1 Introduction
1.1 Background
Occupational stress refers back to the response that people might expertise when confronted with work calls for and pressures that exceed their data and skills, thereby difficult their capability to manage (de Wijn et al., 2022; Zaghini et al., 2020). Occupation-related stress is a rising concern worldwide (Xu et al., 2024). Analysis findings point out that occupational stress adversely impacts people’ psychological and bodily well being, contributes to burnout, and impacts organizational effectiveness (Alinejad et al., 2023; Kabakleh et al., 2020; Kowalczuk et al., 2023; Li et al., 2021; Yang et al., 2021; Zaghini et al., 2020).
Nursing is without doubt one of the most nerve-racking and high-risk professions (Norful et al., 2024). Nurses face a spread of occupational dangers, together with infections, unsafe affected person dealing with, hazardous chemical compounds, radiation, psychosocial hazards, violence, harassment, accidents, and points associated to marital satisfaction (Adib-Hajbaghery et al., 2021; Babapour et al., 2022; Ekingen et al., 2023; Martin et al., 2023). Roughly 16.2 to 53.5% of nurses had been reported to have latent tuberculosis, a prevalence that’s 25 instances increased than that of the overall inhabitants (Aldhawyan et al., 2024; Johansen et al., 2023; Kinikar et al., 2019; Severo et al., 2011). Between 61 and 75.9% of nurses in medical settings reported experiencing persistent decrease again ache, in comparison with solely 18% amongst workplace staff (Fujii et al., 2019; Solar et al., 2021). Globally, between 33.1 and 46% of nurses reported experiencing some type of violence within the office (Bagnasco et al., 2024; Li et al., 2024; McLaughlin and Khemthong, 2024). In the course of the COVID-19 pandemic, roughly 56% of nurses skilled melancholy, whereas between 39 and 42.4% reported experiencing anxiousness (Al-Amer et al., 2022; Pang et al., 2021). Moreover, nurses are reportedly at the next threat of suicide throughout all areas of the world (Hofstetter and Mayer, 2022; Kramer et al., 2024).
The occupational stress skilled by nurses follows common patterns but in addition presents distinctive challenges throughout completely different cultural and healthcare contexts (Yuan and Fang, 2024). A research carried out in Uganda discovered that 70.5% of nurses reported experiencing persistent stress (Kabunga et al., 2023). In China, 64.71% of physicians and nurses in emergency departments thought-about their occupational stress to be excessive or very excessive after contracting COVID-19 (Lv et al., 2023). A cross-sectional research in Iran indicated (Ghaderi et al., 2024) that nurses skilled a higher-than-average degree of occupational stress throughout the COVID-19 pandemic. In Ethiopia, 47.8% of nurses working in public hospitals reported experiencing occupational stress. Within the context of the stress course of mannequin, numerous components might affect the extent of occupational stress amongst nurses, together with private, work-related, and social components (Turner, 2013). Relating to the private traits of nurses, a cross-sectional research carried out in Iran demonstrated that emotional and ethical intelligence mediated the connection between occupational stress and job efficiency amongst nurses (Alinejad et al., 2023). Earlier research (Chen et al., 2022; Meneguin et al., 2024; Wu et al., 2023; Yao et al., 2022; Zhou et al., 2022) have discovered that psychological wellbeing is negatively related to occupational stress in pediatric nurses. In accordance with a research in Iran (Werke and Weret, 2023), the presence of kids was considerably linked to job stress. When it comes to work-related components, research in China and Korea (Choi and Kim, 2022; Yuan and Fang, 2024) indicated {that a} increased frequency of night time shifts, prolonged work hours, and inadequate relaxation time had been related to elevated occupational stress ranges. As well as, a research in Brazil (Meneguin et al., 2024) discovered that the variety of hospitals the place nurses have employment ties and their relationships with administration had been related to stress ranges amongst nurses. A research in China (Yang et al., 2021) revealed that occupational stress was influenced by distributive justice amongst nurses in public hospitals. Relating to the social components, quite a few research (Kasidouli et al., 2024; Kowalczuk et al., 2023; Şanlıtürk, 2021; Saravanan et al., 2023) have proven a excessive prevalence of occupational stress amongst well being staff throughout the COVID-19 pandemic.
China’s fertility fee has considerably declined, dropping to roughly 1.3 kids per girl in 2022, which is nicely under the substitute degree of two.1 (Zhai and Jin, 2023). In 2023, the beginning fee reached a document low of solely 6.39%, marking the bottom because the institution of the nation (Yang et al., 2024; Zhao et al., 2023). This decline in fertility immediately impacts the variety of births, leading to fewer obstetric sufferers and a subsequent discount in demand for pediatric providers. Consequently, hospitals might must reevaluate their useful resource allocation, together with funding, staffing, and services. Nurses, notably these in obstetrics and pediatrics, might expertise job insecurity or uncertainty relating to their roles, which might make them contemplate transitioning to completely different specialties. This case might end in increased turnover charges and a possible want to hunt employment in different fields, thereby affecting workforce stability.
Regardless of the intensive literature on the degrees and associated components of occupational stress amongst nurses, no research have investigated this problem within the context of low fertility in China. Nurses are the spine of any functioning healthcare system; due to this fact, this research was carried out to look at the degrees and associated components of occupational stress amongst nurses within the context of low fertility in China in 2023.
2 Supplies and strategies
2.1 Analysis design
This research utilized a cross-sectional design and was carried out by means of a web-based survey. The Strengthening the Reporting of Observational Research in Epidemiology (STROBE) guidelines was adopted in reporting the findings of the research.
2.2 Analysis members
Contributors had been recruited utilizing comfort sampling. Though comfort sampling has its limitations, researchers can establish key demographics, guarantee variety, and broaden the geographical scope to reinforce pattern representativeness and generalizability.
The inclusion standards had been as follows: (a) nurses aged 18 to 60 years as nurses on this age vary symbolize an important section of the healthcare workforce, contributing to affected person care, schooling, and management throughout the area; (b) registered nurse; and (c) nurses with the power to precisely learn and write in Chinese language. Pupil nurses and people present process standardized coaching had been excluded.
2.3 Analysis instrument
2.3.1 Demographic traits questionnaire
The demographic traits questionnaire included fundamental details about the nurses, comparable to age, schooling, marital standing, month-to-month revenue, main, place, years of working expertise, division, night time shifts previously three months, hospital degree, educating hospital, hospital sort, nursing supervisor, participation in superior research/specialist nurse coaching, employment type, standing of kids, and considerations about job safety.
2.3.2 The nursing job stressors scale (NJSS)
The Nursing Job Stressors Scale (NJSS) is a self-administered, multidimensional scale designed to evaluate the degrees of job stress amongst nurses (Solar et al., 2017). This instrument consists of 35 gadgets divided into 5 domains: skilled and profession points (1–7 gadgets), workload and time strain (8–12 gadgets), useful resource and setting issues (13–15 gadgets), affected person care and interplay (16–26 gadgets), and interpersonal relationships and administration issues (27–35 gadgets) (Luan et al., 2017; Yuan and Fang, 2024). Every merchandise is rated on a 4-point Likert-type scale (1–4), with the entire rating starting from 35 to 140. The interior consistency of the NJSS was reported as 0.931 in China (Solar et al., 2017). Within the current research, the Cronbach’s alpha for the entire NJSS was 0.968, indicating that the interior consistency of the measure was satisfactory.
2.3.3 The Household APGAR Index
The Household APGAR Index consists of 5 gadgets. Every merchandise is rated on a 3-point Likert-type scale (0–2), with the entire rating starting from 0 to 10 (Babincak and Kacmarova, 2023). Based mostly on the entire rating, the Household APGAR Index categorizes households as severely dysfunctional (0–3), reasonably dysfunctional (4–6), or useful (7–10) (Castilla et al., 2014). In China, the Household APGAR Index was reported to have acceptable inside consistency (α = 0.942) (Zhang et al., 2020). Within the present research, the Cronbach’s alpha for the Household APGAR Index was 0.936, indicating that the interior consistency of this instrument was satisfactory.
2.4 Assortment of information
The information for this research had been collected between December 2023 and January 2024 by means of a free Chinese language web-based platform (Sojump) for administering on-line questionnaires. (1) Platform choice: The surveys had been distributed utilizing the Sojump platform, which is a well known on-line survey instrument recognized for its user-friendly interface and strong options. This platform permits for the straightforward creation, distribution, and evaluation of surveys. (2) Goal inhabitants: The goal inhabitants for the survey included registered nurses, particularly these aged 18 to 60 years. (3) Social media invites and outreach: We despatched customized two-dimensional code invites to nursing associations, hospitals, and healthcare organizations, encouraging them to share the survey hyperlink with their members. We utilized social media platforms (e.g., WeChat and QQ) to advertise the survey, focusing on nursing teams and boards to extend visibility and encourage participation.
2.5 High quality management methods
To make sure the information high quality and validity of the net responses, we used numerous approaches.
2.5.1 The primary strategy was survey assortment
Anonymity and confidentiality. The members had been assured that their responses would stay nameless and confidential. This was communicated clearly within the survey introduction to encourage trustworthy and correct responses.
2.5.2 The second strategy was to make sure information high quality and validity
(1) Pre-testing: The survey instrument was pre-tested with 20 nurses previous to full distribution. This helped establish any ambiguities within the questions and allowed for changes to enhance readability and relevance. (2) Use of established scales: The place relevant, we included established and validated scales. This enhanced the reliability of the information collected. (3) Response Time Evaluation: We analyzed the common time taken to finish the survey to establish any outliers or situations of incomplete responses. The members who accomplished the questionnaire in lower than 60 s had been eradicated throughout the closing data-cleaning session. (4) Screening for inconsistencies: After information assortment, we carried out checks for inconsistent or contradictory responses. As an example, if the members indicated excessive values throughout associated questions, we flagged these for additional assessment. (5) Handle monitoring: Sojump permits for IP tackle monitoring, which helped us establish and exclude duplicate responses from the identical supply.
2.6 Evaluation of information
Information had been analyzed utilizing SPSS 29.0 software program with each descriptive and inferential statistics.
• Imply and customary deviation (SD) had been reported for steady variables that adopted a traditional distribution, whereas median and interquartile had been reported for steady variables that adopted a non-normal distribution.
• Quantity and proportion had been reported for categorical variables.
• In accordance with the demographic traits, the variations in occupational stress had been analyzed utilizing the unbiased t-test and one-way evaluation of variance.
• The correlation between the Household APGAR Index and occupational stress was analyzed utilizing Pearson’s correlation coefficients.
• A number of linear regression was carried out to guage the statistical significance of the impact of the demographic components and the Household APGAR Index on occupational stress among the many nurses utilizing the stepwise methodology.
• A p-value of <0.05 was thought-about statistically vital.
2.7 Moral issues
The research protocols acquired endorsement from the Bio-ethical Fee of the Mianyang Central Hospital, underneath reference no. 2023KY082.
3 Analysis outcomes
3.1 The demographic traits of the members
On this research, 47.8% of the members had been aged between 18 and 30 years, and 65.9% had a college diploma. A complete of 69.7% of the members had been married. Furthermore, 55.2% of the members had a month-to-month revenue between 3,001 and 6,000 yuan. Different demographic traits of the members are displayed in Desk 1.
Desk 1. Occupational stress in accordance with the demographic traits of the members (N = 270).
3.2 Ranges of occupational stress and the Household APGAR Index of the members
The members’ common scores for the NJSS and Household APGAR Index had been 1.76 ± 0.58 and 6.35 ± 3.30 factors, respectively (Desk 2).
Desk 2. Descriptive statistics of the research variables (N = 270).
Workload and time strain had been rated highest among the many sub-scales of the NJSS. The highest 5 job stressors for the nurses had been Q3 (Wages and different advantages are low), Q1 (The social standing of nursing is simply too low), Q5 (Frequent shift work), Q12 (An excessive amount of ineffective paperwork), and Q16 (Worry of errors and accidents at work).
3.3 Correlation between occupational stress and the Household APGAR Index of the members
The connection between the Household APGAR Index and occupational stress is a crucial space of research, notably in understanding how household dynamics can affect particular person wellbeing within the office. A unfavourable correlation between these two variables was discovered within the current research, which means that as scores on the Household APGAR Index elevated (indicating higher household functioning and assist), occupational stress ranges tended to lower, and vice versa. By fostering supportive household environments, people might discover themselves higher geared up to handle occupational challenges, resulting in more healthy work experiences and total wellbeing. The full NJSS rating was negatively correlated with the Household APGAR Index (r = −0.19, p < 0.001) (Desk 3).
Desk 3. Correlations between the Nursing Job Stressors Scale and Household APGAR Index (N = 270).
3.4 Influential components of occupational stress within the members
The a number of linear regression evaluation revealed {that a} excessive degree of fear about dropping one’s job and poorer classification of the Household APGAR scores had been related to increased scores on the NJSS (adjusted R2 = 0.061, F = 29.357, p < 0.001).
The regression equation was as follows:
4 Dialogue
Low fertility charges in China can considerably have an effect on the occupational stress ranges of nurses, a vital a part of the healthcare workforce. This dynamic is especially vital to grasp within the context of China’s distinctive demographic and healthcare challenges. Low beginning charges can have a big influence on staffing and workload imbalances, useful resource allocation, and organizational adjustments (Track et al., 2018). On the one hand, a lower within the variety of births might scale back demand for maternal providers and maternity and neonatal care providers, doubtlessly resulting in job insecurity (Bolan et al., 2021). Alternatively, low beginning charges might immediate healthcare services to implement price range cuts, lowering sources obtainable for nursing workers, comparable to coaching, assist providers, and staffing ranges (Aranda et al., 2022). Therefore, with fewer births, nurses might expertise considerations about job safety, resulting in heightened stress ranges (Desk 4).
Desk 4. Outcomes of the a number of linear regression evaluation of the components associated to occupational stress within the nurses (N = 270).
The present research aimed to analyze the degrees and associated components of occupational stress amongst nurses within the context of low fertility in China. The findings confirmed that the imply complete rating of occupational stress was 61.56 ± 20.08 (standardized rating = 1.76 ± 0.58), indicating a average degree of occupational stress among the many nurses on this context. A earlier research (Zhang et al., 2024) reported that the entire rating of the NJSS was 2.56 ± 0.47 for nurses caring for sufferers with gynecological most cancers. The extent of occupational stress among the many nurses was barely decrease in comparison with the discovering of Zhang et al. (2024). This is likely to be attributed to the doubtless excessive ranges of job stress within the oncology division, comparable to extended publicity to unfavourable feelings and chemotherapy medicine (Sarıbudak and Üstün, 2024).
Workload and time strain had been rated highest among the many sub-scales of the NJSS, which is in keeping with the findings of Yuan and Fang (2024). The research identified that prolonged work hours and inadequate relaxation time are linked to elevated ranges of occupational stress (Yuan and Fang, 2024). Addressing these points typically requires a mix of particular person methods (comparable to time administration and setting boundaries) and organizational assist (comparable to selling work-life stability and lowering extreme workloads) (Panahi et al., 2022).
The findings of the research by Wei et al. (2023) on the surgical system in China reported that the highest job stressor for nurses within the working room was ‘Wages and different advantages are low’ (Wei et al., 2023). The results of the current research reported that the highest 5 job stressors for the nurses had been ‘Wages and different advantages are low, The social standing of nursing is simply too low, Frequent shift work, An excessive amount of ineffective paperwork, and Worry of errors and accidents at work. The primary and fifth stressors are in line with the findings of Wei et al. (2023) research. The research by Meneguin et al. (2024) in Brazil additionally discovered a big correlation between occupational stress ranges amongst nurses and revenue (Meneguin et al., 2024). A nationwide survey of 9,256 psychiatric nurses in China reported that 92.5% of the members desired an revenue enhance of at the very least 10%, with greater than half expressing dissatisfaction with their revenue (Gu et al., 2024). Honest compensation can encourage healthcare professionals to ship high-quality care and enhance affected person outcomes (Carter et al., 2016).
Time strain, lack of management over work duties, lengthy working hours, shift work, lack of assist, and ethical harm had been reported as vital threat components for occupational stress amongst well being nurses (Meneguin et al., 2024). We discovered that the nurses who had been extra nervous about dropping their jobs perceived increased ranges of occupational stress. With out adjustments, the closure, diversion, and unemployment in obstetrics, which have typically been reported within the Chinese language scientific group and fashionable media (Chen, 2024), might result in the collapse of obstetrics (Chen, 2024). Subsequently, managers can scale back occupational stress amongst nurses by specializing in efficient methods associated to hospital transformation (Af Ugglas et al., 2020; Barnett et al., 2018).
A very good household setting can enhance nurses’ understanding of nerve-racking occasions (Ma et al., 2023). The outcomes of the present research demonstrated that occupational stress was increased in nurses with poorer classification of the Household APGAR scores. This correlation means that the standard of household assist might play a big position in influencing occupational stress amongst nurses.
Low beginning charges considerably influence the occupational stress ranges of nurses in China, affecting their workload, job safety, high quality of care, and total wellbeing. Because the Chinese language healthcare system navigates these challenges, it’s important to acknowledge the implications of low beginning charges on nursing workers and implement methods that assist their psychological well being, job satisfaction, and retention. By addressing these points, healthcare leaders can make sure that the nursing workforce stays resilient and able to assembly the healthcare calls for of the inhabitants, whilst demographic traits evolve. Enhancing compensation and offering family-oriented assist particularly for nurses are essential, given the demanding nature of their work and the challenges they face in balancing skilled and private duties (Pailhé and Solaz, 2019). Aggressive wage changes and enhanced family-oriented assist for nurses are among the many essential methods to handle occupational stress amongst nurses. Firstly, salaries should be often reviewed and adjusted based mostly on business requirements, geographical value of residing, and the distinctive calls for of nursing roles (Ravari et al., 2020). Providing salaries that replicate the excessive degree of talent and accountability concerned in nursing can enhance retention. Secondly, versatile shift choices ought to be supplied to assist nurses stability their skilled duties with household obligations (Alkhawaldeh et al., 2020). Thirdly, entry to worker help packages (EAPs) that provide counseling and sources for nurses coping with household points and stress administration should be supplied, together with psychological well being assist (Panahi et al., 2022).
There are some limitations on this research. Firstly, 270 nurses had been primarily recruited by means of comfort sampling from southwest China. This might need led to sampling bias and never be consultant of nurses in different areas. The second limitation is subjectivity with self-reported measures. The NJSS and the Household APGAR Index, as self-reported measures, had been used to gather information within the present research. Therefore, the outcomes relied on the people’ perceptions, emotions, and recollections, which might fluctuate extensively. Whereas comfort sampling is inherently restricted, researchers can attempt to incorporate a extra numerous vary of members throughout the obtainable pattern to reinforce representativeness. Moreover, future analysis might use a number of strategies of information assortment (e.g., qualitative interviews and observational research) to corroborate findings and supply a extra complete understanding of occupational stress amongst nurses.
5 Conclusion
In conclusion, this research confirmed that the nurses skilled a average degree of occupational stress within the context of low fertility in China. The important thing predictors of occupational stress among the many nurses had been the extent of fear about dropping their jobs and poorer classification of the Household APGAR scores. The present findings could also be helpful for implementing honest compensation and offering more practical family-oriented assist packages for nurses.
Information availability assertion
The datasets offered on this research may be present in on-line repositories. The names of the repository/repositories and accession quantity(s) may be discovered within the article/supplementary materials.
Ethics assertion
The research involving people had been authorised by the research protocols acquired endorsement from the Bioethical Fee of the Mianyang Central Hospital, underneath reference no. 2023KY082. The research had been carried out in accordance with the native laws and institutional necessities. Written knowledgeable consent for participation on this research was supplied by the members’ authorized guardians/subsequent of kin.
Creator contributions
XZ: Conceptualization, Information curation, Formal evaluation, Funding acquisition, Investigation, Methodology, Mission administration, Assets, Software program, Supervision, Validation, Visualization, Writing – authentic draft, Writing – assessment & enhancing. YZ: Writing – assessment & enhancing. LP: Writing – assessment & enhancing. XL: Writing – assessment & enhancing. YJ: Writing – assessment & enhancing. CP: Writing – assessment & enhancing. BW: Conceptualization, Investigation, Validation, Writing – assessment & enhancing.
Funding
The creator(s) declare that monetary assist was acquired for the analysis, authorship, and/or publication of this text. This research was financially supported by the Well being Humanities Analysis Middle, Key Analysis Base of Philosophy and Social Sciences, Zigong Metropolis (Mission ID: JKRWY23-19 and YDJKY24-23) and the Division of Nursing, Mianyang Central Hospital, College of Drugs (Mission ID: MCHHL2023YB12).
Acknowledgments
The authors want to thank the members for his or her assist.
Battle of curiosity
The authors declare that the analysis was carried out within the absence of any business or monetary relationships that might be construed as a possible battle of curiosity.
Writer’s observe
All claims expressed on this article are solely these of the authors and don’t essentially symbolize these of their affiliated organizations, or these of the writer, the editors and the reviewers. Any product that could be evaluated on this article, or declare that could be made by its producer, just isn’t assured or endorsed by the writer.
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