The Mediating Model Of Professional Self-concept Between Nurses' Professional Identification And Burnout

Objective: To translate the Nurses'self-concept Questionnaire (NSCQ) into Chinese and assess its reliability and validity when applied to the Chinese nurses, as well as examine the impact of nurses'professional identification and professional self-concept on burnout. Methods: A two-stage design was used for this study. Stage 1 developed the Chinese version of the NSCQ (C-NSCQ) following the translation-back-translation procedure, examined the content validity, and established the psychological properties by testing the concurrent, construct validity, as well as internal reliability, test-retest reliability. This stage used convenience sampling, the sample for Stage 1 comprised 347 registered nurses. Stage 2 which included 1212 registered nurses employed a confirmatory factor analysis (CFA) to test the fitness of the data which comes from a larger homogeneous sample to the factor structure extracted from the Stage 1 and multiple dimensions of nurses'self-concept (measured by the nurse self-concept questionnaire), professional identification (measured by the professional identification scale) and burnout (measured by the Maslach Burnout Inventory) were assessed. Correlation matrices and path analysis, measurement and structural models were examined on matching pairs of data.Results: Cronbach's alpha coefficient of the C-NSCQ ranged from 0.831-0.954, test-retest reliability ranged from 0.618-0.827, and the item-CVI was 0.875-1.000. The principal components factor analysis with promax rotation was conducted and yielded six factors based on the criteria of Eigenvalues greater than 1.00, explaining 61.662% of the total sample variance. All included variables loaded highly on these factors, and the variance explained by the six components ranged from 2.83 to 39.10. The findings from CFA revealed that the C-NSCQ showed an acceptable model fit(χ2/df=4.517, GFI=0.866, TLI=0.900, CFI=0.908, IFI=0.908,RMSEA=0.059). Scores on the six subscales of the C-NSCQ significantly and moderately correlated with the Self-Esteem Scale (r=0.35-0.50; P=0.00).The mean score of professional identification was 35.04 (SD=7.49). A comparison of the scores for the dimensions of the C-NSCQ showed a relative difference in terms of mean scores and in descending order. The sample ranked themselves as"staff relations"(M=6.51, SD=0.99),"knowledge"(M=6.09, SD=1.23),"communication"(M=6.04, SD=1.16),"caring"(M=5.97, SD=1.17),"general self-concept"(M=5.18, SD=1.47),"leadership"(M=5.04, SD=1.44). The level of burnout was high, the mean score of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA) was 26.80 (SD=10.71), 8.28 (SD=6.87), 29.65 (SD=9.55) respectively.Nurses'professional identification and professional self-concept was found to have a stronger association with nurses'burnout. The structural equation modeling results showed nurses'professional identification could influence burnout directly and indirectly. In the indirect approach, through the mediating role of nurses'self-concept, nurses'professional identification could make a negative role on emotional exhaustion (Beta=-0.095), depersonalization (Beta=-0.109), personal accomplishment (Beta=-0.207). In the direct approach, professional identification could make a negative effect on emotional exhaustion (Beta=-0.384), depersonalization (Beta=-0.375), personal accomplishment (Beta=-0.229). Professional self-concept could also predict emotional exhaustion (Beta=-0.174), depersonalization (Beta=-0.201), personal accomplishment (Beta=-0.381) negatively and directively.Conclusion: This study verified the reliability and validity of C-NSCQ among nurses from general tertiary-level hospitals in Shanghai and illustrated that nurses'professional identification and professional self-concept was a stronger predictor of nurses'burnout. Future research will be carried out to demonstrate whether the results would be generalized to nurses from different areas.Strategies or interventions requiring implementation and evaluation include: counseling to improve nurses'self-concept, education programs and competencies in enhancing professional identification, understanding the occupational opportunities and occupational benefits as a nurse.