Liu Zhang; Qin Zhang; ShuWen Li; YuHong Li; GuoCui Wu; Ying Chen; YunNa Zhou

doi:10.4040/jkan.24044

Articles

Page Path: HOME > J Korean Acad Nurs > Volume 54(4); 2024 > Article

Research Paper
The Mediating Role of Psychological Resilience in Chinese Nursing Students’ Professional Identity and Learning Burnout: Liu Zhang^1,*, Qin Zhang^1,2,*, ShuWen Li¹, YuHong Li¹, GuoCui Wu¹, Ying Chen¹, YunNa Zhou¹; Journal of Korean Academy of Nursing 2024;54(4):509-518.
DOI: https://doi.org/10.4040/jkan.24044
Published online: November 25, 2024

¹School of Nursing, Anhui Medical University, Hefei, China

²Operating Theatre, The First Affiliated Hospital of Anhui Medical University, Hefei, China

Address reprint requests to : Li, YuHong School of Nursing, Anhui Medical University, Feicui Road, Jingkai District, Hefei, Anhui Province 230032, P.R.China Tel: +86-551-63869161 Fax: +86-551-63869169 E-mail: lyh931024@126.com

*These authors contributed equally as first authors.

• Received: March 28, 2024 • Revised: August 13, 2024 • Accepted: September 21, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

72 Views
8 Download

prev next

Full Article

Download PDF

Abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION
Article Information
References

Abstract

Purpose
This study investigated whether professional identity predicts learning burnout among Chinese nursing students, and whether resilience moderates this relationship.
Methods
This cross-sectional study recruited 635 students from a nursing college at a medical university in Hefei, China. Data were collected using the professional identity questionnaire, learning burnout scale for college students, and 10-item Connor-Davidson Resilience Scale. Pearson’s correlation analysis was used to investigate the relationships between variables. The mediation effect was evaluated using linear regression and the bootstrap method in SPSS.
Results
Nursing students exhibited intermediate learning burnout levels (score: 54.95 ± 10.42). Professional identity was positively correlated with psychological resilience (r = .42, p < . 001), whereas learning burnout was negatively correlated with professional identity (r = - .54, p < . 001) and psychological resilience (r = - .57, p < . 001). Psychological resilience mediated the relationship between professional identity and learning burntout to the tune of 32.8%.
Conclusion
Psychological resilience mediates the relationship between professional identity and learning burnout. Thus, nursing educators can mitigate student burnout by developing their students' professional identities and psychological resilience.
Key words: Students; Nursing; Resilience; Burnout, Psychological; Professional Role

INTRODUCTION

Chinese nurses are currently confronted with the difficulty of engaging in high-intensity and high-risk work due to the effects of population aging and changes in the disease spectrum [1,2]. Although China has the highest number of nurses (5.20 million) [3], its ratio of nurses to the population is far lower than in industrialized nations: just 3.70 nurses per 1,000 people in 2022, according to the National Health Commission of the People’s Republic of China [4]. A significant proportion of nurses resign from their positions as a result of the stress caused by the insufficient nurse-to-patient ratio [5,6]. This detrimental cycle might worsen the absence of nursing workers. Studies suggest that learning burnout can significantly affect students’ academic progress, retention, and clinical performance [7,8]. Moreover, nursing students play a vital role in the reserve nursing team, and mitigating learning burnout at the student level could potentially contribute to a further decrease in the turnover of clinical nurses. Therefore, addressing the issue of learning burnout among nursing students is a priority.

Researchers found that burnout is a state of psychological distress caused by a lack of timely and effective stress relief [9]. Graduates with mental health conditions like learning burnout from their undergraduate years may experience difficulties when they enter the clinical setting. Burnout in creased linearly in a long-term prospective cohort study including 281 students from their first semester of college to 10 months after graduation [10]. Studies conducted on nursing students have shown a strong negative relationship between professional identity and learning exhaustion [11]. However, there is a significant lack of knowledge about the impact of professional identity on learning burnout.

A positive professional identity plays a crucial role in delivering high-quality patient care, enhancing clinical performance, and improving staff retention rates [12]. Studies have demonstrated that an individual’s professional identity can be understood as their self-concept in connection to their work or as their professional self [13]. A nurse’s professional identity, according to Simmonds et al. [14], is the collection of values and beliefs that guide their interactions with patients. The process of developing a professional identity is intricate and dynamic, and the undergraduate years are crucial for developing nurses’ professional skills and morals [5]. The time spent in nursing education is crucial in shaping a nurse’s professional identity [15].

The salutogenic model provides an in-depth look at internal processes by emphasizing personal resources for dealing with stressful situations [16]. General resistance resources (GRRs) refer to the various tools individuals possess to effectively cope with challenges, including resilience [17,18]. This suggests that people use their current or possible resources to deal with stress. It has been established that GRRs are a substantial indicator of professional identity in nurses [19]. The capacity for psychological resilience is a protective factor in the face of adversity [20]. A strong sense of professional identity was associated with greater psychological resilience among students [15]. Educators in the nursing field can help students avoid burnout by creating an attractive learning environment to build resilience [21]. Moreover, a study conducted on senior nursing students revealed that resilience played a partially mediating role in the association between learning engagement and professional identity [22]. Concerning this, psychological resilience could potentially play a role in moderating the relationship between professional identity and learning burnout. Therefore, this study examines, with a focus on strengths, whether maintaining an ongoing professional identity and strong psychological resilience can help prevent learning burnout during the learning process. In addition, we proposed that the relationship between a person’s professional identity and learning burnout might be influenced by their psychological resilience.

METHODS

1. Study design and participants

This study’s design was cross-sectional. Convenience sampling was used to recruit 635 undergraduate nursing students from a university in Hefei, China, between September and November of 2023. Inclusion criteria were as follows: (1) Full-time enrollment in a four-year nursing program, and students living on campus; (2) Informed consent and voluntary participation; (3) Fluency in Mandarin. The sample size for this study was based on the requirement of 30 participants for each study variable [23].

Since this study includes 20 research variables (non-descriptive variables), at least 600 participants were needed to ensure accuracy. A total of 646 questionnaires were distributed, and 635 were valid, resulting in an effective rate of 98.3% and satisfying the sample demand. Eleven questionnaires were deemed invalid due to the presence of identical, consistent responses or inadequate completion time.

2. Instruments

1) Questionnaire on professional identity for baccalaureate nursing students

This study employed the questionnaire on professional identity for baccalaureate nursing students developed by Hu ZH [24]. The questionnaire is then applied to assess the current state of professional identity among nursing undergraduates in China. The questionnaire consists of two sections. The first section consists of demographic data of nursing students: gender, grade, family place of origin (according to the administrative division of regions in China), the order of major admission, the reasons for studying nursing, academic performance, the experience of being a student leader, family income, nursing role model, whether being from a one-child family. The second section includes six dimensions (contains 25 ordered items), which are professional cognition (5 items), professional emotion (5 items), professional will (6 items), professional values (1 item), professional skills (5 items) and professional expectations (3 items). The Likert 5-point scale was used to rate every response. The overall score ranges from 25 to 125, indicating a positive correlation between higher scores and a greater sense of professional identity. Professional disapproval is observed when the score falls within the range of 25 to 50. A moderate level of professional identification is shown when the score is between 50 and 100. A high degree of professional identity is reflected when the score is from 100 to 125 [24]. The Cronbach’s α coefficient for the entire scale in the present study was determined to be .86.

2) The college students’ learning burnout scale

Lian et al. [25] developed a learning burnout scale to assess parameters for college students. The measure consists of a total of 20 items, divided into three aspects: depression (8 items), misbehavior (6 items), and low sense of achievement (6 items). The Likert scale is employed for each item, where a score of 1 denotes “completely inconsistent” and a score of 5 signifies “completely consistent.” Higher total scores indicate greater learning burnout [25]. The total average score of learning burnout is “≤ 3” as no learning burnout, “3~4” as mild to moderate learning burnout, and “≥ 4” as severe burnout. The scale used in this research had a Cronbach’s α of .89.

3) The 10-Item Connor-Davidson Resilience Scale

In 2003, Connor-Davidson created the Connor-Davidson Resilience Scale (CD-RISC) [26], which was originally developed in English, and then translated and improved by Wang et al. [27] in 2010. It consists of 10 items and serves as a generic resilience instrument to measure the ability to recover from a difficult circumstance [27]. The items encompass attributes such as “flexibility in response to change”, “ability to handle unforeseen challenges”, and “inclination to perceive the optimistic aspects of problems”. Each item can be awarded a maximum of 4 points out of a possible 5. Greater psychological resilience is indicated by higher overall scores, which are measured on a scale of 40. The investigation yielded a Cronbach’s α coefficient of .94.

3. Data collection

The ‘Questionnaire Star’ network platform was used to administer the online survey that collected the data. Counselors from each grade were recruited into the program and given uniform training. The counselor shared the quick response code of the electronic questionnaire with the WeChat (the most popular and practical instant communication software in China) Class management group. To evaluate the readability of the questionnaire, a preliminary survey was carried out with a sample of 10 students in this study. The researchers implemented standardized advice to outline the prerequisites for filling out the questionnaire. Following the provision of informed consent, nursing students completed the questionnaire autonomously and confidentially.

4. Data analysis

The data were analyzed using IBM SPSS Statistics 23 (IBM Co.), where the PROCESS macro plug-in (PROCESS V3.4) was added. Descriptive statistics were employed to briefly explain the demographic data of nursing students. A Kolmogorov-Smirnov test was conducted to assess the normality of the data. We employed descriptive statistics to analyze the demographic data of nursing students and identify correlations among our variables of interest. A Pearson correlation study was conducted to investigate the relationship between professional identity, psychological resilience, and learning burnout. In addition, a single-factor test devised by Harman was employed to detect the existence of common method variance (CMV). The hypothesized relationships between professional identity (X), psychological resilience (M), and learning burnout (Y) were investigated in this mediation analysis. For the mediation model, we used the linear regression analysis and the PROCESS Macro Model 4 in SPSS [28]. The mediating effects were computed using the bias-corrected bootstrapping approach. Significant mediating (indirect) effects are present when the confidence interval (CI) does not contain zero. The α calibration level was .05, and p < .050 indicated statistically significant.

5. Ethical consideration

The Anhui Medical University Ethics Committee (IRB No. 2021H010) approved this study. Before participating in the survey, each student reviewed and digitally endorsed a formal informed consent document. Undoubtedly, they were informed that they had the option to withdraw at any given moment. The responses of the respondents were provided anonymously, and the obtained data were solely used for research objectives.

RESULTS

1. Demographic data of participants

There were 635 nursing students, with 162 men (25.5%) and 473 women (74.5%) enrolled. Of these, 132 (20.8%) were the only child in their family, and 262 (41.3%) had relatives or friends in medical-related fields as nursing role models. Approximately 68.5% of the sample population (435) did not rank nursing as their top major option but did rank professional dispensing (professional dispensing refers to students’ professional first choice is not nursing). Table 1 presents a concise overview of the demographic information. Learning burnout was found to vary significantly by grade The Mediating Role of Psychological Resilience in the Professional Identity and Learning Burnout https://doi.org/10.4040/jkan.24044 (F = 1.39, p = .039), motivation for entering the nursing profession (F = 1.98, p < .001), experience of being student leaders (t = 3.73, p < .001), and academic performance (F = 2.14, p < .001), as determined by a t-test or one-way ANOVA. Other demographic data did not show statistically significant differences in learning burnout.

2. Scores of professional identity, psychological resilience, and learning burnout in participants

Nursing students scored 87.80 ± 9.57 on the total professional identity, 26.31 ± 6.21 on psychological resilience, and 54.95 ± 10.42 on learning burnout. The scores of learning burnout in freshmen, sophomore, and junior gradually decreased in turn, and the scores were 57.25 ± 10.04, 54.76 ± 11.29, and 53.21 ± 10.10, respectively (Table 1). In contrast, the scores of professional identity in freshman, sophomore, and junior gradually increased in turn, and the scores were 84.66 ± 8.49, 85.30 ± 9.05, and 91.12 ± 9.48, respectively. The scores of psychological resilience in freshman, sophomore, and junior were 25.87 ± 5.61, 26.97 ± 6.90 and 26.43 ± 6.40, respectively. Statistical significance was observed in the scoring of learning burnout and professional identity across different grades (p < .050). However, there was no statistically significant variation in the scores of psychological resilience among the different grades (p > .050). Table 2 displays the mean score of the overall scale and individual dimensions on the professional identity and learning burnout measures. Furthermore, 191 nursing students had learning burnout, accounting for 30.1%, and 3 had severe learning burnout.

3. Correlation among professional identity, psychological resilience, and learning burnout

Harman’s single-factor test indicated that the unrotated first common factor in the principal component analysis accounted for 26.5% of the variance, which is below the threshold of 40.0% [29]. This finding suggests that there is no significant common method bias present. Based on a Pearson correlation analysis, there was a significant negative correlation between learning burnout and professional identity (r = - .54, p < .001), as well as between learning burnout and psychological resilience (r = - .57, p < .001). Furthermore, there was a positive correlation between professional identity and psychological resilience (r = .42, p < .001).

4. Mediation analysis of psychological resilience between professional identity and learning burnout

The sociodemographic variables (year in school, motivation for entering the nursing profession, experience as a student leader, and academic achievement) were controlled to ascertain the significance of the direct, indirect, and total impacts. The mediating function of psychological resilience was examined using linear regression. The gross explanatory value of professional identity concerning learning burnout amounted to 29.0% (F = 254.78, p < .001). The results demonstrated that the total effect of professional identity on learning burnout was significant (c = - .58, p < .001). Furthermore, Table 3 presents the findings of a mediation model study in which the PROCESS Macro Model 4 in SPSS [28] used psychological resilience as the intermediary variable. The results obtained from the two methods of analysis corroborate each other. Students who reported a stronger professional identity exhibited higher levels of psychological resilience (a = .27), and those with elevated psychological resilience demonstrated reduced levels of learning burnout (b = - .71).

Additionally, the indirect effect of psychological resilience had a 95% confidence interval of - .24 to - .15 (excluding 0). Moreover, with a standardized effect size of - .19, psychological resilience has a significant indirect effect. Table 4 demonstrates how psychological resilience, which accounts for 32.8% of the total effect, moderates professional identity and learning burnout. The suggested model is shown in Figure 1.

DISCUSSION

The present study found learning burnout among nursing students was moderate, which is consistent with prior findings [30]. Learning burnout was detected in 30.1% of nursing students, similar to the findings of Vasconcelos et al. [31] and suggests that college students’ learning environments need improvement. The freshmen burnout score was the highest among the grades, likely due to the significant learning workload associated with entering a new field of medicine, the challenges of adapting to an unfamiliar environment, and the difficulties encountered during the transition to independent learning in a university setting. Previous research has demonstrated that the nursing internship program for fourth-year students substantially increases their levels of learning burnout, possibly due to their anxiety about the upcoming shift from being nursing students to becoming healthcare professionals [21]. The results of this study can be attributed to the lack of fourth-year nursing students.

In this study, the total score of the nursing professional identity was 87.80 ± 9.57, and the professional identity level was in the general state, similar to the results reported in previous studies [32,33]. Only 8.0% of nursing students chose to major in nursing out of their “own interest”, which may explain why many experience academic and emotional distress. This study revealed that as students progress through higher grade levels, those with a stronger sense of professional identity tend to experience lower levels of learning burnout. With the in-depth study of nursing courses, students develop a stronger professional curiosity, resulting in an improved sense of professional identity and ultimately reducing the occurrence of learning burnout. Amidst the COVID-19 pandemic, senior students have participated in the vocational practicum course using online platforms. This experience has allowed them to gain a deep understanding and admiration for the commitment of nurses to saving lives, which aligns with previous research findings [34]. Wei et al. [32] found that students’ self-assurance increased as they progressed through their nursing education. Students who possess a well-defined professional identity in nursing demonstrate a comprehensive understanding of the field, demonstrate intense professional emotions, and possess a strong determination to excel in their professional endeavors. They commit themselves to the profession of nursing and strive to enhance the domain of nursing science. This also emphasized the importance of developing a stronger professional identity among nursing students in higher education to reduce instances of learning burnout. An optimal and nurturing atmosphere, in which educators sincerely demonstrate concern for their students, is essential for fostering academic achievement [35]. Simultaneously, it is crucial to develop an optimistic mindset among students and promote their enthusiastic participation in group activities.

The correlation analysis showed that professional identity and psychological resilience were negatively and strongly correlated with learning burnout, which was corroborated by other studies [10,30]. Greater psychological resilience among nursing students will help them to mature personally and survive through adversity. Resilience training has been shown in a recent systematic review to help with this problem [21].

According to the mediation analysis, the link between professional identity and learning burnout among Chinese nursing students was mediated by psychological resilience. Previous research has identified associations between psychological resilience, professional identity, and learning burnout, but a direct causal relationship among these three categories has not been shown. Psychological resilience was found to partially buffer the relationship between professional identity and learning burnout in nursing students. Mental resilience has been proven to mitigate the harmful effects of stress on mental health [36], alleviate the symptoms of psychological distress, and encourage adaptation. A lack of professional identity causes learning burnout, and those with a high degree of psychological resilience can better adjust to new situations and solve problems. Psychological resilience plays an important role in the development of occupational identity [34]. The salutogenic hypothesis is supported by this result, which is compatible with this concept. Therefore, our findings support the idea that psychological resilience moderates the relationship between learning burnout and professional identity from a strength-based perspective.

1. Implications for nursing education

The results of this study indicated that professional identity and psychological resilience have both direct and indirect impacts on learning burnout in nursing students. Therefore, there are still numerous steps that can be taken to alleviate the learning burnout experienced by nursing students. First and foremost, educators should give utmost importance to the comprehensive formation of their students’ professional identities by incorporating nursing ideals into instruction throughout their academic journey. Secondly, educators in the field of nursing should foster an atmosphere that is both supportive and encouraging for their students, with a focus on helping them cultivate psychological resilience [37,38] and tenacity. Thirdly, nursing students should exhibit a positive attitude towards their surroundings, actively engage in diverse club activities, and proactively pursue knowledge to enhance their cognitive abilities. This strategy not only reduces the stress related to education but also encourages a real passion for knowledge acquisition, thus lowering the possibility of learning burnout.

2. Limitations of the study

There are several limitations to this study. First, the difficulty in evaluating possible causes and effects emerged from the adoption of a cross-sectional design in the study, as compared to a longitudinal approach. In the future, a prospective intervention study can be conducted to validate this mediation model and improve psychological resilience. Furthermore, future research should encompass a wider array of variables that contribute to the phenomenon of learning burnout.

CONCLUSION

This study is the first to examine how psychological resilience affects the connection between nursing students’ professional identity and their experience of learning burnout. To reduce learning burnout, it is important to supply nursing students with the necessary resources to develop an effective professional identity and psychological resilience. University administrators and educators can adopt more practical strategies to improve students’ professional identity and psychological resilience. This can be achieved through the use of interactive teaching methods and the organization of social practice activities, which are crucial in reducing learning burnout.

Article Information

CONFLICTS OF INTEREST

The authors declared no conflict of interest.

ACKNOWLEDGEMENTS

The authors acknowledge the contributions of all the participants.

FUNDING

This research was funded by the Teaching Research Project of Provincial Quality Project of Anhui Higher Education Institution (No. 2021jyxm0682), the key research project of Anhui Nursing Association (No. AHHLa202107), the New Era Education Project of Provincial Quality Project of Anhui Higher Education Institution (No. 2022jyjxggyj206), and national college students innovation and entrepreneurship training program (No. 202310366036).

DATA SHARING STATEMENT

Please contact the corresponding author for data availability.

AUTHOR CONTRIBUTIONS

Conceptualization or/and Methodology: Zhang L & Zhang Q & Li S & Li Y & Wu G & Chen Y & Zhou Y.

Data curation or/and Analysis: Chen Y.

Funding acquisition: Zhang L & Zhang Q & Li S & Wu G.

Investigation: Zhang Q & Chen Y.

Project administration or/and Supervision: Zhang L & Zhang Q & Chen Y.

Resources or/and Software: Zhang L.

Validation: Zhang L & Li S & Li Y & Wu G.

Visualization: Zhang L & Zhang Q.

Writing original draft or/and Review & Editing: Zhang L & Zhang Q & Li S & Li Y & Wu G & Chen Y & Zhou Y.

Fig. 1.

Psychological resilience mediates the connection between professional identity and learning burnout.

Table 1.

Demographic Characteristic Differences in Scores of Learning Burnout (N = 635)

Variables	Categories	n (%)	The scores of learning burnout (M ± SD)	t or F (p)
Gender	Women	473 (74.5)	56.21 ± 11.18	1.78 (.076)
Gender	Men	162 (25.5)	54.52 ± 10.13
Grade	Freshman	236 (37.2)	57.25 ± 10.04	1.39 (.039)
	Sophomore	100 (15.7)	54.76 ± 11.29
	Junior	299 (47.1)	53.21 ± 10.10
Family place of origin	Countryside	317 (49.9)	55.50 ± 10.11	1.34 (.261)
	County town	135 (21.3)	53.74 ± 10.84
	City	183 (28.8)	54.89 ± 10.61
The order of voluntary admission to the nursing profession	The first choice	200 (31.5)	53.05 ± 10.37	1.22 (.139)
	The second choice	66 (10.4)	55.53 ± 10.32
	The third choice	36 (5.7)	56.72 ± 8.44
	The fourth choice	49 (7.7)	55.39 ± 11.43
	The professional adjustment	284 (44.7)	55.86 ± 10.41
Motivation for entering the nursing profession	Own interest	51 (8.0)	47.92 ± 9.87	1.98 (< .001)
	Others' suggestions	92 (14.5)	54.79 ± 11.19
	Easy to find a job	270 (42.5)	55.47 ± 9.42
	Others	222 (35.0)	56.01 ± 10.82
Academic performance	Excellent	45 (7.1)	48.18 ± 9.60	2.14 (< .001)
	Good	245 (38.6)	52.17 ± 9.60
	Average	239 (37.6)	56.90 ± 10.14
	Poor	101 (15.9)	59.66 ± 9.99
	Terrible	5 (0.8)	64.40 ± 9.13
Experience of being student leaders	Yes	290 (45.7)	56.37 ± 9.83	3.73 (< .001)
Experience of being student leaders	No	345 (54.3)	53.28 ± 10.87
Monthly family income (RMB)	< 1,000	141 (22.2)	54.65 ± 10.48	1.38 (.252)
	1,000~2,000	202 (31.8)	55.95 ± 9.94
	> 2,000	292 (46.0)	54.41 ± 10.70

M = Mean; RMB = Renminbi (Chinese yuan); SD = Standard deviation.

Table 2.

The Average Total and Subscale Scores of Participants' Professional Identity and Learning Burnout (N = 635)

Variables	The average score (M ± SD)
The total scale of the professional identity	3.51 ± 0.38
Professional emotion	3.14 ± 0.60
Professional cognition	3.29 ± 0.59
Professional will	3.41 ± 0.46
Professional values	3.42 ± 0.75
Professional skills	3.70 ± 0.41
Professional expectations	4.42 ± 0.36
The total scale of the learning burnout	2.75 ± 0.52
Low sense of achievement	2.71 ± 0.53
Misbehavior	2.75 ± 0.62
Depression	2.77 ± 0.67

M = Mean; SD = Standard deviation.

Table 3.

Results of Mediation Analysis Using PROCESS (N = 635)

Models	Dependent variables	Independent variables	R	R²	F	β	t
1	Learning burnout	Professional identity	.54	.29	254.78^***	– .58	– 15.96^***
2	Psychological resilience	Professional identity	.42	.18	131.86^***	.27	11.48^***
3	Learning burnout	Professional identity	.66	.44	241.12^***	– .39	– 10.98^***
		Psychological resilience				– .71	– 12.75^***

^***p < .001.

Table 4.

Results of the Bias-Corrected Bootstrapping Method (N = 635)

Influencing path	Standardized effect size	Standard error	Bootstrap 95% CI		Percentage of the total effect
Influencing path	Standardized effect size	Standard error	LLCI	ULCI	Percentage of the total effect
Total effect	– .58	.04	– .66	– .51
Direct effect	– .39	.04	– .46	– .32	67.2%
Indirect effect	– .19	.02	– .24	– .15	32.8%

LLCI = Lower limit confidence interval; ULCI = Upper limit confidence interval.

References

1. Ren Z, Zhang X, Li X, He M, Shi H, Zhao H, et al. Relationships of organisational justice, psychological capital and professional identity with job burnout among Chinese nurses: A cross-sectional study. Journal of Clinical Nursing. 2021;30(19-20):2912-2923. https://doi.org/10.1111/jocn.15797Article PubMed
2. Sun Y, Wang D, Han Z, Gao J, Zhu S, Zhang H. Disease prevention knowledge, anxiety, and professional identity during COVID-19 pandemic in nursing students in Zhengzhou, China. Journal of Korean Academy of Nursing. 2020;50(4):533-540. https://doi.org/10.4040/jkan.20125Article PubMed
3. World Health Organization (WHO). Global Health Observatory data repository [Internet]. WHO; c2023 [cited 2023 Jan 12]. Available from: https://apps.who.int/gho/data/node.main.HWFGRP_0040?lang=en
4. National Health Commission of the People’s Republic of China. [Transcript of the press conference of the National Health Commission on May 11] [Internet]. National Health Commission of the People’s Republic of China; c2023 [cited 2023 May 11]. Available from: http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=779c00ca270b-46c5ac8550052107bfe5. Chines
5. Gao Z, Wei X, Yang L, Cui D, Kong L, Qi L, et al. Mediating role of career self-efficacy between clinical learning environment and professional identity in nursing students. Journal of Advanced Nursing. 2022;78(4):1012-1019. https://doi.org/10.1111/jan.15027Article PubMed
6. Melnyk BM. Burnout, depression and suicide in nurses/clinicians and learners: An urgent call for action to enhance professional well-being and healthcare safety. Worldviews on Evidence-Based Nursing. 2020;17(1):2-5. https://doi.org/10.1111/wvn.12416Article PubMed
7. Olvera Alvarez HA, Provencio-Vasquez E, Slavich GM, Laurent JGC, Browning M, McKee-Lopez G, et al. Stress and health in nursing students: The Nurse Engagement and Wellness Study. Nursing Research. 2019;68(6):453-463. https://doi.org/10.1097/NNR.0000000000000383Article PubMed PMC
8. Pérez-Fuentes MC, Molero-Jurado MM, Gázquez-Linares JJ, Simón-Márquez MM. Analysis of burnout predictors in nursing: Risk and protective psychological factors. The European Journal of Psychology Applied to Legal Context. 2019;11(1):33-40. https://doi.org/10.5093/ejpalc2018a13Article
9. Maslach C, Leiter MP. Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry. 2016;15(2):103-111. https://doi.org/10.1002/wps.20311Article PubMed PMC
10. Monrouxe LV, Bullock A, Tseng HM, Wells SE. Association of professional identity, gender, team understanding, anxiety and workplace learning alignment with burnout in junior doctors: A longitudinal cohort study. BMJ Open. 2017;7(12):e017942. https://doi.org/10.1136/bmjopen-2017-017942Article PubMed PMC
11. Hu P, Kong LN, Chen SZ, Luo L. The mediating effect of self-directed learning ability between professional identity and burnout among nursing students. Heliyon. 2024;10(6):e27707. https://doi.org/10.1016/j.heliyon.2024.e27707Article PubMed PMC
12. Wei LZ, Zhou SS, Hu S, Zhou Z, Chen J. Influences of nursing students’ career planning, internship experience, and other factors on professional identity. Nurse Education Today. 2021;99:104781. https://doi.org/10.1016/j.nedt.2021.104781Article PubMed
13. Slay HS, Smith DA. Professional identity construction: Using narrative to understand the negotiation of professional and stigmatized cultural identities. Human Relations. 2011;64(1):85-107. https://doi.org/10.1177/0018726710384290Article
14. Simmonds A, Nunn A, Gray M, Hardie C, Mayo S, Peter E, et al. Pedagogical practices that influence professional identity formation in baccalaureate nursing education: A scoping review. Nurse Education Today. 2020;93:104516. https://doi.org/10.1016/j.nedt.2020.104516Article PubMed
15. Jafarianamiri SR, Qalehsari MQ, Zabihi A. Investigating the professional identity and resilience in nursing students during the COVID-19 pandemic. Journal of Education and Health Promotion. 2022;11:151. https://doi.org/10.4103/jehp.jehp_388_21Article PubMed PMC
16. Kelner M. Unraveling the mystery of health: How people manage stress and stay well. Aaron Antonovsky. Jossey-Bass Publishers, San Francisco, 1987. $35.00. Canadian Journal on Aging / La Revue Canadienne du Vieillissement. 1988;7(1):77-79. https://doi.org/10.1017/S0714980800007133Article
17. Heinen I, Bullinger M, Kocalevent RD. Perceived stress in first year medical students -associations with personal resources and emotional distress. BMC Medical Education. 2017;17(1):4. https://doi.org/10.1186/s12909-016-0841-8Article PubMed PMC
18. Moksnes UK, Haugan G. Validation of the Resilience Scale for Adolescents in Norwegian adolescents 13-18 years. Scandinavian Journal of Caring Sciences. 2018;32(1):430-440. https://doi.org/10.1111/scs.12444Article PubMed
19. Wu X, Lu Y, Zhang Q, Wang H, Sun X, Han H, et al. Stress/resource complex, sense of coherence and professional identity among nursing students: A latent profile and mediation analysis. Psychology Research and Behavior Management. 2022;15:2409-2420. https://doi.org/10.2147/PRBM.S378088Article PubMed PMC
20. Jackson D, Hutchinson M, Everett B, Mannix J, Peters K, Weaver R, et al. Struggling for legitimacy: Nursing students’ stories of organisational aggression, resilience and resistance. Nursing Inquiry. 2011;18(2):102-110. https://doi.org/10.1111/j.1440-1800.2011.00536.xArticle PubMed
21. Wei H, Dorn A, Hutto H, Webb Corbett R, Haberstroh A, Larson K. Impacts of nursing student burnout on psychological well-being and academic achievement. The Journal of Nursing Education. 2021;60(7):369-376. https://doi.org/10.3928/01484834-20210616-02Article PubMed
22. Lin Y, Chen Y, Peng Y, Zhang X, Liao X, Chen L. Mediating role of resilience between learning engagement and professional identity among nursing interns under COVID-19: A cross-sectional study. Nursing Open. 2023;10(6):4013-4021. https://doi.org/10.1002/nop2.1660Article PubMed PMC
23. Gray J, Grove S, Suthland S. Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence, eighth edition [Internet]. Elsevier; c2017 [cited 2016 Sep 28]. Available from: https://www.academia.edu/39306017/Burns_and_Groves_The_Practice_of_Nursing_Research_8th_Edition
24. Zhao Y, Zhou Q, Li J, Luan J, Wang B, Zhao Y, et al. Influence of psychological stress and coping styles in the professional identity of undergraduate nursing students after the outbreak of COVID-19: A cross-sectional study in China. Nursing Open. 2021;8(6):3527-3537. https://doi.org/10.1002/nop2.902Article PubMed PMC
25. Lian R, Yang L, Wu L. Relationship between professional commitment and learning burnout of undergraduates and scales developing. Acta Psychologica Sinica. 2005;37(5):632-636.
26. Connor KM, Davidson JR. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety. 2003;18(2):76-82. https://doi.org/10.1002/da.10113Article PubMed
27. Wang L, Shi Z, Zhang Y, Zhang Z. Psychometric properties of the 10-item Connor-Davidson Resilience Scale in Chinese earthquake victims. Psychiatry and Clinical Neurosciences. 2010;64(5):499-504. https://doi.org/10.1111/j.1440-1819.2010.02130.xArticle PubMed
28. Bolin JH, Andrew F. Hayes (2013). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York, NY: The Guilford Press. Journal of Educational Measurement. 2014;51(3):335-337. https://doi.org/10.1111/jedm.12050Article
29. Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: A critical review of the literature and recommended remedies. The Journal of Applied Psychology. 2003;88(5):879-903. https://doi.org/10.1037/0021-9010.88.5.879Article PubMed
30. Gong Z, Wang H, Zhong M, Shao Y. College students’ learning stress, psychological resilience and learning burnout: Status quo and coping strategies. BMC Psychiatry. 2023;23(1):389. https://doi.org/10.1186/s12888-023-04783-zArticle PubMed PMC
31. Vasconcelos EM, Trindade CO, Barbosa LR, Martino MMF. Predictive factors of burnout syndrome in nursing students at a public university. Revista da Escola de Enfermagem da U S P. 2020;54:e03564. English, Portuguese. https://doi.org/10.1590/S1980-220X2018044003564Article PubMed
32. Wei H, Henderson D, Peery A, Andrews A. Nursing students’ perceptions of faculty caring as a predictor of students’ caring behaviors. International Journal for Human Caring. 2021;25(2):123-130. https://doi.org/10.20467/HumanCaring-D-20-00034Article
33. Sang N, Zhu ZZ, Wu L, Shi PL, Wang LW, Kan HY, et al. The mediating effect of psychological resilience on empathy and professional identity of Chinese nursing students: A structural equation model analysis. Journal of Professional Nursing. 2022;43:53-60. https://doi.org/10.1016/j.profnurs.2022.09.002Article PubMed
34. Zhang Z, Fu W, Tian C, Zhang F, Zhao B, Mao J, et al. Professional identity of Chinese nursing students during the COVID-19 pandemic outbreak: A nation-wide cross-sectional study. Nurse Education in Practice. 2021;52:103040. https://doi.org/10.1016/j.nepr.2021.103040Article PubMed PMC
35. Henderson D, Sewell KA, Wei H. The impacts of faculty caring on nursing students’ intent to graduate: A systematic literature review. International Journal of Nursing Sciences. 2019;7(1):105-111. https://doi.org/10.1016/j.ijnss.2019.12.009Article PubMed PMC
36. Wackerhagen C, Veer IM, van Leeuwen JMC, Reppmann Z, Riepenhausen A, Bögemann SA, et al. Dynamic modelling of mental resilience in young adults: Protocol for a Longitudinal Observational Study (DynaM-OBS). JMIR Research Protocols. 2023;12:e39817. https://doi.org/10.2196/39817Article PubMed PMC
37. Sherblom JC, Umphrey LR, Swiatkowski P. Resilience, identity tension, hope, social capital, and psychological stress during a pandemic. Adversity and Resilience Science. 2022;3(1):37-51. https://doi.org/10.1007/s42844-021-00049-3Article PubMed PMC
38. Wang S, Li H, Chen X, Yan N, Wen D. Learning burnout and its association with perceived stress, social support, and the Big Five personality traits in Chinese medical students during the COVID-19 pandemic: A cross-sectional study. BMC Psychiatry. 2022;22(1):785. https://doi.org/10.1186/s12888-022-04453-6Article PubMed PMC

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

ePub Link

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

The Mediating Role of Psychological Resilience in Chinese Nursing Students’ Professional Identity and Learning Burnout

J Korean Acad Nurs. 2024;54(4):509-518. Published online November 25, 2024

DOI: https://doi.org/10.4040/jkan.24044

XML Download

Figure

We recommend

The Mediating Role of Psychological Resilience in Chinese Nursing Students’ Professional Identity and Learning Burnout

Fig. 1. Psychological resilience mediates the connection between professional identity and learning burnout.

Fig. 1.

The Mediating Role of Psychological Resilience in Chinese Nursing Students’ Professional Identity and Learning Burnout

Variables	Categories	n (%)	The scores of learning burnout (M ± SD)	t or F (p)
Gender	Women	473 (74.5)	56.21 ± 11.18	1.78 (.076)
Gender	Men	162 (25.5)	54.52 ± 10.13
Grade	Freshman	236 (37.2)	57.25 ± 10.04	1.39 (.039)
	Sophomore	100 (15.7)	54.76 ± 11.29
	Junior	299 (47.1)	53.21 ± 10.10
Family place of origin	Countryside	317 (49.9)	55.50 ± 10.11	1.34 (.261)
	County town	135 (21.3)	53.74 ± 10.84
	City	183 (28.8)	54.89 ± 10.61
The order of voluntary admission to the nursing profession	The first choice	200 (31.5)	53.05 ± 10.37	1.22 (.139)
	The second choice	66 (10.4)	55.53 ± 10.32
	The third choice	36 (5.7)	56.72 ± 8.44
	The fourth choice	49 (7.7)	55.39 ± 11.43
	The professional adjustment	284 (44.7)	55.86 ± 10.41
Motivation for entering the nursing profession	Own interest	51 (8.0)	47.92 ± 9.87	1.98 (< .001)
	Others' suggestions	92 (14.5)	54.79 ± 11.19
	Easy to find a job	270 (42.5)	55.47 ± 9.42
	Others	222 (35.0)	56.01 ± 10.82
Academic performance	Excellent	45 (7.1)	48.18 ± 9.60	2.14 (< .001)
	Good	245 (38.6)	52.17 ± 9.60
	Average	239 (37.6)	56.90 ± 10.14
	Poor	101 (15.9)	59.66 ± 9.99
	Terrible	5 (0.8)	64.40 ± 9.13
Experience of being student leaders	Yes	290 (45.7)	56.37 ± 9.83	3.73 (< .001)
Experience of being student leaders	No	345 (54.3)	53.28 ± 10.87
Monthly family income (RMB)	< 1,000	141 (22.2)	54.65 ± 10.48	1.38 (.252)
	1,000~2,000	202 (31.8)	55.95 ± 9.94
	> 2,000	292 (46.0)	54.41 ± 10.70

Variables	The average score (M ± SD)
The total scale of the professional identity	3.51 ± 0.38
Professional emotion	3.14 ± 0.60
Professional cognition	3.29 ± 0.59
Professional will	3.41 ± 0.46
Professional values	3.42 ± 0.75
Professional skills	3.70 ± 0.41
Professional expectations	4.42 ± 0.36
The total scale of the learning burnout	2.75 ± 0.52
Low sense of achievement	2.71 ± 0.53
Misbehavior	2.75 ± 0.62
Depression	2.77 ± 0.67

Models	Dependent variables	Independent variables	R	R²	F	β	t
1	Learning burnout	Professional identity	.54	.29	254.78^***	– .58	– 15.96^***
2	Psychological resilience	Professional identity	.42	.18	131.86^***	.27	11.48^***
3	Learning burnout	Professional identity	.66	.44	241.12^***	– .39	– 10.98^***
		Psychological resilience				– .71	– 12.75^***

Influencing path	Standardized effect size	Standard error	Bootstrap 95% CI		Percentage of the total effect
Influencing path	Standardized effect size	Standard error	LLCI	ULCI	Percentage of the total effect
Total effect	– .58	.04	– .66	– .51
Direct effect	– .39	.04	– .46	– .32	67.2%
Indirect effect	– .19	.02	– .24	– .15	32.8%

Table 1. Demographic Characteristic Differences in Scores of Learning Burnout (N = 635)

M = Mean; RMB = Renminbi (Chinese yuan); SD = Standard deviation.

Table 2. The Average Total and Subscale Scores of Participants' Professional Identity and Learning Burnout (N = 635)

M = Mean; SD = Standard deviation.

Table 3. Results of Mediation Analysis Using PROCESS (N = 635)

***

p < .001.

Table 4. Results of the Bias-Corrected Bootstrapping Method (N = 635)

LLCI = Lower limit confidence interval; ULCI = Upper limit confidence interval.