Work stress, perceived social support, self‐efficacy and burnout among Chinese registered nurses
Open accessAbstract
AIMS: To establish a model and identify structural relationships between Chinese nurses' perceived social support, self-efficacy, work stress and burnout. BACKGROUND: The prevalence of burnout among nurses tends to be high worldwide. A better understanding of relationships between the study variables can help hospital managers apply effective programmes to reduce burnout. However, no studies have identified the structural relationships between these variables in one model, simultaneously. METHODS: We conducted a cross-sectional survey to complete questionnaires from 444 nurses working in three Chinese general tertiary hospitals. The proposed model was examined by structural equation modelling. RESULTS: The proposed model was partially supported by empirical data. The total effect of work stress on burnout was large. Both work stress and the perceived social support moderately and directly affected burnout. Work stress also indirectly affected burnout through perceived social support. Work stress directly influenced perceived social support and self-efficacy. Perceived social support directly affected self-efficacy. However, self-efficacy did not directly influence burnout. CONCLUSIONS: This study validated a model and identified a deep understanding of structural relationships between the selected variables among Chinese nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Apart from reducing work stressors, hospital managers should utilize more social support strategies when designing intervention programmes to reduce burnout.
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Claims the paper makes
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- Findingown data
Self-efficacy did not directly influence burnout.
“However, self-efficacy did not directly influence burnout.”
- Also stated in: § 3.3 | The proposed theoretical model's results · plain
“Self-efficacy 0.08 -0.08”
Quote in the paperSubstantial claim - Also stated in: § 3.3 | The proposed theoretical model's results · plain
- Findingown data
Work stress had a total positive effect on burnout (standardized coefficient 0.61).
“WS 0.45*** 0.16*** 0.61***”
Quote in the paperSubstantial claim - Findingown data
Work stress had a direct negative effect on self-efficacy (standardized coefficient -0.15).
“Self-efficacy 0.14 WS -0.15*** -0.10*** -0.25***”
Quote in the paperSubstantial claim - Findingown data
Work stress directly influenced self-efficacy.
“Work stress directly influenced perceived social support and self-efficacy.”
- Also stated in: § 3.3 | The proposed theoretical model's results · plain
“Self-efficacy 0.14 WS -0.15*** -0.10*** -0.25***”
Quote in the paperSubstantial claim- Rests on an assumption: The cross-sectional design can support the directional causal relationships specified in the model.
- Also stated in: § 3.3 | The proposed theoretical model's results · plain
- Findingown data
Work stress was positively correlated with burnout (r = 0.59).
“Work stress was positively related to burnout (r = 0.59).”
Quote in the paperSubstantial claim
- Findingown data
The model explained 13% of the variance in perceived social support.
“PSS 0.13”
Quote in the paperNot a substantial claim - Findingown data
Work stress was negatively correlated with self-efficacy (r = -0.23).
“Work stress was significantly and negatively related to PSS and self-efficacy (r = -0.30,-0.23, respectively).”
Quote in the paperNot a substantial claim - Findingown data
All study variables were significantly related to each other (p < .01).
“All study variables were significantly related to each other with p-value < .01.”
Quote in the paperNot a substantial claim - Findingown data
The model explained 14% of the variance in self-efficacy.
“Self-efficacy 0.14”
Quote in the paperNot a substantial claim - Findingown data
Work stress had a total negative effect on self-efficacy (standardized coefficient -0.25).
“Self-efficacy 0.14 WS -0.15*** -0.10*** -0.25***”
Quote in the paperSubstantial claim - Findingown data
Work stress was negatively correlated with perceived social support (r = -0.30).
“Work stress was significantly and negatively related to PSS and self-efficacy (r = -0.30,-0.23, respectively).”
Quote in the paperNot a substantial claim - Findingown data
Perceived social support had a total negative effect on burnout (standardized coefficient -0.48).
“PSS -0.50*** 0.02 -0.48***”
Quote in the paperSubstantial claim - Findingown data
Work stress had a direct negative effect on perceived social support (standardized coefficient -0.36).
“PSS 0.13 WS -0.36*** --0.36***”
Quote in the paperSubstantial claim - Findingown data
Self-efficacy was negatively correlated with burnout (r = -0.33).
“Self-efficacy was negatively associated with burnout (r = -0.33).”
Quote in the paperSubstantial claim - Findingown data
Perceived social support was negatively correlated with burnout (r = -0.41).
“Perceived social support negatively correlated with burnout (r = -0.41)and positively correlated with selfefficacy (r = 0.35).”
Quote in the paperSubstantial claim - Findingown data
Perceived social support had a direct positive effect on self-efficacy (standardized coefficient 0.29).
“PSS 0.29*** 0.29***”
Quote in the paperSubstantial claim - Findingown data
Work stress had an indirect negative effect on self-efficacy through perceived social support (standardized coefficient -0.10).
“Self-efficacy 0.14 WS -0.15*** -0.10*** -0.25***”
Quote in the paperSubstantial claim - Findingown data
The model explained 58% of the variance in burnout.
“Burnout 0.58”
Quote in the paperSubstantial claim - Findingown data
Work stress had an indirect positive effect on burnout through perceived social support (standardized indirect effect 0.16).
“Work stress also indirectly affected burnout through perceived social support.”
- Also stated in: § 3.3 | The proposed theoretical model's results · plain
“WS 0.45*** 0.16*** 0.61***”
Quote in the paperSubstantial claim - Also stated in: § 3.3 | The proposed theoretical model's results · plain
- Findingown data
Work stress directly influenced perceived social support.
“Work stress directly influenced perceived social support and self-efficacy.”
- Also stated in: § 3.3 | The proposed theoretical model's results · plain
“PSS 0.13 WS -0.36*** --0.36***”
Quote in the paperSubstantial claim- Rests on an assumption: The cross-sectional design can support the directional causal relationships specified in the model.
- Also stated in: § 3.3 | The proposed theoretical model's results · plain
- Findingown data
The measurement model's factor loadings were statistically significant (p < 0.05).
“the measurement model's factor loadings were statistically significant with p values < 0.05.”
Quote in the paperSubstantial claim - Findingown data
Perceived social support directly affected self-efficacy.
“Perceived social support directly affected self-efficacy.”
- Also stated in: § 3.3 | The proposed theoretical model's results · plain
“PSS 0.29*** 0.29***”
Quote in the paperSubstantial claim - Also stated in: § 3.3 | The proposed theoretical model's results · plain
- Findingown data
Perceived social support had a direct negative effect on burnout (standardized coefficient -0.50).
“PSS -0.50*** 0.02 -0.48***”
Quote in the paperSubstantial claim - Findingown data
Perceived social support was positively correlated with self-efficacy (r = 0.35).
“Perceived social support negatively correlated with burnout (r = -0.41)and positively correlated with selfefficacy (r = 0.35).”
Quote in the paperNot a substantial claim - Findingown data
Work stress had a direct positive effect on burnout (standardized coefficient 0.45).
“Burnout 0.58 WS 0.45*** 0.16*** 0.61***”
Quote in the paperSubstantial claim - Findingown data
Work stress had a direct positive effect on burnout, with a standardized coefficient of 0.45.
“WS directly affected their burnout (β = 0.45), self-efficacy (β = -0.15)and PSS (β = -0.36)”
- Also stated in: § 6 | CON CLUS IONS · boosted
“Work stress is a strong factor influencing nurses' burnout and PSS with moderate effect size.”
Quote in the paperSubstantial claim - Also stated in: § 6 | CON CLUS IONS · boosted
- Findingown data
Perceived social support had a direct positive effect on self-efficacy, with a standardized coefficient of 0.29.
“Perceived social support directly influenced burnout (β = -0.50)and self-efficacy (β = 0.29)”
- Also stated in: § 6 | CON CLUS IONS · plain
“Perceived social support had a small effect on self-efficacy.”
Quote in the paperNot a substantial claim - Also stated in: § 6 | CON CLUS IONS · plain
- Findingown data
Perceived social support had a slightly greater effect than work stress in preventing nurses' burnout.
“This research contributes the new knowledge that PSS has a slightly greater effect than WS, which can prevent nurses' burnout.”
Quote in the paperSubstantial claim - Findingreasoning
The total effect of work stress on burnout was 0.61.
“The overall effects of WS on burnout were 0.61.”
Quote in the paperSubstantial claim - Findingown data
Work stress had a direct negative effect on self-efficacy, with a standardized coefficient of -0.15.
“WS directly affected their burnout (β = 0.45), self-efficacy (β = -0.15)and PSS (β = -0.36)”
- Also stated in: § 6 | CON CLUS IONS · plain
“Work stress was also found to affect self-efficacy with a small effect size.”
Quote in the paperSubstantial claim - Also stated in: § 6 | CON CLUS IONS · plain
- Findingown data
Perceived social support had a direct negative effect on burnout, with a standardized coefficient of -0.50.
“Perceived social support directly influenced burnout (β = -0.50)and self-efficacy (β = 0.29)”
- Also stated in: § 7 | IMPLI C ATI ON S FOR N UR S ING MANAG EMENT · boosted
“Besides WS, PSS is a strong protective factor influencing nurses' burnout.”
Quote in the paperSubstantial claim - Also stated in: § 7 | IMPLI C ATI ON S FOR N UR S ING MANAG EMENT · boosted
- Findingown data
Work stress did not influence burnout through the mediator of self-efficacy.
“However, WS was not found to influence nurses' burnout through the mediator of self-efficacy, since nurses' self-efficacy did not affect burnout in this study.”
Quote in the paperSubstantial claim - Findingown data
Perceived social support and work stress together explained 58% of the variance in nurses' burnout.
“The PSS and WS occupied 58% of the variance in nurses' burnout.”
Quote in the paperSubstantial claim - Findingown data
Work stress had an indirect effect on burnout through perceived social support, with a standardized coefficient of 0.16.
“WS had an indirect effect on burnout (β = 0.16) through PSS.”
- Also stated in: § 6 | CON CLUS IONS · plain
“Additionally, WS also indirectly influenced burnout through PSS, while the preventive role of self-efficacy on nurses' burnout was not shown in the model simultaneously.”
Quote in the paperSubstantial claim - Also stated in: § 6 | CON CLUS IONS · plain
- Findingown data
Work stress had a direct negative effect on perceived social support, with a standardized coefficient of -0.36.
“WS directly affected their burnout (β = 0.45), self-efficacy (β = -0.15)and PSS (β = -0.36)”
- Also stated in: § 6 | CON CLUS IONS · boosted
“Work stress is a strong factor influencing nurses' burnout and PSS with moderate effect size.”
Quote in the paperSubstantial claim - Also stated in: § 6 | CON CLUS IONS · boosted
- Findingown data
Self-efficacy did not have a significant effect on burnout, with a standardized coefficient of 0.08.
“However, self-efficacy did not influence burnout (β = 0.08).”
- Also stated in: § 4 | D ISCUSS I ON · plain
“However, self-efficacy did not directly influence burnout (H3).”
- Also stated in: § 6 | CON CLUS IONS · plain
“while the preventive role of self-efficacy on nurses' burnout was not shown in the model simultaneously.”
Quote in the paperSubstantial claim - Also stated in: § 4 | D ISCUSS I ON · plain
- Premisecitation
When constructs have fewer than three measured variables, more than 400 respondents are required (Hair et al., 2010).
“Additionally, Hair, Black, Babin, and Anderson (2010) mentioned that when the constructs have fewer than three measured variables, more than 400 respondents are required.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hair, Black, Babin, and Anderson (2010)
Not checked in the free run.
- Premisecitation
Self-efficacy moderately influenced burnout among 430 Chinese contract nurses (Gao et al., 2017).
“Gao, Huang, Gu, and Huang (2017) investigated the effect of self-efficacy on nurses' burnout among 430 Chinese contract nurses.It was found that self-efficacy moderately influenced nurses' burnout.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Gao, Huang, Gu, and Huang (2017)
Not checked in the free run.
- Interpretationown data
Work stress had a large total effect on burnout.
“The total effect of work stress on burnout was large.”
Quote in the paperSubstantial claim - Premisecitation
At least 15 respondents are required for every measured variable in structural equation modelling (Siddiqui, 2013).
“According to Siddiqui's (2013) suggestion, at least 15 respondents are required for every measured variable in the structural equation modelling (SEM).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Siddiqui's (2013)
Not checked in the free run.
- Interpretationown data
The proposed structural model was only partly supported by the empirical data.
“The proposed model was partially supported by empirical data.”
Quote in the paperSubstantial claim- Rests on an assumption: No prior studies have simultaneously examined the structural relationships among work stress, perceived social support, self-efficacy, and burnout in one model.
- Premisecitation
Work stressors and workloads significantly influenced nurses' self-efficacy (Molero et al., 2018).
“The empirical studies revealed that stressors relating to work and workloads significantly influenced nurses' self-efficacy (Molero et al., 2018).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Molero et al., 2018
Not checked in the free run.
- Premisecitation
Low perceived social support decreases self-efficacy (Hu et al., 2018).
“when nurses experience low levels of PSS, their self-efficacy will decrease (Hu, Yu, Chang, & Lin, 2018)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hu, Yu, Chang, & Lin, 2018
Not checked in the free run.
- Premisecitation
Work stress significantly influenced perceived social support (Jin et al., 2015).
“several empirical studies have shown that WS significantly influenced nurses' burnout (Khamisa et al., 2017), perceived social support (PSS) (Jin, Zhang, Li, Deng, & Gao, 2015), selfefficacy (Yang et al., 2019) and job satisfaction (Khamisa et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Jin, Zhang, Li, Deng, & Gao, 2015
Not checked in the free run.
- Premisecitation
Work stress significantly influenced nurses' burnout (Khamisa et al., 2017).
“several empirical studies have shown that WS significantly influenced nurses' burnout (Khamisa et al., 2017), perceived social support (PSS) (Jin, Zhang, Li, Deng, & Gao, 2015), selfefficacy (Yang et al., 2019) and job satisfaction (Khamisa et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Khamisa et al., 2017
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- Study design and conductcitation
The study had 12 measured variables, so at least 180 respondents were required.
“In this study, we had 12 measured variables in the proposed model, so at least 180 respondents were required.”
Quote in the paperSubstantial claim - Premisecitation
Work stress significantly influenced self-efficacy (Yang et al., 2019).
“several empirical studies have shown that WS significantly influenced nurses' burnout (Khamisa et al., 2017), perceived social support (PSS) (Jin, Zhang, Li, Deng, & Gao, 2015), selfefficacy (Yang et al., 2019) and job satisfaction (Khamisa et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Yang et al., 2019
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- Premisecitation
Tense relationships between nurses and patients and/or physicians in China decrease nurses' support.
“since the relationships between nurses and patients and/or physicians are sometimes tense in China, this environment also increases nurses' burnout and decreases their support (Feng et al., 2018).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Feng et al., 2018
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- Interpretationown data
Perceived social support was considered an effective coping strategy in the Chinese registered nurse population.
“This new discovery provided the empirical evidence in the Chinese RNs' population that PSS was considered as an effective coping strategy.”
Quote in the paperSubstantial claim - Interpretationown data
The finding that self-efficacy did not directly influence burnout was inconsistent with Bandura's (1997) explanation that high self-efficacy leads to low burnout.
“However, it was inconsistent with Bandura's (1997) explanation that when people have a high rate of self-efficacy, they may experience low rate of burnout.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Bandura's (1997)
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- Interpretationcitation
The finding that self-efficacy did not directly influence burnout was congruent with a previous study by Rees et al. (2016).
“This result was congruent with a previous study by Rees et al. (2016).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Rees et al. (2016)
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- Premisecitation
In China, relationships between nurses and patients and/or physicians are sometimes tense.
“since the relationships between nurses and patients and/or physicians are sometimes tense in China, this environment also increases nurses' burnout and decreases their support (Feng et al., 2018).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Feng et al., 2018
Not checked in the free run.
- Interpretationcitation
The directions of the effects of work stress on burnout, perceived social support, and self-efficacy matched those reported by Jin et al. (2015).
“These types of influence were consistent with previous study's results (Jin et al., 2015).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Jin et al., 2015
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- Premisecitation
Coping strategies can mediate the relationship between stressful events and burnout.
“Coping strategies can perform a mediating role between stressful events and burnout (Lazarus, 1990).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Lazarus, 1990
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- Interpretationcitation
The finding that self-efficacy did not directly influence burnout was incongruent with Yao et al. (2018) study results.
“This finding was also incongruent with Yao et al. (2018) study results.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Yao et al. (2018)
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- Interpretationown data
Perceived social support mediated the relationship between work stress and burnout.
“This study provided new knowledge that PSS played a mediation role between WS and burnout.”
- Also stated in: § 7 | IMPLI C ATI ON S FOR N UR S ING MANAG EMENT · plain
“Perceived social support also presents the mediating relationship between nurses' workplace stress and their burnout.”
Quote in the paperSubstantial claim - Also stated in: § 7 | IMPLI C ATI ON S FOR N UR S ING MANAG EMENT · plain
- Study design and conductreasoning
Recruiting participants from one city may limit the generalizability of this study's findings.
“The participants were recruited in one city, which may limit the generalization of this study's findings.”
Quote in the paperNot a substantial claim - Premisecitation
Tense relationships between nurses and patients and/or physicians in China increase nurses' burnout.
“since the relationships between nurses and patients and/or physicians are sometimes tense in China, this environment also increases nurses' burnout and decreases their support (Feng et al., 2018).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Feng et al., 2018
Not checked in the free run.
- The quote only partly states this claim. 1
- May combine two claims. 9
- Classified as probably not a substantial claim. 18
The quote only partly states this claim.
Findingown dataThe modified model fits the data (p = .08, χ2/df = 1.39, SRMR = 0.03, RMSEA = .03).
“This study's modified model fits the data (p-value = .08,χ 2 /df = 1.39,SRMR = 0.03,”
- Also stated in: § 3.3 | The proposed theoretical model's results · plain
“Chi-square = 41.75, df = 30, p-value = .08,RMSEA = .03”
Quote in the paperSubstantial claim- Also stated in: § 3.3 | The proposed theoretical model's results · plain
May combine two claims.
Findingown dataIn this study, workload was the most common stressor among nurses, followed by the nature of nursing work, family, nurses' expectations, interpersonal relationships, and contact with patients.
“In this study, the nurses' major stressor was workload, which was followed by the nature of nursing work, family, nurses' expectation, interpersonal relationships and contact with patients.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe proposed model was partially supported by the research data, and the model fit was good.
“The proposed model was partially supported by the research data and even model fit is good.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataThe work stress scale had total Cronbach's alpha 0.98 and subscale alphas from 0.85 to 0.93 in this study.
“The total Cronbach's α coefficient was 0.98, and each subscale's Cronbach's α coefficient was from 0.85 to 0.93 in this study”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPerceived social support moderately correlated with burnout among 400 Iranian nurses (Babaeiamiri, 2016).
“It was found that PSS moderately correlated with burnout.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Babaeiamiri (2016)
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Study design and conductnone givenMulti-stage random sampling was used to extract 500 registered nurses from three general tertiary hospitals in Dalian.
“Therefore, multi-stage random sampling was utilized to extract 500 registered nurses (RNs), who came from three general tertiary hospitals in the Dalian city of Liaoning Province in China during June, 2018.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationCo-worker support and salary highly influenced self-efficacy (Hu et al., 2018).
“Moreover, co-worker support and salary highly influenced self-efficacy as well (Hu et al., 2018).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Hu et al., 2018
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Classified as probably not a substantial claim. May combine two claims.
PremisecitationFit index thresholds for the study model were χ2/df < 3, SRMR < 0.07, NFI > 0.90, GFI > 0.90, and RMSEA < 0.07 (Hair et al., 2010).
“the following indicators were established to evaluate the study model: (a) χ 2 /df < 3; (b) standardized root mean residual (SRMR) is <0.07;(c) normed fit index (NFI) is more than 0.90; (d) goodness of fit index (GFI) is more than 0.90; and (e) root mean square error of approximation (RMSEA) is <0.07 (Hair et al., 2010).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hair et al., 2010
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PremisecitationSelf-efficacy can directly or indirectly through psychological resilience influence mental health, including burnout (Rees et al., 2015).
“It was proposed that self-efficacy can directly or indirectly, through psychological resilience, influence the individual's mental health, such as the incidence and severity of burnout.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Rees, Breen, Cusack, and Hegney (2015)
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Study design and conductown data444 questionnaires were analyzed after deleting 11 outliers with absolute Z score greater than three.
“Four hundred and forty-four completed questionnaires were prepared for data analysis, after 11 outliers with the absolute value of a Z score greater than three were deleted.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationSocial support plays a mediating role in stress influencing mental well-being (Jesse et al., 2014).
“Jesse, Kim, and Herndon's (2014) research showed that social support played a mediating role in the stress influencing the individual's mental well-being.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Jesse, Kim, and Herndon's (2014)
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA reliability score higher than 0.8 indicates appropriate reliability (Polit & Beck, 2004).
“Polit and Beck (2004) stated that the score higher than 0.8 meant that the instruments embodied the appropriate reliability.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Polit and Beck (2004)
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Classified as probably not a substantial claim.
PremisecitationSocial support significantly decreases burnout among ICU nurses (Li et al., 2015).
“Li, Ruan, and Yuan (2015) also found that social support significantly decreases nurses' burnout among 356 ICU nurses.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Li, Ruan, and Yuan (2015)
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Classified as probably not a substantial claim.
PremisecitationPositive self-efficacy beliefs protect an individual from the effects of work stress (Brown, 2012).
“Brown (2012) stated that positive beliefs of self-efficacy are a key modifiable cognition, which could protect an individual from the effects of WS.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Brown (2012) source
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Study design and conductown dataThe perceived social support scale had overall Cronbach's alpha 0.95 and subscale alphas 0.90 and 0.93 in this study.
“The overall Cronbach's α coefficient was 0.95, and each subscale's Cronbach's α coefficient was 0.90 and 0.93”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataWork stress and perceived social support each had a moderate direct effect on burnout.
“Both work stress and the perceived social support moderately and directly affected burnout.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationIndividuals with positive self-efficacy are more adaptable to workplace stressors and experience less burnout (Bandura, 1997; Molero et al., 2018; Yao et al., 2018).
“When individuals have positive beliefs of personal self-efficacy, they tend to be more adaptable to handling workplace stressors (Bandura, 1997), experience less workplace burnout (Molero, Perez-Fentes, & Gazquez, 2018;Yao et al., 2018)”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Bandura, 1997
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- cites Molero, Perez-Fentes, & Gazquez, 2018
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- cites Yao et al., 2018
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May combine two claims.
Study design and conductown data455 completed questionnaires were returned, giving a response rate of 91%.
“The RNs returned 455 completed questionnaires.The response rate was 91%.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationThe finding that perceived social support directly negatively influenced burnout was similar to Babaeiamiri's (2016) study finding.
“This result was similar to Babaeiamiri's (2016) study finding.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Babaeiamiri's (2016)
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Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationThe finding that perceived social support directly positively affected self-efficacy was consistent with Hu et al.'s (2018) study results.
“Additionally, we found that PSS directly, positively affected self-efficacy with a small effect size (H2), which was consistent with Hu et al.'s (2018) study results.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Hu et al.'s (2018)
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Study design and conductnone givenThe researcher's workplace Institutional Review Board approved this study.
“The researcher's workplace Institutional Review Board approved this study.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductown dataSEM with generalized least squares estimation was used because multivariate normality was violated.
“The SEM, combined with the generalized least squares estimation method, was utilized for this study, since the assumption of multivariate normality was violated by the observed variables (Hair et al., 2010).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Hair et al., 2010
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductnone givenThe cross-sectional design cannot provide a better understanding of causal relationships between study variables.
“The cross-sectional design cannot provide better understanding of causal relationships between study variables.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenFour assumptions (linearity, normality, multicollinearity, homoscedasticity) were assessed before running the model.
“Before running the model, four assumptions were assessed.These assumptions were linearity, normality, multicollinearity and homoscedasticity.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe General Self-Efficacy Scale had Cronbach's alpha 0.94 in this study.
“The GSES's Cronbach's α coefficient was 0.94”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe existing CNSS and PSSS instruments have acceptable construct validity and reliability but relatively high Cronbach's alpha for the total scale.
“Although the existing instruments of CNSS and PSSS have acceptable construct validity and reliability, they have relatively high Cronbach's α of total scale.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
No prior studies have simultaneously examined the structural relationships among work stress, perceived social support, self-efficacy, and burnout in one model.
“Although some studies have shown a bivariate effect between WS, self-efficacy, PSS and burnout (Babaeiamiri, 2016;Hu et al., 2018;Jin et al., 2015;Khamisa et al., 2017;Laschinger et al., 2015;Yang et al., 2019), no studies have been found to put these variables in one model simultaneously.”
The paper relies on this without support.
The sample of nurses from three tertiary hospitals in Dalian is representative of Chinese registered nurses.
“multi-stage random sampling was utilized to extract 500 registered nurses (RNs), who came from three general tertiary hospitals in the Dalian city of Liaoning Province in China during June, 2018.”
“This study validated a model and identified a deep understanding of structural relationships between the selected variables among Chinese nurses.”
The paper relies on this without support.
The cross-sectional design can support the directional causal relationships specified in the model.
“In this study, the research design was a cross-sectional questionnaire survey.”
“Work stress directly influenced perceived social support and self-efficacy.”
The paper relies on this without support.
China has a serious shortage of registered nurses.
“Since China face a serious shortage of RNs, this can significantly increase every nurse's daily workload.”
The paper relies on this without support.
When nurses are too busy to care for their families, family members may not understand them, leading nurses to feel a loss of family support.
“Furthermore, when nurses are too busy to take care of their own families, the family members may not understand them.Thus, nurses may feel a loss of support from families.”
The paper relies on this without support.
When a patient's condition suddenly changes and requires revival, nurses sometimes cannot handle the situation effectively, which may reduce their self-efficacy.
“What is more, when a patient's condition suddenly changes and they need to be revived, sometimes nurses cannot handle the situation effectively.In such cases, it may significantly reduce nurses' self-efficacy.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Participants' perceived social support level was far less than that of cancer patients, cancer patients' caregivers, and health providers.
“This study also found that participants' perceived social support level was far less than the cancer patient, cancer patient's caregivers, and health providers (Liu and Aungsuroch, 2019; Uslu et al., 2019).”
From Mediator role of presence of meaning and self-esteem in the relationship of social support and death anxiety (2022) · cites this paper as Liu and Aungsuroch, 2019
Section 3.2 reports the Chinese nurses’ mean perceived social support score, but does not compare it with scores for cancer patients, caregivers, or health providers. Searches for those groups and for a comparison of support levels found no passage establishing the claimed difference; the reference to a study of cancer patients is not itself a comparison. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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Challenges faced by nurses while caring for COVID-19 patients: A qualitative study
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“In such situations, as time passes, nurses lose their mental and physical energy more and more and feel exhausted and distressed.[26]”
BackgroundWu, S., Wu, C., Wang, X., Fei, W., & Fu, Y. (2022) · Nursing Open · doi:10.1002/nop2.1322 · Cited by 17 · see citing works
“In our study, the primary sources of work stress for nurses were found to be time distribution and work quantity and nursing specialty and nursing work, similar to the findings in other studies (Liu & Aungsuroch, 2019).”
BackgroundResultBURNOUT SYNDROME IN NURSING PROFESSIONALS IN PUNTA ARENAS, CHILE
Gutiérrez, K. P. M., Ramos, F. R. S., & Dalmolin, G. D. L. (2020) · Texto & Contexto - Enfermagem · doi:10.1590/1980-265x-tce-2019-0273 · Cited by 18 · see citing works
Clinical nurses’ work procrastination and smartphone addiction: a potential profile study
Xue, H., Jing, S., Song, X., Zhang, F., Liu, X., & Si, X. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1387288 · Cited by 17 · see citing works
“…Chinese healthcare environment, clinical nurses work with high work intensity and risks, often needing to deal with more tasks in limited time and facing the double pressures of work and family, which inevitably impacts their psychological well-being (Liu and Aungsuroch, 2019; Hao et al., 2020).”
BackgroundSaharaline: A Collective Social Support Intervention for Teachers in Low-Income Indian Schools
Varanasi, R. A., Dell, N. L., & Vashistha, A. (2024) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3613904.3642617 · Cited by 16 · see citing works
“While these studies focused on stressors in one’s personal life, research has shown similar findings for occupational well-being [26, 52].”
BackgroundWu, L.-P., Chen, Y., Xue, M., Zhu, W., & Wang, W. (2025) · BMC Nursing · doi:10.1186/s12912-025-03615-7 · Cited by 13 · see citing works
“Relevant studies also support this conclusion: high-level perceived social support can enhance individuals’ resistance to stress, depression and anxiety, and improve health and well-being [61, 62].”
Wu, L., Chou, C., & Kao, C.-Y. (2023) · Journal of Nursing Management · doi:10.1155/2023/5599128 · Cited by 15 · see citing works
“Te major stressors for nurses include workload, the nature of nursing work, family responsibilities, personal expectations, interpersonal relationships, and patient contact [33].”
Ardabili, F. S. (2020) · Organizacija · doi:10.2478/orga-2020-0016 · Cited by 15 · see citing works
“A sense of self-efficacy had a significant impact on the level of stress and the ways of dealing with difficult situations among nurses (Chegini, Janati, Asghari-Jafarabadi, & Khosravizadeh, 2019; Liu & Aungsuroch, 2019) and can help to decrease job stress and less exhaustion (Voitenko, 2020).”
BackgroundZhang, Y., He, H., Yang, C., Wang, X., Luo, J., Xiao, J., Fu, B., Chen, Y., & Ma, C. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1269594 · Cited by 14 · see citing works
Psychometric Properties of the Korean Version of the Nursing Profession Self-Efficacy Scale
Seon Mi, K. I. M., Ju Hee, K. I. M., & Jung Min, K. W. A. K. (2022) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000481 · Cited by 14 · see citing works
“It has been proposed that self-efficacymay directly or indirectly influence an individual's mental health and affect psychological resilience via, for example, the frequency and severity of burnout (Liu & Aungsuroch, 2019).”
BackgroundJoshua, R., Chehab, F. H., David, R., et al. (2021) · International Journal of Clinical and Experimental Medicine Research · doi:10.26855/ijcemr.2021.04.018 · Cited by 14 · see citing works
“After wearing the full set of protective clothing, long working hours for nurses working bedside can cause physical and mental exhaustion leading to burnout [15].”
BackgroundBurnout syndrome among nurses in a psychiatric hospital in Dammam, Saudi Arabia
Zafar, M., Alqahtani, R., & Al-Otaibi, S. T. (2020) · Nursing and Midwifery Studies · doi:10.4103/nms.nms_126_19 · Cited by 14 · see citing works
A Stress Relief App Intervention for Newly Employed Nursing Staff: Quasi-Experimental Design
Chang, I., Cheng, W., & Kung, W. (2019) · JMIR mhealth and uhealth · doi:10.2196/15785 · Cited by 11 · see citing works
“A recent literature review showed that studies of nursing stress covered areas from developed to developing countries, departments from general wards to emergency departments, subjects from newly graduated nurses to nurse managers, and topics from the antecedents to the impact of work-related stress [1-11].”
BackgroundStructure Please; Continuous Improvement and Employee Consequences in a Dynamic Task Environment
Benders, J., Bal, M., & Vermeerbergen, L. (2019) · Sustainability · doi:10.3390/su11205564 · Cited by 15 · see citing works
Zeng, Z., Zhou, S., Liu, M., Xie, G., He, Y., & Zhang, J. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1485143 · Cited by 12 · see citing works
“(ii) Effective Utilization of Resources: Perceived social support encourages endoscopy nurses to actively seek help at work and build support networks, thereby improving work efficiency and reducing occupational fatigue caused by excessive psychological stress (58).”
BackgroundYang, Z., Huang, H., & Li, G. (2024) · BMC Nursing · doi:10.1186/s12912-024-01731-4 · Cited by 13 · see citing works
“With the development of global health and safety, nurses are under increased occupational stress due to rapid changes in the healthcare system and the particular nature of nursing work [2–4].”
BackgroundWu, H., Chen, M., & Wang, X. (2023) · International Journal of Contemporary Hospitality Management · doi:10.1108/ijchm-12-2021-1491 · Cited by 13 · see citing works
Huang, Y., Guan, Z., Yan, F., Wiley, J. A., Reynolds, N. R., Tang, S., & Sun, M. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1018097 · Cited by 13 · see citing works
“This study also found that participants’ perceived social support level was far less than the cancer patient, cancer patient’s caregivers, and health providers (Liu and Aungsuroch, 2019; Uslu et al., 2019).”
BackgroundRelationships between perceived support types and the job satisfaction levels of nurses
Polat, Ş., & Terzi̇, B. (2020) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12675 · Cited by 15 · see citing works
Hu, H., Chang, S., Tian, G., Li, Z., Chang, L., Zhang, J., Cheng, C., Zhang, H., & Cui, P. (2025) · BMC Nursing · doi:10.1186/s12912-025-03607-7 · Cited by 12 · see citing works
“In the face of nurse-patient disputes, heavy workloads, and nursing staff shortages, nurses often experience chronic stress and increasing work pressure [1–3].”
Hu, G., Wang, Z., Zhang, C., Xu, J., Shen, Z., Peng, L., & Xu, H. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1550623 · Cited by 13 · see citing works
He, J., Chen, Y., Lin, J., Yang, X., Ding, N., Wang, X., Chen, X., Du, M., Zhang, G., & Song, Y. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e21930 · Cited by 12 · see citing works
“Liu and Aungsuroch [23] confirmed that social support was a mediator between occupational stress and burnout in nurses.”
BackgroundCarnesten, H., Gustin, L. W., Skoglund, K., & Wågert, P. V. H. (2022) · Nursing Open · doi:10.1002/nop2.1250 · Cited by 12 · see citing works
Mulaudzi, F. M., Anokwuru, R., Mogale, R. S., Moloko-Phiri, S. S., & Du-Plessis, M. A. R. (2022) · SAGE Open Nursing · doi:10.1177/23779608221091072 · Cited by 12 · see citing works
“The importance of continuous professional development in nursing is alluded to, by (Kasine et al., 2018; King et al., 2020; Madan, 2020) who cite that optimizing patient care requires new skills and up-to-date knowledge.”
BackgroundZhang, S.-E., Yang, L.-B., Zhao, C.-X., Shi, Y., Wang, H.-N., Zhao, X., Wang, X., Sun, T., & Cao, D. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.631459 · Cited by 12 · see citing works
“Chinese nurses sustain frequent workload and overtime, facing a range of threats, such as alarming stress (Liu and Aungsuroch, 2019), greater fatigue and burnout syndrome (Wang et al.”
BackgroundZeng, Y., Zhao, X., Xie, Z., Lin, X., Qi, M., & Li, P. (2025) · Journal of Advanced Nursing · doi:10.1111/jan.17071 · Cited by 14 · see citing works
Imran, M. K., Sarwar, A., Fatima, T., & Shabeer, S. (2025) · Asia-Pacific Journal of Business Administration · doi:10.1108/apjba-05-2024-0253 · Cited by 13 · see citing works
Su, J. J., Dai, Z., Wu, Y., Liu, X., Ren, T., Liu, X., Zhang, L., Fu, J., Chen, X., Xiao, W., et al. (2023) · QJM · doi:10.1093/qjmed/hcad188 · Cited by 12 · see citing works
Seitz, R., Robertson, J., Moran, T. P., Zdradzinski, M. J., Kaltiso, S.-A. O., Heron, S., & Lall, M. D. (2022) · Advanced Emergency Nursing Journal · doi:10.1097/tme.0000000000000392 · Cited by 14 · see citing works
Zhou, T., Chen, Y., Li, X., Yang, L., & Zhao, Z. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1629174 · Cited by 10 · see citing works
Jing, S., Dai, Z., Wu, Y., Liu, X., Zhang, L., Liu, X., Ren, T., Fu, J., Chen, X., Wang, W., et al. (2025) · BMC Public Health · doi:10.1186/s12889-024-20930-x · Cited by 12 · see citing works
Shi, X., Li, J., Ji, X., Wu, Y., & Zang, S. (2024) · BMC Nursing · doi:10.1186/s12912-024-02546-z · Cited by 13 · see citing works
Development and validation of a nomogram for predicting high‐burnout risk in nurses
Ning, M., Chen, Z., Yang, J., Li, X., Yu, Q., Huang, C., Li, Y., & Tian, Y. (2024) · Journal of Clinical Nursing · doi:10.1111/jocn.17210 · Cited by 10 · see citing works
Middle-Range Theory of Occupational Stress in Health Professionals
Costa, R. H. S., da Silva, A. B. P., Dantas, A. L. D. M., de Menezes, H. F., Prado, N. C. D. C., Santos, R. S. D. C., Manso, R. K. G. D. S., Ferreira, T. T., & da Silva, R. A. R. (2024) · SAGE Open Nursing · doi:10.1177/23779608241236290 · Cited by 10 · see citing works
“Although healthcare requires complex, often immediate, and unpredictable decision-making, several health professionals still work under inadequate conditions (Costa et al., 2020; Hoseinabadi et al., 2020; Liu & Aungsuroch, 2019).”
BackgroundDobnik, M., & Lorber, M. (2023) · Sustainability · doi:10.3390/su151712766 · Cited by 12 · see citing works
Mi, W., Gou, Z., & Ma, Z. (2023) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-023-10047-7 · Cited by 10 · see citing works
“(1996)‘s work refer to this instrument as PSSS (Huang et al., 2019; Liu & Aungsuroch, 2019; Wang et al., 2020).”
MethodPredictors of Teaching Self-efficacy in Clinical Nursing Teachers: A Cross-sectional Study
Wu, P., & Ho, H. (2023) · Florence Nightingale Journal of Nursing · doi:10.5152/fnjn.2023.22179 · Cited by 12 · see citing works
“Several studies have shown that the factor affecting teaching self-efficacy is a bivariate effect between life stress, work stress, and self-efficacy (Khamisa et al., 2017; Laschinger et al., 2015; Liu & Aungsuroch, 2019).”
BackgroundThe Effect of Burnout on Quality of Care Using Donabedian’s Framework
White, K. M., Dulko, D., & DiPietro, B. (2022) · Nursing Clinics of North America · doi:10.1016/j.cnur.2021.11.008 · Cited by 11 · see citing works
Zhu, Y.-Y., Liu, J.-L., Chen, F.-L., Wang, Q., Cao, K., Huang, J.-H., Wang, H., Wang, Q., & Luo, X. (2024) · BMC Public Health · doi:10.1186/s12889-024-20811-3 · Cited by 11 · see citing works
“Compared with received social support, perceived social support has a stronger relationship with a person’s mental health [42].”
Zhang, L., Han, Q., Nan, L., et al. (2024) · BMC Nursing · doi:10.1186/s12912-024-02292-2 · Cited by 9 · see citing works
“By enhancing nurses’ self-efficacy through positive experiences, social support can indirectly improve the quality and efficiency of narrative nursing [25].”
BackgroundZhang, Y., Meng, X., & Zhou, L. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1344185 · Cited by 9 · see citing works
“This implies that perceived support from significant others can serve as a resource for developing and fostering one’s efficacy beliefs regarding performance, functioning, and coping with challenges (Liu and Aungsuroch, 2019).”
BackgroundResult“Everything Is Changing, but I Am Not Alone”: Nurses’ Perceptions of Social Support during COVID-19
Sahay, S., & Wei, W. (2022) · Sustainability · doi:10.3390/su14063262 · Cited by 8 · see citing works
“Social support is known to reduce anxiety, stress, and burnout in nurses [5,8,44].”
BackgroundLi, X., Hu, C., Meng, A., Guo, Y., Chen, Y., & Dang, R. (2022) · Health Science Reports · doi:10.1002/hsr2.477 · Cited by 9 · see citing works
“outcomes.(1,5,6) Nevertheless, those studies mainly assessed the stress level of the subjects by questionnaires, and the examined activities were strongly tied to their perceived stress.”
BackgroundJing, S., Dai, Z., Liu, X., Liu, X., Zhang, L., Wu, Y., Ren, T., Fu, J., Chen, X., Wang, W., et al. (2024) · QJM · doi:10.1093/qjmed/hcae190 · Cited by 9 · see citing works
Explain the professional identity of nursing during COVID ‐19 pandemic
Azizi, T. H., Varasteh, S., & Esmaeili, M. (2024) · Nursing Open · doi:10.1002/nop2.2253 · Cited by 8 · see citing works
“Social support reduces job stress and increases coping abilities (Liu & Aungsuroch, 2019).”
BackgroundZhu, H., Li, X., Zhang, H., Lin, X., You, Q., Yang, L., Ma, Q., & Zhou, C. (2024) · Nurse Education Today · doi:10.1016/j.nedt.2024.106266 · Cited by 10 · see citing works
Widianto, S., & Wilderom, C. (2023) · SAGE Open · doi:10.1177/21582440231201702 · Cited by 10 · see citing works
“A high level of social support from various sources at work may contribute to followers’ self-efficacy and optimism (Liu & Aungsuroch, 2019; Luthans et al., 2008).”
BackgroundChen, X., Xu, Y., Zhang, Q., Huang, H., Tan, X., & Yang, Y. (2025) · BMC Public Health · doi:10.1186/s12889-024-21199-w · Cited by 9 · see citing works
Investigating compassion fatigue and predictive factors in paediatric surgery nurses
Kankaya, E. A., Özlü, N. G. Ö., & Vural, F. (2023) · Nursing Ethics · doi:10.1177/09697330231209283 · Cited by 7 · see citing works
“12 Another study examined the relationship between CF, burnout, CS and social support among nurses.”
BackgroundDong, Y., Zhu, Q., Chang, R., Wang, R., Cai, Y., & Huang, H. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1236645 · Cited by 8 · see citing works
“Moreover, social support, as a protective factor for self-efficacy, can provide additional external resources to help improve self-efficacy when individuals perceive work stress (23).”
BackgroundLuo, Y., Zhang, Y., Chen, J., Lu, G., Liu, J., & Chen, C. (2025) · Nursing Open · doi:10.1002/nop2.70388 · Cited by 7 · see citing works
“In the Chinese context, social support is not only a provision of resources but also a culturally rooted relational identity, which plays a critical buffering role in the pathway from emotional labor to job burnout (Liu and Aungsuroch 2019).”
Mulhem, H. A., Alaoui, K. E., & Pilotti, M. (2023) · Sustainability · doi:10.3390/su15021070 · Cited by 6 · see citing works
- Authors
- Liu, Y., & Aungsuroch, Y.
- Affiliations
- Chulalongkorn University (TH)
- Corresponding author
- Liu, Ying
- Aungsuroch, Yupin
- Venue
- Journal of Nursing Management
- Publisher
- Wiley
- Published
- 2019-08-09
- Volume
- 27
- Issue
- 7
- Pages
- 1445-1453
- ISSN
- 0966-0429 (ISSN-L)
- 1365-2834
- OpenAlex
- W2960992860
- Cited by
- 197
- References
- 51
- Citations by year
- 2026: 17 · 2025: 30 · 2024: 39 · 2023: 30 · 2022: 33 · 2021: 27 · 2020: 16 · 2019: 4 · 2013: 1
- FWCI
- 25.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Nursing Management (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Washington State University
- Department of Education of Liaoning Province (WQ2017004)
- Topics
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Keywords
- burnout, occupational stress, perceived social support, self-efficacy, registered nurses, Chinese nurses, nurse well-being, mediating role of social support
- MeSH terms
- Occupational Stress, Adult, Burnout, Professional, China, Cross-Sectional Studies, Female, Humans, Job Satisfaction, Male, Middle Aged, Nurses, Perception, Social Support, Self Efficacy
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