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Cited by 32Occupational Health and BurnoutHealthcare professionals’ stress and burnoutStress and Burnout Research

Factors associated with clinical nurse’s mental health: a qualitative study applying the social ecological model

Open access
Yu, Qiang, Huang, Chongmei, Tian, Yusheng, Yang, Jiaxin, Li, Xuting, Ning, Meng, Chen, Zengyu, Du, Jie +2 more·2024·BMC Nursing
DOI 10.1186/s12912-024-02005-9PMC PMC11097552
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Abstract

Background: The prevalence of burnout, depression, and anxiety among Chinese nurses was 34%, 55.5%, and 41.8% respectively. Mental health problems have significant impacts on their personal well-being, work performance, patient care quality, and the overall healthcare system. Mental health is influenced by factors at multiple levels and their interactions. Methods: This was a descriptive qualitative study using phenomenological approach. We recruited a total of 48 nurses from a tertiary hospital in Changsha, Hunan Province, China. Data were collected through focus group interviews. Audio-recorded data were transcribed and inductively analysed. Results: Four major themes with 13 subthemes were identified according to the social ecological model: (1) individual-level factors, including personality traits, sleep quality, workplace adaptability, and years of work experience; (2) interpersonal-level factors, encompassing interpersonal support and role conflict; (3) organization-level factors, such as organizational climate, organizational support, career plateau, and job control; and (4) social-level factors, which included compensation packages, social status, and legislative provision and policy. Conclusions: Our study provides a nuanced understanding of the multifaceted factors influencing nurses’ mental health. Recognizing the interconnectedness of individual, interpersonal, organizational, and social elements is essential for developing targeted interventions and comprehensive strategies to promote and safeguard the mental well-being of nurses in clinical settings. Trial and protocol registration: The larger study was registered with Chinese Clinical Trial Registry: ChiCTR2300072142 (05/06/2023) https://www.chictr.org.cn/showproj.html?proj=192676. Reporting method: This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative study used the social ecological model to explore factors associated with clinical nurses’ mental health in a Chinese tertiary hospital. It identified four themes and 13 subthemes spanning individual, interpersonal, organizational, and social levels.

Key findings

  • Four major themes with 13 subthemes were identified: individual-level factors (personality traits, sleep quality, workplace adaptability, years of work experience); interpersonal-level factors (interpersonal support, role conflict); organization-level factors (organizational climate, organizational support, career plateau, job control); and social-level factors (compensation package, social status, legislative provision and policy).
  • A total of 48 nurses participated, recruited from a tertiary hospital in Changsha, Hunan Province, China; seven focus groups were conducted.
  • Participants described cross-level interactions, including that organizational support and family support could mitigate work-family conflict, while workplace incivility from nurses, physicians, supervisors, patients, and visitors evoked negative emotions such as anxiety, depression, and exhaustion.
  • Nurses, especially senior nurses, described a “double career plateau” (hierarchical and content plateau), and some reported lack of control over work time and tasks, including uncompensated work-time extension and meetings/training immediately after night shifts.

Methods

  • Qualitative descriptive study using focus group interviews, reported according to COREQ; the abstract also describes a phenomenological approach.
  • Participants were 48 clinical nurses and head nurses employed for one year or more at a tertiary hospital in Changsha, Hunan Province, China, recruited by convenience and purposive sampling between April and May 2023.
  • Seven focus groups of seven to eight participants each were conducted; interviews lasted 65–94 min (mean 81.5 min), were audio-recorded, transcribed in Mandarin, and inductively analysed, with themes grouped using the social ecological model.

Limitations

  • The paper states that recruiting clinical nurses from only one tertiary hospital may limit generalizability, and that recruitment through the author team’s existing network may lead to selection bias.
  • Evident from the text: the reported gender counts (“female nurse participated in the study (n = 37) rather than male (n = 5)”) do not sum to the stated 48 participants and conflict with Table 1, which lists 48 participants.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12912-024-02005-9

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 15 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Talking to family, friends, colleagues, and supervisors is an effective way for clinical nurses to relieve work stress.

    “They explained that talking to their families, friends, colleagues and supervisor were an effective way to relieve work stress.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Organizational support (instrumental and emotional) is related to job satisfaction and mental health of clinical nurses.

    “Participants perceived that organization support (i.e., instrumental and emotional support) were related to job satisfaction and mental health.”
    Quote in the paperSubstantial claim
  • Findingown data

    Some clinical nurses perceive their social status as low.

    “Some participants perceived their social status as low, and it is common for them to receive discrimination from patients, relatives and doctors.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Clinical nurses, especially seniors, frequently experience double career plateau (hierarchical and content plateau).

    “Our participants, especially seniors frequently mentioned the challenge of double career plateau which includes hierarchical plateau and content plateau.”
    • Also stated in: § Discussion · plain
      “Our study recognized the occurrence of double career plateau in nursing.”
    Quote in the paperSubstantial claim
  • Findingown data

    Workplace incivility evokes negative emotions such as anxiety, depression, and exhaustion in clinical nurses.

    “They felt disrespected, threatened reprimanded, and emotionally abused, which evoke negative emotions, such as anxiety, depression, exhaustion.”
    Quote in the paperSubstantial claim
  • May combine two claims. 12
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingcitation

    The study found that nurses experience more work-to-family conflict than family-to-work conflict, leading to stress and guilt.

    “Consistent with the findings of previous research [31–35], our study found that nurses experience more work-to-family conflict than family-to-work conflict, leading to a feeling of stress and guilt.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [31] Hao J, Wu D, Liu L, Li X, Wu H. Association between work-family conflict and depressive symptoms among Chinese female nurses: the mediating and moderating role of psychological capital. Int J Environ Res Public Health. 2015;12(6):6682–99. source

      Not checked in the free run.

    • cites [32] Allen TD, Herst DE, Bruck CS, Sutton M. Consequences associated with work-to-family conflict: a review and agenda for future research. J Occup Health Psychol. 2000;5(2):278. source

      Not checked in the free run.

    • cites [33] Hwang E, Yu Y. Effect of sleep quality and depression on married female nurses’ work–family conflict. Int J Environ Res Public Health. 2021;18(15):7838. source

      Not checked in the free run.

    • cites [34] Zhang Y, Duffy JF, De Castillero ER. Do sleep disturbances mediate the association between work-family conflict and depressive symptoms among nurses? A cross‐sectional study. J Psychiatr Ment Health Nurs. 2017;24(8):620–8. source

      Not checked in the free run.

    • cites [35] Mohamed BES, Ghaith RFAH, Ahmed HAA. Relationship between work–family conflict, sleep quality, and depressive symptoms among mental health nurses. Middle East Curr Psychiatry. 2022;29(1):19. source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Individual-level factors associated with clinical nurses' mental health include personality traits, sleep quality, workplace adaptability, and years of work experience.

    “Participants reported that their mental health could be impacted by personality traits (i.e., optimistic/negative life outlook), quality of sleep, workplace adaptability, and years of work experience.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Organizational support and family support systems could help mitigate work-family conflict.

    “Notably, our study also found that organizational support (i.e., supportive working environment and flexibility in work schedule) and family support systems could help to mitigate work-family conflict.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Clinical nurses believe that legislative provision and supportive policy is an effective approach to improve social status and professional image.

    “Participants believe that legislative provision and supportive policy was an effective approach to improve social status and professional image.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Organization-level factors associated with clinical nurses' mental health include organizational climate, organizational support, career plateau, and job control.

    “Participants perceived that their mental health was influenced by the following four organizational-level factors, including (1) organization climate, (2) organization support, (3) career plateau, and (4) job control.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Social-level factors associated with clinical nurses' mental health include compensation package, social status, and legislative provision and policy.

    “Participants identified three social-level factors associated with the mental health, including (1) compensation package, (2) social status, and (3) legislative provision and policy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Support from other supervisors and coworkers could create a healthy work environment, which is associated with improved mental health of nurses.

    “We also found that support from other supervisors and coworkers could create healthy work environment, which is associated with improved mental health of nurses.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The study advances the literature by emphasizing that mental health is influenced by multi-level factors, the interaction between factors, and the reciprocal relationship between individuals' mental health and their environments.

    “The study advances the literature by emphasizing (1) the mental health is influenced by multi-level factors which include intrapersonal - (i.e., personality traits, quality of sleep, workplace adaptability, and years of work experience), interpersonal (i.e., interpersonal support and role conflict), organizational (i.e., organization climate, organization support, career plateau, and job control),”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The prevalence of burnout, depression, and anxiety among Chinese clinical nurses was 34%, 55.5%, and 41.8%, respectively.

    “A survey of clinical nurses from 30 Chinese provinces indicated that the rates of burnout, depression, and anxiety was 34%, 55.5%, and 41.8%, respectively [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Li Y, Fan R, Lu Y, Li H, Liu X, Kong G et al. Prevalence of psychological symptoms and associated risk factors among nurses in 30 provinces during the COVID-19 pandemic in China. Lancet Reg Health–Western Pac. 2023;30. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Previous studies fail to offer a complete picture of factors at multiple levels and examine interactions between factors.

    “Therefore, these studies fail to offer a complete picture of factors at multiple levels and examine interactions between factors.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Participants were recruited through the existing network of the author team, which may lead to selection bias.

    “Our participants were recruited through the existing network of the author team, which may lead to selection bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Three authors independently coded the transcripts line by line and deliberated to form a preliminary coding framework.

    “Three authors (the second, eighth, and ninth authors) independently coded the transcripts line by line and then deliberated to form a preliminary coding framework.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The study provides a nuanced understanding of the multifaceted factors influencing nurses' mental health.

    “Our study provides a nuanced understanding of the multifaceted factors influencing nurses’ mental health.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study's rigor was established through attention to credibility, transferability, dependability, and confirmability.

    “The study’s rigor was established through meticulous attention to credibility, transferability, dependability, and confirmability [30].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Lincoln YS, Guba EG. Naturalistic inquiry. sage; 1985. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Mental health is affected by factors at multiple levels and interaction between factors according to the social ecological model.

    “According to the social ecological model, mental health is affected by factors at multiple levels and interaction between factors.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996;10(4):282–98. https://doi.org/10.4278/0890-1171-10.4.282. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Data saturation was reached.

    “Preliminary data collection and data analysis were conducted simultaneously, which enabled collection to cease on reaching data saturation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The study only recruited clinical nurses in one tertiary hospital, which may limit its generalizability.

    “This study only recruited clinical nurses in one tertiary hospital, which may limits its generalizability.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The larger study was registered with Chinese Clinical Trial Registry.

    “The larger study was registered with Chinese Clinical Trial Registry: ChiCTR2300072142 (05/06/2023) https://www.chictr.org.cn/showproj.html?proj=192676.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study is reported according to COREQ.

    “This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Mental health problems among clinical nurses affect their personal well-being, work performance, patient care quality, and the healthcare system.

    “The mental health problems among clinical nurses affects their personal well-being, work performance, patient care quality, and the healthcare system.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The social ecological model includes four levels: individual, interpersonal, organizational, and societal.

    “This model includes four levels: individual, interpersonal, organizational and societal.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996;10(4):282–98. https://doi.org/10.4278/0890-1171-10.4.282. source

      Not checked in the free run.

21 of 21

  • The paper relies on this without support.

    The majority of extant studies adopt quantitative design with standardized measurements, which may neglect the intricacies of personal experiences and the significance of context.

    “Additionally, the majority of extant studies adopt quantitative design with standardized measurements, which may neglect the intricacies of personal experiences and the significance of context.”

  • The paper relies on this without support.

    This is the first qualitative study to explore factors associated with mental health of clinical nurses using the socio-ecological model.

    “To our knowledge, this is the first qualitative study which explored factors associated with mental health of clinical nurses by using socio-ecological model.”

  • The paper relies on this without support.

    Focus group interviews encourage the free exchange of information and yield richer data and deeper insights into the topic.

    “Focus group interviews were used for data collection to encourage the free exchange of information and to yield richer data and deeper insights into the topic.”
3 of 3

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?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Quotation is attributed to an unlisted F7P7

    Minor

    The social-status quotation is attributed to F7P7, but the participant table ends group F7 at F7P6.

  • Seven groups of at least seven cannot contain only 48 participants

    Minor

    Seven focus groups with seven or eight participants each would require at least 49 participants, but the paper says 48 completed the interviews.

  • Reported gender counts do not total 48 participants

    Minor

    The reported 37 female and 5 male participants total 42, leaving six of the 48 interviewed nurses unaccounted for. The participant table also lists different gender counts.

    Reported 48 · recomputed 42

  • Quotation is attributed to an unlisted F2P8

    Minor

    The compensation-package quotation is attributed to F2P8, but Table 1 lists group F2 only through F2P6 before beginning group F3.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Department NRE. Interpretation of the national nursing development plan (2016–2020)》. Nurs Res. 2016;30(35):4608.

Cited by

Sorted by citations

Related

Authors
Yu, Q., Huang, C., Tian, Y., Yang, J., Li, X., Ning, M., Chen, Z., Du, J., He, J., & Li, Y.
Affiliations
  • Central South University (CN)
  • Changsha Medical University (CN)
Corresponding author
Li, Yamin
ORCID
Venue
BMC Nursing
Publisher
Springer Science and Business Media LLC
Published
2024-05-16
Volume
23
Issue
1
Pages
330-330
ISSN
1472-6955 (ISSN-L)
DOI
10.1186/s12912-024-02005-9
PMC
PMC11097552
OpenAlex
W4396957980
Semantic Scholar
57bde8ed1fba99892f7c3a17eeb5080929733015
Cited by
32
References
48
Citations by year
2026: 9 · 2025: 19 · 2024: 4
FWCI
27.13
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Nursing (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Chinese Nursing Association (ZHKY202306)
Topics
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
Keywords
nurse mental health, socio-ecological model, burnout, depression, anxiety, personality traits, sleep quality, role conflict, organizational climate, organizational support, job control, career plateau, compensation, social status, nursing policy, interpersonal support, work experience

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