is a lack of understanding regarding the factors influencing burnout among palliative nurses in China. Methods A cross-sectional design was conducted. A total of 331 palliative nurses from 25 hospitals participated in this study. Anonymous data were collected through a self-designed social-demographic questionnaire, the Nursing Burnout Scale, the Perceived Social Support Scale, the General Self-Efficacy Scale, the Connor-Davidson Resilience Scale, and the Simplified Coping Style Questionnaire. Independent sample t tests, one-way ANOVA, Pearson correlations, and multiple linear regressions were performed to identify the related factors of the three dimensions of burnout. Results In the results of multiple linear regression, resilience, health condition, coping style, and pessimistic personality were common related factors; in addition, end-of-life care training, social support, and income satisfaction were statistically significantly associated with burnout. These factors could explain 38.6%, 27.8%, and 34.5% of the total variance in emotional exhaustion, depersonalization, and reduced personal accomplishment, respectively. Conclusions The findings of this study help policy makers and nurse managers better understand burnout among palliative nurses in China. The results highlighted the importance of implementing culture-oriented training programs, providing perceived organizational support, and building a reasonable salary system to decrease burnout among palliative nurses, increase the quality of nursing and promote the development of Chinese palliative care.

The relationship between patient safety culture and patient safety competency with adverse events: a multicenter cross-sectional study

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Background Patient safety culture and patient safety competency could be associated with adverse events (AEs). This study aimed to investigate the associations between nurses’ perceptions of patient safety culture, patient safety competency, and AEs. Methods A cross-sectional study was carried out among 338 nurses employed in three university hospitals in Qom, Iran between 17 August 2021 and 12 November 2021. Data were collected using three questionnaires: patient safety culture, patient safety competency, and AEs. Data were analyzed using SPSS-21 software. A multiple logistic regression model was used to analyze the data. Results The results of this study showed that medication errors were significantly associated with “frequency of events reported” (OR = 0.706, P = 0.012), “supervisor/manager expectations and actions promoting patient safety” (OR = 0.733, P = 0.048), and “management support for patient safety” (OR = 0.755, P = 0.012). Pressure ulcers were significantly associated with “supervisor/manager expectations and actions promoting patient safety” (OR = 0.729, P = 0.039), “handoffs and transition” (OR = 0.707, P = 0.034), and “comfort speaking up about patient safety” (OR = 0.614, P = 0.016). Falls were significantly associated with “teamwork within units” (OR = 0.735, P = 0.031), “feedback and communication about error” (OR = 0.756, P = 0.046), and “handoffs and transition” (OR = 0.660, P = 0.012). The use of restraints for ≥8 hr. was significantly associated with “management support for patient safety” (OR = 0.701, P = 0.021). Conclusions According to the results of this study, AEs are associated with some dimensions of patient safety culture and patient safety competency. Further research is needed to confirm these findings and identify interventions to reduce the occurrence of AEs.

Work engagement and burnout in anticipation of physically returning to work: The interactive effect of imminence of return and self-affirmation

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The prevalence, related factors and interventions of oncology nurses' burnout in different continents: A systematic review and meta-analysis

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Background: Burnout is a significant occupational problem among oncology nurses, affecting their physical and mental health and the quality of medical care. Besides, there is a gradually increasing trend that we should pay more attention to. Objectives: To investigate the prevalence, influencing factors and interventions of oncology nurses' burnout among different continents. Design: Systematic review and meta-analysis. Data sources: English literature in PubMed, EMBASE, MEDLINE/EBSCOhost, CINAHL Complete and Web and of Science were searched before 1 March 2022. Results: Twenty studies included 5904 oncology nurses in this review. Meta-analysis was performed in 19 of the studies. First, the pooled mean scores estimate for emotional exhaustion (EE) was 22.13 (95% CI: 19.69-24.58), depersonalization (DP) was 6.89 (95% CI: 5.67-8.10) and personal accomplishment (PA) was 32.86 (95% CI: 29.34-36.37). A high level of burnout was defined as a high level of EE (score ≥ 27), a high level of DP (score ≥ 10), and a low level of PA (score ≤ 33). Of these, 36.40% of nurses reported high EE, 28.26% reported high DP and 28.68% reported low levels of PA. Furthermore, there are differences in the prevalence, influencing factors and intervention measures of burnout among oncology nurses in different regions. The highest pooled mean scores for EE and DP were found in Asia. And the highest pooled mean scores for PA were found in the Americas. The factors that influence burnout among Asian oncology nurses are mostly personal-related factors such as empathy and personality traits, while the factors that influence burnout among European oncology nurses are work-related factors. This review included three intervention studies from Europe and the Americas, with fewer intervention studies on burnout in oncology nurses in Asia. Conclusion: Oncology nurses in Asia had the highest pooled mean scores for EE and DP, and the highest mean scores for the PA pool in the Americas. There are regional differences in the prevalence and factors influencing burnout among oncology nurses, but there are few interventions for it. Therefore, future interventions should be developed to address the differences that exist in different regions. Relevance to clinical practice: Burnout among oncology nurses in different regions is a concern, and this review may provide a reference for managers to target interventions to alleviate burnout among oncology nurses.

Initial Validation of an Ecological Momentary Assessment Measure of Self-Efficacy to Manage Negative Emotions

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Jan 2023

Although ecological momentary assessment (EMA) provides an opportunity for the examination of intervention mechanisms in real time, there are few validated tools to assess key treatment mechanisms in EMA studies. Our focus in this study is a potentially critical treatment mechanism, improvement in self-efficacy for managing negative emotions. We examined the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for managing negative emotions scale measured via EMA. Participants (n = 145 college students) in a clinical trial of Dialectical Behavior Therapy skills completed four daily EMAs for 6 weeks (13,153 total responses). Results indicated (a) excellent internal consistency and good factor structure, (b) sufficient variability at both the between- and the within-persons levels, and (c) strong construct and predictive validity. This study supports the validity of an EMA measure of self-efficacy for managing negative emotions that can be used in real time, both in intervention studies and in observational research.

Work stress, burnout, occupational commitment, and social support among Chinese pediatric nurses: A moderated mediation model

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Oct 2022
J Pediatr Nurs

Purpose Pediatric nurses are at high risk for burnout, resulting in unsatisfactory care quality. Although job resources like social support can prevent the development of burnout under work stress, the mediating role of personal resources like occupational commitment is not well studied. This study was to examine the mediating role of occupational commitment in the relationship between work stress and burnout, and test if the effect of work stress on occupational commitment varies at different levels of social support among pediatric nurses. Methods A cross-sectional survey was conducted to collect data of pediatric nurses from 6 hospitals in Chengdu, China. Multiple linear regressions and bias-corrected bootstrap confidence intervals were used to test the proposed model. Results In this sample of 488 pediatric nurses, work stress was significantly associated with emotional exhaustion (β = 0.278, p < 0.001), depersonalization (β = 0.112, p < 0.001), and personal accomplishment (β = −0.047, p < 0.05). Occupational commitment partly mediated the links of work stress and emotional exhaustion (β = 0.056, 95%CI: 0.034–0.082), and depersonalization (β = 0.026, 95%CI: 0.014–0.041), and fully mediated the relationship between work stress and personal accomplishment (β = −0.059, 95%CI: −0.080 ∼ −0.039). Social support significantly moderated the relationship between work stress and occupational commitment (β = 0.007, p < 0.01). Conclusion Among pediatric nurses, work stress has an indirect influence on burnout through occupational commitment, and such an effect is weakened when social support is high. Practice implications Nurse managers could consider developing interventions by promoting both occupational commitment and social support to prevent burnout of employees.

Effects of burnout and work engagement in the relationship between self‐efficacy and safety behaviours—A chained mediation modelling analysis

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