Mediating effects of positive coping styles among oncology nurses between psychological resilience and professional grief: a cross-sectional study

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There is a lack of systematic research on the relationship between psychological resilience, coping styles and professional grief. This study examines the relationship between psychological resilience and professional grief among oncology nurses and the mechanisms by which coping styles play a role. METHODS: A questionnaire survey was conducted among 540 oncology nurses in five tertiary-level hospitals in Sichuan Province from November 2024 to January 2025 using purposive sampling. The questionnaire included psychological resilience (MeRS), coping styles (SCSQ), and professional sadness (GSSN). RESULTS: A total of 518 valid questionnaires were returned, with a validity rate of 95.9%. The results of this study showed that psychological resilience had a significant direct effect on professional grief (β= -0.545, CI [-0.395, -0.302]). In addition, psychological resilience had a significant positive effect on positive coping styles (β= 0.570, CI [0.194, 0.249]). There was a significant effect of positive coping styles on professional grief (β= -0.337, CI [-0.693, -0.418]). Further, psychological resilience had a statistically significant effect on professional grief, i.e., including the mediating variable (β= -0.353, CI [-0.279, -0.173]). Positive coping styles partially mediated the relationship between psychological resilience and professional grief among oncology nurses, with a mediation effect value of 0.192 and a mediation effect of 35.23% of the total effect. CONCLUSION: Positive coping styles partially mediate the relationship between psychological resilience and professional grief in oncology nurses. The hospital administrators should target interventions to promote the mental health of oncology nurses to reduce the incidence of professional grief. Biological sciences/Cancer Biological sciences/Psychology Health sciences/Oncology professional grief psychological resilience coping styles oncology nurses Figures Figure 1 Introduction Professional Grief (PG) in nurses is a set of grief reactions to the death of a patient under the care of nurses in the course of their work [1, 2]. Professional grief manifests itself in the personal dimension in the same way as bereaved people's grief responses, but also has a professional character [3, 4]. On the one hand, nurses may be reluctant to express grief openly when a patient under their care dies [5]. On the other hand, nurses grieve while providing services to other patients and their families, and therefore lack the time and space to express their grief, leading to grief deprivation [6]. However, experiencing professional grief repeatedly over a long period of time can easily lead to burnout and empathy fatigue among nurses, which not only adversely affects personal mood, cognition, and professional development, but also affects the associated quality of care [7-10]. Oncology nurses are exposed to dying or dead patients and families in their work over a long period of time, making them more likely to experience professional grief compared to nursing staff in other units [11, 12]. According to the theory of stress and stress, in the face of stressful events and environments, individuals need to mobilise internal and external resources and take coping actions to reduce the stress response [13]. Psychological resilience (PR) is the ability of an individual to adapt effectively in the face of life adversity, traumatic events, or work challenges [14]. Psychological resilience serves as an internal resource for individuals to cope and adapt well to stressful events [15]. Individuals with higher psychological resilience are more able to actively resist and adapt to trauma [16]. From a positive psychology perspective, psychological resilience, as an individual positive psychological quality, helps nurses to adapt well to a work environment full of heavy stress and trauma [17]. Coping Style (CS) is a set of specific behaviours adopted by an individual to moderate stress, including positive and negative coping styles [18]. It has been suggested that the level of psychological resilience is closely related to different coping styles [19]. Individuals who are more psychologically resilient may be more inclined to confront problems, actively obtain information, adopt positive coping styles, and utilise various types of resources when faced with a stressful event, thereby improving their situation and reducing the occurrence of professional grief [20, 21]. It is hypothesised that coping styles may play a mediating role between psychological resilience and levels of professional grief. However, most of the current studies in China focus on the sadness of family members of deceased patients [22], and there are fewer studies on professional grief among Chinese oncology nurses, and most of them are qualitative [5], and the relationship between professional grief and psychological resilience and coping styles has not been explored. On the basis of existing evidence, we found that whether psychological resilience alleviates professional grief through the mediating role of positive coping styles among Chinese oncology nurses is a question worth exploring. Based on the above, this study examined whether oncology nurses' coping styles were a mediating variable between psychological resilience and professional grief, with a view to informing the development of targeted interventions by clinical care managers to reduce professional grief among oncology nurses. Therefore, based on the literature review, we developed the following four hypotheses after analysing the relationship between nurses' professional grief, psychological resilience and coping styles: 1. psychological resilience has a direct positive impact on professional grief. 2. psychological resilience coping styles have a direct positive impact. 3. coping styles have a direct positive effect on professional grief. 4. the relationship between psychological resilience and professional grief is mediated through coping styles. Our study will help to provide new research directions for clinical care managers to reduce professional grief among oncology nurses. 1. Research Objects and Methods 1.1 Objects of study This was a cross-sectional study, using purposive sampling method and a cross-sectional survey of clinical nurses in the oncology departments of five tertiary care hospitals in Sichuan Province from November 2024 to February 2025 via Question star online questionnaire platform and paper-based questionnaire. Inclusion Criteria: ① Obtained the certificate of nurse practice and work experience of 1 year or more; ② Experienced the death of a patient; ③ Informed consent and voluntary participation in this investigation. Exclusion Criteria: ① Incomplete information; ② Recent major life changes. Sample size calculation: this study used nurses' professional grief as the main observation index to calculate the sample size, according to the pre-survey results, σ=1.06, δ=0.1, α took 0.05, brought into the formula N=(u 1-ɑ/2 σ/δ) 2 ≈432 cases, and considering 20% invalid questionnaires, the final sample size was determined to be 518 cases. Finally, 540 questionnaires were distributed and 22 unreliable data were manually excluded, resulting in 518 valid questionnaires, and 95.9% (518/540) of the valid responses were analysed. 1.2 Research tools 1.2.1 Demographic information: based on the purpose of the study, it was formulated on its own after reviewing relevant literature and consulting with experts. Including: gender, age, highest education, religion, length of service, title, marital status, fertility, nature of hospital, position, etc. 1.2.2 Grief State Scale for Nurses (GSSN): The scale was developed by Japanese scholars Feni et al [23], and translated and converted into Chinese by Wang Yu et al [24] to form the Chinese version of the Nurses' Grief State Scale, which is used to assess the level of professional grief of nursing staff. The scale consists of four dimensions, including mood swings (4 entries), uncomfortable feelings about death (3 entries), sadness about the patient's death (5 entries) and emotional exhaustion (5 entries), with a total of 17 entries. The scale scored on a 5-point Likert scale with an overall score of 85. Higher scores indicate higher levels of professional sadness among nurses. The total Cronbach's alpha coefficient of the scale was 0.813, and the Cronbach's alpha coefficients for each of the four dimensions of mood fluctuation, uncomfortable feelings about death, sadness about the patient's death, and emotional exhaustion were 0.729, 0.855, 0.846, and 0.929, and the retest reliability coefficient was 0.915, which is a good reliability and validity. The Cronbach's alpha coefficient in this study was 0.907. 1.2.3 Medical Professionals Resilience Scale (MeRS): The scale developed by Rahman et al [25] based on the 2021 Comprehensive Resilience Model, incorporating a conceptual model and literature review. Jiao Chunhui et al [26] translated Chinese to form the Chinese version of the Psychological Resilience Scale for Healthcare Workers. The scale includes 4 dimensions of growth (15 entries), participation (6 entries), control (12 entries), and resources (4 entries), with a total of 37 entries, and is scored on a 4-point Likert scale, ‘strongly disagree’, ‘disagree’, ‘strongly disagree’, “disagree”, “agree”, “strongly agree” in the order of 1, 2, 3, 4 points, the total score of 148 points. A score of 37-66 represents a low level of psychological resilience, 67-118 represents a moderate level of psychological resilience, and 119-148 represents a high level of psychological resilience. The overall Cronbach's alpha coefficient for the scale was 0.90, and the Cronbach's alpha coefficients for the four dimensions were 0.891, 0.719, 0.818, and 0.779, respectively. The Cronbach's alpha coefficient in this study was 0.966. 1.2.4 Simplified Coping Style Questionnaire (SCSQ): The scale compiled by Chinese scholar Xie Yaning [27] to simplify and modify the foreign coping style scales, it is used to measure the ways of coping with stressful situations in life or work of different individuals. It included two dimensions of positive coping (12 entries) and negative coping (8 entries), with a total of 20 entries. The scale was scored on a 4-point Likert scale, with ‘not used’ scoring 0 and ‘often used’ scoring 3. The mean scores of the positive dimension entries were subtracted from the mean scores of the negative dimension entries to obtain the difference, and if the difference is greater than 0, it indicates that the subjects' preferred coping style is positive coping, and vice versa for negative coping. The Cronbach's alpha coefficient for the total scale was 0.90, and the Cronbach's alpha coefficients for the positive coping and negative coping dimensions were 0.89 and 0.78, respectively. In the present study, the total Cronbach's alpha coefficient of the scale was 0.838, and the Cronbach's alpha coefficients for the positive coping and negative coping dimensions were 0.877 and 0.832, respectively. 1.2.5 Data collection methodology: The study was conducted with the consent of the head of the nursing department of each hospital. 3 investigators who were centrally trained by the subject matter team, distributed paper questionnaires or questionnaire stars. The questionnaires included general information about the nurses (gender, age, highest education level, religion, length of service, title, and marital status) and GSSN, MeRS, and SCSQ. The investigator explained the purpose, significance and considerations of the study to the research participants using a uniform guide to explain unclear and ambiguous points. Questionnaires were distributed after obtaining the consent and support of the nurses, who answered the questionnaires themselves. Each questionnaire took approximately 10 to 15 minutes to complete. 1.2.6. Statistical methods: all analyses were performed using IBM SPSS statistical software version 27.0 (Almonk, NY, USA). A two-tailed test was performed at a significance level of α = 0.05. Continuous data were presented as mean ± standard deviation and categorical data were presented as (n) and percentage (%).Pearson correlation analysis was used to test for correlation between variables. Similarly, McKinnon's four-step method (46) was used to analyse the mediating role, which had to satisfy four specific criteria:(1) there was a significant correlation between the independent variable (MeRS) and the dependent variable (GSSN); (2) there was also a significant correlation between the independent variable (MeRS) and the mediating variable. (3) After adjusting for the control of the independent variable (MeRS), there is a significant positive correlation between the mediator variable (SCSQ) and the dependent variable (GSSN); (4) significant indirect correlation coefficient between the independent variable (MeRS) and the dependent variable (GSSN) through the mediator variable (SCSQ). The first three steps were tested by linear regression equations with αin = 0.05 and αout = 0.01, respectively. Finally, the mediating effect was analysed using the PROCESS macro (Model 4) of SPSS version 4.0. Statistical significance was found when the 95% confidence interval did not contain zero. 2. Results 2.1 Common method bias test As this study used self-assessment scales, in order to further improve the rigour of this study, the issue of common method bias may exist for the data. In order to control common method bias, this study used the Harman one-way test for testing. The results show that there are 13 factors with eigenvalues greater than 1, and the variance explained by the first factor is 30.033%, which is less than the critical standard of 40%, and there is no situation of ‘only one factor or one factor has a very high explanatory rate’, so the data in this study do not have serious common method bias. 2.2 Socio-demographic characteristics Table 1 shows the socio-demographic characteristics of oncology nurses. Of the 518 eligible oncology nurses, 500 (96.5%) were female and 18 (3.5%) were male of the 518 eligible oncology nurses.131 subjects were 50 years of age (5.0%).87 (16.8%) were junior college, 412 ( 79.5%) were undergraduate, and 19 (3.7%) were master degree or above.483 (93.2%) had no religious affiliation, and 35 (6.8%) had a religious affiliation.58 (11.2%) had a working experience of 21 years. 52 (10.0%) had the title of nurse, 197 (38.0%) had the title of senior nurse, 224 (43.2%) had the title of supervisor nurse, and 45 (8.7%) had the title of co-chief nurse or above. 111 (21.4%) were unmarried, 388 (74.9%) were married, and 19 (3.7%) were divorced or widowed.375 (72.4%) had children and 143 (27.6%) had no children.383 (73.9%) were employed in specialized hospitals and 135 (26.1%) in general hospitals.326 (62.9%) were charge nurses, 128 (24.7%) were responsible group leader, 36 (6.9%) were office nurses and 28 (5.4%) were general services nurse. 105 (20.3 per cent) did not voluntarily choose the nursing profession, while 413 (79.7 per cent) did. 286 (55.2 per cent) had not attended psychological training, while 232 (44.8 per cent) had. Table 1 Sociodemographic information of the participants(n=518) Variable Mean ± SD (range) N (%) Gender Female 500（96.5） Male 18（3.5） Age (years) ＜30 131（25.3） 30～50 361（69.7） ＞50 26（5.0） Education level Junior college 87（16.8） Undergraduate 412（79.5） Master degree or above 19（3.7） religious belief not have 483（93.2） there are 35（6.8） Length of service(years) ＜3 58（11.2） 3～10 163（31.5） 11～20 208（40.2） ＞21 89（17.2） Professional title Nurse 52（10.0） Senior nurse 197（38.0） Supervisor nurse 224（43.2） Co-chief nurse or above 45（8.7） Marital status Unmarried 111（21.4） Married 388（74.9） Divorced or widowed 19（3.7） Fertility Having children 375（72.4） Childless 143（27.6） Hospital category Specialized hospital 383（73.9） General hospital 135（26.1） Position Charge nurse 326（62.9） Responsible group leader 128（24.7） Office nurse 36（6.9） General services nurse 28（5.4） Whether the nursing profession is chosen voluntarily Involuntary 105（20.3） Voluntariness 413（79.7） Whether or not they have participated in psychological training Not attended 286（55.2） Past 232（44.8） 2.3 Correlation analysis of oncology nurses' coping styles, psychological resilience, and professional grief The results of Pearson's correlation analysis showed that oncology nurses' professional grief was negatively correlated with psychological resilience and positive coping (P 0.05); psychological resilience was negatively correlated with positive coping (P < 0.01), and psychological resilience had a correlation with negative coping but the r-value was too low; positive coping had a correlation with negative coping, but the r-value was too low, see Table 2. Thus, hypotheses 1, 2 and 3 were partially tested. Table 2 Means, SDs, and correlations of all variables Variables Mean SD 1 2 3 4 1. professional grief 35.69 9.217 1 2. psychological resilience 114.06 14.395 -0.545 ** 1 3. positive coping style 24.32 6.727 -0.538 ** 0.570 ** 1 4. negative coping style 11.73 4.829 0.019 0.155 ** 0.124 ** 1 2.4 Analysis of the Mediating Effect of Positive Coping Styles between Psychological Resilience and Professional Grief in Oncology Nurses In order to explore the underlying mechanism of the significant positive effect of psychological resilience on professional grief, positive coping style was further introduced as a mediating variable to be substituted into the structural equation modeling in the study. By using Model 4 in the SPSS macro program Process to conduct the test of mediating effects, the mediating role of analyzing positive coping styles between psychological resilience and professional grief was verified and analyzed according to the methodology of Bootstrap provided by Hayes. The path coefficients between the variables of positive coping style, psychological resilience and professional grief are shown in Figure 1. Table 3 reports the analysis of mediating effects between variables. After controlling for variables, psychological resilience had a significant direct effect on professional grief (β= -0.545, CI [-0.395, -0.302]). In addition, psychological resilience had a significant positive effect on positive coping styles (β= 0.570, CI [0.194, 0.249]). Positive coping styles had a significant effect on professional grief (β= -0.337, CI [-0.693, -0.418]). Further, the effect of psychological resilience on professional grief was statistically significant, i.e., including the mediating variable (β= -0.353, CI [-0.279, -0.173]). Based on the bootstrap 95% confidence interval without zero, it can be concluded that positive coping style mediates the relationship between psychological resilience and professional grief. The mediating effect, which accounted for 35.23% of the total effect, confirmed that positive coping style mediated the relationship between psychological resilience and professional grief (Table 4), and Figure 1 shows the final mediation model. Hypothesis 4 was partially established. Table 3 Regression analysis among study measures Variables β t P LLCI ULCI R 2 F Result variable: positive coping style Predictor psychological resilience 0.570 15.776 ＜0.001 0.194 0.249 0.325 248.895 Result variable: professional grief Predictor psychological resilience -0.353 -8.308 ＜0.001 -0.279 -0.173 0.373 153.448 Mediator positive coping style -0.337 -7.928 ＜0.001 -0.693 -0.418 Result variable: professional grief Independent variable psychological resilience -0.545 -14.762 ＜0.001 -0.395 -0.302 0.297 217.916 According to Table 4, the upper and lower bootstrap 95% confidence intervals of the mediating effect of psychological resilience on professional grief and positive coping styles do not contain 0, indicating that psychological resilience not only acts as a direct effect on professional grief, but also acts as a mediating effect on professional grief through the variable of positive coping styles. This direct effect (0.353) and mediating effect (0.192) accounted for 64.77% and 35.23% of the total effect (1.0), respectively. The 95% confidence interval is the 95% CI. psychological resilience mediates model hypotheses for professional grief through positive coping styles (all coefficients are standardized). Table 4 Analysis of the mediating effect of positive coping style on psychological resilience and professional grief Path Effect Boot SE Boot LLCI Boot ULCI Effect ratio Total effect -0.545** 0.024 -0.395 -0.302 1 Direct effect -0.353** 0.027 -0.279 -0.173 64.77% Indirect effect -0.192** 0.027 -0.247 -0.140 35.23% ∗∗∗P < 0.001. 3. Discussion Psychological Resilience and Professional Grief First, based on the results of this study, we demonstrated that psychological resilience has a significant effect on professional grief among Chinese oncology nurses. This is consistent with the findings of previous studies [28, 29]. Our findings may strengthen the link between psychological resilience and professional grief. On the one hand, oncology nurses with a high level of psychological resilience have a stronger ability to adapt psychologically and are more likely to recover their physical and mental health after suffering from negative or stressful events [30, 31]. On the other hand, oncology nurses with a high level of psychological resilience have a higher degree of subjective initiative, and are able to actively seek the help of external resources to adapt to the environment and fight against stress, and to reduce the physiological, psychological, cognitive and other aspects of the discomfort response brought about by professional grief [21]. The Mediating Role of Active Response Modalities The findings suggest that positive coping styles mediate the relationship between psychological resilience and professional grief, revealing a possible mechanism by which psychological resilience indirectly influences professional grief. More importantly, psychological resilience not only has a direct impact on professional grief, but also an indirect impact through positive coping styles. In fact, on the one hand, individuals with higher levels of psychological resilience have stronger adaptability, self-confidence, and problem-solving ability, and tend to look at problems in a more positive and optimistic manner, and are more calm in the face of problems, which enables them to adjust their mindset and adapt to the changes brought about by negative events [32-35]. At the same time, they are also good at maintaining their own emotional stability, can face difficulties and pressure, proactively mobilise their own available resources, and take active measures to deal with uncomfortable environments, pressures, and stresses, in order to reduce the harm of these stimuli on the physical and mental health of individuals [36, 37]. On the other hand, psychological resilience is a facilitator of positive coping styles. Individuals with high levels of psychological resilience recognise the importance of positive coping and usually tend to adopt positive coping styles such as seeking help from others, seeking solutions, or releasing and venting bad emotions through communication with others [38, 39]. Psychological resilience, and positive coping styles can also be regarded as important internal positive resources for oncology nurses to promote and maintain their physical and mental health in the face of stressful events [13], and both of them can directly alleviate negative emotions and promote personal development and growth, respectively [40, 41]. In addition, psychological resilience can further alleviate the irritation and adverse emotions associated with stressful events by prompting individuals to recognise the importance of positive coping, which inclines them to adopt positive coping styles to cope with and deal with stressful events [42, 43]. These are possible explanations for the relationship between psychological resilience, positive coping styles, and professional grief. This study reveals the mechanism of psychological resilience on professional grief, enriches the research on the relationship between psychological resilience and professional grief, and provides a new direction for improving the level of psychological resilience, as well as guiding the use of positive coping styles towards intervening in professional grief among oncology nurses. Clinical Significance With the increasing prevalence of professional grief among oncology nurses, there is a growing need to identify the underlying causes of these behaviours. Our study found that psychological resilience was positively associated with professional grief. Thus, along with a focus on professional grief, there is a need to focus on psychological resilience. Interventions to reduce professional grief, in turn, require a multilevel approach, including the identification of positive psychological factors that alleviate professional grief. Therefore, individuals with low levels of psychological resilience need the same attention. In addition, psychologists are advised to start by guiding oncology nurses to adopt positive coping styles, which mediates the shift in psychological resilience weakening professional grief. Finally, it is important to improve the level of psychological resilience of oncology nurses and establish positive coping skills for negative stressful events. At the same time, hospitals and the government should provide professional psychological assistance and guidance to promote positive coping styles to deal with stressful events. In addition, positive staff activities may help to express and vent negative emotions and contribute to the reduction of professional grief. 4. Conclusion The problem of professional grief among oncology nurses needs to be addressed urgently and it was found that psychologically resilient oncology nurses were more inclined to adopt a positive coping style, which reduced their professional grief from the passing away of patients. The state, government, and educational institutions establish a complete psychological intervention system. Provide professional treatment and support for oncology nurses' psychological and behavioural health and reduce their professional grief. 5. Limitations Our study has several limitations. First, we tested only one mediating variable. The mediating effect was only 35.23% of the total effect. Therefore, caution must be exercised when generalising research results. Future research needs to further explore other potential variables related to professional grief, such as social support, professional grief support, sense of meaning in life, and self-efficacy. Second, this was a cross-sectional study and causal relationships between the study variables could not be inferred. Third, all study measures were self-reported and may have been subjectively biased. In addition, this study was quantitative and qualitative research was necessary to ensure insight into the impact of professional grief on oncology nurses. Finally, the sample size of this study only included oncology nurses from five hospitals in Sichuan Province. Due to the limited sample size, it is necessary to use a multicentre and more representative sample to test and summarise the causal relationships between the variables obtained in this study. Abbreviations GSSN Grief State Scale for Nurses MeRS Medical Professionals Resilience Scale SCSQ Simplified Coping Style Questionnaire Declarations Acknowledgements We appreciate all the staff and participants involved in this study. Authors ’ contributions QG and ML designed the study. SYY, MLH and XXW collected the data. ML analyzed the data and drafted the manuscript. ML and QG revised the manuscript. All authors read and approved the final manuscript. Data availability statements All data supporting this study are included in the article and its supplementary materials. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Ethics approval and consent to participate All procedures of this study were approved by the Sichuan Cancer Hospital Ethics Committee (No. SCCHEC-02-2021-038) and conducted following the ethical standards of the 1964 Declaration of Helsinki. Students must complete anonymous online surveys. Participants volunteered for the study during the survey. The investigators explained the purpose and significance of the study to the oncology nurses through face-to-face discussions and obtained their informed consent. Since no identifying information, such as the name and address of any participant, was collected, the privacy and anonymity of the participants were fully protected, and the data were aggregated and reported in summary form only. Consent for publication Not applicable. Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. References Chen C, Chow A, Tang S. Professional caregivers' bereavement after patients' deaths: A scoping review of quantitative studies[J]. Death Stud, 2019,43(8):500-508. Barnes S, Jordan Z, Broom M. Health professionals' experiences of grief associated with the death of pediatric patients: a systematic review[J]. JBI Evid Synth, 2020,18(3):459-515. Doka, Kenneth J. Disenfranchised grief[J]. Bereavement Care, 1999,18(3):37-39. Botha E, Gwin T, Purpora C. 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Mediating effects of coping styles between psychological resilience and negative emotions[J]. Journal of Dali University, 2021,6(7):121-128. Song S J, Xu X P, You J F. The relationship between rural college students' experiences of staying behind and their psychological resilience and perceptions of adversity[J]. Chinese Journal of Mental Health, 2020,34(4). Southwick S M, Charney D S. The science of resilience: implications for the prevention and treatment of depression[J]. Science, 2012,338(6103):79-82. Song R, Li M. The relationship between social support and depression in secondary school students: The chain-mediated effects of coping styles and psychological resilience[J]. Chinese Journal of Health Psychology, 2020,28(9):6. Zhang H, Long L, Hu K Q, et al. Correlation between psychological resilience and coping styles of medical students and its influencing factors[J]. Chinese Journal of Health Psychology, 2017,25(3):4. Masten A S. Ordinary magic. Resilience processes in development[J]. Am Psychol, 2001,56(3):227-238. Cao X, Wang L, Wei S, et al. Prevalence and predictors for compassion fatigue and compassion satisfaction in nursing students during clinical placement[J]. Nurse Educ Pract, 2021,51:102999. Xu J, Yang X. The influence of resilience on stress reaction of college students during COVID-19: the mediating role of coping style and positive adaptive response[J]. Curr Psychol, 2023:1-12. Huang W, Li L, Zhuo Y, et al. Analysis of Resilience, Coping Style, Anxiety, and Depression Among Rescue Nurses on EMTs During the Disaster Preparedness Stage in Sichuan, China: A Descriptive Cross-Sectional Survey[J]. Disaster Med Public Health Prep, 2022,17: e268. Huang Y, Li B, Feng S, et al. Mediating and Suppressing Effects of Coping Styles Between Resilience and Empathy for Pain in Clinical Nurses: A Cross-Sectional Study[J]. J Multidiscip Healthc, 2024,17:4653-4667. McCoy T P, Sauer P A, Sha S. Resilience in Nurses: The Reliability and Validity of the Resilience Scale (TM)[J]. J Nurs Meas, 2024,32(1):106-116. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 03 Dec, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 08 Sep, 2025 Reviews received at journal 14 Aug, 2025 Reviewers agreed at journal 05 Aug, 2025 Reviews received at journal 16 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers invited by journal 08 Jul, 2025 Editor assigned by journal 02 Jul, 2025 Editor invited by journal 21 Mar, 2025 Submission checks completed at journal 19 Mar, 2025 First submitted to journal 18 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-6256780","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":482357080,"identity":"802f6773-8386-4eb3-b5be-9ecea362aec0","order_by":0,"name":"Min Luo","email":"","orcid":"","institution":"Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital \u0026 Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Luo","suffix":""},{"id":482357082,"identity":"0136150d-6b5b-4234-a875-c13e0da50a26","order_by":1,"name":"Qin Guo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACfvnzHx8kGNjUt7E3EKlFcgaDscGHgjTGPp4DRGoxuMFgJjnjw2HGeRIJxGq53ZBszGPAzMwm+XjjDYYam2jCDrtz4OBjHgM2NjbptGILhmNpuQ2EtPAdSGwG2sLDwyadYybB2HCYsBaGA8ls0jwGEhJskmeI1CJwI41NcoaBgQGbBA+RWiR7zjAbfDBISGDjAfolgRi/8LP3MD5I+PM/Qb798MYbH2psiPALEjAgOmqQtJCqYxSMglEwCkYGAADptzx08V0VzAAAAABJRU5ErkJggg==","orcid":"","institution":"Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital \u0026 Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China","correspondingAuthor":true,"prefix":"","firstName":"Qin","middleName":"","lastName":"Guo","suffix":""},{"id":482357083,"identity":"a6c13bdb-6226-4cf6-961b-b03361d60dd6","order_by":2,"name":"Siyou Yan","email":"","orcid":"","institution":"Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital \u0026 Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Siyou","middleName":"","lastName":"Yan","suffix":""},{"id":482357084,"identity":"d1aaf4f8-ec2e-447c-ae2c-2ea4c51952cd","order_by":3,"name":"Meiling Huang","email":"","orcid":"","institution":"Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital \u0026 Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Meiling","middleName":"","lastName":"Huang","suffix":""},{"id":482357085,"identity":"b42d61a6-3c1b-47ac-a007-317c15c37970","order_by":4,"name":"Xiaoxue Wang","email":"","orcid":"","institution":"Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital \u0026 Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Xiaoxue","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-03-19 00:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6256780/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6256780/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-28402-x","type":"published","date":"2025-12-03T15:57:46+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86652791,"identity":"9886af06-e75c-42d9-8e55-99af81814a96","added_by":"auto","created_at":"2025-07-14 09:55:29","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":136001,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe hypothesised mediation model relating the effect of psychological resilience on professional grief through positive coping style (All coefficients are standardized coefficients)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6256780/v1/58a4e813b394613d05617f7d.jpeg"},{"id":97724548,"identity":"5b15dee3-5949-43f6-9cdb-df530b387c2f","added_by":"auto","created_at":"2025-12-08 16:12:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1203945,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6256780/v1/ef5f7645-1592-419f-8806-5e61329ae42f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mediating effects of positive coping styles among oncology nurses between psychological resilience and professional grief: a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProfessional Grief (PG) in nurses is a set of grief reactions to the death of a patient under the care of nurses in the course of their work [1, 2]. Professional grief manifests itself in the personal dimension in the same way as bereaved people\u0026apos;s grief responses, but also has a professional character [3, 4]. On the one hand, nurses may be reluctant to express grief openly when a patient under their care dies [5]. On the other hand, nurses grieve while providing services to other patients and their families, and therefore lack the time and space to express their grief, leading to grief deprivation [6]. However, experiencing professional grief repeatedly over a long period of time can easily lead to burnout and empathy fatigue among nurses, which not only adversely affects personal mood, cognition, and professional development, but also affects the associated quality of care [7-10]. Oncology nurses are exposed to dying or dead patients and families in their work over a long period of time, making them more likely to experience professional grief compared to nursing staff in other units [11, 12].\u003c/p\u003e\n\u003cp\u003eAccording to the theory of stress and stress, in the face of stressful events and environments, individuals need to mobilise internal and external resources and take coping actions to reduce the stress response [13]. Psychological resilience (PR) is the ability of an individual to adapt effectively in the face of life adversity, traumatic events, or work challenges [14]. Psychological resilience serves as an internal resource for individuals to cope and adapt well to stressful events [15]. Individuals with higher psychological resilience are more able to actively resist and adapt to trauma [16]. From a positive psychology perspective, psychological resilience, as an individual positive psychological quality, helps nurses to adapt well to a work environment full of heavy stress and trauma [17]. Coping Style (CS) is a set of specific behaviours adopted by an individual to moderate stress, including positive and negative coping styles [18]. It has been suggested that the level of psychological resilience is closely related to different coping styles [19]. Individuals who are more psychologically resilient may be more inclined to confront problems, actively obtain information, adopt positive coping styles, and utilise various types of resources when faced with a stressful event, thereby improving their situation and reducing the occurrence of professional grief [20, 21]. It is hypothesised that coping styles may play a mediating role between psychological resilience and levels of professional grief. However, most of the current studies in China focus on the sadness of family members of deceased patients [22], and there are fewer studies on professional grief among Chinese oncology nurses, and most of them are qualitative [5], and the relationship between professional grief and psychological resilience and coping styles has not been explored. On the basis of existing evidence, we found that whether psychological resilience alleviates professional grief through the mediating role of positive coping styles among Chinese oncology nurses is a question worth exploring. Based on the above, this study examined whether oncology nurses\u0026apos; coping styles were a mediating variable between psychological resilience and professional grief, with a view to informing the development of targeted interventions by clinical care managers to reduce professional grief among oncology nurses.\u003c/p\u003e\n\u003cp\u003eTherefore, based on the literature review, we developed the following four hypotheses after analysing the relationship between nurses\u0026apos; professional grief, psychological resilience and coping styles:\u003c/p\u003e\n\u003cp\u003e1. psychological resilience has a direct positive impact on professional grief.\u003c/p\u003e\n\u003cp\u003e2. psychological resilience coping styles have a direct positive impact.\u003c/p\u003e\n\u003cp\u003e3. coping styles have a direct positive effect on professional grief.\u003c/p\u003e\n\u003cp\u003e4. the relationship between psychological resilience and professional grief is mediated through coping styles.\u003c/p\u003e\n\u003cp\u003eOur study will help to provide new research directions for clinical care managers to reduce professional grief among oncology nurses.\u003c/p\u003e"},{"header":"1. Research Objects and Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 Objects of study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional study, using purposive sampling method and a cross-sectional survey of clinical nurses in the oncology departments of five tertiary care hospitals in Sichuan Province from November 2024 to February 2025 via Question star online questionnaire platform and paper-based questionnaire. Inclusion Criteria:\u0026nbsp;①\u0026nbsp;Obtained the certificate of nurse practice and work experience of 1 year or more;\u0026nbsp;②\u0026nbsp;Experienced the death of a patient;\u0026nbsp;③\u0026nbsp;Informed consent and voluntary participation in this investigation. Exclusion Criteria:\u0026nbsp;①\u0026nbsp;Incomplete information;\u0026nbsp;②\u0026nbsp;Recent major life changes. Sample size calculation: this study used nurses\u0026apos; professional grief as the main observation index to calculate the sample size, according to the pre-survey results, \u0026sigma;=1.06, \u0026delta;=0.1, \u0026alpha; took 0.05, brought into the formula N=(u\u003csub\u003e1-ɑ/2\u003c/sub\u003e\u0026sigma;/\u0026delta;)\u003csup\u003e2\u003c/sup\u003e\u0026asymp;432 cases, and considering 20% invalid questionnaires, the final sample size was determined to be 518 cases. Finally, 540 questionnaires were distributed and 22 unreliable data were manually excluded, resulting in 518 valid questionnaires, and 95.9% (518/540) of the valid responses were analysed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Research tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1 Demographic information:\u0026nbsp;\u003c/strong\u003ebased on the purpose of the study, it was formulated on its own after reviewing relevant literature and consulting with experts. Including: gender, age, highest education, religion, length of service, title, marital status, fertility, nature of hospital, position, etc.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.2 Grief State Scale for Nurses (GSSN):\u003c/strong\u003e The scale was developed by Japanese scholars Feni et al [23], and translated and converted into Chinese by Wang Yu et al [24] to form the Chinese version of the Nurses\u0026apos; Grief State Scale, which is used to assess the level of professional grief of nursing staff. The scale consists of four dimensions, including mood swings (4 entries), uncomfortable feelings about death (3 entries), sadness about the patient\u0026apos;s death (5 entries) and emotional exhaustion (5 entries), with a total of 17 entries. The scale scored on a 5-point Likert scale with an overall score of 85. Higher scores indicate higher levels of professional sadness among nurses. The total Cronbach\u0026apos;s alpha coefficient of the scale was 0.813, and the Cronbach\u0026apos;s alpha coefficients for each of the four dimensions of mood fluctuation, uncomfortable feelings about death, sadness about the patient\u0026apos;s death, and emotional exhaustion were 0.729, 0.855, 0.846, and 0.929, and the retest reliability coefficient was 0.915, which is a good reliability and validity. The Cronbach\u0026apos;s alpha coefficient in this study was 0.907.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.3 Medical Professionals Resilience Scale (MeRS):\u0026nbsp;\u003c/strong\u003eThe scale developed by Rahman et al [25] based on the 2021 Comprehensive Resilience Model, incorporating a conceptual model and literature review. Jiao Chunhui et al [26] translated Chinese to form the Chinese version of the Psychological Resilience Scale for Healthcare Workers. The scale includes 4 dimensions of growth (15 entries), participation (6 entries), control (12 entries), and resources (4 entries), with a total of 37 entries, and is scored on a 4-point Likert scale,\u0026nbsp;\u0026lsquo;strongly disagree\u0026rsquo;,\u0026nbsp;\u0026lsquo;disagree\u0026rsquo;,\u0026nbsp;\u0026lsquo;strongly disagree\u0026rsquo;,\u0026nbsp;\u0026ldquo;disagree\u0026rdquo;,\u0026nbsp;\u0026ldquo;agree\u0026rdquo;,\u0026nbsp;\u0026ldquo;strongly agree\u0026rdquo;\u0026nbsp;in the order of 1, 2, 3, 4 points, the total score of 148 points. A score of 37-66 represents a low level of psychological resilience, 67-118 represents a moderate level of psychological resilience, and 119-148 represents a high level of psychological resilience. The overall Cronbach\u0026apos;s alpha coefficient for the scale was 0.90, and the Cronbach\u0026apos;s alpha coefficients for the four dimensions were 0.891, 0.719, 0.818, and 0.779, respectively. The Cronbach\u0026apos;s alpha coefficient in this study was 0.966.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.4 Simplified Coping Style Questionnaire (SCSQ):\u003c/strong\u003e The scale compiled by Chinese scholar Xie Yaning [27] to simplify and modify the foreign coping style scales, it is used to measure the ways of coping with stressful situations in life or work of different individuals. It included two dimensions of positive coping (12 entries) and negative coping (8 entries), with a total of 20 entries. The scale was scored on a 4-point Likert scale, with\u0026nbsp;\u0026lsquo;not used\u0026rsquo;\u0026nbsp;scoring 0 and\u0026nbsp;\u0026lsquo;often used\u0026rsquo;\u0026nbsp;scoring 3. The mean scores of the positive dimension entries were subtracted from the mean scores of the negative dimension entries to obtain the difference, and if the difference is greater than 0, it indicates that the subjects\u0026apos; preferred coping style is positive coping, and vice versa for negative coping. The Cronbach\u0026apos;s alpha coefficient for the total scale was 0.90, and the Cronbach\u0026apos;s alpha coefficients for the positive coping and negative coping dimensions were 0.89 and 0.78, respectively. In the present study, the total Cronbach\u0026apos;s alpha coefficient of the scale was 0.838, and the Cronbach\u0026apos;s alpha coefficients for the positive coping and negative coping dimensions were 0.877 and 0.832, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.5 Data collection methodology:\u0026nbsp;\u003c/strong\u003eThe study was conducted with the consent of the head of the nursing department of each hospital. 3 investigators who were centrally trained by the subject matter team, distributed paper questionnaires or questionnaire stars. The questionnaires included general information about the nurses (gender, age, highest education level, religion, length of service, title, and marital status) and GSSN, MeRS, and SCSQ. The investigator explained the purpose, significance and considerations of the study to the research participants using a uniform guide to explain unclear and ambiguous points. Questionnaires were distributed after obtaining the consent and support of the nurses, who answered the questionnaires themselves. Each questionnaire took approximately 10 to 15 minutes to complete.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.6. Statistical methods:\u0026nbsp;\u003c/strong\u003eall analyses were performed using IBM SPSS statistical software version 27.0 (Almonk, NY, USA). A two-tailed test was performed at a significance level of \u0026alpha; = 0.05. Continuous data were presented as mean \u0026plusmn; standard deviation and categorical data were presented as (n) and percentage (%).Pearson correlation analysis was used to test for correlation between variables. Similarly, McKinnon\u0026apos;s four-step method (46) was used to analyse the mediating role, which had to satisfy four specific criteria:(1) there was a significant correlation between the independent variable (MeRS) and the dependent variable (GSSN); (2) there was also a significant correlation between the independent variable (MeRS) and the mediating variable. (3) After adjusting for the control of the independent variable (MeRS), there is a significant positive correlation between the mediator variable (SCSQ) and the dependent variable (GSSN); (4) significant indirect correlation coefficient between the independent variable (MeRS) and the dependent variable (GSSN) through the mediator variable (SCSQ). The first three steps were tested by linear regression equations with \u0026alpha;in = 0.05 and \u0026alpha;out = 0.01, respectively. Finally, the mediating effect was analysed using the PROCESS macro (Model 4) of SPSS version 4.0. Statistical significance was found when the 95% confidence interval did not contain zero.\u0026nbsp;\u003c/p\u003e"},{"header":"2. Results","content":"\u003cp\u003e\u003cstrong\u003e2.1 Common method bias test\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs this study used self-assessment scales, in order to further improve the rigour of this study, the issue of common method bias may exist for the data. In order to control common method bias, this study used the Harman one-way test for testing. The results show that there are 13 factors with eigenvalues greater than 1, and the variance explained by the first factor is 30.033%, which is less than the critical standard of 40%, and there is no situation of\u0026nbsp;\u0026lsquo;only one factor or one factor has a very high explanatory rate\u0026rsquo;, so the data in this study do not have serious common method bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Socio-demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 shows the socio-demographic characteristics of oncology nurses. Of the 518 eligible oncology nurses, 500 (96.5%) were female and 18 (3.5%) were male of the 518 eligible oncology nurses.131 subjects were \u0026lt;30 years of age (25.3%), 361 subjects were between 30 and 50 years of age (69.7%), and 26 subjects were \u0026gt;50 years of age (5.0%).87 (16.8%) were junior college, 412 ( 79.5%) were undergraduate, and 19 (3.7%) were master degree or above.483 (93.2%) had no religious affiliation, and 35 (6.8%) had a religious affiliation.58 (11.2%) had a working experience of \u0026lt;3 years, 163 (31.5%) had a working experience of 3-10 years, 208 (40.2%) had a working experience of 10-20 years, and 89 (17.2%) had a length of service \u0026gt; 21 years. 52 (10.0%) had the title of nurse, 197 (38.0%) had the title of senior nurse, 224 (43.2%) had the title of supervisor nurse, and 45 (8.7%) had the title of co-chief nurse or above. 111 (21.4%) were unmarried, 388 (74.9%) were married, and 19 (3.7%) were divorced or widowed.375 (72.4%) had children and 143 (27.6%) had no children.383 (73.9%) were employed in specialized hospitals and 135 (26.1%) in general hospitals.326 (62.9%) were charge nurses, 128 (24.7%) were responsible group leader, 36 (6.9%) were office nurses and 28 (5.4%) were general services nurse. 105 (20.3 per cent) did not voluntarily choose the nursing profession, while 413 (79.7 per cent) did. 286 (55.2 per cent) had not attended psychological training, while 232 (44.8 per cent) had.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Sociodemographic information of the participants(n=518)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD (range) N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e500（96.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e18（3.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e＜30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e131（25.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e30～50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e361（69.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e＞50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e26（5.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e87（16.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e412（79.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eMaster degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e19（3.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003ereligious belief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003enot have\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e483（93.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003ethere are\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e35（6.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eLength of service(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e＜3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e58（11.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e3～10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e163（31.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e11～20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e208（40.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e＞21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e89（17.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eProfessional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e52（10.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eSenior nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e197（38.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eSupervisor nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e224（43.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eCo-chief nurse or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e45（8.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e111（21.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e388（74.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eDivorced or widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e19（3.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eFertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eHaving children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e375（72.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eChildless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e143（27.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eHospital category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eSpecialized hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e383（73.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eGeneral hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e135（26.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003ePosition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eCharge nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e326（62.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eResponsible group leader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e128（24.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eOffice nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e36（6.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eGeneral services nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e28（5.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eWhether the nursing profession is chosen\u0026nbsp;\u003c/p\u003e\n \u003cp\u003evoluntarily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eInvoluntary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e105（20.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eVoluntariness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e413（79.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eWhether or not they have participated in\u0026nbsp;\u003c/p\u003e\n \u003cp\u003epsychological training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003eNot attended\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e286（55.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003ePast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 277px;\"\u003e\n \u003cp\u003e232（44.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Correlation analysis of oncology nurses\u0026apos; coping styles, psychological resilience, and professional grief\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of Pearson\u0026apos;s correlation analysis showed that oncology nurses\u0026apos; professional grief was negatively correlated with psychological resilience and positive coping (P \u0026lt; 0.01), and had no correlation with negative coping (P \u0026gt; 0.05); psychological resilience was negatively correlated with positive coping (P \u0026lt; 0.01), and psychological resilience had a correlation with negative coping but the r-value was too low; positive coping had a correlation with negative coping, but the r-value was too low, see Table 2. Thus, hypotheses 1, 2 and 3 were partially tested.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e2 \u003cstrong\u003eMeans, SDs, and correlations of all variables\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1. professional grief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e35.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e9.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2. psychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e114.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e14.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.545\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3. positive coping style\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e24.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.538\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.570\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4. negative coping style\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e11.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.155\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.124\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Analysis of the Mediating Effect of Positive Coping Styles between Psychological Resilience and Professional Grief in Oncology Nurses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn order to explore the underlying mechanism of the significant positive effect of psychological resilience on professional grief, positive coping style was further introduced as a mediating variable to be substituted into the structural equation modeling in the study. By using Model 4 in the SPSS macro program Process to conduct the test of mediating effects, the mediating role of analyzing positive coping styles between psychological resilience and professional grief was verified and analyzed according to the methodology of Bootstrap provided by Hayes. The path coefficients between the variables of positive coping style, psychological resilience and professional grief are shown in Figure 1.\u003c/p\u003e\n\u003cp\u003eTable 3 reports the analysis of mediating effects between variables. After controlling for variables, psychological resilience had a significant direct effect on professional grief (\u0026beta;= -0.545, CI [-0.395, -0.302]). In addition, psychological resilience had a significant positive effect on positive coping styles (\u0026beta;= 0.570, CI [0.194, 0.249]). Positive coping styles had a significant effect on professional grief (\u0026beta;= -0.337, CI [-0.693, -0.418]). Further, the effect of psychological resilience on professional grief was statistically significant, i.e., including the mediating variable (\u0026beta;= -0.353, CI [-0.279, -0.173]). Based on the bootstrap 95% confidence interval without zero, it can be concluded that positive coping style mediates the relationship between psychological resilience and professional grief. The mediating effect, which accounted for 35.23% of the total effect, confirmed that positive coping style mediated the relationship between psychological resilience and professional grief (Table 4), and Figure 1 shows the final mediation model. Hypothesis 4 was partially established.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;3 Regression analysis among study measures\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eLLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eResult variable: positive coping style\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003ePredictor psychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e15.776\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e248.895\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eResult variable: professional grief\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003ePredictor psychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e-8.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e153.448\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eMediator positive coping style\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-0.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e-7.928\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eResult variable: professional grief\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eIndependent variable psychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-0.545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e-14.762\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e-0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e217.916\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAccording to Table 4, the upper and lower bootstrap 95% confidence intervals of the mediating effect of psychological resilience on professional grief and positive coping styles do not contain 0, indicating that psychological resilience not only acts as a direct effect on professional grief, but also acts as a mediating effect on professional grief through the variable of positive coping styles. This direct effect (0.353) and mediating effect (0.192) accounted for 64.77% and 35.23% of the total effect (1.0), respectively.\u003c/p\u003e\n\u003cp\u003eThe 95% confidence interval is the 95% CI. psychological resilience mediates model hypotheses for professional grief through positive coping styles (all coefficients are standardized).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Analysis of the mediating effect of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003epositive coping style on psychological resilience and professional grief\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"578\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003ePath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eEffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eBoot SE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eBoot LLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eBoot ULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eEffect ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eTotal effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.545**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eDirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.353**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e64.77%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eIndirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.192**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e35.23%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026lowast;\u0026lowast;\u0026lowast;P \u0026lt; 0.001.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003e\u003cstrong\u003ePsychological Resilience and Professional Grief\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst, based on the results of this study, we demonstrated that psychological resilience has a significant effect on professional grief among Chinese oncology nurses. This is consistent with the findings of previous studies [28, 29]. Our findings may strengthen the link between psychological resilience and professional grief. On the one hand, oncology nurses with a high level of psychological resilience have a stronger ability to adapt psychologically and are more likely to recover their physical and mental health after suffering from negative or stressful events [30, 31]. On the other hand, oncology nurses with a high level of psychological resilience have a higher degree of subjective initiative, and are able to actively seek the help of external resources to adapt to the environment and fight against stress, and to reduce the physiological, psychological, cognitive and other aspects of the discomfort response brought about by professional grief [21].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Mediating Role of Active Response Modalities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings suggest that positive coping styles mediate the relationship between psychological resilience and professional grief, revealing a possible mechanism by which psychological resilience indirectly influences professional grief. More importantly, psychological resilience not only has a direct impact on professional grief, but also an indirect impact through positive coping styles. In fact, on the one hand, individuals with higher levels of psychological resilience have stronger adaptability, self-confidence, and problem-solving ability, and tend to look at problems in a more positive and optimistic manner, and are more calm in the face of problems, which enables them to adjust their mindset and adapt to the changes brought about by negative events [32-35]. At the same time, they are also good at maintaining their own emotional stability, can face difficulties and pressure, proactively mobilise their own available resources, and take active measures to deal with uncomfortable environments, pressures, and stresses, in order to reduce the harm of these stimuli on the physical and mental health of individuals [36, 37]. On the other hand, psychological resilience is a facilitator of positive coping styles. Individuals with high levels of psychological resilience recognise the importance of positive coping and usually tend to adopt positive coping styles such as seeking help from others, seeking solutions, or releasing and venting bad emotions through communication with others [38, 39]. Psychological resilience, and positive coping styles can also be regarded as important internal positive resources for oncology nurses to promote and maintain their physical and mental health in the face of stressful events [13], and both of them can directly alleviate negative emotions and promote personal development and growth, respectively [40, 41]. In addition, psychological resilience can further alleviate the irritation and adverse emotions associated with stressful events by prompting individuals to recognise the importance of positive coping, which inclines them to adopt positive coping styles to cope with and deal with stressful events [42, 43]. These are possible explanations for the relationship between psychological resilience, positive coping styles, and professional grief. This study reveals the mechanism of psychological resilience on professional grief, enriches the research on the relationship between psychological resilience and professional grief, and provides a new direction for improving the level of psychological resilience, as well as guiding the use of positive coping styles towards intervening in professional grief among oncology nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Significance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith the increasing prevalence of professional grief among oncology nurses, there is a growing need to identify the underlying causes of these behaviours. Our study found that psychological resilience was positively associated with professional grief. Thus, along with a focus on professional grief, there is a need to focus on psychological resilience. Interventions to reduce professional grief, in turn, require a multilevel approach, including the identification of positive psychological factors that alleviate professional grief. Therefore, individuals with low levels of psychological resilience need the same attention. In addition, psychologists are advised to start by guiding oncology nurses to adopt positive coping styles, which mediates the shift in psychological resilience weakening professional grief. Finally, it is important to improve the level of psychological resilience of oncology nurses and establish positive coping skills for negative stressful events. At the same time, hospitals and the government should provide professional psychological assistance and guidance to promote positive coping styles to deal with stressful events. In addition, positive staff activities may help to express and vent negative emotions and contribute to the reduction of professional grief.\u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eThe problem of professional grief among oncology nurses needs to be addressed urgently and it was found that psychologically resilient oncology nurses were more inclined to adopt a positive coping style, which reduced their professional grief from the passing away of patients. The state, government, and educational institutions establish a complete psychological intervention system. Provide professional treatment and support for oncology nurses\u0026apos; psychological and behavioural health and reduce their professional grief.\u003c/p\u003e"},{"header":"5. Limitations","content":"\u003cp\u003eOur study has several limitations. First, we tested only one mediating variable. The mediating effect was only 35.23% of the total effect. Therefore, caution must be exercised when generalising research results. Future research needs to further explore other potential variables related to professional grief, such as social support, professional grief support, sense of meaning in life, and self-efficacy. Second, this was a cross-sectional study and causal relationships between the study variables could not be inferred. Third, all study measures were self-reported and may have been subjectively biased. In addition, this study was quantitative and qualitative research was necessary to ensure insight into the impact of professional grief on oncology nurses. Finally, the sample size of this study only included oncology nurses from five hospitals in Sichuan Province. Due to the limited sample size, it is necessary to use a multicentre and more representative sample to test and summarise the causal relationships between the variables obtained in this study.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGSSN Grief State Scale for Nurses\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMeRS Medical Professionals Resilience Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSCSQ Simplified Coping Style Questionnaire\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate all the staff and participants involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQG and ML designed the study. SYY, MLH and XXW collected the data. ML analyzed the data and drafted the manuscript. ML and QG revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data supporting this study are included in the article and its supplementary materials. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures of this study were approved by the Sichuan Cancer Hospital Ethics Committee (No. SCCHEC-02-2021-038) and conducted following the ethical standards of the 1964 Declaration of Helsinki. Students must complete anonymous online surveys. Participants volunteered for the study during the survey. The investigators explained the purpose and significance of the study to the oncology nurses through face-to-face discussions and obtained their informed consent. Since no identifying information, such as the name and address of any participant, was collected, the privacy and anonymity of the participants were fully protected, and the data were aggregated and reported in summary form only.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChen C, Chow A, Tang S. 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Resilience in Nurses: The Reliability and Validity of the Resilience Scale (TM)[J]. J Nurs Meas, 2024,32(1):106-116.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"professional grief, psychological resilience, coping styles, oncology, nurses","lastPublishedDoi":"10.21203/rs.3.rs-6256780/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6256780/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND: \u003c/strong\u003eNurses‘ professional grief is a series of grief reactions that nurses experience as a result of the death of a patient under their care during the course of their work, and this behaviour can have a serious impact on nurses’ mental health and work status. There is a lack of systematic research on the relationship between psychological resilience, coping styles and professional grief. This study examines the relationship between psychological resilience and professional grief among oncology nurses and the mechanisms by which coping styles play a role.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS:\u003c/strong\u003e A questionnaire survey was conducted among 540 oncology nurses in five tertiary-level hospitals in Sichuan Province from November 2024 to January 2025 using purposive sampling. The questionnaire included psychological resilience (MeRS), coping styles (SCSQ), and professional sadness (GSSN).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS: \u003c/strong\u003eA total of 518 valid questionnaires were returned, with a validity rate of 95.9%. The results of this study showed that psychological resilience had a significant direct effect on professional grief (β= -0.545, CI [-0.395, -0.302]). In addition, psychological resilience had a significant positive effect on positive coping styles (β= 0.570, CI [0.194, 0.249]). There was a significant effect of positive coping styles on professional grief (β= -0.337, CI [-0.693, -0.418]). Further, psychological resilience had a statistically significant effect on professional grief, i.e., including the mediating variable (β= -0.353, CI [-0.279, -0.173]). Positive coping styles partially mediated the relationship between psychological resilience and professional grief among oncology nurses, with a mediation effect value of 0.192 and a mediation effect of 35.23% of the total effect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION:\u003c/strong\u003e Positive coping styles partially mediate the relationship between psychological resilience and professional grief in oncology nurses. The hospital administrators should target interventions to promote the mental health of oncology nurses to reduce the incidence of professional grief.\u003c/p\u003e","manuscriptTitle":"Mediating effects of positive coping styles among oncology nurses between psychological resilience and professional grief: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 09:55:24","doi":"10.21203/rs.3.rs-6256780/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-08T17:18:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-14T19:13:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316672243370430611032042694379328562404","date":"2025-08-05T12:03:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-16T12:06:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247677394427579475366614310062933683891","date":"2025-07-08T07:36:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-08T06:44:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-02T07:58:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-21T06:07:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-19T09:27:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-03-19T00:48:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"38538f4c-e615-4895-9fcd-ad0bef9a612c","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":51216386,"name":"Biological sciences/Cancer"},{"id":51216387,"name":"Biological sciences/Psychology"},{"id":51216388,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2025-12-08T16:08:50+00:00","versionOfRecord":{"articleIdentity":"rs-6256780","link":"https://doi.org/10.1038/s41598-025-28402-x","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-12-03 15:57:46","publishedOnDateReadable":"December 3rd, 2025"},"versionCreatedAt":"2025-07-14 09:55:24","video":"","vorDoi":"10.1038/s41598-025-28402-x","vorDoiUrl":"https://doi.org/10.1038/s41598-025-28402-x","workflowStages":[]},"version":"v1","identity":"rs-6256780","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6256780","identity":"rs-6256780","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}