| Objective:Nurses were the most direct and main participant in medical activities.Nurses' mental health is of great significance to their own development and the quality of nursing services.However,previous studied showed that nurses had high mental workload,which was affected by many factors,besides external environmental factors and internal psychological factors.This study aimed to analyze nurses' mental workload and its influencing factors in China.Then,explore the potential characteristics of nurses' mental workload.Lastly,analyze the relationship among mental workload,psychological capital and coping styles,which can provide the reference for developing comprehensive intervention strategies for reducing the nurses' mental workload,improving the psychological health of nurses and the quality of nursing services.Methods:1.Reliability and validity test of nurse-version NASA Task Load Index: NASA Task Load Index was introduced,translated,and revised combined with Chinese cultural background.Internal consistency,retest reliability,Cronbach's ? coefficient,content validity,exploratory factor analysis and confirmatory factor analysis were applied to conduct strict tests on the reliability and validity of the scale.2.Analysis of nurses' psychological workload and its influencing factors: A large sample survey.Combined stratified sampling and convenient sampling method,nurses in five general hospital of Shanghai were selected.The nurse-version of NASA Task Load Index scale,Psychological Capital Questionnaire and Nurse's Coping Style Questionnaire were adopted to the cross-sectional survey.The single factor analysis,correlation analysis and multiple regression analysis were used to analyze the influence factors of nurses' mental workload.3.Latent profile analysis of nurses' mental workload: Based on the large sample survey,the latent profile analysis of nurses' mental workload was conducted and further explore whether there were differences from the distribution of demographic variables among different latent categories.4.The relationship among nurses' mental workload,psychological capital and coping styles:Based on the large sample survey and latent profile analysis,the differences of scores from nurses' mental workload,psychological capital and coping styles were compared among different latent categories.Then explore the relationship among nurses' mental workload,psychological capital and coping styles.Lastly,Bootstrap test was used to examine themediating effects of coping style on the association between psychological capital and mental workload in total and different potential categories nurses.Results:1.Reliability and validity test of nurse-version NASA Task Load Index: The nurse-version NASA Task Load Index consisted of 6 items.All the correlation coefficients between its item score and total score were(0.659~0.766)(P<0.05).There were significant differences between high score group and low score group in the critical ratio method.The content validity index was 1.00.Two factors were extracted by exploratory factor analysis,which could explain72.251% of the total variance.The confirmatory factor analysis results show that all the fitting indexes of the model reached the standard.The retest reliability of NASA Task Load Index was0.901,and the Cronbach's ? coefficient was 0.782.2.Analysis of nurses' mental workload and its influencing factors: The total score of nurses' mental workload was(79.09±21.44),and its two dimensions' score were: workload perception(59.54±15.59),performance self-evaluation(19.55±9.46).The total score of psychological capital was(99.24±13.90).and its four dimensions' score were: self-efficacy(24.28±3.77),hope(24.10±3.97),resilience(24.95±3.59),optimism(25.91±3.66).The mean score of coping style's six dimensions were: solving-question(2.90±0.64),avoiding or self-blame(0.90±0.36),easing mood(2.41±0.75),seeking social support(2.61±0.68),positive reinterpretation(2.78±0.69),behavioral disengagement(2.44±0.72).The multiple regression analysis showed that nurses' mental workload was influenced by hospital grade,working department,professional title,working in night shift or not,average weekly overtime,psychological capital,solving-problem,avoiding or self-blame,behavioral disengagement,which could explain 48.5% variation of nurses' mental workload.3.Latent profile analysis of nurses' mental workload: Nurses' mental workload was divided into four categories: "low workload perception & high self-evaluation" group(5.6%),"moderate workload perception & moderate self-evaluation" group(29.8%),"high workload perception & low self-evaluation" group(26.2%) and "high workload perception & high self-evaluation" group(38.4%).Different distribution of hospital grade,professional title,working department,working years,number of night shift,number of swing shift,number of patients in day shift,average weekly overtime existed in different groups(P<0.05).There was no statistical difference in distribution of different group on gender,age,marital status,having children or not,working status,authorized strength,initial degree,highest degree and number of patients in night shift(P>0.05).Their characteristics were shown as followed: Theproportion of nurses in "low workload perception & high self-evaluation" group with lower seniority,lower professional title,lower income and working in secondary hospitals was higher than those in other three groups.The proportion of nurses in "high workload perception & low self-evaluation" group with working for 4 to 6 years,nurse practitioner title,living alone,working in the tertiary hospital,working in night shift,number of night shift,number of swing shift(over five),number of patients in day shift(over five),average weekly overtime(over ten hours)was higher than those in other three groups.Meanwhile,the proportion of nurses working in emergency department,gynecology,pediatrics,ICU was higher than those in other three groups.The proportion of nurses in "high workload perception & high self-evaluation" group with working more than 10 years,higher professional title and higher income was higher than those in other three groups.4.The relationship between nurses' mental workload,psychological capital and coping style:There are differences from nurses' mental workload,psychological capital and coping style in four latent categories,and these three variables were correlated with each other,but the specific correlation was different.Multiple mediating effect model analysis and Bootstrap test displayed:(1)For total nurses,psychological capital could directly and negatively predict mental workload.Solving-problem and easing mood coping style could directly and negatively predict mental workload.Avoidance and self-blame could directly and positively predict mental workload.Psychological capital could also indirectly reduce mental workload through solving problems and easing mood,and indirectly increase mental workload through avoiding and self-blame.This meant solving-problem,avoidance and self-blame,easing mood coping style,played a partial mediating role on the association between psychological capital and mental workload,and the effect size accounted for 7.56%,24.60%,15.47% of the total effect.(2)For nurses in"moderate workload perception & moderate self-evaluation" group,psychological capital couldn't directly predict mental workload,but it could indirectly reduce mental workload through solving-problem and behavioral disengagement,and indirectly increase mental workload through avoidance and self-blame.This meant solving-problem,avoidance and self-blame,behavioral disengagement coping style played a complete mediating role on the association between psychological capital and mental workload,and the effect size accounted for 26.77%,25.97%,21.94% of the total effect.(3)For nurses in "high workload perception &high self-evaluation" group,psychological capital could directly and negatively predict mental workload.Easing mood,seeking social support,and behavioral disengagement coping style could directly and negatively predict mental workload.Psychological capital could alsoindirectly reduce mental workload through easing mood,seeking social support,and behavioral disengagement.This meant easing mood,seeking social support,and behavioral disengagement coping style played a partial mediating role on the association between psychological capital and mental workload,and the effect size accounted for 19.97%,12.54%,15.18% of the total effect.(4)For nurses in "low workload perception & low self-evaluation" group and "high workload perception & low self-evaluation" group,coping style had no mediating effect on the association between psychological capital and mental workload.Conclusions:1.The nurse-version of NASA Task Load Index had good reliability and validity.It provided an effective measurement tool for assessing nurses' mental workload in China.2.Nurses' mental workload was influence by hospital grade,working department,professional title,average weekly overtime,psychological capital,solving-problem,avoidance and self-blame and behavioral disengagement.3.Nurses' mental workload can be divided into four categories:"low workload perception &high self-evaluation" group,"moderate workload perception & moderate self-evaluation" group,"high workload perception & low self-evaluation" group and "high workload perception &high self-evaluation" group.Nurses in "low workload perception & high self-evaluation" group were characterized by lower seniority,lower professional title and lower income.Nurses in"high workload perception & low self-evaluation" group were characterized by medium seniority,nurse practitioner title,higher proportion of living alone and working in the tertiary hospital,working in night shift,more frenquency of swing shift and night shift,longer overtime,higher proportion of working in emergency,gynecological,pediatric and ICU.Nurses in "high workload perception & high self-evaluation" group were characterized by higher seniority,higher professional title and higher income.4.For total nurses,solving-problem,avoidance and self-blame,easing mood coping style played a partial mediating role on the association between psychological capital and mental workload.For nurses in "moderate workload perception & moderate self-evaluation" group,solving problem,avoidance and self-blame,behavioral disengagement coping style played a complete mediating role on the association between psychological capital and mental workload.For nurses in "high workload perception & high self-evaluation" group,easing mood,seeking social support,and behavioral disengagement coping style played a partial mediating role on the association between psychological capital and mental workload.For nurses in "low workload perception & low self-evaluation" group and "high workload perception & lowself-evaluation" group nurses,coping style had no mediating effect on the association between psychological capital and mental workload. |
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