Perceived stress and mobile phone addiction among Chinese undergraduate nursing students: The mediating role of organisational caring climate and self-control

doi:10.21203/rs.3.rs-3451669/v1

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Research Article

Perceived stress and mobile phone addiction among Chinese undergraduate nursing students: The mediating role of organisational caring climate and self-control

https://doi.org/10.21203/rs.3.rs-3451669/v1

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Background: The rapid development of digital technology has fuelled the widespread use of various electronic devices in daily life, particularly, mobile phones. However, the alarming rise in problematic mobile phone use poses a threat to healthcare professionals’ clinical practice, resulting in adverse physiological, psychological, and social effects.

Methods: Between February and May 2023, 900 Chinese nursing graduate students from ten colleges completed questionnaires, resulting in a response rate of 98.47%. The questionnaires covered general demographics, perceived stress, organizational climate, self-control, and mobile phone addiction tendency. The data were analysed using SPSS23.0 and macro PROCESS.

Results: (1) Perceived stress among undergraduate nursing students positively correlated with mobile addiction (r=0.362, P<0.01) and negatively correlated with organisational caring climate and self-control (r = -0.162, -0.515, P<0.01). Organisational caring climate positively correlated with self-control (r=0.152,P < 0.01) and negatively correlated with mobile phone addiction (r =-0.156, P < 0.01). Self-control negatively correlated with mobile phone addiction (r = -0.468, P < 0.01). (2) Perceived stress indirectly influenced mobile addiction through three paths: the independent mediating effect of organisational caring climate, the independent mediating effect of self-control, and the chain mediating effect of organizational caring climate and self-control.

Conclusions: Greater perception of an organisational caring climate among graduate nursing students enhances their self-control abilities, facilitating effective stress management and mitigating the negative impact of mobile phone addiction on the clinical practice of healthcare professionals.

Psychosocial Job Stressors

Effort-Reward Imbalance model

Psychological Capital

Insomnia symptoms

As society has progressed, mobile phones have become an integral part of our lives. The 45th China Internet Development Statistics Report reveals that as of March 2020, the number of mobile Internet users in China reached 899 million, marking an increase of 79.92 million since the end of 2018. The proportion of Chinese Internet users reached 99.3%, a 0.7% rise from the end of 2018. However, smartphones, while providing convenience, also pose potential harm. Excessive use of mobile phones is referred to as mobile phone addiction (MPA)[1], also termed as mobile phone dependency[2] or mobile phone overuse [3]. A 2020 study indicated that China, Saudi Arabia, and Malaysia had the highest rates of mobile phone addiction[4]. The mobile phone addiction rates among medical and nursing students in China are 39.7%[5]and 25.1%[6], respectively. A global meta-analysis showed that the mobile phone addiction rate among undergraduate nursing students was 22%[5]. Mobile phone addiction has several adverse effects. Mobile phone addiction among nursing students is associated with physical pain in certain body parts [7], feelings of loneliness[8], anxiety and depression[9], poor sleep quality[10], low academic performance[11], and eating disorders[12]. According to media dependency theory, individuals who exhibit a stronger dependence on media content are more susceptible to the influences of media, which can shape their attitudes and behaviours. Particularly, severe mobile phone dependency or addiction can detrimentally affect an individual’s health, leading to irreversible consequences.

Research has shown that mobile phone addiction is a pathological phenomenon influenced by multiple factors, with the main influencing factors being high academic stress[13] and low self-control ability [14]. One study indicated that mobile phone addiction among college students is caused by high levels of perceived stress[15]. Perceived stress is the psychological response of individuals to evaluative judgments of threatening stimuli in their environment, negatively affecting their psychological well-being[16]. According to general stress theory, many problematic behaviours result from negative experiences caused by various stressors or tensions[17]. Currently, undergraduate nursing students experience significant stress, primarily attributed to academic studies and internships. The prevalence of stress-related illnesses among nursing students during internships was found to be 61.97% in one study[18]. Therefore, we propose the following hypothesis:

H1: Perceived stress positively predicts mobile phone addiction among undergraduate nursing students.

Owing to advancements in technology, the use of mobile phones has become unavoidable for nursing students. A thorough understanding of the relationship between perceived stress and students’ mobile phone addiction is insufficient to mitigate the harm of mobile phone addiction. It is crucial to explore the positive influencing factors in both areas to provide insights into reducing the prevalence of mobile phone addiction among undergraduate nursing students. Therefore, this study aimed to explore the intrinsic connections between the two.

Previous research on mobile phone addiction among college students mainly focused on demographic variables but later transitioned to exploring individual psychological characteristics and family factors. As mobile phone addiction has gradually become a significant global health issue, researchers have found that the impact of the social environment, such as interpersonal relationships, on mobile phone addiction cannot be overlooked. According to Person–Environment Interaction Theory, individual behavioural problems arise from interactions between individual factors and the environment. Perceived stress is an individual factor, whereas organizational support is an environmental factor. Perceived organisational caring climate[19] refers to nursing students’ perceptions of the support and care provided by nursing management staff (including head nurses and preceptors) during their clinical internships as well as the listening, concern, and understanding demonstrated by teachers and counsellors throughout their academic period, aiming to foster a sense of self-worth [20]. Studies have found that the lower the perceived stress level among nurses, the higher the degree of organisational support and care they receive [21]. A negative correlation exists between stress experienced by undergraduate nursing students and the degree of care provided by teachers during their academic period[22]. According to social support theory, individuals who exhibit strong social support networks are better equipped to cope with various environmental challenges. Particularly, a negative correlation exists between the perceived stress of nursing students and the care and concern they receive from their surroundings [23]. Nursing students are more susceptible to mobile phone addiction when they experience low levels of support from their surroundings, leading to heightened feelings of loneliness. This suggests that the environment interacts with individuals and influences their development. Organisational support, as an environmental factor, influences individual behaviours. Therefore, this study proposed the following hypothesis:

H2: The organisational caring climate of undergraduate nursing students mediates the relationship between perceived stress and mobile phone addiction.

Self-control is the ability to resist external temptations and achieve internal goals [24]. According to the theory of limited self-control, self-control energy is finite[25]. Self-control shares the same pool of energy with activities such as attention and emotion regulation[26]. The depletion of energy in one activity leads to a decrease in the available energy for other activities[27]. Perceived stress among undergraduate nursing students can result in negative emotions such as anxiety and depression[28], depleting self-control energy, and reducing self-control resources.. Low self-control in adolescents is associated with smartphone addiction.[29, 30] Therefore, this study proposes the following hypothesis:

H3: Self-control plays a mediating role between perceived stress and smartphone addiction.

Many theories and experimental studies have indicated that self-control is an intermediate factor that can explain the influence of environmental factors on an individual’s psychological and behavioural outcomes, encompassing both internal and external issues[31]. Organizational caring climate, as an external environmental factor, refers to the extent to which individuals are cared for by those around them. Social support significantly predicts self-control ability[32]. Specifically, the care and support individuals perceive from others can help enhance their self-control. Hence, we proposed the following hypothesis:

H4: Perceived stress among undergraduate nursing students influences mobile phone addiction through the mediating role of organisational caring climate and self-control.

This hypothesis indicates that organisational caring climate and self-control contribute to the impact of perceived stress on mobile phone addiction among undergraduate nursing students.

To the best of our knowledge, the mediating role of organisational caring climate and self-control between perceived stress and mobile phone addiction in undergraduate nursing students has not been studied based on the Person–Environment Interaction Theory. To address this gap and find intermediate factors that mitigate the effects of perceived stress on mobile phone addiction, interventions on intermediate factors at a later stage can lead to new ideas for the prevention and treatment of mobile phone addiction due to perceived stress. This study focused on Chinese undergraduate nursing students and investigated the potential mediating effects of organizational care climate and self-control on the positive association between perceived stress and mobile phone addiction.

Participants and procedures

A multi-stage cluster stratified random sampling method was used to recruit undergraduate nursing students from 10 schools in Shanxi province, located in the Northwest of China, from February to May 2023. The sample size was calculated using a multistage cluster-stratified random sampling calculation formula. In a previous study [6], the prevalence of mobile phone addiction among Chinese nursing students was 25.1%, so P = 25.1%. The design effect was set at 1.5, and we used a two-tailed test with α = 0.05 for statistically significant differences; thus, the value of u was 1.96, and the allowable error (d) was set at 0.15P. Based on the following equation for the sample size:

$$N=deff\frac{{u}^{2}P\left(1-P\right)}{{d}^{2}}$$

a value of N = 764 was obtained. Considering a dropout rate of 15%, the required sample size was determined to be 878.

A multi-stage cluster-stratified random selection of samples was performed in the following order: city, school, grade, class, and nursing students. First, we randomly selected one undergraduate medical college from each of the 10 cities in Shanxi Province. Second, we stratified by grade, including four grades from freshmen to seniors. Third, one class in each grade was randomly selected. Fourth, 40–50% of students in each class were randomly selected. Four-year undergraduate nursing students were recruited for the study after obtaining informed consent. Individuals who were not currently enrolled in school because of taking a leave of absence or joining the military were excluded from this study. This study was approved by the Research Ethics Committee of the corresponding author’s institution. Well-trained researchers sent questionnaires to students who met the inclusion and exclusion criteria after informed consent was provided by the schools, teachers, and participants.

In total, 914 questionnaires were distributed. After excluding questionnaires with irregular item scores and insufficient response times, 900 valid questionnaires were collected, resulting in an effective response rate of 98.47%.

Instruments

Perceived stress scale

Perceived stress was measured using the Chinese adaptation[33] of the perceived stress scale[34]. It comprises 14 items and two dimensions: a sense of loss of control (seven items) and a sense of tension (seven items). It uses a 5-point Likert scale, with positive items scored positively from ‘never’ to ‘always’ with values ranging from 1 to 5, and negative items are reverse scored. The total score ranges from 14 to 70, with higher scores indicating higher levels of perceived stress. The scale demonstrated good reliability and validity in previous studies [35], with a Cronbach’s alpha of 0.730. In the current study, Cronbach’s alpha for the scale was 0.741.

Organizational climate for caring questionnaire

Organisational care climate was measured using the organizational climate for caring questionnaire. It was developed by Hughes[36] based on Noddings’ theory of caring education and assesses the perceived organisational caring climate among nursing students in the teacher–student interaction process. The Chinese version was translated by Qiu Pingping[37]. The scale comprises 30 items and three dimensions: exemplar (14 items), dialogue (9 items), and affirmation (7 items). It uses a 6-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’, with values ranging from 1 to 6. The total score ranges from 30 to 180, with higher scores indicating a stronger perception of the organizational care climate. The scale demonstrated good reliability and validity in previous studies, with a Cronbach’s alpha of 0.933[38]. In the current study, Cronbach’s alpha for the scale was 0.971.

Self-control scale

Self-control was measured using the Chinese adaptation [39]of the self-control scale[24]. It comprises 19 items and five dimensions: impulse control (six items), health habits (three items), resistance to temptation (four items), work focus (three items), and moderation of entertainment (three items). It uses a 5-point Likert scale, ranging from ‘completely disagree’ to ‘completely agree’ with values from 1 to 5 for positively worded items, and reverse scoring for negatively worded items. The total score ranges from 19 to 75, with higher scores indicating higher levels of self-control. The scale demonstrated good reliability and validity in previous studies with a Cronbach’s alpha of 0.970[40]. In the current study, Cronbach’s alpha for the scale was 0.879.

Mobile phone addiction tendency scale

Mobile phone addiction was measured using the 16 items developed by [41]. This scale comprises four dimensions: withdrawal symptoms (six items), salience (four items), social comfort (three items), and mood modifications (three items). It uses a 5-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’, with values ranging from 1 to 5. The total score ranges from 16 to 80, with scores ≥ 48 indicating smartphone addiction and higher scores suggesting a higher level of smartphone addiction. The scale has demonstrated good reliability and validity in previous studies, with a Cronbach’s alpha of 0.830[42, 16]. In this study, Cronbach’s alpha for the scale was 0.927.

Demographic characteristics

Data regarding sex (male/female) and grade (freshman/sophomore/junior/ senior) were obtained for each participant.

Data analysis

IBM SPSS Statistics 23.0, and macro PROCESS were used to analyse the data. Pearson’s correlation analysis was performed to examine the relationships among the variables. The Bootstrap method was used to test the mediation effects.

Preliminary analyses

The distribution of mobile phone addiction is shown in Table 1. The percentages of female and male participants were 94% and 6%, respectively. Regarding grade, 21.67, 22.88, 28.89, and 26.56% of the participants were freshmen, sophomores, juniors, and seniors, respectively.

The prevalence of mobile phone addiction among Chinese graduate students was found to be 34.89%. A one-way analysis of variance showed no significant differences in mobile phone addiction based on gender or grade (P > 0.05).

Table 1

Demographic characteristics and comparison of mobile phone addiction of nursing graduate students (N = 900)
Variable	Category	N(%)	Mobile phone addiction
gender	Male	54(6)	40.94 ± 10.06
gender	Female	846(94)	41.49 ± 10.13
	t		-0.383
	P		0.702
grade	freshman	195(21.67)	41.26 ± 9.87
	sophomore	206(22.88)	42.86 ± 8.81
	junior	260(28.89)	41.27 ± 10.44
	senior	239(26.56)	41.29 ± 9.92
	F		0.769
	P		0.511

Common Method Bias Test

The data in this study were collected through self-reported measures, which may be susceptible to common method bias. To address this concern, anonymous responses and reverse scoring were used to control common method bias during implementation. Additionally, Harman’s one-factor method was applied to the four questionnaires to test for the presence of common method bias, and exploratory factor analysis was performed on the items related to the four research variables. Among the 79 items, 12 factors with eigenvalues greater than 1 were extracted. The first common factor explained 24.332% of the variance, which was less than the critical value of 40%, demonstrating that common method bias was not a problem in this study.

Bivariate correlation analysis

The means, standard deviations, and correlations of each variable are presented in Table 2. The results show that perceived stress was negatively correlated with organisational caring climate (r = -0.162, P < 0.01) and self-control (r = -0.515, P < 0.01), but positively correlated with mobile phone addiction (r = 0.362, P < 0.01). Organisational care climate was positively correlated with self-control (r = 0.152, P < 0.01) and negatively correlated with mobile phone addiction (r=-0.156, P < 0.01). Self-control was negatively correlated with mobile phone addiction (r=-0.468, P < 0.01).

Table 2

Descriptive statistics and pearson’s correlations of the research variables
	M	SD	1	2	3	4
1. Perceived stress	40.07	5.90	1
2. organizational caring climate	128.14	27.21	-0.162**	1
3. self-control	61.71	9.96	-0.515**	0.152**	1
4. mobile phone addiction	41.46	10.12	0.362**	-0.156**	-0.468**	1
Note: **P < 0.01.

Test the mediating effect of organizational caring climate and self-control in perceived stress and mobile phone addiction

The mediating effect of organizational caring climate and self-control on the relationship between perceived stress and mobile phone addiction was determined. The results of the analysis of perceived stress on mobile phone addiction mediated by organizational caring climate and self-control are presented in Fig. 1 and Table 3. The whole regression equation was significant (R² = 0.133, F = 45.775, P < 0.001).

The total effect of perceived stress on mobile phone addiction was found to be significant (c = 0.625, t = 11.695, P < 0.001) (Step 1). In addition, perceived stress had a negative direct effect on organizational caring climate (β = -0.736, t = -4.844, P < 0.001) and self-control (β = -0.856, t = -17.565, P < 0.001). The direct effect of organisational caring climate as the first mediating variable on the second mediating variable of self-control was also significant (β = 0.027, t = 2.518, P < 0.05) (Step 2). A review of the direct effects of the mediating variables on mobile phone addiction showed that the effects of an organizational caring climate (β = -0.028, t = -2.559, P < 0.05) and self-control (β = -0.380, t = -10.956, P < 0.001) were significant (Step 3). When perceived stress and the two mediating variables were simultaneously entered into the model (Step 4), the direct effect of perceived stress (c’ = 0.271, t = 4.627, P < 0.001) on mobile phone addiction symptoms were also found to be significant. Overall, these results revealed that multiple serial mediations had occurred.

As presented in Table 4, when considering all variables (including covariates) in the tested model, the paths through single mediation of organisational care climate (point estimate = 0.021; 95% BC CI [0.001, 0.043]), self-control (point estimate = 0.043; 95% BC CI [0.241, 0.414]), and both mediators (point estimate = 0.008; 95% BC CI [0.001, 0.017]) were all statistically significant. The total indirect effect was statistically significant (point estimate = 0.354; 95% confidence interval [0.267, 0.445]). Thus, the path through both mediators was significant, and the indirect effect through both organisational caring climate and self-control was also significant.

Table 3

.Multiple linear regression analysis of the variables
regression model		Overall fit index			Significance of regression coefficients
Dependent variable	Independent variable	R	R ²	F	β	t
Organizational caring climate		0.177	0.031	9.666
	gender				8.373	2.183*
	grade				-0.738	-0.679
	perceived stress				-0.736	-4.844***
Self-control		0.524	0.275	84.830
	gender				-1.048	-0.860
	grade				0.797	2.311*
	organizational caring climate				0.027	2.518*
	perceived stress				-0.856	-17.565***
Mobile phone addiction		0.495	0.245	57.900
	gender				0.989	0.782
	grade				-0.194	-0.539
	organizational caring climate				-0.028	-2.559*
	self-control				-0.380	-10.956***
	perceived stress				0.271	4.627***
Note: P < 0.05、**P < 0.001

Table 4

Comparison of indirect effects of perceived stress on mobile phone addiction mediated by organizational caring climate and self control
	Point Estimate	Boot SE	BootLL CI	BootUL CI	Relative effect value
Total indirect effffect of X on Y	0.354	0.046	0.267	0.445	56.64%
Indirect effffect 1: X → M1 → Y	0.021	0.011	0.001	0.043	3.36%
Indirect effffect2: X → M2 → Y	0.325	0.045	0.241	0.414	52.00%
Indirect effffect3: X → M1 → M2 → Y	0.008	0.004	0.001	0.017	1.28%
model1 versus model 2	-0.305	0.047	-0.398	-0.216
model1 versus model 3	0.013	0.012	-0.010	0.036
Model2 versus model 3	0.318	0.044	0.235	0.405

Note: N = 900. Number of bootstrap samples for bias corrected bootstrap confifidence intervals: 10,000. Level of confifidence for all confifidence intervals: 95%. X = perceived stress, M1 = organizational caring climate, M2 = self control, Y = mobile phone addiction. Model 1 = perceived stress – organizational caring climate – mobile phone addiction ; Model 2 = perceived stress – self control – mobile phone addiction; Model 3 = perceived stress – organizational caring climate– self control –mobile phone addiction; LL = lower level; UL = upper level.

This study revealed the sequential mediation effect of organisational caring climate and self-control on the process of stress perception leading to mobile phone addiction among Chinese undergraduate nursing students. Additionally, it explored the mechanism by which stress perception contributes to mobile phone addiction. Regarding theory, we not only enrich the research content of cyberpsychology, but also guide the exploration and development of the ‘general strain theory’, ‘the strength model of self-control’, and the ‘person–environment interaction theory’. Regarding practical applications, our results have broad prospects for providing ideas for the prevention and treatment of mobile phone addiction among undergraduate nursing students.

Impact of perceived stress on mobile phone addiction

Our study indicates that perceived stress has a significant direct effect on mobile phone addiction, thus verifying H1. This finding suggests that nursing undergraduates who exhibit higher levels of perceived stress are more likely to develop mobile phone addiction, which is consistent with previous research and fits the general strain theory [43, 44, 17]that individuals typically develop problem behaviours to alleviate stressful feelings when exposed to stressful events.

Nursing students are more vulnerable to stress than other groups of students [45]. Studies have documented moderate to high perceived stress among nursing students[46], with sources including academic, clinical, and personal sources[47]. Specifically, nursing students experience longer study hours and an associated lack of free time. Predictably, stress significantly impacted nursing students, and the greater the perceived psychological stress in response to objective stress events, the higher the risk of mobile phone addiction. This is because mobile phones offer an escape from reality and a way to relieve stress, causing individuals to develop a greater dependence on and addiction to mobile phones during anxious and stressful situations. Conversely, the less perceived psychological stress, the more likely it is to promote healthy mobile phone usage habits among college students. To further clarify the relationship between perceived stress and mobile phone addiction, the study examined the roles of organisational caring climate and self-control.

Mediating role of organizational caring climate in the relationship between perceived stress and mobile phone addiction

This study found that the association between perceived stress and mobile phone addiction was mediated by the organisational caring climate, thus supporting H2. Regarding the mediating role of organisational caring climate, the more stress adolescents perceive, the lower their level of perceived organisational caring climate. the higher the likelihood they were addicted to mobile was. Perceived organisational caring climate alleviates the negative effect of stress on mobile phone addiction.

Chinese nursing students face various internal and external pressures which can lead to negative emotions and an increased risk of mobile phone addiction. According to the person–environment interaction theory, individual behavioural problems are the result of the interaction between individual and environmental factors[48]. Therefore, an individual’s tendency toward mobile phone addiction may also be regulated by the environmental system.

Interpersonal relationships are considered crucial environmental factors influencing mobile phone addiction. Individuals with difficulty in regulating their emotions are more likely to have social adaptation problems and internal self-imbalances. According to the main-effects model of social support, social support is conducive to maintaining good emotional experiences and, thus, better mental health. Adolescents are troubled and confused because of new social demands and conflicts, and when they do not receive sufficient social support, they are unable to obtain good advice and a sense of security to help them solve their current problems. This leads to negative emotions. A study[49] concluded that social support could lower the levels of mobile phone addiction among adolescents by reducing depression and loneliness. In addition, previous research[38] has also shown that nursing students who perceive a higher level of organisational caring climate are more likely to enhance their learning abilities through interactions with their surroundings and peers. They are also better able to develop emotional control skills, establish meaningful relationships, and receive support and companionship. These factors help in alleviating stress and reducing negative emotions, aligning with the findings of this study.

Thus, a possible explanation for the moderating role of the perception of organisational caring climate is considered a form of self-control over external environments, and in stressful situations, individuals can continuously adjust themselves to cope with stress by increasing their positive perception of the external environment. In contrast, students who lack interpersonal skills and are unable to perceive organisational support and care find that mobile phones meet their needs in many ways. They find solace and relief from boredom through their phones and gradually develop a dependency on them. Hence, schools and families can reduce mobile phone addiction by creating a suitable caring climate within the organisation, increasing students’ sense of being needed and involved, enhancing their perception of the caring atmosphere, and alleviating their perceived stress.

Mediating role of self-control in the relationship between perceived stress and mobile phone addiction

This study found that self-control serves as an additional mediating variable between perceived stress and smartphone addiction, providing support for H3 and confirming the predictions of the strength model of self-control. The path (perceived stress, self-control, and mobile phone addiction) can be conceptualised regarding the demands on psychological resources. Perceived stress was found to significantly and negatively predict self-control ability, which is consistent with previous research and supports the ‘self-control resource’ theory[50]. Stress may trigger negative emotions and cognition, and the regulation of these emotions and thoughts consumes self-control resources, resulting in a lack of resources in other domains. As available self-control resources decrease, this can lead to a decrease in self-control ability or even failure. Simultaneously, self-control was also found to significantly and negatively predict mobile phone addiction, which is consistent with previous research results[51, 52, 18]. Individuals with low self-control lack the psychological resources to resist impulsive behaviour, making it difficult for them to resist the urge to use mobile phones. However, the stronger an individual’s self-control, the higher their problem-solving and emotion regulation abilities; the more they know what they want, the lower their level of mobile phone addiction [53, 54]. This suggests that parents and teachers should aim to enhance students’ self-control in daily teaching and educational processes, thereby reducing their level of mobile phone addiction.

Sequential mediation model

This study discovered the important sequential mediating effect of organisational care atmosphere on self-control in exploring the mechanism of the relationship between perceived stress and mobile phone addiction for the first time. This indicates that perceived stress exerts an indirect effect on mobile phone addiction through organisational care atmosphere and self-control, thereby supporting H4. The results of this study reveal a close relationship between organisational care atmosphere and self-control. Moreover, the strength model of self-control purports that the individual resources of self-control are limited[55]. When individuals perceive a low-level organisational care atmosphere, their interpersonal problem-solving abilities deteriorate and their ability to regulate emotions decreases, making it easier for them to develop negative emotions[56]. When an individual is in a negative emotional state, their consumption of self-control resources increases, thereby reducing their self-control [57]. In general, by creating an organisational care atmosphere and improving the perception of this atmosphere, undergraduate nursing students can better cope with various stressors in life, improve their self-control abilities, and make reasonable choices in controlling themselves when managing their mobile phone usage, thereby reducing their mobile phone addiction.

However, this study has several limitations. First, this study used self-reporting methods to survey college students, which may allow for social desirability bias, potentially affecting the research results. Data could be obtained through multi-rater assessments, such as teacher, peer, and parent evaluations, to compensate for the limitations of self-reported data in future research. Second, the participants were from 10 medical schools in the same Chinese province, which may limit the generalisability of this study to other regions. Future research should expand the sample size and increase the representativeness of the study results. Third, the cross-sectional study design does not explain the causal relationship between the variables. Future research should use a longitudinal study design to explore the causal relationship between stress perception and mobile phone addiction.

Despite these limitations, this study has important implications for the prevention of and intervention for mobile phone addiction in nursing students. Based on the general strain theory, the strength model of self-control, and person–environment interaction theory, this study reveals a specific mechanism by which perceived stress is related to mobile phone addiction, enriches and develops relevant theories, and provides practical guidance for reducing the incidence of this problematic behaviour from the perspective of individual and environmental factors.

First, as a predictor of problematic behaviour, perceived stress is an important trigger of mobile phone addiction. Parents and educators should pay close attention to students’ feelings of stress and create an external environment with less stress to promote adaptive functioning. Second, this study indicates that organisational care climate and self-control are two explanatory factors for how perceived stress is associated with mobile phone addiction in nursing students.

On the one hand, schools and parents should pay attention to the influence of a caring climate on students’ emotions and interpersonal relationships. For schools, to improve teachers’ humanistic care education abilities, regular care education and training should be provided. Additionally, the concept and behaviour of care should be applied to undergraduate teaching. Simultaneously, schools need to offer positive resources, including organising corresponding activities for students, such as mental health week activities and campus situational dramas, to stimulate students’ enthusiasm, encourage them to actively participate, enrich their school life, and bring them closer to their schoolmates and teachers. Parents should be concerned about their children’s physical and mental health, set good examples, avoid excessive use of mobile phones in front of their children, and increase communication and interaction with their children in real life. On the other hand, it is necessary to realise the organic combination of schools and families and improve undergraduate students’ self-control level; training in individual self-control ability may weaken the ‘bridge’ between perceived stress and mobile phone addiction.

Perceived stress significantly predicted mobile phone addiction among undergraduate nursing students. The organisational caring climate plays a mediating role in the relationship between perceived stress and mobile phone addiction. Self-control mediated the relationship between perceived stress and smartphone addiction. Perceived stress not only directly affects mobile phone addiction but also indirectly affects it through a sequential mediation effect involving organisational caring climate and self-control.

Acknowledgements

All the authors wish to thank all of the participants, and Hayes who provided the PROCESS macro for SPSS.

Conflicts of interest

None

Funding

This work was supported by the science and technology innovation talents boost "Navigation Action" - New Flight Plan of Air Force Medical University ( No. [2023] 11).

Ethics statement

The present study was approved by the Ethics Committee of Tangdu Hospital, the Fourth Military Medical University. The attributes, benefits, uses, and disadvantageous effects of the study were explained to all participants and informed consent was also obtained.

AUTHOR CONTRIBUTIONS

Conceived and designed the research: Juan Du, Hongjuan Lang.

Performed the research: Juan Du, Chao Wu, Xiumin Yin, Wenkai Zheng, Xinting Wei; Qian Chen.

Data analyses: Juan Du, Wenkai Zheng, Chunni Heng.

Wrote the paper: Juan Du, Yanbo Ji.

All authors reviewed the manuscript.

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No competing interests reported.

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Perceived stress and mobile phone addiction among Chinese undergraduate nursing students: The mediating role of organisational caring climate and self-control

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Abstract

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Background

Methods

Participants and procedures

Instruments

Perceived stress scale

Organizational climate for caring questionnaire

Self-control scale

Mobile phone addiction tendency scale

Demographic characteristics

Data analysis

Results

Preliminary analyses

Common Method Bias Test

Bivariate correlation analysis

Discussion

Impact of perceived stress on mobile phone addiction

Mediating role of self-control in the relationship between perceived stress and mobile phone addiction

Sequential mediation model

Conclusions

Declarations

References

Additional Declarations

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