Obstetric nursing is a nursing specialty that takes care of pregnant women who have quick maternal changes and emergency situations to the health of both mother and child along with China’s family planning policy to be involved in the whole society of family health-care services, resulting in long-term obstetric nurses’ stress and high work load condition.1 In clinical work, psychological pressure is relatively more generally in clinical nursing staff,2 and resilience is a trait or ability to face the pressure an individual is in the face of adversity,trauma, disaster, and other great life pressure, and good development of the successful adaptation of 3, 4, 5 resilience is even considered6 one of the important factors that nurses should adapt during physiological and psychological pressure in nursing activities, especially in the nursing profession. Social support as a protective factor of resilience of the most important individual in alleviating the pressure eliminates the psychological barriers, promotes the individual’s mental health, and plays an important role,7 and research shows that social support and mental health are positively correlated; social support can predict individual’s health level.8 In recent years, China began to study nursing work pressure, but the research on the psychological pressure of obstetric nurses is rare, and with resilience as a positive psychological quality, able to buffer the stress causedby the negative impact,9 this study aimed not only to understand the obstetric nurses’ resilience, social support, and anxiety status in order to reduce the degree of anxiety and improve the work efficiency and the level of mental health but also provides theoretical basis for the study of resilience on the report as follows.
†This study was supported by The National Social Science Fund of China (No. 15BRK023).
In May 2017, 190 nurses from three hospitals in Tai’an were selected by the convenient sampling method. Inclusion criteria are as follows: registered nurses; nurses in obstetrics nursing work for more than 1 year; and the willingness to participate in this study.
The method of questionnaire investigation was used in this study; unified questionnaires were provided to the nursing department. The nurses were asked to truthfully fill out the questionnaire according to the instructions, and at the day of recovery, a total of 190 questionnaires were distributed; of those, 183 questionnaires were recovered, with an effective recovery rate of 96.3%.
Some researchers have designed the questionnaire themselves according to the purpose of the study, including age, education, title, position, number of years in obstetrics, type of work, and so on.
CD-RISC includes 25 items, each with five items of the questionnaire for self-evaluation as follows: 0 is able to do so; 1 is divided into two occasionally do; in general can be divided into three parts; can be divided into 4; be complete, and the total score is 0–100. The higher the score, the higher the level of psychological toughness. CD-RISC has good reliability and validity, and its clonal Baja coefficient is 0.89.10
Based on the Zung Self-Rating Anxiety Scale compiled in 1971, a total of 20 questions (15 questions for positive evaluation and five questions for reverse evaluation) with a score of 1–4, 1 points for the few, 2 people sometimes, 3 points for most of the time, and most of the time is divided into 4 were asked to evaluate the subjective feelings of the patients. The sum score of 20 questions to the total score, standard score (Y= score of 1.25 after rounding), score >50 has a tendency of anxiety, the higher the score, the more obvious tendency of anxiety.
Equal to 1980s compiled by Xiao Shuiyuan, including the three dimensions (objective support, subjective support, and utilization of support) a total of 10 items, with 1–4 grade score, total score of social support score, score 66 points, the lowest score was 12 points, the higher the score is, the higher level of social support. The score of <20 means low social support, 20–30 means general social support, and >30 means high social support. The scale was applied to a number of domestic studies with good reliability and validity. The test–retest reliability was 0.92, and the consistency of each item was from 0.89 to 0.94.
After all the data were audited, a database was set up and analyzed by SPSS 23.0 software, including descriptive statistics analysis, variance analysis, t-test, correlation analysis, and regression analysis.
All the 183 finally enrolled nurses (female, aged 20–50 years; mean 34.1±7.24 years) engaged in obstetric care for 1–26 years (average 8.26±6.72 years) and other basic conditions were included in this study (Table 1).
Basic situation of obstetric nurses (n=183).
| Characteristics | Number of people (n) | Constituent ratio (N/n%) |
|---|---|---|
| Age (years) | ||
| <30 | 76 | 41.4 |
| 31–40 | 69 | 37.8 |
| >41 | 38 | 20.6 |
| Education | ||
| Secondary specialized | ||
| school | 15 | 8.2 |
| Junior college | 60 | 32.8 |
| Undergraduate | 106 | 57.9 |
| Master degree or above | 2 | 1.1 |
| Positional titles | ||
| Nurse | 49 | 26.8 |
| Primary nurse | 83 | 45.4 |
| The nurse in charge | 47 | 25.7 |
| Deputy director of the | ||
| nurse | 4 | 2.2 |
| Post | ||
| Nurse | 163 | 89.1 |
| Head nurse | 20 | 10.9 |
| Engaged in obstetric nursing work (years) | ||
| 1–5 | 49 | 26.8 |
| 5–10 | 50 | 27.3 |
| 11–15 | 39 | 21.3 |
| 16–20 | 21 | 11.5 |
| >20 | 24 | 13.1 |
| Work type | ||
| On regular payroll | 75 | 41.0 |
| Contract | 104 | 56.8 |
| Personnel agency | 4 | 2.2 |
Scores of dimensions of resilience scale of obstetric nurses (mean±SD).
| Items | Dimensions | Scores |
|---|---|---|
| Resilience scale | Personal ability | 17.52±4.36 |
| Sense of control | 18.44±4.40 | |
| Spiritual influence | 4.70±1.50 | |
| Endure negative emotions | 10.48±2.18 | |
| Accept changes | 14.00±2.89 | |
| The total score | 65.58±10.65 | |
| Self-rating scale | Positive scoring | 24.07±6.49 |
| Reverse scoring | 12.80±3.50 | |
| The total score | 36.89±6.87 | |
| Social Support | Subjective support | 26.03±4.59 |
| Rating Scale | Objective support | 11.75±3.01 |
| Utilization of support | 8.43±1.91 | |
| The total score | 44.37±7.86 |
Scores of anxiety self-rating scale in obstetric nurses (mean±SD).
| Dimensions | Scores |
|---|---|
| Positive scoring | 24.07±6.49 |
| Reverse scoring | 12.80±3.50 |
| The total score | 36.89±6.87 |
Dimensions of social support dimensions of obstetric nurses (mean±SD).
| Dimensions | Scores |
|---|---|
| Subjective support | 26.03±4.59 |
| Objective support | 11.75±3.01 |
| Utilization of support | 8.43±1.91 |
| The total score | 44.37±7.86 |
The 183 obstetric nurses’ age, education, work experience, job title, the type of single factor variance analysis engaged in, differences in the type of work, and the score of psychological resilience were analyzed (P<0.05), and the difference was statistically significant (Table 5).
Differences of resilience scores among obstetric nurses in general demographic data.
| Characteristics | Number | (mean±Score SD) | F | P |
|---|---|---|---|---|
| Age (years) | ||||
| <30 | 76 | 66.20±10.77 | ||
| 30–40 | 69 | 66.92±12.94 | ||
| >40 | 38 | 66.05±13.73 | ||
| 0.88 | 0.915 | |||
| Education | ||||
| Secondary | ||||
| specialized school | 15 | 67.80±14.22 | ||
| Junior college | 60 | 68.23±11.63 | ||
| Undergraduate | 106 | 64.93±12.06 | ||
| Master degree or | ||||
| above | 2 | 82.50±6.36 | ||
| 2.232 | 0.086 | |||
| Positional titles | ||||
| Nurse | 49 | 64.06±11.90 | ||
| Primary nurse | 83 | 66.96±11.68 | ||
| The nurse in charge | 47 | 68.78±12.87 | ||
| Deputy director of the nurse | ||||
| 4 | 57.25±14.00 | |||
| 2.042 | 0.110 | |||
| Post | ||||
| Nurse | 163 | 66.34±12.13 | ||
| Head nurse | 20 | 67.25±13.10 | ||
| 0.177 | 0.675 | |||
| Engaged in obstetric (years) | ||||
| 1–5 | 49 | 65.56±10.27 | ||
| 5–10 | 50 | 66.52±10.64 | ||
| 11–15 | 39 | 68.92±15.28 | ||
| 16–20 | 21 | 67.19±12.89 | ||
| >20 | 24 | 63.41±12.81 | ||
| 0.855 | 0.492 | |||
| Work type | ||||
| On regular payroll | 75 | 67.09±14.07 | ||
| Contract | 104 | 65.41±10.50 | ||
| Personnel agency | 4 | 66.44±12.20 | ||
| 3.411 | 0.035 |
Correlation analysis of resilience and anxiety and social support of obstetric nurses.
| Project | Total score of resilience | Personal ability | Sense of control | Spiritual influence | Endure negative emotions | Accept changes |
|---|---|---|---|---|---|---|
| Anxiety score | −0.303** | −0.157* | −0.320** | −0.056 | 0.034 | −0.102 |
| Support total score | 0.221** | 0.189* | 0.176* | 0.084 | 0.198** | 0.232(1) |
Note: *P<0.05;
There were significant differences in total scores of resilience and total scores of anxiety and social support (P<0.01), which were statistically significant (Table 6).
Table 5 shows that there is a difference in the score of work type and resilience score (P<0.05), and the difference is statistically significant. This is consistent with the studies by domestic scholars such as Yang et al.,13 Wang et al.,14 and others. Different work types have different working states such as the contract nurses often shift, low welfare, occupation development is limited, promotion, go out the opportunity to study less, low return, high pay, psychological pressure ratio relative to the nurses more; therefore, nursing managers should pay attention to working conditions, different types of work of nurses, the balance of different types of work and nurses’ mental state, should return in wages and benefits, income, job prospects, better maintenance of obstetric nurses’ physical and mental health, so as to better optimize the quality of nursing service, with greater enthusiasm to work.
Obstetric nurse resilience scores and anxiety scores were significantly negatively correlated (P<0.01), namely the higher the resilience score, the lighter the anxiety symptom, and negatively related to personal ability and anxiety resilience of obstetric nurses (P<0.05), namely the higher the ability of individual scores, the lighter the anxiety symptom; sense of control and obstetric resilience have a significant negative correlation with anxiety (P<0.01), that is the better the sense of control, the lighter the anxiety symptom. Resilience is difficult when individuals face great pressure,15 and in the study by the domestic scholar Wang et al.,16 it is shown that good adaptation ability can improve the resilience level of obstetric nurses, especially to enhance their ability to deal with problems and cultivate the sense of self-control, and can reduce the degree of depression and anxiety. Hospital managers should also pay attention to psychological health of obstetric nurses and make reasonable arrangements of nursing work to avoid the long time work overload, pay attention to emotional management of obstetric nurses, and reduce the incidence of anxiety of nurses.
The resilience score and social support score of obstetric nurses were positively related (P<0.01), namely, the higher the degree of social support, the higher the score of psychological resilience; the resilience of individual ability score and total score of social support were positively correlated (P<0.05), namely, the higher the degree of social support, the higher the score of resilience ability; the control the feeling score and social support score were positively related (P<0.05), namely, the higher the degree of social support, the higher the score of psychological sense of control; elasticity to bear negative emotions and social support scores were significantly correlated (P<0.01), namely the higher the score, the higher the score with negative emotional resilience; acceptance with the change score and the social support score were positively correlated (P<0.01), namely, the higher the degree of social support, the higher the score to accept change. The higher the degree of social support, the greater the intensity of individual stress relief, the stronger the adaptability, which is consistent with the studies by the domestic scholar Si.17 Therefore, to improve the nurses’ social support, with respect to friends and family, the hospital and the patient’s understanding is helpful to improve their psychological resilience and mental health level, increase their social identity, and increase working enthusiasm.
In summary, closely related to obstetric nurses’ psychological resilience, social support, and anxiety, resilience can predict anxiety in different degree. Strengthening the level of resilience is an effective way to reduce anxiety and improve the obstetric nurses’ psychological health level. Obstetric nurses should pay attention to enhance their level of resilience in the work, improve coping and resilience, maintain a good attitude, and atthe same time, the nursing managers should pay attention to the social support of obstetric nurses, arrange more obstetric nurses’ working group activities, talk of the trouble, create a harmonious working environment, and reduce the psychological pressure of obstetric nurses to improve the quality of obstetric nursing work.
P<0.01.