The mediating effect of positive self-belief on the relationship between work stress and humanistic nursing competence among Chinese nurses: a cross-sectional study

The mediating effect of positive self-belief on the relationship between work stress and humanistic nursing competence among Chinese nurses: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The mediating effect of positive self-belief on the relationship between work stress and humanistic nursing competence among Chinese nurses: a cross-sectional study Lu Sun, Huixia Cui, Qingyun Li, Wenlong Tang, Qianya Zhang, Rong Mao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7907024/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Feb, 2026 Read the published version in BMC Nursing → Version 1 posted 13 You are reading this latest preprint version Abstract Background Humanistic nursing competence constitutes not only the core competency of nurses but also their professional integrity and service ethos. This study aims to investigate the mediating role of positive self-belief in the relationship between nurses' work stress and humanistic nursing competence. Methods This cross-sectional study employed convenience sampling to recruit 542 clinical nurses from hospitals of varying tiers across 10 cities in Anhui Province. The research aimed to investigate the sources of participants' nursing work stress, positive self-belief, and humanistic nursing competencies. Following model construction, path analysis was conducted via AMOS 26.0 software. Results The results of the structural equation modelling analysis indicate that clinical nurses' work stress has a negative predictive effect on humanistic nursing competence (β = -0.426, P < 0.01), whereas positive self-belief has a positive predictive effect on humanistic nursing competence (β = 0.629, P < 0.01). Furthermore, work stress has a negative predictive effect on positive self-belief (β = -0.460, P < 0.01). The results of the mediation analysis revealed that the total effect of work stress on clinical nurses' humanistic nursing competency was − 0.155, with a direct effect of -0.041, accounting for 26.67% of the total effect. Positive self-belief partially mediated the relationship between clinical nurses' work stress and humanistic nursing competency, with a mediating effect of -0.113, representing 73.33% of the total effect. Conclusions The humanistic nursing ability of clinical nurses in Anhui Province is relatively low. By implementing interventions to alleviate work stress, clinical nurses can strengthen their positive self-beliefs, thereby effectively enhancing their humanistic nursing competencies. Specific strategies include rationally allocating human resources, optimizing performance evaluation systems, and regularly conducting training programs centered on positive psychology. Clinical Nurses Work Stress Positive Self-Belief Humanized Nursing Competency Figures Figure 1 Background Humanized nursing has emerged as a prominent research focus within the nursing field in recent years. This patient-centered approach prioritizes holistic care for both physical and mental well-being while upholding patient rights and addressing individual needs. This model emphasizes the delivery of professional medical services alongside enhanced humanistic care, thereby alleviating psychological distress and physical discomfort to improve treatment outcomes and patient satisfaction [ 1 , 2 , 3 ]. Humanistic nursing competence constitutes one of the core competencies for nurses, denoting the professional's individual capacity to perform duties while respecting all individuals and attending to their physical, psychological, and emotional needs [4, 5]. It not only represents a vital core competency for nurses but also embodies their professional integrity and service ethos. Research indicates that nurses who possess greater humanistic nursing competencies can effectively enhance the quality of nursing services, promote patient satisfaction [ 6 ], and strengthen their sense of responsibility [ 7 ]. Conversely, a lack of such competencies may lead to negative outcomes such as occupational burnout, work-related stress, and emotional exhaustion [ 8 ]. The unique nature of the hospital environment can easily induce feelings of fear and helplessness in patients, potentially even fostering distrust toward healthcare professionals. This significantly impedes patient recovery and health promotion. The contemporary medical paradigm emphasizes the holistic nature of human beings, positing that disease onset and progression result not only from biological factors but also from psychological and social determinants [ 9 ]. Consequently, nurses should enhance their humanistic nursing competencies. This approach not only facilitates patient recovery and improves nurse-patient relationships but also strengthens nurses' sense of self-efficacy. The work-related stress experienced by nurses is widely recognized as a major challenge facing the global nursing profession [ 10 , 11 , 12 ]. While appropriate levels of work stress can enhance clinical nurses' efficiency and increase their commitment to their work, prolonged exposure to high-intensity occupational stress severely compromises their emotional, physical, and mental health. This leads to professional burnout, diminished job satisfaction, and increased staff turnover [ 13 , 14 ]. Research indicates that excessive work pressure adversely affects the quality of patient care and reduces patient satisfaction [ 15 ]. The occupational characteristics of nurses inevitably expose them to numerous stressors during their work. Multiple cross-sectional studies [ 16 , 17 ] indicate that various factors—including childcare responsibilities, high-intensity workloads, frequent night shifts, complex nursing tasks, interactions with patients and their families, the need to manage sudden changes in patient conditions and other emergencies, and occupational exposure risks—can all contribute to nursing work stress. These stressors profoundly impact the physical and mental health of clinical nurses, the quality of the nursing services they provide, and their future career development. Therefore, nursing administrators must implement relevant measures to alleviate the work stress of clinical nurses. This approach enhances their capacity for humanistic care, thereby improving the quality of nursing services, the physical and mental well-being of nurses themselves, and their future career development. Belief is an organic entity that integrates emotion, cognition, and consistency, determining how individuals feel, think, and act. Positive self-belief plays a crucial role in fostering psychological well-being, emphasizing the importance of maintaining a positive mindset regarding self-awareness, self-worth, and capabilities. It is typically closely associated with mental health, happiness, and personal growth [ 18 ]. Individuals with positive self-beliefs possess greater self-efficacy. When encountering setbacks and facing challenges, they are more proactive in seeking solutions and mobilizing resources to overcome obstacles [ 19 ]. Research indicates that nurses with higher levels of positive self-esteem demonstrate greater confidence in their work. When encountering challenges, they actively seek solutions, believe in their ability to perform effectively, and thus enhance job satisfaction while mitigating the negative impacts of work stress [ 20 , 21 ]. Positive self-belief can promote nurses' professional growth, making them more willing to proactively learn new knowledge and skills to enhance their capabilities. Currently, the relationships among clinical nurses' work stress, positive self-belief, and humanistic nursing competence remain unexplored. Therefore, four hypotheses are proposed, and a theoretical model is constructed. The purpose of this study is to provide important insights for nursing administrators by alleviating nurses' work stress through effective measures and leveraging the indirect benefits of positive self-belief to enhance humanistic nursing competence, thereby optimizing the quality of nursing services. This study aims to investigate the relationship between work stress and humanistic nursing competence among Chinese nurses, as well as whether positive self-beliefs mediate this relationship. The following four hypotheses are proposed: H1 Work stress is negatively correlated with positive self-belief (Path a). H2 Work stress is negatively correlated with humanistic nursing competence (Path c). H3 Positive self-belief is positively correlated with humanistic nursing competence (Path b). H4 The effect of work stress on humanistic nursing competence is partially mediated by positive self-belief (Path c’). Methods Research design This study employed a cross-sectional survey method to examine the relationships among three variables: nurses' work stress, positive self-belief, and humanistic nursing competence. The implementation and documentation of the study strictly adhered to the Standardized Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Participants and sample This study employed convenience sampling to select 542 clinical nurses from medical institutions across 10 prefecture-level cities in Anhui Province as research subjects. The inclusion criteria were as follows: (1) held a valid nurse practice licence; (2) were currently employed at a hospital; (3) had at least one year of professional work experience; and (4) signed an informed consent form and voluntarily participated in the study. The exclusion criteria were as follows: (1) intern nurses or student nurses; and (2) personnel on leave during the survey period. The sample size calculation for this study was based on the method proposed by Kendall, which recommends a sample size typically 10 times the number of study variables [ 22 ]. This study included 26 variables: demographic characteristics (12), nurses' work stress source (5), positive self-belief (4), and humanistic nursing competence (5). Accounting for a 20% potential attrition rate, the calculated sample size was N = 26 × 10 × (1 + 20%) = 312. The minimum sample size required was 312 participants. A total of 563 questionnaires were distributed, with 542 valid responses ultimately collected, yielding a 96.3% response rate that met the sample requirements. Evaluation methods and tools Sociodemographic data questionnaire This encompasses twelve items: nurses' gender, age, educational attainment, marital status, family residence, years of service, hospital tier, current department, monthly personal income, employment status, professional title, and administrative role. Nurses' Work Stress Sources Scale The Nurses' Work Stress Sources Scale was developed in 2000 by Chinese scholars, including Li Xiaomei [ 23 ]. It is used to assess the current work stress levels of nursing staff and the sources of that stress. This scale comprises five dimensions and 35 items: the nursing profession and duties, workload and time allocation, the work environment and resources, patient care, and management and interpersonal relationships. It employs a four-point Likert scale, with responses ranging from ‘Strongly Disagree’ to ‘Strongly Agree’ scored from 1 to 4 points, respectively. The total score ranges from 35 to 140 points, with higher scores indicating greater occupational stress levels. The scale has a Cronbach's α coefficient of 0.948. The Oxford Positive Self Scale Professor Daniel of the United Kingdom developed this scale in 2022 [ 24 ]. This study employs a scale previously translated into Chinese by our research team. It comprises four dimensions and 24 items, including the Mastery Dimension, the Strength Dimension, the Enjoyment Dimension, and the Character Dimension. A five-point Likert scale is employed, with scores ranging from 0 to 4, corresponding to“Not at all true”to“Completely true”. Higher scores indicate a greater level of positive self-belief. The Chinese version of the scale has good reliability and validity, with a Cronbach's α coefficient of 0.893 and a test-retest reliability coefficient of 0.978. The Healthcare Professional Humanization Scale (HUMAS) for Nursing Developed by Pérez-Fuente et al. [ 25 ] and adapted for Chinese use by scholar Li Kangyuan [ 26 ]. There are 19 items across five dimensions: disposition to optimism, sociability, emotional understanding, self-efficacy, and affection. Employing a five-point Likert scale ranging from ‘never’ to ‘always’ (scored 1–5, respectively), the total score ranges from 19 to 95 points. Higher scores indicate stronger humanistic nursing competencies (0–73 points: poor; 74–81 points: moderate; 82–95 points: good). The scale demonstrated a Cronbach's α coefficient of 0.906. Study settings and data collection The research data were collected between January 2025 and March 2025. This study surveyed nurses across hospitals of varying grades in 10 prefecture-level cities within Anhui Province, which is located in eastern China. The nursing staff surveyed encompassed four educational levels: secondary technical school, junior college, undergraduate, and master's degree or above; three professional titles: junior, intermediate, and senior. Following approval from the School Ethics Committee of Wannan Medical College, data collection commenced. Before conducting the survey, we contacted the nursing management experts of relevant hospitals to secure their support. We provided the participating nurses with detailed explanations of the survey process, objectives, and significance. After signing the informed consent forms, the nurses voluntarily completed the anonymous data collection by scanning a QR code for the electronic questionnaire created via the Chinese electronic platform Questionnaire Star. Researchers extracted completed questionnaires from the backend and rigorously reviewed response quality. Any questionnaire exhibiting ten consecutive identical selections or showing obvious repetitive patterns was deemed invalid and excluded. Ethical considerations This study was approved by the Ethics Committee of Wannan Medical College (Ethics Approval Number: 2025003). The study was conducted in accordance with the Declaration of Helsinki. All participants were involved in the survey anonymously and provided their anonymous informed consent. We assure participants that their participation in this study will not adversely affect their relationship with their employer hospitals. To ensure the confidentiality of the data, they will be stored in an encrypted file format, and all collected data will be accessible only to the researchers and used solely for the study. Additionally, if participants experience any discomfort or unpleasantness during the research process, they may withdraw or halt the survey at any time. This study does not involve any interventions or experimental procedures. Data analysis Data collation and analysis were performed using via SPSS 27.0 statistical software package developed by IBM. The count data are presented as numbers and percentages; the measurement data are presented as the means and standard deviations. Statistical analysis was conducted via Pearson correlation and other methods. AMOS 26.0 structural equation modelling software was used to investigate the pathways through which work pressure and humanistic nursing competence influence positive self-belief among clinical nurses, while the mediating role of positive self-belief between these two factors was tested. Bootstrap sampling was conducted 5000 times, with a significance level of α = 0.05. Results Characteristics of participants Among the 542 nurses surveyed, the ages ranged from 22–54 years, with years of service spanning from 1–29 years. The cohort comprised 408 female nurses and 134 male nurses. Their places of work were distributed as follows: 198 in northern Anhui, 166 in the central region, and 178 in the southern region. With respect to educational qualifications, 100 held vocational school diplomas, 132 held college diplomas, 225 held bachelor's degrees, and 85 held master's degrees or higher. Within China's professional title system, 134 were nurses, 240 were nurse practitioners, 101 were nurse supervisors, 35 were corefendent nurses, and 32 were chief superintendent nurses. With respect to marital status, 215 individuals were unmarried, and 327 were married (including those who had remarried or were widowed). Concerning current departmental placement, 222 nurses worked in internal medicine, 172 in surgery, 51 in gynecology, 36 in pediatrics, and 61 in critical care departments. Table 1 contains their detailed data. Table 1 Characteristics of the participants (n = 542) Variable Category Frequency (n) Percentage (%) Sex Male 134 24.7 Female 408 75.3 Age 50 17 3.1 Working age 0 ~ 10 331 61.1 11 ~ 20 184 33.9 21 ~ 30 27 5.0 Professional title Nurse 134 24.7 Nurse Practitioner 240 44.3 Nurse Supervisor 101 18.6 Co - chief superintendent nurse 35 6.5 Chief superintendent nurse 32 5.9 Marital status Unmarried 215 39.7 Married (Remarry) 327 60.3 Academic Qualifications Secondary technical school 100 18.5 Junior college 132 24.4 Undergraduate 225 41.5 Master's degree or above 85 15.7 Grade of hospital Grade III Level A hospitals 263 48.5 Grade III Level B hospitals 98 18.1 Grade III Level C hospitals 68 12.5 Grade II hospitals 72 13.3 Grade I hospitals 41 7.6 Location Northern Anhui 198 36.5 Central Anhui 166 30.6 Southern Anhui 178 32.9 Current Department Internal Medicine 222 41.0 Surgery 172 31.7 Obstetrics & Gynecology 51 9.4 Pediatrics 36 6.6 Emergency Department and Intensive Care Unit 61 11.3 Clinical nurses' humanistic nursing competence, work stress, positive self-belief total score and dimension scores Table 2 shows the total scores and subscale scores for humanistic nursing competence, work stress, and positive self-belief among the 542 clinical nurses who participated in the study. The nurses' work stress score was 78.54 ± 24.10, the humanistic nursing competence total score was 69.83 ± 11.47, and the positive self-belief total score was 72.94 ± 18.24. Table 2 Clinical nurses' humanistic nursing competence, work stress, and positive self-belief scores (n = 542) Dimension Number of items Min Max Score (Mean ± SD) Entry Score (Mean ± SD) Nurses' Work Stress 35 35 140 78.54 ± 24.10 2.24 ± 0.69 Workload and time allocation 5 5 20 12.16 ± 4.41 2.43 ± 0.88 Working environment and resources 3 3 12 6.73 ± 2.64 2.24 ± 0.88 Patient care 11 6 44 23.34 ± 8.85 2.12 ± 0.80 Nursing specialization and employment 6 7 28 15.77 ± 5.68 2.63 ± 0.95 Management and interpersonal relations 9 9 56 20.73 ± 8.83 2.30 ± 0.98 Humanistic Nursing Competence 19 24 95 69.83 ± 11.47 3.68 ± 0.60 Disposition to Optimism 3 4 15 12.90 ± 2.46 4.30 ± 0.82 Sociability 3 3 15 12.82 ± 2.46 4.27 ± 0.82 Emotional Understanding 3 3 15 12.60 ± 2.73 4.20 ± 0.91 Self-efficacy 5 6 25 20.67 ± 4.73 4.13 ± 0.95 Affection 5 4 30 10.85 ± 4.49 2.17 ± 0.90 Positive Self-Belief 24 17 96 72.94 ± 18.24 3.04 ± 0.76 Character 4 1 16 12.38 ± 3.29 3.09 ± 0.82 Mastery 7 2 28 21.07 ± 5.66 3.01 ± 0.81 Strength 8 2 32 24.41 ± 6.36 3.05 ± 0.80 Enjoyment 5 1 20 15.15 ± 3.94 3.03 ± 0.79 Correlation analysis of nurses' work stress, humanistic nursing competence, and positive self-belief Pearson correlation analysis revealed that nurses' work stress was negatively correlated with both humanistic nursing competence and positive self-belief (r = − 0.426, − 0.460; both P < 0.001). Humanistic care competence was positively correlated with positive self-belief (r = 0.629; P < 0.001) (Table 3) Table 3 Correlation analysis between humanistic nursing competence for nurses' work stress, and positive self-belief (n=542, r-value) Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1 1 2 0.859** 1 3 0.761** 0.609** 1 4 0.728** 0.586** 0.570** 1 5 0.758** 0.540** 0.453** 0.546** 1 6 0.823** 0.692** 0.586** 0.510** 0.363** 1 7 -0.460** -0.426** -0.381** -0.319** -0.350** 0.361** 1 8 -0.420** -0.400** -0.343** -0.273** -0.308** 0.337** 0.952** 1 9 -0.462** -0.429** -0.380** -0.334** -0.344** 0.365** 0.968** 0.886** 1 10 -0.438** -0.398** -0.370** -0.310** -0.339** 0.338** 0.926** 0.832** 0.867** 1 11 -0.409** -0.368** -0.339** -0.281** -0.337** 0.309** 0.925** 0.850** 0.868** 0.826** 1 12 -0.426** -0.374** -0.324** -0.307** -0.305** -0.387** 0.629** 0.578** 0.632** 0.575** 0.582** 1 13 -0.401** -0.381** -0.317** -0.303** -0.263** -0.343** 0.656** 0.611** 0.644** 0.610** 0.609** 0.868** 1 14 -0.362** -0.325** -0.301** -0.281** -0.232** -0.332** 0.626** 0.593** 0.617** 0.570** 0.578** 0.860** 0.850** 1 15 -0.378** -0.361** -0.332** -0.262** -0.199** -0.374** 0.596** 0.569** 0.598** 0.540** 0.526** 0.857** 0.819** 0.849** 1 16 -0.381** 0-.338** -0.344** -0.262** -0.237** -0.360** 0.655** 0.611** 0.653** 0.599** 0.599** 0.898** 0.866** 0.867** 0.861** 1 17 -0.041 0.007 0.075 -0.029** -0.137** -0.014 -0.147** -0.172** -0.127** -0.136** -0.113** 0.143** -0.246** -0.246** -0.240** -0.231** 1 Note：** P <0.01 1: Nurses' Work Stress 2: Nursing specialisation and employment 3: Workload and time allocation 4: Working environment and resources 5: Patient care 6: Management and interpersonal relations 7: Positive Self-Belief 8: Mastery 9: Strength 10: Enjoyment 11: Character 12: Humanistic Nursing Competence 13: Disposition to Optimism 14: Sociability 15: Emotional Understanding 16: Self-efficacy 17: Affection Analysis of the Mediating Effect of Positive Self-Belief on the Relationship between Nursing Work Stress and Humanistic Nursing Competence Common Method Bias Test The common method bias test was conducted via Harman's single-factor test. The results revealed eight factors with eigenvalues exceeding 1. The first principal component obtained before rotation accounted for 31.01% of the total factor loadings, falling below the 40% critical threshold. This finding indicates that no significant common method bias exists in this study [ 27 ]. Analysis of the Mediating Effect of Positive Self-Belief on the Relationship between Clinical Nurses' Work Stress and Humanized Nursing Competence Controlling for general demographic variables, this study employed clinical nursing work stress as the independent variable, positive self-belief as the mediating variable, and humanistic nursing competence as the dependent variable. Structural equation modelling was conducted via AMOS 26.0 software, with model modifications made on the basis of model fit indices. Structural equation modelling was conducted via AMOS 26.0 software, with model modifications applied on the basis of model fit indices. The final results yielded a χ²/df of 2.275, with the following fit indices: Goodness-of-Fit Index (GFI) = 0.958, Adjusted Goodness-of-Fit Index (AGFI) = 0.938, Comparative Fit Index (CFI) = 0.986, and Normed Fit Index (NFI) = 0.976. Mediation effects were examined via 5,000 bootstrap resamples, yielding a 95% confidence interval for the mediation effect of -0.145 -- -0.083 (excluding zero). The difference was statistically significant (P < 0.001), indicating that humanistic nursing competence mediates the relationship between clinical nurses' work stress and positive self-belief, accounting for 73.33% of the total effect. See Fig. 1 and Table 4 . Note NSAE Nursing specialization and employment, WATA Workload and time allocation, WEAR Working environment and resources, PC Patient care, MAIR Management and interpersonal relations, MA Mastery, ST Strength, EN Enjoyment, CH Character, DTO Disposition to optimism, SI Social Interaction, EU Emotional Understanding, SE Self-efficacy, AF Affection. Table 4 Bootstrap analysis of path effect significance testing (n = 542) Effect relationship Path situation Boot SE 95% CI P Proportion of effect size (%) Total effect -0.155 0.021 -0.195ཞ-0.114 < 0.001 100.00 Direct effect -0.041 0.015 -0.074ཞ-0.014 0.006 26.67 Indirect effect -0.113 0.016 -0.145ཞ-0.083 < 0.001 73.33 Discussion We investigated work stress levels among nursing staff and employed structural equation modelling (SEM) to validate the mediating role of positive self-belief in the relationship between work stress and humanistic nursing competence. relationship between work stress and humanistic nursing competence. The findings revealed significant associations among nurses' work stress, positive self-belief, and humanistic nursing competence, with positive self-belief partially mediating the relationship between work stress and humanistic nursing competence. The findings of this study indicate that nurses' humanistic nursing competency scores (69.83 ± 11.47) align with those reported by the Chinese scholar Liu Shenmei [ 28 ]. Compared with the grading criteria of the original scale [ 26 ], clinical nurses demonstrate relatively poor humanistic nursing competency. This situation may stem from nurses' heavy workload and strained nurse-patient relationships, which led to work-related frustration and diminished enthusiasm. This accelerates emotional exhaustion among nurses, thereby limiting their ability to cultivate and develop qualities, awareness, and competencies related to humanistic care through clinical practice, ultimately reducing their humanistic nursing capacity. Humanistic nursing constitutes a creative, personalized, holistic, and effective nursing model [ 29 ]. Currently, the persistent global prevalence of traditional biomedical models and hospital management systems lacking patient-centered approaches necessitates urgent reform of the nursing paradigm. This requires the integration of core values such as empathy, compassion, respect for cultural diversity, and the promotion of self-care [ 30 ]. Consequently, nursing administrators must prioritize enhancing nurses' humanistic care competence to deliver high-quality patient care services. The findings of this study indicate that clinical nurses' positive self-belief is positively correlated with their humanistic nursing ability, meaning that positive self-belief can positively predict humanistic nursing competence. This suggests that the stronger a nurse's positive self-belief is, the greater their capacity for humanistic nursing. As individuals' positive cognition and evaluation of their own abilities, value, and potential, positive self-belief provides the core psychological motivation for nurses to deliver humanistic care. Research has indicated [ 31 ] that nurses with greater subjective well-being tend to proactively perceive patients' physical and psychological needs, demonstrating heightened levels of empathy and humanistic care awareness during nursing practice. This enables nurses to maintain a positive mindset when confronted with complex care situations and effectively manage workplace setbacks and pressures, thereby sustaining consistent delivery of humanistic care competencies. When nurses possess confidence in their abilities and recognize their professional value, they are more proactive in acquiring humanistic care skills, continually refining their practice to establish a virtuous cycle of ‘positive self-belief–enhanced humanistic care capabilities’. Furthermore, this study revealed a negative correlation between work pressure and humanistic nursing competence. This may stem from the demanding nature of clinical nursing—characterized by high workload, high risk, and high expectations. Nurses enduring prolonged periods of intensive therapeutic procedures, complex doctor-patient communication, and a relentless pace experience continuous depletion of psychological resources [ 32 ]. When nurses' work pressure exceeds their individual tolerance threshold, they struggle to allocate sufficient energy to address patients' emotional needs and personalized experiences, thereby diminishing the quality of humanistic care delivery. From a resource conservation theory perspective, excessive work pressure triggers resource depletion in nurses, including emotional exhaustion and cognitive fatigue, which are essential psychological foundations for providing humanistic care. Under high-pressure conditions, nurses are more prone to adopting mechanical work patterns, neglecting humanistic care for patients. Research indicated [ 33 ] that low wages and benefits, heavy workloads, significant responsibilities, and concerns about errors in practice impose substantial occupational stress on nurses. Elevated stress levels may precipitate professional burnout, thereby diminishing their capacity for humanistic care. Furthermore, this study revealed a negative correlation between positive self-belief and occupational stress, suggesting that clinical nurses with stronger positive self-beliefs experience reduced stress levels. This aligns with Self-Determination Theory [ 34 ], which posits that an individual's intrinsic motivation influences their experience of stress. Nurses with strong positive self-beliefs possess greater inherent competence and autonomy, rendering them more resilient to external stressors. This resilience enables them to maintain intrinsic motivation, thereby mitigating their stress experience. The study further revealed that positive self-belief partially mediated the relationship between nurses' work stress and their capacity for humanistic care, accounting for 73.33% of the total effect. These findings suggest that clinical nurses' work stress not only directly affects their ability to provide humanistic care but also indirectly impacts this capacity through the lens of positive self-belief. As a positive psychological trait, positive self-belief enhances individuals' adaptive capacity and coping ability when facing stress. In clinical practice, when nurses perceive high work pressure, they can better regulate their emotions, alleviate psychological stress, and enhance their ability to employ empathy, communication skills, and personalized humanistic care through psychological suggestions rooted in positive self-belief. This enables them to provide high-quality nursing services, alleviate patients' suffering, and simultaneously increase patient and family satisfaction with nursing care [ 35 ]. Positive self-belief mitigates the adverse effects of work pressure on nurses, thereby bolstering their capacity for humanistic patient care. However, relevant research indicates [ 36 , 37 , 38 ] that when clinical nurses are subjected to prolonged exposure to high-pressure and demanding work environments, potential psychological strain may deplete their mental and physical resources, leading to energy exhaustion and health issues. This depletion of resources can result in occupational burnout, potentially compromising the quality of nursing care and nurse-patient relationships. Consequently, nursing managers should regularly organize psychological counselling sessions for nurses to alleviate work-related stress. Concurrently, training programs focused on enhancing humanistic care competencies should be implemented. This dual approach prevents the transmission of work pressure into self-denial, thereby mitigating occupational fatigue. Ultimately, this strategy elevates nurses' capacity for humanistic care, improves the quality of nursing services, and enhances patient satisfaction. Strengths This study reveals two potential implications for practice. First, for nurses, the findings highlight the positive role of alleviating work stress and enhancing positive self-belief in improving their capacity for humanistic care. This study revealed a significant association between enhanced nursing service quality and both work stress levels and positive self-belief, providing a theoretical basis for nurses to enhance their humanistic care capabilities. Second, for nursing managers, this study underscores that enhancing nurses' positive self-beliefs and perceptions and alleviating their work stress can increase their humanistic care ability. This finding offers reference pathways for nursing managers to implement high-quality nursing service management. For example, conducting regular stress assessments and implementing targeted, personalized measures to alleviate nurses' work stress and enhance their positive self-belief perceptions can foster humanistic care capabilities, thereby increasing the overall quality of nursing services. Limitations First, this cross-sectional study employed convenience sampling, which may not comprehensively reflect the circumstances of all clinical nurses, thereby limiting the generalizability of the findings. Furthermore, the investigation utilized an electronic questionnaire, and participants may have experienced fatigue from prolonged exposure to digital screens, which could have potentially affected the accuracy of their responses. Second, the study sample was restricted to nurses from Anhui Province, which introduces limitations to the sample's representativeness. Consequently, future research should consider employing random sampling methods to conduct multiprovince, multicenter surveys targeting clinical nurses. Furthermore, incorporating offline distributions of paper questionnaires could enhance the quality of survey responses. Conclusion This study examined the relationships among positive self-belief, work stress, and humanistic nursing competence among clinical nurses in China, providing a theoretical basis for the interactions among these three constructs. These findings confirmed that positive self-belief partially mediates the relationship between clinical nurses' work stress and their humanistic nursing competence. These findings offer reference points for subsequent exploratory and intervention studies. Subsequent research should examine the external factors influencing nurses' positive self-belief and work stress in multiple dimensions, including occupational burnout, organizational culture, and leadership styles. Consideration should also be given to implementing targeted interventions to enhance nurses' humanistic nursing capabilities. Furthermore, adopting a mixed-methods approach combining quantitative and qualitative research could yield more comprehensive insights. Exploring variations among nurses across different regions would increase the specificity of research conclusions. Implications and recommendations This study fills a research gap concerning the relationship between work stress among Chinese nursing staff and their capacity for humanistic care while also examining the role of positive self-belief in this relationship. Nursing managers should carefully consider the findings of this study and formulate relevant nursing management measures aimed at alleviating nurses' work-related stress, enhancing their positive self-beliefs and perceptions, and improving their capacity for humanistic nursing through appropriate management strategies. Therefore, at the level of nursing practice, nursing managers should align with Maslow's hierarchy of needs theory to fulfill nurses' requirements for belonging and respect. This entails conducting regular stress assessments and implementing targeted interventions for high-stress groups promptly while also actively promoting humanistic care training and establishing psychological mutual support groups. In the field of nursing research, future studies should adopt longitudinal designs to track the long-term impact of nurses' work stress and positive self-belief on their capacity for humanistic care. Expanding the scope to include nursing cohorts across different regions would increase the generalizability of the research. At the nursing education level, integrating the enhancement of positive self-belief and the improvement of humanistic care competencies into the curriculum would equip students to proactively address clinical challenges. Declarations Data availability All data involved in this study can be obtained from the corresponding author upon reasonable request. Acknowledgements We extend our sincere gratitude to the 563 clinical nurses who participated in this survey; your contributions have been invaluable to the conduct of this research. We would also like to express our appreciation to the administrative staff of the relevant hospitals for their substantial support with this survey. Funding This study was funded by the Horizontal Research Projects from Wannan Medical College (Grant Number: H202502). Author Contributions Lu Sun was responsible for formulating the research plan and drafting the manuscript, including the initial draft, revisions, and final review. Qingyun Li, Qianya Zhang, Rong Mao, and Na Xu undertook the data collection, management, and analysis. Huixia Cui and Wenlong Tang provided conceptual framework development, methodological guidance, data analysis support, and review for this study. All the authors have read and approved the final version submitted. Corresponding authors Correspondence to Huixia Cui. E-mail address: [email protected] Data availability All data involved in this study can be obtained from the corresponding author upon reasonable request. Ethics Declarations Ethical approval This study was approved by the Ethics Committee of Wannan Medical College, with ethics review number 20250003. Furthermore, the research adhered to the ethical standards of the Declaration of Helsinki. All participants signed informed consent forms and participated in the survey anonymously. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details 1 School of Nursing, Wannan Medical College, Wuhu, 241003, China References Luiz FF, Caregnato RCA, Costa MRD: Humanization in the Intensive Care: perception of family and healthcare professionals. Rev Bras Enferm .2017, 70(5):1040-1047. Meneses-La-Riva ME, Fernández-Bedoya VH, Suyo-Vega JA, Ocupa-Cabrera HG, Paredes-Díaz SE: Humanized Care in Nursing Practice: A Phenomenological Study of Professional Experiences in a Public Hospital. Int J Environ Res Public Health .2025, 22(8). 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LI Xiao，WANG Yajuan，LUO Zhonghua，YU Juan，WANG Haihong，JIANG Luping，LU Liwei: Mediating effects of nurses' occupational stress between mental health and nurse-patient relationship. China Journal Of Health Psychology. 2021, 29(03):358-362. Xia Lisheng, Hu Ruidan: The Validity of The Oxford Positive Self Scale for Adolescents. Encyclopedic Knowledge. 2024(09):68-70. Wang A, Jia S, Shi Z, Sun X, Zhu Y, Shen M: Validation and Psychometric Testing of the Chinese Version of the Mental Health Literacy Scale Among Nurses. Front Psychol. 2021, 12:791883. Jay E-K, Moxham L, Patterson C: An empathic shared learning community fosters positive mental health. Aust Nurs Midwifery J. 2021;27(4):46. Bonett DG, Wright TA. Sample size requirements for estimating Pearson, Kendall and spearman correlations. Psychometrika. 2000;65(1):23–8 LI Xiaomei，LIU Yanjun: Job Stressors and Burnout among Staff Nurses. Chinese Journal of Nursing. 2000(11):4-8. Freeman D, Rosebrock L, Loe BS, Saidel S, Freeman J, Waite F: The Oxford Positive Self Scale: psychometric development of an assessment of cognitions associated with psychological well-being. Psychol Med .2023, 53(15):7161-7169. Pérez-Fuentes MDC, Herera-Peco I, Molero Jurado MDM, Oropesa Ruiz NF, Ayuso-Murillo D, Gázquez Linares JJ: The Development and Validation of the Healthcare Professional Humanization Scale (HUMAS) for Nursing. Int J Environ Res Public Health .2019, 16(20). Li Kangyuan, Cui Huixia, Meng Di, Shi Xusheng: Translation and validation of the Healthcare Professional Humanization Scale for Nursing. Journal of Nursing Science. 2020, 35(23):55-58. Podsakoff PM, MacKenzie SB, Podsakoff NP: Sources of method bias in social science research and recommendations on how to control it. Annu Rev Psychol .2012, 63:539-569. Liu Shenmei, Liu Peijun: Chain mediating effect of humanization nursing ability and job-esteem on nurses′ decent work perception and felt obligation. Journal of Nursing Science. 2022, 37(15):12-16. Correa-Yantany K, Osorio-Spuler X, Bustos-Medina L, Toffoletto MC, Barrios-Casas S: Perception of patients in relation to the humanized care provided by nursing. Rev Cuid .2025, 16(2):e4477. Meneses-La-Riva ME, Fernández-Bedoya VH, Suyo-Vega JA, Ocupa-Cabrera HG, Paredes-Díaz SE: Humanized Care in Nursing Practice: A Phenomenological Study of Professional Experiences in a Public Hospital. Int J Environ Res Public Health 2025, 22(8). Chen Caifeng, Zha Dahui, Li Yuhong: Mediating effects of social support and psychological capital on job stressors and subjective well-being of nurses from perspective of job demands-resources theory. Occupation and Health. 2022, 38(14):1930-1935+1940. Wang L, Huang Q, Zhang Y, Liu J, Chen C: The impact of perceived workload on nurse presenteeism and missed nursing care: the mediating role of emotional intelligence and occupational stress. BMC Nurs 2025, 24(1):863. Cheng Mingkun: Analysis of the Current State of Work Engagement Among ICU Nu-rses and the Pathways of Influencing Factors. Master's degree. 2022. DOI:10.27434/d.cnki.gxxyc.2022.000450. Ryan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000, 55(1):68-78. Rushton CH, Batcheller J, Schroeder K, Donohue P: Burnout and Resilience Among Nurses Practicing in High-Intensity Settings. Am J Crit Care .2015, 24(5):412-420. Yang Xue, Sun Chao: Nurses perceived caring from managers and its relationship with job burnout and turnover intention. Chinese Nursing Management .2021, 21(08):1226-1230. Lindmark T, Engström M, Trygged S: Psychosocial Work Environment and Well-Being of Direct-Care Staff Under Different Nursing Home Ownership Types: A Systematic Review. J Appl Gerontol 2023, 42(2):347-359. Tims M, Bakker AB. Job crafting: towards a new model of individual job redesign. South Afr J Ind Psychol. 2010;36(2):1–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Feb, 2026 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 13 Nov, 2025 Reviews received at journal 12 Nov, 2025 Reviewers agreed at journal 08 Nov, 2025 Reviews received at journal 08 Nov, 2025 Reviewers agreed at journal 08 Nov, 2025 Reviewers agreed at journal 08 Nov, 2025 Reviews received at journal 08 Nov, 2025 Reviewers agreed at journal 08 Nov, 2025 Reviewers invited by journal 07 Nov, 2025 Editor invited by journal 28 Oct, 2025 Editor assigned by journal 23 Oct, 2025 Submission checks completed at journal 23 Oct, 2025 First submitted to journal 20 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":83513,"visible":true,"origin":"","legend":"\u003cp\u003eMediating effect model of positive self-belief\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7907024/v1/560004cfe0da83fff8ec1664.jpg"},{"id":103766625,"identity":"7e4ac724-ba69-401c-a556-4196ec90f054","added_by":"auto","created_at":"2026-03-02 16:15:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1389146,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7907024/v1/c734a947-3671-41af-b900-eabcbb4318bc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The mediating effect of positive self-belief on the relationship between work stress and humanistic nursing competence among Chinese nurses: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eHumanized nursing has emerged as a prominent research focus within the nursing field in recent years. This patient-centered approach prioritizes holistic care for both physical and mental well-being while upholding patient rights and addressing individual needs. This model emphasizes the delivery of professional medical services alongside enhanced humanistic care, thereby alleviating psychological distress and physical discomfort to improve treatment outcomes and patient satisfaction [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Humanistic nursing competence constitutes one of the core competencies for nurses, denoting the professional's individual capacity to perform duties while respecting all individuals and attending to their physical, psychological, and emotional needs [4, 5]. It not only represents a vital core competency for nurses but also embodies their professional integrity and service ethos. Research indicates that nurses who possess greater humanistic nursing competencies can effectively enhance the quality of nursing services, promote patient satisfaction [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and strengthen their sense of responsibility [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Conversely, a lack of such competencies may lead to negative outcomes such as occupational burnout, work-related stress, and emotional exhaustion [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The unique nature of the hospital environment can easily induce feelings of fear and helplessness in patients, potentially even fostering distrust toward healthcare professionals. This significantly impedes patient recovery and health promotion. The contemporary medical paradigm emphasizes the holistic nature of human beings, positing that disease onset and progression result not only from biological factors but also from psychological and social determinants [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Consequently, nurses should enhance their humanistic nursing competencies. This approach not only facilitates patient recovery and improves nurse-patient relationships but also strengthens nurses' sense of self-efficacy.\u003c/p\u003e\u003cp\u003eThe work-related stress experienced by nurses is widely recognized as a major challenge facing the global nursing profession [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. While appropriate levels of work stress can enhance clinical nurses' efficiency and increase their commitment to their work, prolonged exposure to high-intensity occupational stress severely compromises their emotional, physical, and mental health. This leads to professional burnout, diminished job satisfaction, and increased staff turnover [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Research indicates that excessive work pressure adversely affects the quality of patient care and reduces patient satisfaction [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The occupational characteristics of nurses inevitably expose them to numerous stressors during their work. Multiple cross-sectional studies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e17\u003c/span\u003e] indicate that various factors\u0026mdash;including childcare responsibilities, high-intensity workloads, frequent night shifts, complex nursing tasks, interactions with patients and their families, the need to manage sudden changes in patient conditions and other emergencies, and occupational exposure risks\u0026mdash;can all contribute to nursing work stress. These stressors profoundly impact the physical and mental health of clinical nurses, the quality of the nursing services they provide, and their future career development. Therefore, nursing administrators must implement relevant measures to alleviate the work stress of clinical nurses. This approach enhances their capacity for humanistic care, thereby improving the quality of nursing services, the physical and mental well-being of nurses themselves, and their future career development.\u003c/p\u003e\u003cp\u003eBelief is an organic entity that integrates emotion, cognition, and consistency, determining how individuals feel, think, and act. Positive self-belief plays a crucial role in fostering psychological well-being, emphasizing the importance of maintaining a positive mindset regarding self-awareness, self-worth, and capabilities. It is typically closely associated with mental health, happiness, and personal growth [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Individuals with positive self-beliefs possess greater self-efficacy. When encountering setbacks and facing challenges, they are more proactive in seeking solutions and mobilizing resources to overcome obstacles [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Research indicates that nurses with higher levels of positive self-esteem demonstrate greater confidence in their work. When encountering challenges, they actively seek solutions, believe in their ability to perform effectively, and thus enhance job satisfaction while mitigating the negative impacts of work stress [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Positive self-belief can promote nurses' professional growth, making them more willing to proactively learn new knowledge and skills to enhance their capabilities.\u003c/p\u003e\u003cp\u003eCurrently, the relationships among clinical nurses' work stress, positive self-belief, and humanistic nursing competence remain unexplored. Therefore, four hypotheses are proposed, and a theoretical model is constructed. The purpose of this study is to provide important insights for nursing administrators by alleviating nurses' work stress through effective measures and leveraging the indirect benefits of positive self-belief to enhance humanistic nursing competence, thereby optimizing the quality of nursing services. This study aims to investigate the relationship between work stress and humanistic nursing competence among Chinese nurses, as well as whether positive self-beliefs mediate this relationship.\u003c/p\u003e\u003cp\u003eThe following four hypotheses are proposed:\u003c/p\u003e\n\u003ch3\u003eH1\u003c/h3\u003e\n\u003cp\u003eWork stress is negatively correlated with positive self-belief (Path a).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eH2\u003c/h2\u003e\u003cp\u003eWork stress is negatively correlated with humanistic nursing competence (Path c).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eH3\u003c/h3\u003e\n\u003cp\u003ePositive self-belief is positively correlated with humanistic nursing competence (Path b).\u003c/p\u003e\n\u003ch3\u003eH4\u003c/h3\u003e\n\u003cp\u003eThe effect of work stress on humanistic nursing competence is partially mediated by positive self-belief (Path c\u0026rsquo;).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eResearch design\u003c/h2\u003e\u003cp\u003eThis study employed a cross-sectional survey method to examine the relationships among three variables: nurses' work stress, positive self-belief, and humanistic nursing competence. The implementation and documentation of the study strictly adhered to the Standardized Reporting of Observational Studies in Epidemiology (STROBE) guidelines.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eParticipants and sample\u003c/h2\u003e\u003cp\u003eThis study employed convenience sampling to select 542 clinical nurses from medical institutions across 10 prefecture-level cities in Anhui Province as research subjects. The inclusion criteria were as follows: (1) held a valid nurse practice licence; (2) were currently employed at a hospital; (3) had at least one year of professional work experience; and (4) signed an informed consent form and voluntarily participated in the study. The exclusion criteria were as follows: (1) intern nurses or student nurses; and (2) personnel on leave during the survey period.\u003c/p\u003e\u003cp\u003eThe sample size calculation for this study was based on the method proposed by Kendall, which recommends a sample size typically 10 times the number of study variables [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This study included 26 variables: demographic characteristics (12), nurses' work stress source (5), positive self-belief (4), and humanistic nursing competence (5). Accounting for a 20% potential attrition rate, the calculated sample size was N\u0026thinsp;=\u0026thinsp;26 \u0026times; 10 \u0026times; (1\u0026thinsp;+\u0026thinsp;20%)\u0026thinsp;=\u0026thinsp;312. The minimum sample size required was 312 participants. A total of 563 questionnaires were distributed, with 542 valid responses ultimately collected, yielding a 96.3% response rate that met the sample requirements.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEvaluation methods and tools\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eSociodemographic data questionnaire\u003c/h2\u003e\u003cp\u003eThis encompasses twelve items: nurses' gender, age, educational attainment, marital status, family residence, years of service, hospital tier, current department, monthly personal income, employment status, professional title, and administrative role.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eNurses' Work Stress Sources Scale\u003c/h2\u003e\u003cp\u003eThe Nurses' Work Stress Sources Scale was developed in 2000 by Chinese scholars, including Li Xiaomei [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. It is used to assess the current work stress levels of nursing staff and the sources of that stress. This scale comprises five dimensions and 35 items: the nursing profession and duties, workload and time allocation, the work environment and resources, patient care, and management and interpersonal relationships. It employs a four-point Likert scale, with responses ranging from \u0026lsquo;Strongly Disagree\u0026rsquo; to \u0026lsquo;Strongly Agree\u0026rsquo; scored from 1 to 4 points, respectively. The total score ranges from 35 to 140 points, with higher scores indicating greater occupational stress levels. The scale has a Cronbach's α coefficient of 0.948.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eThe Oxford Positive Self Scale\u003c/h2\u003e\u003cp\u003eProfessor Daniel of the United Kingdom developed this scale in 2022 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This study employs a scale previously translated into Chinese by our research team. It comprises four dimensions and 24 items, including the Mastery Dimension, the Strength Dimension, the Enjoyment Dimension, and the Character Dimension. A five-point Likert scale is employed, with scores ranging from 0 to 4, corresponding to\u0026ldquo;Not at all true\u0026rdquo;to\u0026ldquo;Completely true\u0026rdquo;. Higher scores indicate a greater level of positive self-belief. The Chinese version of the scale has good reliability and validity, with a Cronbach's α coefficient of 0.893 and a test-retest reliability coefficient of 0.978.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eThe Healthcare Professional Humanization Scale (HUMAS) for Nursing\u003c/h2\u003e\u003cp\u003eDeveloped by P\u0026eacute;rez-Fuente et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and adapted for Chinese use by scholar Li Kangyuan [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. There are 19 items across five dimensions: disposition to optimism, sociability, emotional understanding, self-efficacy, and affection. Employing a five-point Likert scale ranging from \u0026lsquo;never\u0026rsquo; to \u0026lsquo;always\u0026rsquo; (scored 1\u0026ndash;5, respectively), the total score ranges from 19 to 95 points. Higher scores indicate stronger humanistic nursing competencies (0\u0026ndash;73 points: poor; 74\u0026ndash;81 points: moderate; 82\u0026ndash;95 points: good). The scale demonstrated a Cronbach's α coefficient of 0.906.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eStudy settings and data collection\u003c/h2\u003e\u003cp\u003eThe research data were collected between January 2025 and March 2025. This study surveyed nurses across hospitals of varying grades in 10 prefecture-level cities within Anhui Province, which is located in eastern China. The nursing staff surveyed encompassed four educational levels: secondary technical school, junior college, undergraduate, and master's degree or above; three professional titles: junior, intermediate, and senior. Following approval from the School Ethics Committee of Wannan Medical College, data collection commenced. Before conducting the survey, we contacted the nursing management experts of relevant hospitals to secure their support. We provided the participating nurses with detailed explanations of the survey process, objectives, and significance. After signing the informed consent forms, the nurses voluntarily completed the anonymous data collection by scanning a QR code for the electronic questionnaire created via the Chinese electronic platform Questionnaire Star. Researchers extracted completed questionnaires from the backend and rigorously reviewed response quality. Any questionnaire exhibiting ten consecutive identical selections or showing obvious repetitive patterns was deemed invalid and excluded.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eEthical considerations\u003c/h2\u003e\u003cp\u003e This study was approved by the Ethics Committee of Wannan Medical College (Ethics Approval Number: 2025003). The study was conducted in accordance with the Declaration of Helsinki. All participants were involved in the survey anonymously and provided their anonymous informed consent. We assure participants that their participation in this study will not adversely affect their relationship with their employer hospitals. To ensure the confidentiality of the data, they will be stored in an encrypted file format, and all collected data will be accessible only to the researchers and used solely for the study. Additionally, if participants experience any discomfort or unpleasantness during the research process, they may withdraw or halt the survey at any time. This study does not involve any interventions or experimental procedures.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eData collation and analysis were performed using via SPSS 27.0 statistical software package developed by IBM. The count data are presented as numbers and percentages; the measurement data are presented as the means and standard deviations. Statistical analysis was conducted via Pearson correlation and other methods. AMOS 26.0 structural equation modelling software was used to investigate the pathways through which work pressure and humanistic nursing competence influence positive self-belief among clinical nurses, while the mediating role of positive self-belief between these two factors was tested. Bootstrap sampling was conducted 5000 times, with a significance level of α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eCharacteristics of participants\u003c/h2\u003e\u003cp\u003eAmong the 542 nurses surveyed, the ages ranged from 22\u0026ndash;54 years, with years of service spanning from 1\u0026ndash;29 years. The cohort comprised 408 female nurses and 134 male nurses. Their places of work were distributed as follows: 198 in northern Anhui, 166 in the central region, and 178 in the southern region. With respect to educational qualifications, 100 held vocational school diplomas, 132 held college diplomas, 225 held bachelor's degrees, and 85 held master's degrees or higher. Within China's professional title system, 134 were nurses, 240 were nurse practitioners, 101 were nurse supervisors, 35 were corefendent nurses, and 32 were chief superintendent nurses. With respect to marital status, 215 individuals were unmarried, and 327 were married (including those who had remarried or were widowed). Concerning current departmental placement, 222 nurses worked in internal medicine, 172 in surgery, 51 in gynecology, 36 in pediatrics, and 61 in critical care departments. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e contains their detailed data.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the participants (n\u0026thinsp;=\u0026thinsp;542)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e408\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u0026thinsp;~\u0026thinsp;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e243\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u0026thinsp;~\u0026thinsp;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026thinsp;~\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e61.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026thinsp;~\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u0026thinsp;~\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional title\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse Practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse Supervisor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCo - chief superintendent nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChief superintendent nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried (Remarry)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e327\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Qualifications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary technical school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUndergraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster's degree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade of hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade III Level A hospitals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade III Level B hospitals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade III Level C hospitals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade II hospitals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade I hospitals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNorthern Anhui\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCentral Anhui\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSouthern Anhui\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Department\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObstetrics \u0026amp; Gynecology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePediatrics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency Department and Intensive Care Unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eClinical nurses' humanistic nursing competence, work stress, positive self-belief total score and dimension scores\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the total scores and subscale scores for humanistic nursing competence, work stress, and positive self-belief among the 542 clinical nurses who participated in the study. The nurses' work stress score was 78.54\u0026thinsp;\u0026plusmn;\u0026thinsp;24.10, the humanistic nursing competence total score was 69.83\u0026thinsp;\u0026plusmn;\u0026thinsp;11.47, and the positive self-belief total score was 72.94\u0026thinsp;\u0026plusmn;\u0026thinsp;18.24.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical nurses' humanistic nursing competence, work stress, and positive self-belief scores (n\u0026thinsp;=\u0026thinsp;542)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDimension\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of items\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMin\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMax\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eScore (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEntry Score (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNurses' Work Stress\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e78.54\u0026thinsp;\u0026plusmn;\u0026thinsp;24.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorkload and time allocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e12.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking environment and resources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e6.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e23.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNursing specialization and employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e15.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManagement and interpersonal relations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e20.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHumanistic Nursing Competence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e69.83\u0026thinsp;\u0026plusmn;\u0026thinsp;11.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisposition to Optimism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e12.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e4.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSociability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e12.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e4.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional Understanding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e12.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e4.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e20.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e4.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAffection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e10.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePositive Self-Belief\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e72.94\u0026thinsp;\u0026plusmn;\u0026thinsp;18.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMastery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e21.07\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrength\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e24.41\u0026thinsp;\u0026plusmn;\u0026thinsp;6.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnjoyment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e15.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eCorrelation analysis of nurses' work stress, humanistic nursing competence, and positive self-belief\u003c/h2\u003e\u003cp\u003ePearson correlation analysis revealed that nurses' work stress was negatively correlated with both humanistic nursing competence and positive self-belief (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.426, \u0026minus;\u0026thinsp;0.460; both P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Humanistic care competence was positively correlated with positive self-belief (r\u0026thinsp;=\u0026thinsp;0.629; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;3)\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Correlation analysis between humanistic nursing competence for nurses\u0026apos; work stress, and positive self-belief (n=542, r-value)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.859**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.761**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.609**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.728**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.586**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.570**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.758**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.540**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.453**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.546**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.823**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.692**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.586**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.510**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.363**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.460**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.426**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.381**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.319**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.350**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.361**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.420**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.400**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.343**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.273**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.308**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.337**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.952**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.462**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.429**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.380**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.334**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.344**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.365**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.968**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.886**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.438**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.398**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.370**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.310**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.339**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.338**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.926**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.832**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.867**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.409**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.368**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.339**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.281**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.337**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.309**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.925**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.850**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.868**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.826**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.426**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.374**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.324**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.307**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.305**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.387**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.629**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.578**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.632**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.575**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.582**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.401**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.381**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.317**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.303**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.263**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.343**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.656**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.611**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.644**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.610**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.609**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.868**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.362**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.325**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.301**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.281**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.232**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.332**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.626**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.593**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.617**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.570**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.578**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.860**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.850**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.378**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.361**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.332**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.262**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.199**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.374**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.596**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.569**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.598**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.540**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.526**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.857**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.819**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.849**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.381**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0-.338**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.344**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.262**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.237**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.360**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.655**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.611**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.653**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.599**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e0.599**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.898**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.866**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.867**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.861**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.029**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.137**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.147**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.172**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.127**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.136**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.113**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.143**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.246**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.246**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.240**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.231**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 50px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote：**\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01 \u0026nbsp;1: Nurses\u0026apos; Work Stress 2: Nursing specialisation and employment 3: Workload and time allocation 4: Working environment and resources 5: Patient care\u0026nbsp;6:\u0026nbsp;Management and interpersonal relations\u0026nbsp;7:\u0026nbsp;Positive Self-Belief\u0026nbsp;8:\u0026nbsp;Mastery\u0026nbsp;9:\u0026nbsp;Strength\u0026nbsp;10:\u0026nbsp;Enjoyment\u0026nbsp;11:\u0026nbsp;Character\u0026nbsp;12:\u0026nbsp;Humanistic Nursing Competence\u0026nbsp;13:\u0026nbsp;Disposition to Optimism\u0026nbsp;14:\u0026nbsp;Sociability\u0026nbsp;15: \u0026nbsp;Emotional Understanding\u0026nbsp;16: Self-efficacy\u0026nbsp;17:\u0026nbsp;Affection\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis of the Mediating Effect of Positive Self-Belief on the Relationship between Nursing Work Stress and Humanistic Nursing Competence\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eCommon Method Bias Test\u003c/h2\u003e\u003cp\u003eThe common method bias test was conducted via Harman's single-factor test. The results revealed eight factors with eigenvalues exceeding 1. The first principal component obtained before rotation accounted for 31.01% of the total factor loadings, falling below the 40% critical threshold. This finding indicates that no significant common method bias exists in this study [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis of the Mediating Effect of Positive Self-Belief on the Relationship between Clinical Nurses' Work Stress and Humanized Nursing Competence\u003c/b\u003e\u003c/p\u003e\u003cp\u003eControlling for general demographic variables, this study employed clinical nursing work stress as the independent variable, positive self-belief as the mediating variable, and humanistic nursing competence as the dependent variable. Structural equation modelling was conducted via AMOS 26.0 software, with model modifications made on the basis of model fit indices. Structural equation modelling was conducted via AMOS 26.0 software, with model modifications applied on the basis of model fit indices. The final results yielded a χ\u0026sup2;/df of 2.275, with the following fit indices: Goodness-of-Fit Index (GFI)\u0026thinsp;=\u0026thinsp;0.958, Adjusted Goodness-of-Fit Index (AGFI)\u0026thinsp;=\u0026thinsp;0.938, Comparative Fit Index (CFI)\u0026thinsp;=\u0026thinsp;0.986, and Normed Fit Index (NFI)\u0026thinsp;=\u0026thinsp;0.976. Mediation effects were examined via 5,000 bootstrap resamples, yielding a 95% confidence interval for the mediation effect of -0.145 -- -0.083 (excluding zero). The difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that humanistic nursing competence mediates the relationship between clinical nurses' work stress and positive self-belief, accounting for 73.33% of the total effect. See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e\u003cp\u003e\u003cem\u003eNSAE\u003c/em\u003e Nursing specialization and employment, \u003cem\u003eWATA\u003c/em\u003e Workload and time allocation, \u003cem\u003eWEAR\u003c/em\u003e Working environment and resources, \u003cem\u003ePC\u003c/em\u003e Patient care, \u003cem\u003eMAIR\u003c/em\u003e Management and interpersonal relations, \u003cem\u003eMA\u003c/em\u003e Mastery, \u003cem\u003eST\u003c/em\u003e Strength, \u003cem\u003eEN\u003c/em\u003e Enjoyment, \u003cem\u003eCH\u003c/em\u003e Character, \u003cem\u003eDTO\u003c/em\u003e Disposition to optimism, \u003cem\u003eSI\u003c/em\u003e Social Interaction, \u003cem\u003eEU\u003c/em\u003e Emotional Understanding, \u003cem\u003eSE\u003c/em\u003e Self-efficacy, \u003cem\u003eAF\u003c/em\u003e Affection.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBootstrap analysis of path effect significance testing (n\u0026thinsp;=\u0026thinsp;542)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEffect relationship\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePath situation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBoot SE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eProportion of effect size (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.195ཞ-0.114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.074ཞ-0.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndirect effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.145ཞ-0.083\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe investigated work stress levels among nursing staff and employed structural equation modelling (SEM) to validate the mediating role of positive self-belief in the relationship between work stress and humanistic nursing competence. relationship between work stress and humanistic nursing competence. The findings revealed significant associations among nurses' work stress, positive self-belief, and humanistic nursing competence, with positive self-belief partially mediating the relationship between work stress and humanistic nursing competence.\u003c/p\u003e\u003cp\u003eThe findings of this study indicate that nurses' humanistic nursing competency scores (69.83\u0026thinsp;\u0026plusmn;\u0026thinsp;11.47) align with those reported by the Chinese scholar Liu Shenmei [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Compared with the grading criteria of the original scale [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e], clinical nurses demonstrate relatively poor humanistic nursing competency. This situation may stem from nurses' heavy workload and strained nurse-patient relationships, which led to work-related frustration and diminished enthusiasm. This accelerates emotional exhaustion among nurses, thereby limiting their ability to cultivate and develop qualities, awareness, and competencies related to humanistic care through clinical practice, ultimately reducing their humanistic nursing capacity. Humanistic nursing constitutes a creative, personalized, holistic, and effective nursing model [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Currently, the persistent global prevalence of traditional biomedical models and hospital management systems lacking patient-centered approaches necessitates urgent reform of the nursing paradigm. This requires the integration of core values such as empathy, compassion, respect for cultural diversity, and the promotion of self-care [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Consequently, nursing administrators must prioritize enhancing nurses' humanistic care competence to deliver high-quality patient care services.\u003c/p\u003e\u003cp\u003eThe findings of this study indicate that clinical nurses' positive self-belief is positively correlated with their humanistic nursing ability, meaning that positive self-belief can positively predict humanistic nursing competence. This suggests that the stronger a nurse's positive self-belief is, the greater their capacity for humanistic nursing. As individuals' positive cognition and evaluation of their own abilities, value, and potential, positive self-belief provides the core psychological motivation for nurses to deliver humanistic care. Research has indicated [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e] that nurses with greater subjective well-being tend to proactively perceive patients' physical and psychological needs, demonstrating heightened levels of empathy and humanistic care awareness during nursing practice. This enables nurses to maintain a positive mindset when confronted with complex care situations and effectively manage workplace setbacks and pressures, thereby sustaining consistent delivery of humanistic care competencies. When nurses possess confidence in their abilities and recognize their professional value, they are more proactive in acquiring humanistic care skills, continually refining their practice to establish a virtuous cycle of \u0026lsquo;positive self-belief\u0026ndash;enhanced humanistic care capabilities\u0026rsquo;.\u003c/p\u003e\u003cp\u003eFurthermore, this study revealed a negative correlation between work pressure and humanistic nursing competence. This may stem from the demanding nature of clinical nursing\u0026mdash;characterized by high workload, high risk, and high expectations. Nurses enduring prolonged periods of intensive therapeutic procedures, complex doctor-patient communication, and a relentless pace experience continuous depletion of psychological resources [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. When nurses' work pressure exceeds their individual tolerance threshold, they struggle to allocate sufficient energy to address patients' emotional needs and personalized experiences, thereby diminishing the quality of humanistic care delivery. From a resource conservation theory perspective, excessive work pressure triggers resource depletion in nurses, including emotional exhaustion and cognitive fatigue, which are essential psychological foundations for providing humanistic care. Under high-pressure conditions, nurses are more prone to adopting mechanical work patterns, neglecting humanistic care for patients. Research indicated [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e] that low wages and benefits, heavy workloads, significant responsibilities, and concerns about errors in practice impose substantial occupational stress on nurses. Elevated stress levels may precipitate professional burnout, thereby diminishing their capacity for humanistic care.\u003c/p\u003e\u003cp\u003eFurthermore, this study revealed a negative correlation between positive self-belief and occupational stress, suggesting that clinical nurses with stronger positive self-beliefs experience reduced stress levels. This aligns with Self-Determination Theory [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e], which posits that an individual's intrinsic motivation influences their experience of stress. Nurses with strong positive self-beliefs possess greater inherent competence and autonomy, rendering them more resilient to external stressors. This resilience enables them to maintain intrinsic motivation, thereby mitigating their stress experience.\u003c/p\u003e\u003cp\u003eThe study further revealed that positive self-belief partially mediated the relationship between nurses' work stress and their capacity for humanistic care, accounting for 73.33% of the total effect. These findings suggest that clinical nurses' work stress not only directly affects their ability to provide humanistic care but also indirectly impacts this capacity through the lens of positive self-belief. As a positive psychological trait, positive self-belief enhances individuals' adaptive capacity and coping ability when facing stress. In clinical practice, when nurses perceive high work pressure, they can better regulate their emotions, alleviate psychological stress, and enhance their ability to employ empathy, communication skills, and personalized humanistic care through psychological suggestions rooted in positive self-belief. This enables them to provide high-quality nursing services, alleviate patients' suffering, and simultaneously increase patient and family satisfaction with nursing care [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Positive self-belief mitigates the adverse effects of work pressure on nurses, thereby bolstering their capacity for humanistic patient care. However, relevant research indicates [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e38\u003c/span\u003e] that when clinical nurses are subjected to prolonged exposure to high-pressure and demanding work environments, potential psychological strain may deplete their mental and physical resources, leading to energy exhaustion and health issues. This depletion of resources can result in occupational burnout, potentially compromising the quality of nursing care and nurse-patient relationships. Consequently, nursing managers should regularly organize psychological counselling sessions for nurses to alleviate work-related stress. Concurrently, training programs focused on enhancing humanistic care competencies should be implemented. This dual approach prevents the transmission of work pressure into self-denial, thereby mitigating occupational fatigue. Ultimately, this strategy elevates nurses' capacity for humanistic care, improves the quality of nursing services, and enhances patient satisfaction.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003eStrengths\u003c/h2\u003e\u003cp\u003eThis study reveals two potential implications for practice. First, for nurses, the findings highlight the positive role of alleviating work stress and enhancing positive self-belief in improving their capacity for humanistic care. This study revealed a significant association between enhanced nursing service quality and both work stress levels and positive self-belief, providing a theoretical basis for nurses to enhance their humanistic care capabilities. Second, for nursing managers, this study underscores that enhancing nurses' positive self-beliefs and perceptions and alleviating their work stress can increase their humanistic care ability. This finding offers reference pathways for nursing managers to implement high-quality nursing service management. For example, conducting regular stress assessments and implementing targeted, personalized measures to alleviate nurses' work stress and enhance their positive self-belief perceptions can foster humanistic care capabilities, thereby increasing the overall quality of nursing services.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFirst, this cross-sectional study employed convenience sampling, which may not comprehensively reflect the circumstances of all clinical nurses, thereby limiting the generalizability of the findings. Furthermore, the investigation utilized an electronic questionnaire, and participants may have experienced fatigue from prolonged exposure to digital screens, which could have potentially affected the accuracy of their responses. Second, the study sample was restricted to nurses from Anhui Province, which introduces limitations to the sample's representativeness. Consequently, future research should consider employing random sampling methods to conduct multiprovince, multicenter surveys targeting clinical nurses. Furthermore, incorporating offline distributions of paper questionnaires could enhance the quality of survey responses.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study examined the relationships among positive self-belief, work stress, and humanistic nursing competence among clinical nurses in China, providing a theoretical basis for the interactions among these three constructs. These findings confirmed that positive self-belief partially mediates the relationship between clinical nurses' work stress and their humanistic nursing competence. These findings offer reference points for subsequent exploratory and intervention studies. Subsequent research should examine the external factors influencing nurses' positive self-belief and work stress in multiple dimensions, including occupational burnout, organizational culture, and leadership styles. Consideration should also be given to implementing targeted interventions to enhance nurses' humanistic nursing capabilities. Furthermore, adopting a mixed-methods approach combining quantitative and qualitative research could yield more comprehensive insights. Exploring variations among nurses across different regions would increase the specificity of research conclusions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications and recommendations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study fills a research gap concerning the relationship between work stress among Chinese nursing staff and their capacity for humanistic care while also examining the role of positive self-belief in this relationship. Nursing managers should carefully consider the findings of this study and formulate relevant nursing management measures aimed at alleviating nurses' work-related stress, enhancing their positive self-beliefs and perceptions, and improving their capacity for humanistic nursing through appropriate management strategies. Therefore, at the level of nursing practice, nursing managers should align with Maslow's hierarchy of needs theory to fulfill nurses' requirements for belonging and respect. This entails conducting regular stress assessments and implementing targeted interventions for high-stress groups promptly while also actively promoting humanistic care training and establishing psychological mutual support groups. In the field of nursing research, future studies should adopt longitudinal designs to track the long-term impact of nurses' work stress and positive self-belief on their capacity for humanistic care. Expanding the scope to include nursing cohorts across different regions would increase the generalizability of the research. At the nursing education level, integrating the enhancement of positive self-belief and the improvement of humanistic care competencies into the curriculum would equip students to proactively address clinical challenges.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data involved in this study can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our sincere gratitude to the 563 clinical nurses who participated in this survey; your contributions have been invaluable to the conduct of this research. We would also like to express our appreciation to the administrative staff of the relevant hospitals for their substantial support with this survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Horizontal Research Projects from Wannan Medical College (Grant Number: H202502).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLu Sun was responsible for formulating the research plan and drafting the manuscript, including the initial draft, revisions, and final review. Qingyun Li, Qianya Zhang, Rong Mao, and Na Xu undertook the data collection, management, and analysis. Huixia Cui and Wenlong Tang provided conceptual framework development, methodological guidance, data analysis support, and review for this study. All the authors have read and approved the final version submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Huixia Cui. E-mail address:\u0026nbsp;[email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data involved in this study can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declarations\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Wannan Medical College, with ethics review number 20250003. Furthermore, the research adhered to the ethical standards of the Declaration of Helsinki. All participants signed informed consent forms and participated in the survey anonymously.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 School of Nursing, Wannan Medical College, Wuhu, 241003, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLuiz FF, Caregnato RCA, Costa MRD: Humanization in the Intensive Care: perception of family and healthcare professionals. 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Chinese Medical Ethics. 2017, 30(09):1059-1065.\u003c/li\u003e\n\u003cli\u003eKhamisa N, Oldenburg B, Peltzer K, Ilic D: Work related stress, burnout, job satisfaction and general health of nurses. Int J Environ Res Public Health 2015, 12(1):652-666.\u003c/li\u003e\n\u003cli\u003eLiu Y, Aungsuroch Y, Gunawan J, Zeng D: Job Stress, Psychological Capital, Perceived Social Support, and Occupational Burnout Among Hospital Nurses. J Nurs Scholarsh 2021, 53(4):511-518.\u003c/li\u003e\n\u003cli\u003eSarazine J, Heitschmidt M, Vondracek H, Sarris S, Marcinkowski N, Kleinpell R: Mindfulness Workshops Effects on Nurses\u0026apos; Burnout, Stress, and Mindfulness Skills. Holist Nurs Pract 2021, 35(1):10-18.\u003c/li\u003e\n\u003cli\u003eKhamisa N, Oldenburg B, Peltzer K, Ilic D: Work related stress, burnout, job satisfaction and general health of nurses. Int J Environ Res Public Health 2015, 12(1):652-666.\u003c/li\u003e\n\u003cli\u003eLiu Y, Aungsuroch Y: Work stress, perceived social support, self-efficacy and burnout among Chinese registered nurses. J Nurs Manag. 2019, 27(7):1445-1453.\u003c/li\u003e\n\u003cli\u003eYang J, Tang S, Zhou W: Effect of Mindfulness-Based Stress Reduction Therapy on Work Stress and Mental Health of Psychiatric Nurses. Psychiatr Danub .2018, 30(2):189-196.\u003c/li\u003e\n\u003cli\u003eEzenwaji IO, Eseadi C, Okide CC, Nwosu NC, Ugwoke SC, Ololo KO, Oforka TO, Oboegbulem AI: Work-related stress, burnout, and related sociodemographic factors among nurses: Implications for administrators, research, and policy. Medicine (Baltimore) .2019, 98(3):e13889.\u003c/li\u003e\n\u003cli\u003eXie Jianhui, Zhu Lihui, Deng Fengliang, Liu Xin, Xiong Hua, Zhang Qiang, Yi Yinzhi : Correlation between turnover intention and job satisfaction and social support characteristics of pediatric nurses. 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Sample size requirements for estimating Pearson, Kendall and spearman correlations. Psychometrika. 2000;65(1):23\u0026ndash;8 \u003c/li\u003e\n\u003cli\u003eLI Xiaomei，LIU Yanjun: Job Stressors and Burnout among Staff Nurses. Chinese Journal of Nursing. 2000(11):4-8.\u003c/li\u003e\n\u003cli\u003eFreeman D, Rosebrock L, Loe BS, Saidel S, Freeman J, Waite F: The Oxford Positive Self Scale: psychometric development of an assessment of cognitions associated with psychological well-being. Psychol Med .2023, 53(15):7161-7169.\u003c/li\u003e\n\u003cli\u003eP\u0026eacute;rez-Fuentes MDC, Herera-Peco I, Molero Jurado MDM, Oropesa Ruiz NF, Ayuso-Murillo D, G\u0026aacute;zquez Linares JJ: The Development and Validation of the Healthcare Professional Humanization Scale (HUMAS) for Nursing. 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BMC Nurs 2025, 24(1):863.\u003c/li\u003e\n\u003cli\u003eCheng Mingkun: Analysis of the Current State of Work Engagement Among ICU Nu-rses and the Pathways of Influencing Factors. Master\u0026apos;s degree. 2022. DOI:10.27434/d.cnki.gxxyc.2022.000450.\u003c/li\u003e\n\u003cli\u003eRyan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000, 55(1):68-78.\u003c/li\u003e\n\u003cli\u003eRushton CH, Batcheller J, Schroeder K, Donohue P: Burnout and Resilience Among Nurses Practicing in High-Intensity Settings. Am J Crit Care .2015, 24(5):412-420.\u003c/li\u003e\n\u003cli\u003eYang Xue, Sun Chao: Nurses perceived caring from managers and its relationship with job burnout and turnover intention. Chinese Nursing Management .2021, 21(08):1226-1230.\u003c/li\u003e\n\u003cli\u003eLindmark T, Engstr\u0026ouml;m M, Trygged S: Psychosocial Work Environment and Well-Being of Direct-Care Staff Under Different Nursing Home Ownership Types: A Systematic Review. J Appl Gerontol 2023, 42(2):347-359.\u003c/li\u003e\n\u003cli\u003eTims M, Bakker AB. Job crafting: towards a new model of individual job redesign. South Afr J Ind Psychol. 2010;36(2):1\u0026ndash;9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Clinical Nurses, Work Stress, Positive Self-Belief, Humanized Nursing Competency","lastPublishedDoi":"10.21203/rs.3.rs-7907024/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7907024/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHumanistic nursing competence constitutes not only the core competency of nurses but also their professional integrity and service ethos. This study aims to investigate the mediating role of positive self-belief in the relationship between nurses' work stress and humanistic nursing competence.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study employed convenience sampling to recruit 542 clinical nurses from hospitals of varying tiers across 10 cities in Anhui Province. The research aimed to investigate the sources of participants' nursing work stress, positive self-belief, and humanistic nursing competencies. Following model construction, path analysis was conducted via AMOS 26.0 software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe results of the structural equation modelling analysis indicate that clinical nurses' work stress has a negative predictive effect on humanistic nursing competence (β = -0.426, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), whereas positive self-belief has a positive predictive effect on humanistic nursing competence (β\u0026thinsp;=\u0026thinsp;0.629, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Furthermore, work stress has a negative predictive effect on positive self-belief (β = -0.460, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The results of the mediation analysis revealed that the total effect of work stress on clinical nurses' humanistic nursing competency was \u0026minus;\u0026thinsp;0.155, with a direct effect of -0.041, accounting for 26.67% of the total effect. Positive self-belief partially mediated the relationship between clinical nurses' work stress and humanistic nursing competency, with a mediating effect of -0.113, representing 73.33% of the total effect.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe humanistic nursing ability of clinical nurses in Anhui Province is relatively low. By implementing interventions to alleviate work stress, clinical nurses can strengthen their positive self-beliefs, thereby effectively enhancing their humanistic nursing competencies. Specific strategies include rationally allocating human resources, optimizing performance evaluation systems, and regularly conducting training programs centered on positive psychology.\u003c/p\u003e","manuscriptTitle":"The mediating effect of positive self-belief on the relationship between work stress and humanistic nursing competence among Chinese nurses: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 11:49:38","doi":"10.21203/rs.3.rs-7907024/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-14T03:41:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-12T07:10:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19688454692890611492465225658077009618","date":"2025-11-08T14:47:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-08T14:26:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192146356167639650666847453808458349307","date":"2025-11-08T13:38:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295804190637863115863423513984085537578","date":"2025-11-08T07:47:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-08T05:56:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29133605649770030472784610659372023382","date":"2025-11-08T05:53:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-07T07:58:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-28T12:34:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-23T06:27:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-23T06:26:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-10-20T14:57:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"41270482-7cf4-4984-8435-818373fca759","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:13:16+00:00","versionOfRecord":{"articleIdentity":"rs-7907024","link":"https://doi.org/10.1186/s12912-026-04468-4","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2026-02-28 15:58:40","publishedOnDateReadable":"February 28th, 2026"},"versionCreatedAt":"2025-11-19 11:49:38","video":"","vorDoi":"10.1186/s12912-026-04468-4","vorDoiUrl":"https://doi.org/10.1186/s12912-026-04468-4","workflowStages":[]},"version":"v1","identity":"rs-7907024","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7907024","identity":"rs-7907024","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}