The relationship between the practice environment and safety behaviour among nurses working in geriatric wards: The mediating role of occupational coping self-efficacy

The relationship between the practice environment and safety behaviour among nurses working in geriatric wards: The mediating role of occupational coping self-efficacy | 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 relationship between the practice environment and safety behaviour among nurses working in geriatric wards: The mediating role of occupational coping self-efficacy Jingjing Li, Nuo Chen, Shangui Chen, Xiumei Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7191933/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Nurses' safety behaviour is a key factor in efforts to ensure patient safety and enhance the quality of care, especially in geriatric wards. Although the nursing practice environment is known to influence nurses' safety behaviour, the mechanisms underlying this influence remain unclear. This study investigated the mediating role played by occupational coping self-efficacy in the relationship between the practice environment and safety behaviour among nurses working in geriatric wards, thus providing new strategies that can be used to optimize safety behaviour. Methods This study featured a cross-sectional design in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Data were collected from 1099 nurses who were recruited from selected geriatric wards in Grade 3A hospitals in Anhui Province; these nurses completed the validated Nurse Practice Environment Assessment Scale, Safety Behaviour Scale, and Occupational Coping Self-Efficacy Scale. Descriptive statistics, Pearson’s correlations, and a mediating effects analysis were employed to analyse the data with the assistance of SPSS software (version 24). Results The participants’ total scores on the Safety Behaviour Scale, Practice Environment Assessment Scale, and Occupational Coping Self-Efficacy Scale were 52.225 ± 8.360, 36.257 ± 7.103, and 77.778 ± 23.384, respectively, all of which represented moderate scores. Their total score on the Nurse Safety Behaviour Scale was positively correlated with their total scores on the Occupational Coping Self-Efficacy Scale and Practice Environment Assessment Scale ( r = 0.678, 0.479, P < 0.01), and their total score on the Nurse Practice Environment Assessment Scale was significantly positively correlated with their total score on the Nurse Occupational Coping Self-Efficacy Scale ( r = 0.492, P < 0.01). Nurses’ occupational coping self-efficacy partially mediated the relationship between the practice environment and nurses’ safety behaviours, as indicated by a mediating effect of 0.102, which accounted for 59.65% of the total effect. Conclusion Nurses' occupational coping self-efficacy mediates the relationship between the practice environment and nurses’ safety behaviour. Nursing managers should focus on the task of cultivating nurses' occupational coping self-efficacy with the aim of optimizing the work environment of clinical nurses, thereby improving those nurses’ safety behaviours and ensuring patient safety. Clinical trial number Not applicable. Practice environment Safety behaviour Occupational coping self-efficacy Nurses Mediating role Figures Figure 1 1. Introduction As the global population continues to age, the World Health Organization predicts that one-sixth of the world's population will reach the age of 60 years or older by 2030 and that the global population aged 60 years or older will double by 2050 (2.1 billion) [1] . The proportion of elderly individuals continues to increase, thus placing greater demands on the healthcare system, especially in terms of geriatric ward care services. Multimorbidity and cognitive decline are common among elderly patients. These issues entail the triple characteristics of high complexity, high intensity and high risk for nursing care [2,3] . In this context, geriatric nurses face unique professional challenges: the need to cope simultaneously with the sophisticated care needs of elderly patients (e.g., debilitation management), measures aimed at ensuring safety (e.g., falls, pressure ulcers, and multiple medication errors), and the emotional exhaustion associated with end-of-life care. Safety behaviour is particularly important in geriatric wards, where it represents a key competency that nurses need to proactively identify risks, follow protocols, and prevent adverse events in clinical practice [4] . Elderly patients face significantly greater risks of falls, pressure sores, and infections than do patients in general wards because of the physical vulnerability and medication complexity that characterize the former group; accordingly, studies on this topic have identified nurse safety behaviour as an effective way of reducing medical errors, nosocomial infections, and the incidence of adverse events [5] . However, the high workload, complex conditions and emotional stress associated with geriatric wards may increase nurses' burnout, thereby potentially weakening their safety behaviour performance [5] . Therefore, exploring the factors that impact nurses' safety behaviour in geriatric wards is highly important in clinical contexts. Previous research has indicated that the nursing practice environment, as a multidimensional external support system, significantly influences nurses' safety behaviours through core elements such as resource allocation, team collaboration models, and managerial support strategies [6,7] . The extant literature on this topic has revealed that a favourable practice environment enhances nurses' adherence to clinical safety guidelines and significantly reduces the frequency of missed nursing care [7] . Structural equation modelling analyses have confirmed that positive practice environments affect safety behaviour via two key psychological pathways: enhancing nurses' self-efficacy and job engagement directly and doing so indirectly by reducing nurses’ levels of occupational burnout [8,9] . Notably, the dimensions of the practice environment that are most closely associated with safety behaviour include job satisfaction and quality management, whereas organizational factors such as involvement in hospital affairs and staffing adequacy have only relatively limited impacts on safety behaviour [10,11] . Consequently, the mechanisms underlying the relationship between practice environments and safety behaviours require further exploration, particularly with respect to potential mediating variables in this context. Occupational coping self-efficacy serves as a core psychological resource that nurses can use to address occupational stress and the corresponding challenges; accordingly, nurses’ level of occupational coping self-efficacy is significantly associated with their work behaviours and mental health [12-15] . Intensive care unit (ICU) nurses who exhibit higher levels of occupational coping self-efficacy are characterized by lower rates of presenteeism, and this form of self-efficacy independently explains 18.35% of the variance in presenteeism [13] . A survey of 1,313 nurses working in geriatric wards revealed a significant positive correlation between occupational coping self-efficacy and geriatric care competencies [14] . One study that investigated 365 registered nurses revealed that occupational coping self-efficacy significantly moderates the relationship between occupational stress and mental health [15] . Enhanced occupational coping self-efficacy has been validated as a protective factor against negative work behaviours, such that organizations are able to strengthen nurses' coping efficacy through strategy training, role modelling, and verbal encouragement [16] . These findings identify occupational coping self-efficacy as a key moderating variable in nurses' responses to professional challenges. Among ICU nurses working in public hospitals, a structural equation modelling analysis revealed that higher levels of self-efficacy among these individuals correspond to better safety behaviour performance (β=0.103, p<0.001) while simultaneously promoting safety behaviours indirectly via enhanced work engagement [17] . In geriatric care settings, occupational coping self-efficacy may improve safety behaviour by alleviating chronic stress and complex care demands, although this pathway requires further empirical validation. Bandura's triadic reciprocal determinism theory proposes that personal factors (i.e., cognition, motivation, and emotion), environmental conditions, and behaviour interact through a process involving mutual determination and reciprocal influence [18] . In the high-risk care setting of geriatric wards, nurses' occupational coping self-efficacy, as a core cognitive factor, is not only influenced directly by organizational support within the practice environment (such as professional training and participation in decision-making) [19,20] ; it also modulates safety behaviour patterns by regulating individuals’ stress-coping strategies (e.g., problem-focused coping) and emotional regulation capacities (e.g., anxiety inhibition)) [21] . Empirical studies have reported that positive interventions in the practice environment (such as role modelling and interdisciplinary collaboration mechanisms) can enhance nurses' occupational coping self-efficacy, thereby reducing the burnout-related risks of nursing errors [22] . In the unique context of geriatric care, the functional dependency of multimorbid patients and the high prevalence of cognitive disorders significantly increase the complexity of nursing procedures [23-25] , thereby amplifying the environmental influence on safety behaviour [26,27] . In this scenario, occupational coping self-efficacy not only exhibits a stress-buffering function but also optimizes safety behaviours through resource conversion mechanisms (e.g., by transforming managerial support into adherence to standardized procedures) [27] . Notably, while previous research on this topic has focused predominantly on the linear relationships between the practice environment and safety behaviours or between occupational coping self-efficacy and safety behaviours, few studies have explored these tripartite relationships and the corresponding interaction mechanisms, particularly in geriatric nursing wards. On the basis of Bandura's triadic reciprocal determinism theory and empirical evidence, the following hypotheses are thus proposed in this study: H1: The practice environment positively predicts the occupational coping self-efficacy exhibited by nurses working in geriatric wards. H2: The practice environment positively predicts the safety behaviours exhibited by nurses working in geriatric wards. H3: Occupational coping self-efficacy positively predicts the safety behaviours exhibited by nurses working in geriatric wards. H4: Occupational coping self-efficacy mediates the relationship between the practice environment and the safety behaviour exhibited by nurses working in geriatric wards. Therefore, to ensure the safety of patients in geriatric wards and improve nurses' safety behaviour, this study investigates the effects of nurses' practice environment and occupational coping self-efficacy on their safety behaviour, alongside the mediating role played by occupational coping self-efficacy with respect to these relationships, with the aim of facilitating the development of standardized interventions for nurses' safety behaviour. 2. Methods 2.1 Study design This cross-sectional study was conducted in line with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational studies. Between July and October 2024, clinical nurses working in selected geriatric wards in Grade 3A hospitals in Anhui Province were surveyed via a questionnaire-based approach. Nurses who met the inclusion criteria were randomly selected from the hospital roster, and simple random sampling ensured that every nurse in the geriatric wards of the participating hospitals had an equal chance of being selected, thus minimizing selection bias. 2.2 Participants The inclusion criteria used for the participants in this study were as follows: a) nurses engaged in geriatric nursing who b) had engaged in clinical nursing practice for ≥ 1 year and c) held a valid nursing licence. The exclusion criteria used for these participants were as follows: a) nurses who were not directly involved in patient care (e.g., administrative or research nurses); b) those who were absent from their duties for more than 3 months during the study period; and c) those who had experienced major life events within the past 3 months (e.g., divorce, death or severe illness of spouse, children, or parents). 2.3 Sample size According to the sample size estimation methods used for mediation analysis, the sample size should be calculated as 5–10 times the number of items to be tested, preferably 15 times or greater [ 28 ] . This study used the criterion of 15 times the number of items to be tested. The questionnaire used in this research contained 67 items. Therefore, the sample size calculation formula was N = 67*15 = 1005. Considering a 5% nonresponse rate, the calculated minimum required sample size was N = 690÷(1–5%) ≈ 1058. 2.4 Measurements 2.4.1 General information questionnaire Following an extensive review of the extant literature on this topic, the research team developed a general information questionnaire that included respondents’ age, gender, marital status, education, title, type of employment, years of experience in geriatric nursing, specialist nurse status, and level of affection towards elderly individuals. 2.4.2 Nurse Practice Environment Assessment Scale The scale was developed under the leadership of the Nursing Center of the Institute of Hospital Management of the National Health and Welfare Commission in China, specifically in the context of Chinese society and culture [ 29 ] . The scale includes 10 dimensions, such as hospital management participation, clinical nursing professionalism, leadership and communication, quality management, internal support, physician‒nurse collaboration, professional development, staffing adequacy, social status, and compensation; overall, the scale included a total of 36 items, alongside one overall evaluation item. Each item was scored on a scale ranging from 0 to 100, in which 0 indicated "very dissatisfied/disagree" and 100 indicated "very satisfied/agree". The final score on this scale was calculated as the average of the scores of all the items. The Cronbach's α coefficients for each dimension of the scale ranged from 0.81 to 0.90, and the overall Cronbach's α coefficient was 0.975. 2.4.3 Occupational Coping Self-Efficacy Scale Occupational coping self-efficacy refers to the ability to regulate one's beliefs in response to occupational stress. A high occupational coping self-efficacy score is conducive to the task of maintaining positive beliefs regarding one's work, thus enabling one to cope positively with occupational stress and reduce burnout. Yanxue Zhai et al. translated the Chinese version of the occupational coping self-efficacy scale [ 30 , 31 ] , which includes two dimensions: occupational burden and relationship difficulties. Thes scale also includes of nine entries. Each item uses is scored on 5-point Likert scale ranging from "Cannot cope easily" (1 point) to "Completely able to cope easily" (5 points). The higher these scores are, the stronger the respondents' sense of occupational coping self-efficacy. The Cronbach's α coefficient for this scale was 0.857. 2.4.4.4 Safety Behaviour Scale The Chinese version of the Nurses' Safety Behaviour Scale [ 32 ] , which was translated by Yenfu Rong [ 33 ] , was used to understand nurses' behaviour with the aim of helping them avoid or minimize harm to patients in the context of nursing care. This one-dimensional questionnaire includes 12 items that are scored on a 5-point Likert scale ranging from "never" to "always". Total scores of 12–60 points are possible, and higher scores indicate higher levels of safety behaviour. The Cronbach's α coefficient is 0.915, and this measure has been widely used in surveys of nurses' safety behaviour. 2.5 Data collection An electronic questionnaire survey method was used in this context. After approval for this research was obtained from the nursing department and nurse managers of the geriatric wards associated with the surveyed hospitals, links to the questionnaire were distributed to nurses working in the ward via the corresponding nurse managers. The questionnaire was anonymous, and the purpose and significance of the survey were explained to the participants, who were free to choose whether to participate in this research. Each section of the questionnaire contained clear instructions, and technical controls ensured that each WeChat account or internet protocol (IP) address could submit only one response. All the questions were mandatory. After the questionnaires were collected, the researcher checked them individually and eliminated those that featured an answer time of less than two minutes, obvious regularity in terms of the answers, or illogicality. A total of 1,124 questionnaires were collected as part of this survey, and 1,099 valid questionnaires remained following the screening process, resulting in an effective recovery rate of 97.77%. This study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (PJ2024-06-31), and all participants provided informed consent and participated in the survey voluntarily. 2.6 Data analysis The SPSS 24.0 statistical software package was used to analyse the data. Measurements that conformed to a normal distribution are presented in terms of means ± standard deviations, whereas the count data are presented in terms of frequency counts and constitutive ratios. Pearson's correlation analysis was performed to test the correlations among nurses' safety behaviour, practice environment and occupational coping self-efficacy. A mediating effects analysis was then conducted with the assistance of the Process plug-in in SPSS software, at a significance level of α = 0.05. 3. Results 3.1 Sociodemographic characteristics of the sample A total of 1099 nurses working in geriatric wards associated with Grade 3A hospitals in Anhui Province completed survey forms. The ages of these 1099 nurses working in geriatric wards ranged from 21 to 56 (34.10 ± 6.368) years, their years of working experience ranged from 1 to 37 (9.18 ± 6.357) years, and the general information of the respondents is presented in Table 1 . Table 1 General information of the nurses working in geriatric wards who were included in this survey ( n = 1099) Variables Categories Number of nurses (percentage, %) Age (years) ≤ 29 269(24.477) 30–39 654(59.509) ≥ 40 176(16.015) Gender (%) Male 42(3.822) Female 1057(96.178) Marital status Unmarried 200(18.198) Married 889(80.892) Divorced/widowed 10(0.910) Education Junior college or below 122(11.101) Bachelor’s degree or above 977(88.899) Title Registered Nurse (RN) 99(9.008) Nurse Practitioner (NP) 338(30.755) Senior Nurse 590(53.685) Deputy Chief Nurse or higher 72(6.551) Type of employment contract Formal establishment 141(12.830) Personnel agency 434(39.490) Contract system 524(47.680) Years of experience working as a nurse in geriatric wards(%) 1ཞ5 372(33.849) 6ཞ10 328(29.845) 11ཞ20 350(31.847) ≥ 21 49(4.459) Specialist nurse Nonspecialized nurse 917(83.439) Other specialized nurses 139(12.648) Geriatric specialized nurses 43(3.913) Level of affection towards elderly individuals Not too much 120(10.919) Don't like it very much 566(51.501) Liked it a great deal 286(26.024) Liked it very much 127(11.556) 3.2 The scores obtained by nurses working in geriatric wards on the Nurse Safety Behaviour Scale, the Occupational Coping Self-Efficacy Scale for Nurses, and the Practice Environment Scale The results of this study revealed that the total score on the Nurse Safety Behaviour Scale obtained by nurses working in geriatric wards was 52.225 ± 8.360. The total score of the Nurse Occupational Coping Self-Efficacy Scale was 36.257 ± 7.103, and the two dimensions of this scale received the following scores: occupational burden (23.849 ± 4.876) and interpersonal difficulty (12.408 ± 2.415). With respect to the Nurse Practice Environment Scale, the overall evaluation score was 77.778 ± 23.384, and the mean scores for the subscale items ranged from 61.272 ± 30.073 to 82.683 ± 20.974, as shown in Table 2 . Table 2 Scores on the Safety Behaviour Scale, The Practice Environment Scale and the Occupational Coping Self-Efficacy Scale [ n = 1099, scores, mean ± SD] Variables Number of items Average item score Total score Safety Behaviour Scale 12 4.352 ± 0.697 52.225 ± 8.360 Occupational Coping Self-Efficacy Scale Total Score for Occupational Coping Self-Efficacy 9 4.029 ± 0.789 36.257 ± 7.103 Occupational Burden Dimension 6 3.975 ± 0.813 23.849 ± 4.876 Interpersonal Difficulty Dimension 3 4.136 ± 0.805 12.408 ± 2.415 Nurse Practice Environment Assessment Scale Overall Evaluation of Nursing Practice Environment 1 77.778 ± 23.384 77.778 ± 23.384 Hospital Management Participation Dimension 3 61.272 ± 30.073 183.817 ± 90.218 Clinical Nursing Professionalism Dimension 2 76.828 ± 22.525 153.657 ± 45.051 Leadership and Communication Dimension 4 77.898 ± 22.580 311.591 ± 90.319 Quality Management Dimension 6 81.255 ± 20.683 487.529 ± 124.101 Internal Support Dimension 5 78.230 ± 21.657 391.152 ± 108.283 Physician‒Nurse Collaboration Dimension 2 82.683 ± 20.974 165.367 ± 41.949 Professional Development Dimension 4 79.029 ± 21.545 316.115 ± 86.181 Staffing Adequacy Dimension 5 79.731 ± 21.247 398.657 ± 106.233 Social Status Dimension 2 76.010 ± 24.088 152.020 ± 48.176 Compensation Dimension 3 74.002 ± 24.698 222.005 ± 74.095 Note: SD: Standard deviation. 3.3 Correlation analysis of nurses’ safety behaviours, occupational coping self-efficacy, and practice environment The results of a Pearson correlation analysis revealed significant positive correlations among the variables included in this research, i.e., safety behaviour, occupational coping self-efficacy, and the practice environment, among nurses working in geriatric wards, thus indicating statistically significant differences ( p < 0.001), and the results are shown in Table 3 . Table 3 Correlations among the studied under investigation ( r values) Variables Safety Behaviour Occupational Coping Self-Efficacy Nursing Practice Environment Safety Behaviour 1 - - Occupational Coping Self-Efficacy 0.678 ** 1 - Occupational Burden Dimension 0.644 ** 0.987 ** 0.483 ** Interpersonal Difficulty Dimension 0.694 ** 0.948 ** 0.472 ** Nursing Practice Environment 0.479 ** 0.492 ** 1 Hospital Management Participation Dimension 0.292 ** 0.386 ** 0.645 ** Clinical Nursing Professionalism Dimension 0.504 ** 0.476 ** 0.705 ** Leadership and Communication Dimension 0.523 ** 0.513 ** 0.768 ** Quality Management Dimension 0.575 ** 0.516 ** 0.799 ** Internal Support Dimension 0.503 ** 0.506 ** 0.847 ** Physician‒Nurse Collaboration Dimension 0.536 ** 0.493 ** 0.788 ** Professional Development Dimension 0.508 ** 0.494 ** 0.828 ** Staffing Adequacy Dimension 0.529 ** 0.522 ** 0.846 ** Social Status Dimension 0.451 ** 0.501 ** 0.833 ** Compensation Dimension 0.437 ** 0.473 ** 0.874 ** Note: r : Pearson correlation coefficient; ** : Statistically significant at p < 0.001. 3.4 The mediating effect of nurses' occupational coping self-efficacy on the relationship between the practice environment and safety behaviour In this study, Model 4 in the Process plug-in developed by Hayes was used to test the mediating effect of occupational coping self-efficacy on the relationship between the practice environment and safety behaviour by standardizing the variables into equations. A mediation model was constructed, in which the practice environment served as the independent variable, safety behaviour served as the dependent variable, and occupational coping self-efficacy served as the mediating variable. The significance test for the regression coefficients was conducted via the bootstrapping method (on the basis of 5000 repeated samples) to obtain estimates of the parameters as well as 95% confidence intervals (CIs); this information would indicate that the effect was significant if the CI did not contain zero. The results revealed that the practice environment had a positive predictive effect on safety behaviours ( β = 0.171, p < 0.001). After the mediator (professional coping self-efficacy) was introduced, the practice environment continued to have a significant direct predictive effect on safety behaviours ( β = 0.069, p < 0.001). The practice environment was identified as a positive predictor of nurses' occupational coping self-efficacy ( β = 0.149, p < 0.001), and nurses' occupational coping self-efficacy was identified as a positive predictor of safety behaviours ( β = 0.687, p < 0.001). The results of the mediating effect analysis revealed that the direct effect of the practice environment on safety behaviours was 0.069, 95% CI [0.051 ~ 0.086], and the indirect effect of occupational coping self-efficacy was 0.102, 95% CI [0.087 ~ 0.120]. The 95% CIs for both the direct and indirect effects did not contain 0, thus indicating that nurses' occupational coping self-efficacy partially mediated the relationship between the practice environment and safety behaviours; furthermore, the indirect effect value accounted for 59.65% of the total effect. See Table 4 , Table 5 and Fig. 1 . Table 4 The mediating effect of occupational coping self-efficacy on the relationship between the practice environment and safety behaviour ( n = 1099) Dependent variable Independent Variable R R 2 F β t Safety Behaviour Practice Environment 0.479 0.230 327.315 0.171 18.092** Occupational Coping Self-Efficacy Practice Environment 0.492 0.242 350.065 0.149 18.710** Safety Behaviour Practice Environment Occupational Coping Self-Efficacy 0.699 0.488 522.939 0.069 0.687 7.744** 23.530** Note: R : multiple correlation coefficient; R2: coefficient of determination; F : F values for the model; β : standardized coefficients; t : t test of significance; **: statistically significant at p < 0.001. Table 5 The direct and indirect effects of occupational coping self-efficacy on the practice environment and safety behaviour ( n = 1099) Items Standardized Effect Standard error 95% CI (LL ~ UL) Proportion of Total Effect (%) Conclusion Total effect 0.171 0.010 0.153ཞ0.190 Partial Complementary Mediation Direct Effect 0.069 0.009 0.051ཞ0.086 40.35% Indirect Effect 0.102 0.008 0.087ཞ0.120 59.65% Note: CI : Confidence interval; LL : Lower limit; UL : Upper limit. 4. Discussion This study focuses on a special and important group of geriatric nurses. Namely, it explores the relationships among the practice environment, occupational coping self-efficacy, and safety behaviour and verifies the mediating role played by occupational coping self-efficacy in the relationship between the practice environment and safety behaviour. The findings of this research reveal the positive role played by nurses working in geriatric wards in efforts to protect patient safety as well as the underlying mechanisms, thereby providing important empirical evidence and ideas to support interventions aimed at improving the safety and quality of geriatric care. The results of this study also revealed that the nurses working in geriatric wards who participated in this research obtained moderate scores with respect to safety behaviour, the practice environment, and occupational coping self-efficacy. These scores were lower than the safety behaviour scores that have been obtained by nurses working in oncology specialty hospitals (55.45 ± 6.879) [ 17 ] , the occupational coping self-efficacy scores (37.22 ± 5.45) that have been obtained by nurses working in ICUs [ 13 ] , and the practice environment scores (82.62 ± 6.59) obtained nurses working in other contexts [ 34 ] . One possible reason for the lower scores observed in this context is that elderly patients tend to be characterized by multiple comorbidities [ 4 ] , declining cognitive function, and multiple caregiving needs [ 35 ] . This situation results in heavy workloads and multiple stressors for nurses working in this context, thus making it difficult for them to maintain a high-level practice environment. These nurses may lack sufficient systematic training and psychological support in the context of their efforts to cope with the complex situations that are specific to geriatric care, such as sudden delirium, refractory behavioural symptoms, high-risk fall prevention, and complex communication and coordination, thus leading them to fail to achieve a higher level of occupational coping self-efficacy [ 14 ] . The level of practice environment observed in this context is moderate, whereas the dimensions of hospital management involvement and compensation packages are particularly inadequate. These findings may be the result of issues such as tight strict allocation, inadequate equipment resources, or insufficient management support. However, a moderate level is not negative. These findings thus suggest that nurses have the basic competencies, environmental perceptions, and confidence necessary for them to cope. The key action in this context is to identify shortcomings in key variables accurately and to seek improvement. The practice environment and occupational coping self-efficacy are key positive factors that influence the safety behaviour of geriatric nurses. The results of this research revealed that nurses' safety behaviour was significantly and positively correlated with the practice environment ( r = 0.479, p < 0.01), thus indicating that the higher their safety behaviour scores were, the greater the extent to which they engaged in safety behaviour. This finding is consistent with the results supported by Fan et al. [ 36 ] . According to social exchange theory [ 37 ] , a behaviour should be viewed as an outcome of an exchange, thus indicating that individual behaviour is governed by activities that offer benefits. When nurses are provided with sufficient personnel and support and when they perceive that the hospital acknowledges their status and compensation, they are more inclined to adhere to safety norms. In turn, this inclination results in enhanced levels of safety behaviour among such nurses. Therefore, nursing managers should increase nurses' participation in hospital affairs, ensure the availability of adequate manpower, establish a reasonable compensation system, and improve the practice environment with the aim of promoting safety behaviour. Nurse safety behaviour was significantly positively correlated with occupational coping self-efficacy ( r = 0.678, p < 0.01). The higher the nurses’ occupational coping self-efficacy scores were, the greater the extent to which they engaged in safety behaviour, which is consistent with the findings reported by Liu et al. [ 17 ] . Nurses’ belief in their ability to cope effectively with challenges in the workplace serves as a crucial psychological driver that motivates them to proactively choose and adhere to safe operating procedures in the high-risk, high-stress environment of geriatric care [ 38 , 39 ] . High levels of occupational coping self-efficacy are conducive to the active identification of risks, standardized operations, and the maintenance of resilience in response to challenges [ 36 ] . Among nurses working in geriatric wards, occupational coping self-efficacy has also been revealed to be positively correlated with nursing competence. High levels of occupational coping self-efficacy promote positive nursing practices, including safety behaviour [ 14 , 27 ] . These results strongly suggest to managers that enhancing nurses' occupational coping self-efficacy can effectively activate those nurses’ intrinsic motivation to engage in safety behaviour. This study identified the nurse practice environment as a significant predictor of safety behaviour in a geriatric ward ( β = 0.171, p < 0.001). This relationship was partially mediated by nurses' professional coping self-efficacy ( β = 0.687, p < 0.001), which accounted for 59.65% of the total effect. These results suggest that the practice environment can influence safety behaviour both directly and indirectly by enhancing nurses’ occupational coping self-efficacy. This finding is in line with Bandura's ternary interaction decision theory. This theory emphasizes the dynamic interactions among the environment, individual subjective factors (e.g., cognition), and behaviour. Specifically, the practice environment not only directly shapes safety behaviours (e.g., following safety guidelines) [ 40 , 41 ] but also regulates such behaviours indirectly by influencing individual subjective factors (e.g., professional coping self-efficacy) [ 42 , 43 ] . The results of this research highlight the strong association between environmental support and psychological empowerment. Nurses' safety behaviour results from the interaction between the practice environment and nurses’ perceptions thereof. For example, the external support provided by the positive environment reinforces nurses’ self-efficacy, thus enabling them to engage in safety behaviour (e.g., reducing errors) more confidently. This finding confirms the established pattern that environmental resources enhance behavioural performance via intrinsic motivation [ 7 , 8 ] . The mediating effect observed in this context accounted for nearly 60% of the total effect, thus highlighting the central and pivotal position of occupational coping self-efficacy in this context. Safety in the field of geriatric nursing cannot rely solely on institutional or resource inputs, and environmental strengths must be translated into intrinsic efficacy beliefs on the part of nurses to maximize safety behaviour. Bandura's ternary interaction decision theory posits that self-efficacy, as a subjective assessment of competence, moderates the indirect pathways by which environmental influences impact behaviour [ 18 ] . In response to the complex challenges associated with geriatric wards, high levels of self-efficacy motivate nurses to translate environmental resources (e.g., training) into specific actions (e.g., adherence to infection control) more effectively, thereby ensuring patient safety. This finding is consistent with the literature: occupational coping self-efficacy is a protective factor with regard to negative behaviour [ 16 ] , and a good environment must be reinforced by personal factors such as self-efficacy because of its indirect impacts on the quality and safety of care [ 4 ] . This interaction is particularly critical in light of the high-risk nature of geriatric wards. Therefore, managers should implement a dual-track strategy that involves both strengthening the practice environment and enhancing nurses’ professional coping self-efficacy with the aim of promoting safe nursing practices. Conclusion In summary, this study demonstrates that the safety behaviour exhibited by geriatric nurses, their practice environment, and their occupational coping self-efficacy are currently moderate overall, although these factors also exhibit room for improvement. The findings of this research confirm that the practice environment and occupational coping self-efficacy contribute significantly to nurses’ safety behaviour. Notably, these findings reveal that occupational coping self-efficacy partially mediates the influence of the practice environment on safety behaviour. These results deepen our understanding of the mechanisms that shape nurses' safety behaviour and highlight the importance of prioritizing the development and empowerment of nurses' intrinsic psychological resources, particularly occupational coping self-efficacy, while simultaneously enhancing the objective practice environment. Practical and clinical implications Future management practices should begin with an in-depth assessment of the specific limitations of the current practice environment, alongside targeted improvements aimed at providing a solid guarantee of safe practice for nurses. Moreover, the development of occupational coping self-efficacy should be incorporated into core competency building programmes and continuing education systems for nurses, and evidence-based intervention programmes (e.g., situational simulation training, cognitive behavioural skills workshops, and peer support groups) should be developed and implemented with the aim of increasing nurses' confidence and ability to cope with the unique challenges entailed by geriatric nursing. Ultimately, by taking full advantage of the mediating role played by occupational coping self-efficacy in this context, the positive impact of environmental improvements on safety behaviour can be maximized, thereby effectively enhancing the quality of geriatric nursing safety and patient outcomes. Study limitations First, the cross-sectional design of this research verified that the practice environment influences safety behaviour via occupational coping self-efficacy. However, the direction of causality in this context could not be established, and this point must be verified through longitudinal tracking or intervention experiments in the future. Second, the representativeness of the sample investigated in this research was limited because the data were collected only from geriatric nurses working in tertiary hospitals in the same province. This approach limited the generalizability of the results because it did not cover scenarios such as secondary hospitals, community hospitals, and geriatric care facilities. Third, the theoretical model used in this research is insufficient to support an analysis of the differential paths of action associated with the subdimensions of the practice environment or to facilitate an examination of the concurrent mediating effects of other psychological factors in this context. Declarations Ethics approval and consent to participate The First Affiliated Hospital of Anhui Medical University's Ethics Committee approved the study (PJ2024-06-31).The study followed the ethical guidelines of the Declaration of Helsinki. All participants provided written informed consent to ensure their confidentiality and voluntary participation. Consent for publication Not applicable. Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This work was supported by the Hefei Health and Health Applied Medical Research Project [grant numbers Hwk2021zc006] and the Chinese Nursing Association Research Project [grant numbers ZHKY202211]. Authors' contributions J.L. and N.C. were involved in research design, data collection, data analysis, and writing the manuscript of the paper; S.C.andX.Z. provided support in distributing the questionnaires, collecting the data, and interpreting the data, and participated in critical intellectual revision of the article. All authors reviewed the manuscript and approved the final version. Acknowledgements We sincerely grateful for all the hospital administrators and nurses who participated in this study. Author information Department of anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China Jingjing Li&Shangui Chen School of Nursing, Anhui Medical University, Hefei, China Nuo Chen Department of Nursing, The First Affiliated Hospital of Anhui Medical University, Hefei, China Xiumei Zhang Corresponding author Correspondence to Xiumei Zhang Email: [email protected] References World Health Organization:WHO,Ageing and health 2024.https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Fusama M, Nakahara H, Urata Y, Kawahata K, Kawahito Y, Kojima M, Sugihara T, Hashimoto M, Miyamae T, Murashima A, Mori M, Yajima N, Matsui T. Challenges nurses face in providing care to older patients with rheumatoid arthritis: A qualitative study. Mod Rheumatol. 2025;35(2):256-264. doi: 10.1093/mr/roae087. Chen KX, Pai MC, Hong WP, Wang CJ, Wang JJ. Exploring nurses' difficulties and strategies when caring for patients with dementia in a neurological ward. Nurs Health Sci. 2024;26(2):e13119. doi: 10.1111/nhs.13119. Huh A, Shin JH. Person-Centered Care Practice, Patient Safety Competence, and Patient Safety Nursing Activities of Nurses Working in Geriatric Hospitals. Int J Environ Res Public Health. 2021;18(10):5169. doi: 10.3390/ijerph18105169. Labrague LJ. Nurses' adherence to patient safety protocols and its relationship with adverse patient events. J Nurs Scholarsh. 2024;56(2):282-290. doi: 10.1111/jnu.12942. Pereira SCA, Ribeiro OMPL, Fassarella CS, Santos EJF. The impact of nursing practice environments on patient safety culture in primary health care: a scoping review. BJGP Open. 2024;8(1):BJGPO.2023.0062. doi: 10.3399/BJGPO.2023.0062. Labrague LJ, Al Sabei S, AbuAlRub R, Burney I, Al Rawajfah O. The role of nurses' adherence to clinical safety guidelines in linking nurse practice environment to missed nursing care. J Nurs Scholarsh. 2025;57(2):354-362. doi: 10.1111/jnu.13017. Dan X, Huang Y, Ren JH, Tian YL, He YL. Professional Nursing Practice Environment and Work Engagement: The Mediating Roles of Self-Efficacy and Achievement Motivation. J Nurs Res. 2023;31(4):e285. doi: 10.1097/jnr.0000000000000563. Liu X, Zheng J, Liu K, Baggs JG, Liu J, Wu Y, You L. Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis. Int J Nurs Stud. 2018;86:82-89. doi: 10.1016/j.ijnurstu.2018.05.005. Chiang HY, Hsiao YC, Lee HF. Predictors of Hospital Nurses' Safety Practices: Work Environment, Workload, Job Satisfaction, and Error Reporting. J Nurs Care Qual. 2017;32(4):359-368. doi: 10.1097/NCQ.0000000000000240. Eva GF, Amo-Setién F, César LC, Concepción SS, Roberto MM, Jesús MM, Carmen OM. Effectiveness of intervention programs aimed at improving the nursing work environment: A systematic review. Int Nurs Rev. 2024;71(1):148-159. doi: 10.1111/inr.12826. Lin Q, Fu M, Sun K, Liu L, Chen P, Li L, Niu Y, Wu J. 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The protective role of self-efficacy against workplace incivility and burnout in nursing: A time-lagged study. Health Care Manage Rev. 2018;43(1):21-29. doi: 10.1097/HMR.0000000000000126. Liu M, Liu L, Lv Z, Ma F, Mao Y, Liu Y. Effects of burnout and work engagement in the relationship between self-efficacy and safety behaviours-A chained mediation modelling analysis. J Adv Nurs. 2024;80(4):1473-1483.doi: 10.1111/jan.15925. Bandura A.Social foundations of thought and action;a socialcognitive theory.Englewood Cliffs,NJ:Prentice-Hall,1986. Mi Y, Xi F. Self-Efficacy Mediates the Relationship Between Organisational Support and Health Education Competency: A Cross-Sectional Study Among 9182 Nurses. Nurs Open. 2025;12(4):e70209. doi: 10.1002/nop2.70209. Ni Y, Li L, Bao Y, You G, Li J. Relationship between perceived organisational support, self-efficacy, proactive personality and career self-management among nurses: a moderated mediation analysis. BMJ Open. 2024;14(6):e081334. doi: 10.1136/bmjopen-2023-081334. Karantzas GC, McCabe MP, Mellor D, Von Treuer K, Davison TE, O'Connor D, Haselden R, Konis A. Organizational climate and self-efficacy as predictors of staff strain in caring for dementia residents: A mediation model. Arch Gerontol Geriatr. 2016;66:89-94. doi: 10.1016/j.archger.2016.05.006. Kong Y, Zhang Y, Sun P, Zhang J, Lu Y, Li J, Zheng Y. Interdisciplinary cooperation with solution-focused brief therapy to reduce job stress, burnout, and coping in Chinese nurses: A randomised controlled trial. Heliyon. 2024;10(22):e40138. doi: 10.1016/j.heliyon.2024.e40138. Doroszkiewicz H. How the Cognitive Status of Older People Affects Their Care Dependency Level and Needs: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(16):10257. doi: 10.3390/ijerph191610257. Jiang M, Dai B. Effect of depression combined with cognitive impairment on dependency risk in rural older adults: analysis of data from the China health and retirement longitudinal study (CHARLS 2020). BMC Psychol. 2025;13(1):167. doi: 10.1186/s40359-024-02335-y. Kok S, Schoonhoven L, Vernooij LM, Reitsma JB, Verstraten C, Metzelthin SF, Bleijenberg N, de Man-van Ginkel JM. The effectiveness of Function Focused Care among patients acutely admitted to hospital: A stepped wedge cluster trial. Int J Nurs Stud. 2024;160:104893. doi: 10.1016/j.ijnurstu.2024.104893. Malinowska-Lipień I, Sasak P, Gabryś T, Kózka M, Gniadek A, Lompart Ł, Brzostek T. Nurses' attitudes towards factors determining the safety of patients treated in intensive care units: A cross-sectional study. Nurs Crit Care. 2024;29(5):1015-1022. doi: 10.1111/nicc.13040. Lan Y, Qin Y, Zhou Y, Jiang Z, Liu Q, Huang D, Tan W. Relationship between ICU nurses' perception of patient safety, caring behaviour, professional self-efficacy and nursing deficits: A multiple mediation analysis. Nurs Crit Care. 2025;30(2):e13294. doi: 10.1111/nicc.13294. Preacher KJ, Kelley K. Effect size measures for mediation models: quantitative strategies for communicating indirect effects.Psychol Methods. 2011;16(2):93-115. doi: 10.1037/a0022658. ZHANG Haiyan,WU Zhijun,LIANG Junqing,et al. Revision and reliability validity evaluation of the nurse practice environment assessment scale. China Nursing Management,2019;19(3):388-393. Pisanti R, Lombardo C, Lucidi F, Lazzari D, Bertini M. Development and validation of a brief Occupational Coping Self-Efficacy Questionnaire for Nurses. J Adv Nurs. 2008;62(2):238-47. doi: 10.1111/j.1365-2648.2007.04582.x. PMID: 18394036. ZHAI Yanxue,CHAI Xiaoyu,LIU Kun,et al. Chineseization and reliability of the Nurses' Occupational Coping Self-Efficacy Scale. Modern Preventive Medicine,2021;48(3):423-426. Shih CP,Chang L,Chen JC,et al.The factors influencing safety behavior of medical staffs in emergency room of a medical center in Taiwan.J Manag,2008;25(4):451-465. Rong YF.The relationshipbetween patient safety culture and safety behavior.master.Tzu Chi University;2009. Huang X, Shang Wenhua, An L, et al. A Study on the Correlation between the Practice Environment and Turnover Rate of Nurses in 188 Tertiary Grade A Public General Hospitals. Chinese Journal of Nursing,2023;58(15):1858-1864. Chen C, Shannon K, Napier S, Neville S, Montayre J. Ageism directed at older nurses in their workplace: A systematic review. J Clin Nurs. 2024;33(7):2388-2411. doi: 10.1111/jocn.17088. Fox MT, McCague H, Sidani S, Butler JI. The Relationships Between the Geriatric Practice Environment, Nursing Practice, and the Quality of Hospitalized Older Adults' Care. J Nurs Scholarsh. 2018;50(5):513-521. doi: 10.1111/jnu.12414. Nord WR. Social exchange theory: an integrative approach to social conformity. Psychol Bull. 1969;71(3):174-208. doi: 10.1037/h0027032. Kang K, Cho H. Nursing students' experiences of safety threats and coping processes during clinical practice: A qualitative study. Nurse Educ Today. 2023;127:105842. doi: 10.1016/j.nedt.2023.105842. Altıntaş S, Çelik S, Karahan E, Uçar Ö, Yücel M. Investigation of the relationship between the self-efficacy levels in clinical practice and coping behaviors with stress among international nursing students. Nurse Educ Today. 2024;143:106366. doi: 10.1016/j.nedt.2024.106366. Fox MT, Sidani S, Butler JI, Tregunno D. Nurses' Perspectives on the Geriatric Nursing Practice Environment and the Quality of Older People's Care in Ontario Acute Care Hospitals. Can J Nurs Res. 2017;49(2):94-100. doi: 10.1177/0844562117707140. Pereira S, Santos EJ, Fassarella CS, Ribeiro OM. Effectiveness of the positive nursing practice environment promotion program in improving patient safety in primary health care: study protocol for a randomized controlled clinical trial. BJGP Open. 2025:BJGPO.2025.0025. doi: 10.3399/BJGPO.2025.0025. Chen X, Li J, Arber A, Qiao C, Wu J, Sun C, Han X, Wang D, Zhu Z, Zhou H. The impact of the nursing work environment on compassion fatigue: The mediating role of general self-efficacy. Int Nurs Rev. 2025;72(2):e13044. doi: 10.1111/inr.13044. Lucas P, Jesus É, Almeida S, Araújo B. Relationship of the nursing practice environment with the quality of care and patients' safety in primary health care. BMC Nurs. 2023;22(1):413. doi: 10.1186/s12912-023-01571-8. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7191933","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509335689,"identity":"95c32f8b-155b-4f85-b8c9-4177b48396b6","order_by":0,"name":"Jingjing Li","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jingjing","middleName":"","lastName":"Li","suffix":""},{"id":509335690,"identity":"f2c202bf-2e9d-4ad9-ad5b-70bd276aaaef","order_by":1,"name":"Nuo Chen","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Nuo","middleName":"","lastName":"Chen","suffix":""},{"id":509335691,"identity":"4eb6388e-57c6-4056-ab43-f65888b5caec","order_by":2,"name":"Shangui Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shangui","middleName":"","lastName":"Chen","suffix":""},{"id":509335692,"identity":"39d3079d-8387-436d-9476-4076f24b3f29","order_by":3,"name":"Xiumei Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACCTjJ2PiAsQHMMyBaS7MBKVrAgE2CKC3ys5ufPfzaZpG4tr25reLnjm2JDezN2yQYau7g1MI455i5scwZicRtZw623ew9czuxgedYmQTDsWc4tTBLJJhJS1QAtdxIbLvB2wbUIpFjBnThYZxa2CTSv0lLGAC13H/YVvgXpEX+DX4tPEAzJT+AbWFsY4bYwoNfi4RETpk0wxkJ421nEpulZdtuG7fxpBVbJBzDrUV+Rvo2yZ9tdbLbjh9/+PFt223ZfvbDG298qMGtBRwEPCi+AxEJeDUAA/oHAQWjYBSMglEwwgEAbFBYg/C52L8AAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital of Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xiumei","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-07-23 04:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7191933/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7191933/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90884569,"identity":"51aad15a-1c4e-4b55-8323-1a96b65cf85c","added_by":"auto","created_at":"2025-09-09 10:00:43","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37971,"visible":true,"origin":"","legend":"\u003cp\u003eModel of the mediating effect of occupational coping self-efficacy on the relationship between the practice environment and safety behaviour\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7191933/v1/fc89dc00ca76c330eb1808b2.jpeg"},{"id":90886065,"identity":"052e7c2a-ae0b-4e25-bd98-fdf55c50a6d0","added_by":"auto","created_at":"2025-09-09 10:08:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1377286,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7191933/v1/6b2e3e95-fe61-495b-9046-3bafe20d3bac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The relationship between the practice environment and safety behaviour among nurses working in geriatric wards: The mediating role of occupational coping self-efficacy","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAs the global population continues to age, the World Health Organization predicts that one-sixth of the world's population will reach the age of 60 years or older by 2030 and that the global population aged 60 years or older will double by 2050 (2.1 billion) \u003csup\u003e[1]\u003c/sup\u003e. The proportion of elderly individuals continues to increase, thus placing greater demands on the healthcare system, especially in terms of geriatric ward care services.\u003c/p\u003e\n\u003cp\u003eMultimorbidity and cognitive decline are common among elderly patients. These issues entail the triple characteristics of high complexity, high intensity and high risk for nursing care \u003csup\u003e[2,3]\u003c/sup\u003e. In this context, geriatric nurses face unique professional challenges: the need to cope simultaneously with the sophisticated care needs of elderly patients (e.g., debilitation management), measures aimed at ensuring safety (e.g., falls, pressure ulcers, and multiple medication errors), and the emotional exhaustion associated with end-of-life care. Safety behaviour is particularly important in geriatric wards, where it represents a key competency that nurses need to proactively identify risks, follow protocols, and prevent adverse events in clinical practice\u003csup\u003e\u0026nbsp;[4]\u003c/sup\u003e. Elderly patients face significantly greater risks of falls, pressure sores, and infections than do patients in general wards because of the physical vulnerability and medication complexity that characterize the former group; accordingly, studies on this topic have identified nurse safety behaviour as an effective way of reducing medical errors, nosocomial infections, and the incidence of adverse events\u003csup\u003e[5]\u003c/sup\u003e. However, the high workload, complex conditions and emotional stress associated with geriatric wards may increase nurses' burnout, thereby potentially weakening their safety behaviour performance\u003csup\u003e[5]\u003c/sup\u003e. Therefore, exploring the factors that impact nurses' safety behaviour in geriatric wards is highly important in clinical contexts.\u003c/p\u003e\n\u003cp\u003ePrevious research has indicated that the nursing practice environment, as a multidimensional external support system, significantly influences nurses' safety behaviours through core elements such as resource allocation, team collaboration models, and managerial support strategies\u003csup\u003e[6,7]\u003c/sup\u003e. The extant literature on this topic has revealed that a favourable practice environment enhances nurses' adherence to clinical safety guidelines and significantly reduces the frequency of missed nursing care\u003csup\u003e[7]\u003c/sup\u003e. Structural equation modelling analyses have confirmed that positive practice environments affect safety behaviour via two key psychological pathways: enhancing nurses' self-efficacy and job engagement directly and doing so indirectly by reducing nurses’ levels of occupational burnout\u003csup\u003e[8,9]\u003c/sup\u003e. Notably, the dimensions of the practice environment that are most closely associated with safety behaviour include job satisfaction and quality management, whereas organizational factors such as involvement in hospital affairs and staffing adequacy have only relatively limited impacts on safety behaviour\u003csup\u003e[10,11]\u003c/sup\u003e. Consequently, the mechanisms underlying the relationship between practice environments and safety behaviours require further exploration, particularly with respect to potential mediating variables in this context.\u003c/p\u003e\n\u003cp\u003eOccupational coping self-efficacy serves as a core psychological resource that nurses can use to address occupational stress and the corresponding challenges; accordingly, nurses’ level of occupational coping self-efficacy is significantly associated with their work behaviours and mental health\u003csup\u003e[12-15]\u003c/sup\u003e. Intensive care unit (ICU) nurses who exhibit higher levels of occupational coping self-efficacy are characterized by lower rates of presenteeism, and this form of self-efficacy independently explains 18.35% of the variance in presenteeism\u003csup\u003e[13]\u003c/sup\u003e. A survey of 1,313 nurses working in geriatric wards revealed a significant positive correlation between occupational coping self-efficacy and geriatric care competencies\u003csup\u003e[14]\u003c/sup\u003e. One study that investigated 365 registered nurses revealed that occupational coping self-efficacy significantly moderates the relationship between occupational stress and mental health\u003csup\u003e[15]\u003c/sup\u003e. Enhanced occupational coping self-efficacy has been validated as a protective factor against negative work behaviours, such that organizations are able to strengthen nurses' coping efficacy through strategy training, role modelling, and verbal encouragement\u003csup\u003e[16]\u003c/sup\u003e. These findings identify occupational coping self-efficacy as a key moderating variable in nurses' responses to professional challenges. Among ICU nurses working in public hospitals, a structural equation modelling analysis revealed that higher levels of self-efficacy among these individuals correspond to better safety behaviour performance (β=0.103, p\u0026lt;0.001) while simultaneously promoting safety behaviours indirectly via enhanced work engagement\u003csup\u003e[17]\u003c/sup\u003e. In geriatric care settings, occupational coping self-efficacy may improve safety behaviour by alleviating chronic stress and complex care demands, although this pathway requires further empirical validation.\u003c/p\u003e\n\u003cp\u003eBandura's triadic reciprocal determinism theory proposes that personal factors (i.e., cognition, motivation, and emotion), environmental conditions, and behaviour interact through a process involving mutual determination and reciprocal influence\u003csup\u003e[18]\u003c/sup\u003e. In the high-risk care setting of geriatric wards, nurses' occupational coping self-efficacy, as a core cognitive factor, is not only influenced directly by organizational support within the practice environment (such as professional training and participation in decision-making)\u003csup\u003e[19,20]\u003c/sup\u003e; it also modulates safety behaviour patterns by regulating individuals’ stress-coping strategies (e.g., problem-focused coping) and emotional regulation capacities (e.g., anxiety inhibition))\u003csup\u003e[21]\u003c/sup\u003e. Empirical studies have reported that positive interventions in the practice environment (such as role modelling and interdisciplinary collaboration mechanisms) can enhance nurses' occupational coping self-efficacy, thereby reducing the burnout-related risks of nursing errors\u003csup\u003e[22]\u003c/sup\u003e. In the unique context of geriatric care, the functional dependency of multimorbid patients and the high prevalence of cognitive disorders significantly increase the complexity of nursing procedures\u003csup\u003e[23-25]\u003c/sup\u003e, thereby amplifying the environmental influence on safety behaviour\u003csup\u003e[26,27]\u003c/sup\u003e. In this scenario, occupational coping self-efficacy not only exhibits a stress-buffering function but also optimizes safety behaviours through resource conversion mechanisms (e.g., by transforming managerial support into adherence to standardized procedures)\u003csup\u003e[27]\u003c/sup\u003e. Notably, while previous research on this topic has focused predominantly on the linear relationships between the practice environment and safety behaviours or between occupational coping self-efficacy and safety behaviours, few studies have explored these tripartite relationships and the corresponding interaction mechanisms, particularly in geriatric nursing wards.\u003c/p\u003e\n\u003cp\u003eOn the basis of Bandura's triadic reciprocal determinism theory and empirical evidence, the following hypotheses are thus proposed in this study:\u003c/p\u003e\n\u003cp\u003eH1: The practice environment positively predicts the occupational coping self-efficacy exhibited by nurses working in geriatric wards.\u003c/p\u003e\n\u003cp\u003eH2: The practice environment positively predicts the safety behaviours exhibited by nurses working in geriatric wards.\u003c/p\u003e\n\u003cp\u003eH3: Occupational coping self-efficacy positively predicts the safety behaviours exhibited by nurses working in geriatric wards.\u003c/p\u003e\n\u003cp\u003eH4: Occupational coping self-efficacy mediates the relationship between the practice environment and the safety behaviour exhibited by nurses working in geriatric wards.\u003c/p\u003e\n\u003cp\u003eTherefore, to ensure the safety of patients in geriatric wards and improve nurses' safety behaviour, this study investigates the effects of nurses' practice environment and occupational coping self-efficacy on their safety behaviour, alongside the mediating role played by occupational coping self-efficacy with respect to these relationships, with the aim of facilitating the development of standardized interventions for nurses' safety behaviour.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design\u003c/h2\u003e\u003cp\u003e This cross-sectional study was conducted in line with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational studies. Between July and October 2024, clinical nurses working in selected geriatric wards in Grade 3A hospitals in Anhui Province were surveyed via a questionnaire-based approach. Nurses who met the inclusion criteria were randomly selected from the hospital roster, and simple random sampling ensured that every nurse in the geriatric wards of the participating hospitals had an equal chance of being selected, thus minimizing selection bias.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Participants\u003c/h2\u003e\u003cp\u003eThe inclusion criteria used for the participants in this study were as follows: a) nurses engaged in geriatric nursing who b) had engaged in clinical nursing practice for \u0026ge;\u0026thinsp;1 year and c) held a valid nursing licence. The exclusion criteria used for these participants were as follows: a) nurses who were not directly involved in patient care (e.g., administrative or research nurses); b) those who were absent from their duties for more than 3 months during the study period; and c) those who had experienced major life events within the past 3 months (e.g., divorce, death or severe illness of spouse, children, or parents).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Sample size\u003c/h2\u003e\u003cp\u003eAccording to the sample size estimation methods used for mediation analysis, the sample size should be calculated as 5\u0026ndash;10 times the number of items to be tested, preferably 15 times or greater\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. This study used the criterion of 15 times the number of items to be tested. The questionnaire used in this research contained 67 items. Therefore, the sample size calculation formula was \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;67*15\u0026thinsp;=\u0026thinsp;1005. Considering a 5% nonresponse rate, the calculated minimum required sample size was \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;690\u0026divide;(1\u0026ndash;5%)\u0026thinsp;\u0026asymp;\u0026thinsp;1058.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Measurements\u003c/h2\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.4.1 General information questionnaire\u003c/h2\u003e\u003cp\u003eFollowing an extensive review of the extant literature on this topic, the research team developed a general information questionnaire that included respondents\u0026rsquo; age, gender, marital status, education, title, type of employment, years of experience in geriatric nursing, specialist nurse status, and level of affection towards elderly individuals.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.4.2 Nurse Practice Environment Assessment Scale\u003c/h2\u003e\u003cp\u003eThe scale was developed under the leadership of the Nursing Center of the Institute of Hospital Management of the National Health and Welfare Commission in China, specifically in the context of Chinese society and culture\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. The scale includes 10 dimensions, such as hospital management participation, clinical nursing professionalism, leadership and communication, quality management, internal support, physician‒nurse collaboration, professional development, staffing adequacy, social status, and compensation; overall, the scale included a total of 36 items, alongside one overall evaluation item. Each item was scored on a scale ranging from 0 to 100, in which 0 indicated \"very dissatisfied/disagree\" and 100 indicated \"very satisfied/agree\". The final score on this scale was calculated as the average of the scores of all the items. The Cronbach's α coefficients for each dimension of the scale ranged from 0.81 to 0.90, and the overall Cronbach's α coefficient was 0.975.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.4.3 Occupational Coping Self-Efficacy Scale\u003c/h2\u003e\u003cp\u003eOccupational coping self-efficacy refers to the ability to regulate one's beliefs in response to occupational stress. A high occupational coping self-efficacy score is conducive to the task of maintaining positive beliefs regarding one's work, thus enabling one to cope positively with occupational stress and reduce burnout. Yanxue Zhai et al. translated the Chinese version of the occupational coping self-efficacy scale\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e, which includes two dimensions: occupational burden and relationship difficulties. Thes scale also includes of nine entries. Each item uses is scored on 5-point Likert scale ranging from \"Cannot cope easily\" (1 point) to \"Completely able to cope easily\" (5 points). The higher these scores are, the stronger the respondents' sense of occupational coping self-efficacy. The Cronbach's α coefficient for this scale was 0.857.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section4\"\u003e\u003ch2\u003e2.4.4.4 Safety Behaviour Scale\u003c/h2\u003e\u003cp\u003eThe Chinese version of the Nurses' Safety Behaviour Scale\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e, which was translated by Yenfu Rong\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e, was used to understand nurses' behaviour with the aim of helping them avoid or minimize harm to patients in the context of nursing care. This one-dimensional questionnaire includes 12 items that are scored on a 5-point Likert scale ranging from \"never\" to \"always\". Total scores of 12\u0026ndash;60 points are possible, and higher scores indicate higher levels of safety behaviour. The Cronbach's α coefficient is 0.915, and this measure has been widely used in surveys of nurses' safety behaviour.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Data collection\u003c/h2\u003e\u003cp\u003eAn electronic questionnaire survey method was used in this context. After approval for this research was obtained from the nursing department and nurse managers of the geriatric wards associated with the surveyed hospitals, links to the questionnaire were distributed to nurses working in the ward via the corresponding nurse managers. The questionnaire was anonymous, and the purpose and significance of the survey were explained to the participants, who were free to choose whether to participate in this research. Each section of the questionnaire contained clear instructions, and technical controls ensured that each WeChat account or internet protocol (IP) address could submit only one response. All the questions were mandatory. After the questionnaires were collected, the researcher checked them individually and eliminated those that featured an answer time of less than two minutes, obvious regularity in terms of the answers, or illogicality. A total of 1,124 questionnaires were collected as part of this survey, and 1,099 valid questionnaires remained following the screening process, resulting in an effective recovery rate of 97.77%. This study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (PJ2024-06-31), and all participants provided informed consent and participated in the survey voluntarily.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Data analysis\u003c/h2\u003e\u003cp\u003eThe SPSS 24.0 statistical software package was used to analyse the data. Measurements that conformed to a normal distribution are presented in terms of means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, whereas the count data are presented in terms of frequency counts and constitutive ratios. Pearson's correlation analysis was performed to test the correlations among nurses' safety behaviour, practice environment and occupational coping self-efficacy. A mediating effects analysis was then conducted with the assistance of the Process plug-in in SPSS software, at a significance level of α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Sociodemographic characteristics of the sample\u003c/h2\u003e\u003cp\u003eA total of 1099 nurses working in geriatric wards associated with Grade 3A hospitals in Anhui Province completed survey forms. The ages of these 1099 nurses working in geriatric wards ranged from 21 to 56 (34.10\u0026thinsp;\u0026plusmn;\u0026thinsp;6.368) years, their years of working experience ranged from 1 to 37 (9.18\u0026thinsp;\u0026plusmn;\u0026thinsp;6.357) years, and the general information of the respondents is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\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\u003eGeneral information of the nurses working in geriatric wards who were included in this survey (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1099)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of nurses (percentage, %)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e269(24.477)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e654(59.509)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e176(16.015)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender (%)\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\u003e42(3.822)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1057(96.178)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\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\u003e200(18.198)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e889(80.892)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced/widowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10(0.910)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior college or below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e122(11.101)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor\u0026rsquo;s degree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e977(88.899)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegistered Nurse (RN)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99(9.008)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse Practitioner (NP)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e338(30.755)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSenior Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e590(53.685)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDeputy Chief Nurse or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72(6.551)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eType of employment contract\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFormal establishment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e141(12.830)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePersonnel agency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e434(39.490)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContract system\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e524(47.680)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eYears of experience working as a nurse in geriatric wards(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1ཞ5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e372(33.849)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6ཞ10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e328(29.845)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11ཞ20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e350(31.847)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49(4.459)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSpecialist nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNonspecialized nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e917(83.439)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther specialized nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e139(12.648)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeriatric specialized nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43(3.913)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eLevel of affection towards elderly individuals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot too much\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e120(10.919)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDon't like it very much\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e566(51.501)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiked it a great deal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e286(26.024)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLiked it very much\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127(11.556)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.2 The scores obtained by nurses working in geriatric wards on the Nurse Safety Behaviour Scale, the Occupational Coping Self-Efficacy Scale for Nurses, and the Practice Environment Scale\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of this study revealed that the total score on the Nurse Safety Behaviour Scale obtained by nurses working in geriatric wards was 52.225\u0026thinsp;\u0026plusmn;\u0026thinsp;8.360. The total score of the Nurse Occupational Coping Self-Efficacy Scale was 36.257\u0026thinsp;\u0026plusmn;\u0026thinsp;7.103, and the two dimensions of this scale received the following scores: occupational burden (23.849\u0026thinsp;\u0026plusmn;\u0026thinsp;4.876) and interpersonal difficulty (12.408\u0026thinsp;\u0026plusmn;\u0026thinsp;2.415). With respect to the Nurse Practice Environment Scale, the overall evaluation score was 77.778\u0026thinsp;\u0026plusmn;\u0026thinsp;23.384, and the mean scores for the subscale items ranged from 61.272\u0026thinsp;\u0026plusmn;\u0026thinsp;30.073 to 82.683\u0026thinsp;\u0026plusmn;\u0026thinsp;20.974, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\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\u003eScores on the Safety Behaviour Scale, The Practice Environment Scale and the Occupational Coping Self-Efficacy Scale [\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1099, scores, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD]\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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=\"char\" char=\"\u0026plusmn;\" 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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of items\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAverage item score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSafety Behaviour Scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.352\u0026thinsp;\u0026plusmn;\u0026thinsp;0.697\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e52.225\u0026thinsp;\u0026plusmn;\u0026thinsp;8.360\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eOccupational Coping Self-Efficacy Scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Score for Occupational Coping Self-Efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.029\u0026thinsp;\u0026plusmn;\u0026thinsp;0.789\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e36.257\u0026thinsp;\u0026plusmn;\u0026thinsp;7.103\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOccupational Burden Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.975\u0026thinsp;\u0026plusmn;\u0026thinsp;0.813\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e23.849\u0026thinsp;\u0026plusmn;\u0026thinsp;4.876\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterpersonal Difficulty Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.136\u0026thinsp;\u0026plusmn;\u0026thinsp;0.805\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e12.408\u0026thinsp;\u0026plusmn;\u0026thinsp;2.415\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e\u003cp\u003e\u003cb\u003eNurse Practice Environment Assessment Scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall Evaluation of Nursing Practice Environment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e77.778\u0026thinsp;\u0026plusmn;\u0026thinsp;23.384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e77.778\u0026thinsp;\u0026plusmn;\u0026thinsp;23.384\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHospital Management Participation Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e61.272\u0026thinsp;\u0026plusmn;\u0026thinsp;30.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e183.817\u0026thinsp;\u0026plusmn;\u0026thinsp;90.218\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical Nursing Professionalism Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e76.828\u0026thinsp;\u0026plusmn;\u0026thinsp;22.525\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e153.657\u0026thinsp;\u0026plusmn;\u0026thinsp;45.051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeadership and Communication Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e77.898\u0026thinsp;\u0026plusmn;\u0026thinsp;22.580\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e311.591\u0026thinsp;\u0026plusmn;\u0026thinsp;90.319\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuality Management Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e81.255\u0026thinsp;\u0026plusmn;\u0026thinsp;20.683\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e487.529\u0026thinsp;\u0026plusmn;\u0026thinsp;124.101\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal Support Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e78.230\u0026thinsp;\u0026plusmn;\u0026thinsp;21.657\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e391.152\u0026thinsp;\u0026plusmn;\u0026thinsp;108.283\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysician‒Nurse Collaboration Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e82.683\u0026thinsp;\u0026plusmn;\u0026thinsp;20.974\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e165.367\u0026thinsp;\u0026plusmn;\u0026thinsp;41.949\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional Development Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e79.029\u0026thinsp;\u0026plusmn;\u0026thinsp;21.545\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e316.115\u0026thinsp;\u0026plusmn;\u0026thinsp;86.181\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStaffing Adequacy Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e79.731\u0026thinsp;\u0026plusmn;\u0026thinsp;21.247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e398.657\u0026thinsp;\u0026plusmn;\u0026thinsp;106.233\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSocial Status Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e76.010\u0026thinsp;\u0026plusmn;\u0026thinsp;24.088\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e152.020\u0026thinsp;\u0026plusmn;\u0026thinsp;48.176\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCompensation Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e74.002\u0026thinsp;\u0026plusmn;\u0026thinsp;24.698\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e222.005\u0026thinsp;\u0026plusmn;\u0026thinsp;74.095\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: SD: Standard deviation.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Correlation analysis of nurses\u0026rsquo; safety behaviours, occupational coping self-efficacy, and practice environment\u003c/h2\u003e\u003cp\u003eThe results of a Pearson correlation analysis revealed significant positive correlations among the variables included in this research, i.e., safety behaviour, occupational coping self-efficacy, and the practice environment, among nurses working in geriatric wards, thus indicating statistically significant differences (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\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 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelations among the studied under investigation (\u003cem\u003er\u003c/em\u003e values)\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSafety Behaviour\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOccupational Coping Self-Efficacy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNursing Practice Environment\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\u003eSafety Behaviour\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupational Coping Self-Efficacy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.678\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupational Burden Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.644\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.987\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.483\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInterpersonal Difficulty Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.694\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.948\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.472\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNursing Practice Environment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.479\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.492\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital Management Participation Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.292\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.386\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.645\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Nursing Professionalism Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.504\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.476\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.705\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeadership and Communication Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.523\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.513\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.768\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality Management Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.575\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.516\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.799\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInternal Support Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.503\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.506\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.847\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysician‒Nurse Collaboration Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.536\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.493\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.788\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional Development Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.508\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.494\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.828\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStaffing Adequacy Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.529\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.522\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.846\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial Status Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.451\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.501\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.833\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompensation Dimension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.437\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.473\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.874\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: \u003cem\u003er\u003c/em\u003e: Pearson correlation coefficient; \u003csup\u003e**\u003c/sup\u003e: Statistically significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.4 The mediating effect of nurses' occupational coping self-efficacy on the relationship between the practice environment and safety behaviour\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, Model 4 in the Process plug-in developed by Hayes was used to test the mediating effect of occupational coping self-efficacy on the relationship between the practice environment and safety behaviour by standardizing the variables into equations. A mediation model was constructed, in which the practice environment served as the independent variable, safety behaviour served as the dependent variable, and occupational coping self-efficacy served as the mediating variable. The significance test for the regression coefficients was conducted via the bootstrapping method (on the basis of 5000 repeated samples) to obtain estimates of the parameters as well as 95% confidence intervals (CIs); this information would indicate that the effect was significant if the CI did not contain zero.\u003c/p\u003e\u003cp\u003eThe results revealed that the practice environment had a positive predictive effect on safety behaviours (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.171, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). After the mediator (professional coping self-efficacy) was introduced, the practice environment continued to have a significant direct predictive effect on safety behaviours (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.069, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The practice environment was identified as a positive predictor of nurses' occupational coping self-efficacy (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.149, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and nurses' occupational coping self-efficacy was identified as a positive predictor of safety behaviours (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.687, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The results of the mediating effect analysis revealed that the direct effect of the practice environment on safety behaviours was 0.069, \u003cem\u003e95% CI\u003c/em\u003e [0.051\u0026thinsp;~\u0026thinsp;0.086], and the indirect effect of occupational coping self-efficacy was 0.102, \u003cem\u003e95% CI\u003c/em\u003e [0.087\u0026thinsp;~\u0026thinsp;0.120]. The \u003cem\u003e95% CIs\u003c/em\u003e for both the direct and indirect effects did not contain 0, thus indicating that nurses' occupational coping self-efficacy partially mediated the relationship between the practice environment and safety behaviours; furthermore, the indirect effect value accounted for 59.65% of the total effect. See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe mediating effect of occupational coping self-efficacy on the relationship between the practice environment and safety behaviour (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1099)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDependent variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndependent Variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafety Behaviour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePractice Environment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.479\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e327.315\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e18.092**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupational Coping Self-Efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePractice Environment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.492\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.242\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e350.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e18.710**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafety Behaviour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePractice Environment\u003c/p\u003e\u003cp\u003eOccupational Coping Self-Efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.699\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.488\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e522.939\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003cp\u003e0.687\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7.744**\u003c/p\u003e\u003cp\u003e23.530**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: \u003cem\u003eR\u003c/em\u003e: multiple correlation coefficient; R2: coefficient of determination; \u003cem\u003eF\u003c/em\u003e: \u003cem\u003eF\u003c/em\u003e values for the model; \u003cem\u003eβ\u003c/em\u003e: standardized coefficients; \u003cem\u003et\u003c/em\u003e: t test of significance; **: statistically significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe direct and indirect effects of occupational coping self-efficacy on the practice environment and safety behaviour (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1099)\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=\".\" 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\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStandardized Effect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eStandard error\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003cp\u003e\u003cem\u003e(LL\u0026thinsp;~\u0026thinsp;UL)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eProportion of Total Effect (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eConclusion\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=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.153ཞ0.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePartial Complementary Mediation\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=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.051ཞ0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e40.35%\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=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.087ཞ0.120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e59.65%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: \u003cem\u003eCI\u003c/em\u003e: Confidence interval; \u003cem\u003eLL\u003c/em\u003e: Lower limit; \u003cem\u003eUL\u003c/em\u003e: Upper limit.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study focuses on a special and important group of geriatric nurses. Namely, it explores the relationships among the practice environment, occupational coping self-efficacy, and safety behaviour and verifies the mediating role played by occupational coping self-efficacy in the relationship between the practice environment and safety behaviour. The findings of this research reveal the positive role played by nurses working in geriatric wards in efforts to protect patient safety as well as the underlying mechanisms, thereby providing important empirical evidence and ideas to support interventions aimed at improving the safety and quality of geriatric care.\u003c/p\u003e\u003cp\u003eThe results of this study also revealed that the nurses working in geriatric wards who participated in this research obtained moderate scores with respect to safety behaviour, the practice environment, and occupational coping self-efficacy. These scores were lower than the safety behaviour scores that have been obtained by nurses working in oncology specialty hospitals (55.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.879)\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, the occupational coping self-efficacy scores (37.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.45) that have been obtained by nurses working in ICUs\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, and the practice environment scores (82.62\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59) obtained nurses working in other contexts\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. One possible reason for the lower scores observed in this context is that elderly patients tend to be characterized by multiple comorbidities\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, declining cognitive function, and multiple caregiving needs\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. This situation results in heavy workloads and multiple stressors for nurses working in this context, thus making it difficult for them to maintain a high-level practice environment. These nurses may lack sufficient systematic training and psychological support in the context of their efforts to cope with the complex situations that are specific to geriatric care, such as sudden delirium, refractory behavioural symptoms, high-risk fall prevention, and complex communication and coordination, thus leading them to fail to achieve a higher level of occupational coping self-efficacy\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. The level of practice environment observed in this context is moderate, whereas the dimensions of hospital management involvement and compensation packages are particularly inadequate. These findings may be the result of issues such as tight strict allocation, inadequate equipment resources, or insufficient management support. However, a moderate level is not negative. These findings thus suggest that nurses have the basic competencies, environmental perceptions, and confidence necessary for them to cope. The key action in this context is to identify shortcomings in key variables accurately and to seek improvement.\u003c/p\u003e\u003cp\u003eThe practice environment and occupational coping self-efficacy are key positive factors that influence the safety behaviour of geriatric nurses. The results of this research revealed that nurses' safety behaviour was significantly and positively correlated with the practice environment (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.479, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), thus indicating that the higher their safety behaviour scores were, the greater the extent to which they engaged in safety behaviour. This finding is consistent with the results supported by Fan et al. \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. According to social exchange theory\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e, a behaviour should be viewed as an outcome of an exchange, thus indicating that individual behaviour is governed by activities that offer benefits. When nurses are provided with sufficient personnel and support and when they perceive that the hospital acknowledges their status and compensation, they are more inclined to adhere to safety norms. In turn, this inclination results in enhanced levels of safety behaviour among such nurses. Therefore, nursing managers should increase nurses' participation in hospital affairs, ensure the availability of adequate manpower, establish a reasonable compensation system, and improve the practice environment with the aim of promoting safety behaviour.\u003c/p\u003e\u003cp\u003eNurse safety behaviour was significantly positively correlated with occupational coping self-efficacy (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.678, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The higher the nurses\u0026rsquo; occupational coping self-efficacy scores were, the greater the extent to which they engaged in safety behaviour, which is consistent with the findings reported by Liu et al.\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Nurses\u0026rsquo; belief in their ability to cope effectively with challenges in the workplace serves as a crucial psychological driver that motivates them to proactively choose and adhere to safe operating procedures in the high-risk, high-stress environment of geriatric care \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. High levels of occupational coping self-efficacy are conducive to the active identification of risks, standardized operations, and the maintenance of resilience in response to challenges\u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. Among nurses working in geriatric wards, occupational coping self-efficacy has also been revealed to be positively correlated with nursing competence. High levels of occupational coping self-efficacy promote positive nursing practices, including safety behaviour\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. These results strongly suggest to managers that enhancing nurses' occupational coping self-efficacy can effectively activate those nurses\u0026rsquo; intrinsic motivation to engage in safety behaviour.\u003c/p\u003e\u003cp\u003eThis study identified the nurse practice environment as a significant predictor of safety behaviour in a geriatric ward (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.171, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This relationship was partially mediated by nurses' professional coping self-efficacy (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.687, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which accounted for 59.65% of the total effect. These results suggest that the practice environment can influence safety behaviour both directly and indirectly by enhancing nurses\u0026rsquo; occupational coping self-efficacy. This finding is in line with Bandura's ternary interaction decision theory. This theory emphasizes the dynamic interactions among the environment, individual subjective factors (e.g., cognition), and behaviour. Specifically, the practice environment not only directly shapes safety behaviours (e.g., following safety guidelines)\u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e but also regulates such behaviours indirectly by influencing individual subjective factors (e.g., professional coping self-efficacy)\u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e. The results of this research highlight the strong association between environmental support and psychological empowerment. Nurses' safety behaviour results from the interaction between the practice environment and nurses\u0026rsquo; perceptions thereof. For example, the external support provided by the positive environment reinforces nurses\u0026rsquo; self-efficacy, thus enabling them to engage in safety behaviour (e.g., reducing errors) more confidently. This finding confirms the established pattern that environmental resources enhance behavioural performance via intrinsic motivation \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe mediating effect observed in this context accounted for nearly 60% of the total effect, thus highlighting the central and pivotal position of occupational coping self-efficacy in this context. Safety in the field of geriatric nursing cannot rely solely on institutional or resource inputs, and environmental strengths must be translated into intrinsic efficacy beliefs on the part of nurses to maximize safety behaviour. Bandura's ternary interaction decision theory posits that self-efficacy, as a subjective assessment of competence, moderates the indirect pathways by which environmental influences impact behaviour \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. In response to the complex challenges associated with geriatric wards, high levels of self-efficacy motivate nurses to translate environmental resources (e.g., training) into specific actions (e.g., adherence to infection control) more effectively, thereby ensuring patient safety. This finding is consistent with the literature: occupational coping self-efficacy is a protective factor with regard to negative behaviour\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, and a good environment must be reinforced by personal factors such as self-efficacy because of its indirect impacts on the quality and safety of care\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. This interaction is particularly critical in light of the high-risk nature of geriatric wards. Therefore, managers should implement a dual-track strategy that involves both strengthening the practice environment and enhancing nurses\u0026rsquo; professional coping self-efficacy with the aim of promoting safe nursing practices.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this study demonstrates that the safety behaviour exhibited by geriatric nurses, their practice environment, and their occupational coping self-efficacy are currently moderate overall, although these factors also exhibit room for improvement. The findings of this research confirm that the practice environment and occupational coping self-efficacy contribute significantly to nurses\u0026rsquo; safety behaviour. Notably, these findings reveal that occupational coping self-efficacy partially mediates the influence of the practice environment on safety behaviour. These results deepen our understanding of the mechanisms that shape nurses' safety behaviour and highlight the importance of prioritizing the development and empowerment of nurses' intrinsic psychological resources, particularly occupational coping self-efficacy, while simultaneously enhancing the objective practice environment.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePractical and clinical implications\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFuture management practices should begin with an in-depth assessment of the specific limitations of the current practice environment, alongside targeted improvements aimed at providing a solid guarantee of safe practice for nurses. Moreover, the development of occupational coping self-efficacy should be incorporated into core competency building programmes and continuing education systems for nurses, and evidence-based intervention programmes (e.g., situational simulation training, cognitive behavioural skills workshops, and peer support groups) should be developed and implemented with the aim of increasing nurses' confidence and ability to cope with the unique challenges entailed by geriatric nursing. Ultimately, by taking full advantage of the mediating role played by occupational coping self-efficacy in this context, the positive impact of environmental improvements on safety behaviour can be maximized, thereby effectively enhancing the quality of geriatric nursing safety and patient outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFirst, the cross-sectional design of this research verified that the practice environment influences safety behaviour via occupational coping self-efficacy. However, the direction of causality in this context could not be established, and this point must be verified through longitudinal tracking or intervention experiments in the future. Second, the representativeness of the sample investigated in this research was limited because the data were collected only from geriatric nurses working in tertiary hospitals in the same province. This approach limited the generalizability of the results because it did not cover scenarios such as secondary hospitals, community hospitals, and geriatric care facilities. Third, the theoretical model used in this research is insufficient to support an analysis of the differential paths of action associated with the subdimensions of the practice environment or to facilitate an examination of the concurrent mediating effects of other psychological factors in this context.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe First Affiliated Hospital of Anhui Medical University's Ethics Committee approved the study (PJ2024-06-31).The study followed the ethical guidelines of the Declaration of Helsinki. All participants provided written informed consent to ensure their confidentiality and voluntary participation.\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\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Hefei Health and Health Applied Medical Research Project [grant numbers Hwk2021zc006] and the Chinese Nursing Association Research Project [grant numbers ZHKY202211].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJ.L. and N.C. were involved in research design, data collection, data analysis, and writing the manuscript of the paper; S.C.andX.Z. provided support in distributing the questionnaires, collecting the data, and interpreting the data, and participated in critical intellectual revision of the article. All authors reviewed the manuscript and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely grateful for all the hospital administrators and nurses who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China\u003c/p\u003e\n\u003cp\u003eJingjing Li\u0026amp;Shangui Chen\u003c/p\u003e\n\u003cp\u003eSchool of Nursing, Anhui Medical University, Hefei, China\u003c/p\u003e\n\u003cp\u003eNuo Chen\u003c/p\u003e\n\u003cp\u003eDepartment of Nursing, The First Affiliated Hospital of Anhui Medical University, Hefei, China\u003c/p\u003e\n\u003cp\u003eXiumei Zhang\u003c/p\u003e\n\u003cp\u003eCorresponding author\u003c/p\u003e\n\u003cp\u003eCorrespondence to Xiumei Zhang\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization:WHO,Ageing and health 2024.https://www.who.int/news-room/fact-sheets/detail/ageing-and-health.\u003c/li\u003e\n\u003cli\u003eFusama M, Nakahara H, Urata Y, Kawahata K, Kawahito Y, Kojima M, Sugihara T, Hashimoto M, Miyamae T, Murashima A, Mori M, Yajima N, Matsui T. 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BMC Nurs. 2023;22(1):413. doi: 10.1186/s12912-023-01571-8. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"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":"Practice environment, Safety behaviour, Occupational coping self-efficacy, Nurses, Mediating role","lastPublishedDoi":"10.21203/rs.3.rs-7191933/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7191933/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eNurses' safety behaviour is a key factor in efforts to ensure patient safety and enhance the quality of care, especially in geriatric wards. Although the nursing practice environment is known to influence nurses' safety behaviour, the mechanisms underlying this influence remain unclear. This study investigated the mediating role played by occupational coping self-efficacy in the relationship between the practice environment and safety behaviour among nurses working in geriatric wards, thus providing new strategies that can be used to optimize safety behaviour.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e This study featured a cross-sectional design in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Data were collected from 1099 nurses who were recruited from selected geriatric wards in Grade 3A hospitals in Anhui Province; these nurses completed the validated Nurse Practice Environment Assessment Scale, Safety Behaviour Scale, and Occupational Coping Self-Efficacy Scale. Descriptive statistics, Pearson\u0026rsquo;s correlations, and a mediating effects analysis were employed to analyse the data with the assistance of SPSS software (version 24).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe participants\u0026rsquo; total scores on the Safety Behaviour Scale, Practice Environment Assessment Scale, and Occupational Coping Self-Efficacy Scale were 52.225\u0026thinsp;\u0026plusmn;\u0026thinsp;8.360, 36.257\u0026thinsp;\u0026plusmn;\u0026thinsp;7.103, and 77.778\u0026thinsp;\u0026plusmn;\u0026thinsp;23.384, respectively, all of which represented moderate scores. Their total score on the Nurse Safety Behaviour Scale was positively correlated with their total scores on the Occupational Coping Self-Efficacy Scale and Practice Environment Assessment Scale (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.678, 0.479, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and their total score on the Nurse Practice Environment Assessment Scale was significantly positively correlated with their total score on the Nurse Occupational Coping Self-Efficacy Scale (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.492, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Nurses\u0026rsquo; occupational coping self-efficacy partially mediated the relationship between the practice environment and nurses\u0026rsquo; safety behaviours, as indicated by a mediating effect of 0.102, which accounted for 59.65% of the total effect.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eNurses' occupational coping self-efficacy mediates the relationship between the practice environment and nurses\u0026rsquo; safety behaviour. Nursing managers should focus on the task of cultivating nurses' occupational coping self-efficacy with the aim of optimizing the work environment of clinical nurses, thereby improving those nurses\u0026rsquo; safety behaviours and ensuring patient safety.\u003c/p\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"The relationship between the practice environment and safety behaviour among nurses working in geriatric wards: The mediating role of occupational coping self-efficacy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 10:00:38","doi":"10.21203/rs.3.rs-7191933/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-09-02T13:14:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-07T11:09:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-25T04:41:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-25T04:41:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-07-23T04:21:10+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":"b8122573-7342-4c3c-aa43-a6593e74bbf1","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T10:00:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 10:00:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7191933","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7191933","identity":"rs-7191933","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}