In this study, the prevalence of HRS in pediatric nurses was 54.3%, and the mean score of CPSS was 25.80(SD = 6.85), which was much higher than that among the radiological medical personnel in Zhengzhou, China(22.11(SD = 4.69))[33] and among the medical personnel in Sichuan, China(25.31(SD = 6.44))[34]. The results of the present study regarding the CPSS test revealed that pediatric nurses working in locked units experienced relatively high levels of stress. It is may related to the working conditions of pediatric nurses have become exhausting due to service particularity, heavy workload, occupational environment and complexly interpersonal relationships, work-family conflicts, notable is the high prevalence of aggressive behavior and workplace violence towards nurses, as stated in the quotes. we also found that the occupational stress had significant difference among gender and professional title. As for gender, female nurses had a significantly higher occupational stress when compared to male. A possible reason is that 84% of the male nurses are from intensive-care unit(ICU), where the ratio of bed were the highest than other departments in children’s hospital. And ICU may can reduce the probability of workplace violence due to it’s an unaccompanied ward, which a little direct contact with the children’s parents. Additionally, the gender differences in occupational stress may be attributed to psychological behavior factors, Wu et al.[35] indicated that female may have more stronger negative response than male to physiology, cognition, emotion and behavior, so the cognitive stress response of females was higher than males.
The risks of occupational stress in pediatric nurses may also be affected by different professional title. Our data showed that senior nurses had significantly higher occupational stress than junior and advanced nurses. The main reason may be attributed to the ranking professional title system in mainland China. In China, a nurse wants to promote the titles from junior to senior, they just need to pass the major exam when he or she has 2–4 years of clinical experience according to the education background. However, for senior nurses, if they want to be advanced one, they should conform to the more higher criterion including years of clinical nursing experience, the professional title examination, English level exam and research paper presentations[36]. Especially, for most of nurses, little or rarely experience in scientific research and paper writing means little or rarely chances to promote the tittle in contest of Chinese, which becomes a main work-stressor and a big barrier for them[27, 37–38].
Pediatric nurses are the major force in hospitals and are in the front line in contact with ill children and their parents, but our findings evidenced positive screens of mental healthy problems as obsessive-compulsive symptoms (52.0%), depression (33.1%), hostility (32.8%), and so on, the status of pediatric nurses’ mental health may be worse in mainland China. Moreover, among the pediatric nurses in this study, we also found that they had both significantly higher risks of developing obsessive-compulsive symptoms, anxiety and psychological symptoms compared to general population and national nurse population. Suspicion of child abuse and critically ill children are two topics that distinguish pediatric from other specialties and why this specific specialty can have high emotional burden[9]. Interestingly, the obsessive-compulsive symptoms was ranked first in the SCL-90 subscales. This result might be explained by the necessity of more unasked attention and care from nurses due to lack of the expression ability of illness and immaturity children. Otherwise, the medications used in pediatric clinics are usually complex and varied significantly among different age group with different medicines, which need pediatric nurses to repeatedly check the name and dose of medicine over and over again, as a result of them more vulnerably to have obsessive compulsive. Additionally, previous studies of nurses that have evidence mental health problems and associated conditions(e.g., depression, stress, exposure to trauma, anxiety) as significant factors related to suicidal behaviors[10, 39–40].Therefor, these finding indicated that the prevention for pediatric nurses need to focus more on mental health should be provided.
Looking at the level of mental health among our participants, the study revealed a significant relationship among these variables. Changes on some variables will predict changes on other variables. From the SEM model in Fig. 1, it could be seen that coping styles was an important independent variable that have several paths of influence with other variables in the model. For instance, positive coping style had a negative direct predictive effect on occupational stress (-0.499) and mental health (-0.115), negative coping style had positive predictive effect on occupational stress(0.185) and mental health(0.205). Consistently, Hasan et al.[41] illustrated that strategies for coping were inversely correlated with work stress and depression. A nurse who used ineffective coping techniques such as secrecy was at higher risk of psychological distress than that who used more effective coping strategies[42]. It could be explained by different stressful situations and mood experiences might required different, multiple, and complexly coping styles. Empowering nurses may have increased self-efficacy and reduced the occupational stress experienced by improving coping strategies, the positive coping style beneficial for nurses to improve the psychological adaptability,while the negative style would aggravate physical and mental exhaustion[42–43]. Moreover, occupational stress had significant impact on mental health(0.416), this relationship reflected that the level of work-related stress increased, the level of obsessive-compulsive symptoms, depression, hostility, anxiety, and so on also increased, consistent with previous research[5, 41]. Furthermore, we found that occupational stress played a part of mediating effect between coping style and mental health. It means that coping styles could indirectly affect the mental health of pediatric nurses through occupational stress. Thus, future intervention programs should target pediatric nurses (e.g., establish an accessible employee assistance program for then) as well as their mental health, especially to decrease the work-related stress problems and enhance positive coping style. Doing this can strengthen work satisfaction in clinical setting and reinforce better coping strategies.
This study also has some limitations. Firstly, the study data was obtained from a single city in southwestern China, the sample may not have been representative of China pediatric nurses. Future research could involve the nurses from different grades or regions of hospital. Second, the study is mainly used structure questionnaires. So that, qualitative study approach is recommended to explore this issue further. Thirdly, we gave little consideration on the relations between occupational stress, coping styles and mental health, which need to be further researched in the future.