Professional Identity as a Protective Resource: A Cross-Sectional Study of Workplace Negative Behaviors and Psychological Distress Among Chinese Nursing Interns

Professional Identity as a Protective Resource: A Cross-Sectional Study of Workplace Negative Behaviors and Psychological Distress Among Chinese Nursing Interns | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Professional Identity as a Protective Resource: A Cross-Sectional Study of Workplace Negative Behaviors and Psychological Distress Among Chinese Nursing Interns Hong Jiang, Chao Zeng, Fulan Wang, Qian Wu, Bizhen Liao, Yan Hu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8002801/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Nursing interns are particularly vulnerable to workplace negative behaviors during their clinical practicum, which can critically shape their professional development and the quality of patient care. However, the psychological mechanisms underlying this relationship remain inadequately explained within comprehensive theoretical frameworks. Methods In this cross-sectional study, 234 undergraduate nursing interns were recruited from two tertiary hospitals in Southwest China. Participants completed validated measures including the Negative Acts Questionnaire-Revised, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Simplified Coping Style Questionnaire. Data analysis employed Spearman's correlation and multiple linear regression. Results The mean scores indicated moderate exposure to workplace negative behavior (28.71 ± 6.10), with anxiety (44.02 ± 9.99) and depression (47.01 ± 10.69) levels approaching clinical significance. Regression analysis revealed that depression (β = 0.442, p < 0.001), anxiety (β = 0.229, p = 0.001), and positive coping strategies (β = 0.218, p = 0.002) were significant predictors, collectively explaining 34.3% of the variance. Professional attitude demonstrated the strongest correlation with exposure to workplace negative behavior (r = 0.399, p < 0.001). Conclusion The impact of workplace negative behaviors on nursing interns is substantially mediated through psychological distress, while coping strategies and professional attitude serve as important moderating factors. These findings suggest that healthcare institutions should implement integrated support systems incorporating mental health screening, resilience training, and professional identity development to mitigate adverse effects and promote successful transition to professional practice. Clinical trial number : not applicable. Nursing education Clinical internship Workplace behavior Psychological distress Coping strategies Introduction Workplace negative behavior in healthcare settings refers to persistent hostile actions occurring among healthcare professionals. These behaviors typically present as nonverbal gestures, relational manipulation, and verbal aggression [ 1 ]. The hierarchical structure of healthcare organizations facilitates both horizontal and vertical manifestations of such conduct [ 2 – 3 ], creating complex interpersonal dynamics that profoundly influence the workplace atmosphere. Healthcare environments report higher rates of workplace negative behavior compared to other professional fields [ 4 – 6 ]. Nurses are particularly vulnerable due to their central role in patient care and intermediate position within the organizational hierarchy [ 7 – 9 ]. Substantial evidence associates exposure to such behaviors with negative professional outcomes, including increased job insecurity, emotional exhaustion, and higher turnover intention [ 10 – 12 ]. Studies also consistently report adverse effects on professional satisfaction and psychological well-being [ 13 – 15 ]. Beyond individual repercussions, these behaviors jeopardize fundamental healthcare goals by undermining care quality and patient safety [ 16 ]. Clinical practicum constitutes a critical transitional stage in nursing education, bridging academic training and professional practice[ 17 , 18 ]. This period immerses nursing interns in workplace dynamics where negative behaviors are not uncommon [ 19 – 21 ]. Grounded in Conservation of Resources theory [ 22 , 23 ], this study frames workplace negative behavior as a salient stressor that depletes personal resources, potentially triggering psychological distress and activating coping responses. When internal and external resources are insufficient, this process may lead to anxiety, depression, and maladaptive coping. Although the prevalence of workplace negative behavior is well-documented, the mechanisms through which it affects nursing interns remain inadequately understood. Prior research often suffers from imprecise operational definitions and limited theoretical integration [ 24 – 26 ], constraining both practical application and intervention design. This study addresses these gaps through three main objectives: establishing clear operational definitions of key constructs using validated instruments; analyzing their interrelationships within a theoretical framework; and proposing evidence-based strategies to support nursing interns’ professional growth. Methods Study Design and Participants A cross-sectional design was employed to investigate the prevalence and correlates of workplace negative behavior among nursing interns. Using convenience sampling, 234 undergraduate nursing students were recruited from two Class A tertiary hospitals in Chongqing, China, yielding a response rate of 70.91%. While offering practical insights, this sampling method limits generalizability to wider populations. Eligible participants were full-time undergraduate nursing students actively completing clinical practicum during the study period. The only exclusion criterion was unwillingness to participate after receiving full study details. Measures and Operational Definitions Workplace negative behavior was measured using the Chinese version of the Negative Acts Questionnaire-Revised [ 27 ]. This 22-item tool assesses three dimensions: personal-related, work-related, and physically intimidating behaviors. Items are rated on a 5-point Likert scale (1 = never to 5 = daily), with total scores ≥ 33 indicating clinically significant exposure [ 28 ]. The scale has demonstrated strong psychometric properties in Chinese healthcare samples [ 27 ]. Psychological distress was evaluated using the Self-Rating Anxiety Scale and Self-Rating Depression Scale [ 29 ]. Each comprises 20 items rated on 4-point scales, with standard scores ≥ 50 (anxiety) and ≥ 53 (depression) indicating clinically significant symptoms. Both instruments have shown excellent reliability in Chinese healthcare populations [ 29 ]. Coping styles were conceptualized based on transactional stress models [ 30 ] and assessed via the Simplified Coping Style Questionnaire [ 31 ]. This 20-item instrument includes positive and negative coping subscales, rated on a 4-point frequency scale (0 = never to 3 = always). It has acceptable reliability in Chinese student samples [ 31 ]. Additional data collected covered demographic variables, professional attitudes, perceived workload, and career planning. Data Collection and Ethical Considerations Data were collected over 14 days in November 2024 using an electronic survey platform. Ethical approval was granted by the Institutional Review Board of the First Affiliated Hospital of Chongqing Medical University (Approval No. ZZ2025-237-01). Written informed consent was obtained from all participants after explaining study procedures and confidentiality safeguards. Statistical Analysis Analyses were performed using SPSS 26.0. Descriptive statistics summarized sample characteristics and key variables. Spearman’s correlation assessed bivariate relationships, and multiple linear regression identified significant predictors of outcomes. Statistical significance was set at p < 0.05 (two-tailed). Variance inflation factors below 5.0 confirmed no multicollinearity. Results Participants’ Characteristics The sample was predominantly female (90.17%), consistent with gender distributions in Chinese nursing education. Most participants were aged 21–22 years (92.74%) and were non-only children (72.22%). Professional attitudes toward nursing were generally neutral (70.09%). A considerable proportion perceived hospital (41.03%) and departmental (37.61%) workloads as excessive (Table 1 ). Table 1 Participants’ Characteristics Characteristic of Participant Frequency(n) % Gender Male 23 9.83 Female 211 90.17 Overall 234 100 Age (years) 20 11 4.70 21 122 52.14 22 95 40.60 23 6 2.56 Only child Yes 65 27.78 No 169 72.22 Relationship status Never been in love 104 44.44 Have been in love (broken up) 54 23.08 Be in love 76 32.48 Attitude towards the nursing profession Like very much 4 1.70 Like 56 23.93 General 164 70.09 Not really 5 2.14 Not at all 5 2.14 Hospital internship tasks suitable 138 58.97 too heavy 96 41.03 light 0 0 suitable 146 62.39 too heavy 88 37.61 light 0 0 Future career planning Engaged in nursing related work 133 56.84 To engage in non-nurse medical and health work 13 5.56 Take a postgraduate exam in nursing 40 17.09 I'm tired. Take some time off and think about it. 12 5.13 I haven't decided yet. Let it be. 36 15.38 Prevalence of Key Variables The mean workplace negative behavior score (28.71 ± 6.10) was below the clinical cutoff, indicating moderate but notable exposure. Anxiety (44.02 ± 9.99) and depression (47.01 ± 10.69) scores approached clinical thresholds, reflecting considerable psychological distress. Positive coping strategies (25.40 ± 7.20) were more frequently reported than negative ones (11.34 ± 4.49) (Table 2 ). Table 2 Students’ workplace negative behaviors(WNB), SAS, SDS, and coping styles Variable Mean Score SD Lowest Score Highest Score SAS 44.02 9.99 25.00 85.00 SDS 47.01 10.69 27.50 73.75 WNB 28.71 6.10 22.00 55.00 coping styles negative coping 11.34 4.49 0.00 24.00 positive coping 25.40 7.20 2.00 36.00 Bivariate Relationships Correlation analyses indicated several significant associations (Table 3 ). Age correlated positively with workplace negative behavior (r = 0.173, p = 0.008), anxiety (r = 0.234, p < 0.001), depression (r = 0.143, p = 0.029), and positive coping (r = 0.267, p < 0.001). Professional attitude showed the strongest correlation with workplace negative behavior (r = 0.399, p < 0.001). Relationship status and perceived workload were also significantly associated with multiple outcome variables. Table 3 Correlation for Students’ demographic characteristics and WNB, SAS, SDS, and coping styles WNB p-value(r) SAS p-value (r) SDS p-value (r) negative coping p-value (r) positive coping p-value (r) Gender 0.279 (−0.071) 0.081 (−0.114) 0.861 (−0.011) 0.178 (−0.088) 0.068 (−0.120) Age 0.008** (0.173) < 0.001**(0.234) 0.029* (−0.143) 0.056(0.125) < 0.001**(0.267) Only child 0.424 (−0.052) 0.075(0.116) 0.027* (−0.145) 0.294 (0.069) 0.123 (0.101) Relationship status 0.002** (0.202) < 0.001**(0.249) 0.621 (0.033) 0.003**(0.196) 0.004**(0.185) Attitude towards the nursing profession < 0.001** (0.399) 0.037*(0.136) < 0.001**(0.392) < 0.001**(0.244) < 0.001**(−0.234) Hospital internship tasks < 0.001** (0.343) < 0.001**(0.312) 0.001**(0.215) 0.365(0.059) 0.101 (0.108) Department practice task < 0.001** (0.378) < 0.001**(0.242) 0.003**(0.194) 0.124 (0.101) 0.002**(0.203) Future career planning 0.001** (0.224) 0.001**(0.232) < 0.001**(0.293) 0.020*(0.152) 0.637(−0.031) Note: *P ≤ 0.05, **P ≤ 0.01. Multivariate Analysis Regression analysis accounted for 34.3% of the variance in outcomes (Table 4 ). Depression (β = 0.442, p < 0.001), anxiety (β = 0.229, p = 0.001), and positive coping (β = 0.218, p = 0.002) were significant predictors. The direct effect of workplace negative behavior was non-significant in the multivariate model, suggesting possible mediation pathways. Table 4 Correlation for Students’ WNB, SAS, SDS, and coping styles Predictor Estimate SE 95% CI t p Stand. Estimate Lower Upper WNB −0.868 13.476 −27.420 25.684 −0.064 0.949 SAS 0.229 0.070 0.092 0.366 3.296 0.001 0.230 SDS 0.442 0.070 0.304 0.581 6.293 < 0.001 0.444 negative coping 0.118 0.069 −0.017 0.253 1.722 0.086 0.118 positive coping 0.218 0.069 0.082 0.354 3.160 0.002 0.219 Note:R = .586; R 2 = .343. Discussion This investigation elucidates the psychological mechanisms through which workplace negative behaviors impact nursing interns, a population positioned at the critical juncture between academic preparation and professional practice. The observed levels of psychological distress, approaching clinical thresholds, underscore the significant emotional toll exacted by the clinical training environment. Within the conceptual framework of Conservation of Resources (COR) theory, our findings illustrate how exposure to negative acts functions as a salient psychosocial stressor that threatens personal resources and challenges adaptive coping capacities. A pivotal finding of this study is the pronounced correlation between professional attitude and the experience of workplace negative behavior. COR theory posits that individuals are motivated to acquire, retain, and protect their valued resources. A positive professional attitude can be conceptualized as a key resource in itself—a psychological asset that fosters resilience, provides a buffer against interpersonal adversity, and motivates active coping efforts [ 32 , 33 ]. Interns with a stronger professional identity may interpret negative encounters as less threatening to their core self-worth, thereby mitigating the depleting effects of such stressors. Conversely, a weaker professional identity may represent a state of resource scarcity, increasing vulnerability to the detrimental impacts of workplace negativity. Notably, depression emerged as the most potent predictor in our multivariate model. While the cross-sectional design precludes causal inference, this robust association suggests a complex, likely bidirectional, relationship. Depression may operate through several pathways: it can amplify the perception of negative social interactions via cognitive biases such as increased vigilance to threat and negative interpretative tendencies [ 34 , 35 ]. Simultaneously, the chronic stress of enduring workplace negativity may deplete psychological resources, precipitating or exacerbating depressive symptomatology. The finding that the direct effect of workplace negative behavior was attenuated when psychological distress was accounted for in the model suggests that the relationship is substantially mediated through internalizing symptoms. This underscores that the primary harm of such behaviors may lie not merely in the events themselves, but in their internal psychological consequences. Furthermore, the significant role of positive coping strategies reinforces the importance of resource investment and replenishment. COR theory proposes that effective coping involves strategically deploying resources to manage stressors. Our results indicate that the mere frequency of "positive" coping is less critical than its strategic application and contextual appropriateness [ 36 , 37 ]. Effective copers may be those who can flexibly employ different strategies—such as problem-solving, seeking support, or cognitive reframing—depending on the specific nature of the stressor, thereby conserving and rebuilding resources more efficiently. The association between perceived excessive workload and adverse outcomes further validates the transactional stress models. High clinical demands can consume substantial cognitive and emotional energy, leaving interns with diminished residual capacity to constructively manage interpersonal conflicts or setbacks [ 38 , 39 ]. This creates a precarious cycle wherein resource depletion from high workload increases susceptibility to the negative effects of interpersonal stressors, which in turn further depletes resources, heightening the risk of burnout and attrition. In summary, this study moves beyond documenting prevalence to propose a mechanistic model: workplace negative behaviors act as resource threats whose impact is filtered through the intern's existing resource pool (e.g., professional identity) and subsequently manifested through psychological distress (e.g., depression), with coping processes serving as critical, modifiable resource management strategies. This theoretical framing provides a coherent foundation for developing multifaceted interventions aimed at resource preservation and replenishment, which are essential for safeguarding the well-being and professional development of the next generation of nurses. Future longitudinal research is imperative to definitively establish temporal precedence and causality within this proposed model. Conclusion This study demonstrates that the experience of workplace negative behaviors among nursing interns cannot be viewed in isolation, but rather represents a complex interplay between external stressors and internal psychological processes. Within the framework of Conservation of Resources theory, workplace negative behaviors function as significant resource depletion stressors, whose impact is substantially mediated through psychological distress, particularly depression. The identification of professional attitude as a key correlate and positive coping as a significant predictor reveals critical intervention points. These findings collectively suggest that the detrimental effects of workplace adversity are not inevitable, but can be mitigated through strategic resource preservation and enhancement. Healthcare institutions should therefore implement integrated support systems that simultaneously address mental health screening, cultivate adaptive coping competencies through resilience training, and foster professional identity development. Such multifaceted interventions are essential not only for supporting nursing interns during their critical transition to practice but also for promoting the long-term sustainability of the nursing workforce. Future longitudinal research is warranted to further elucidate the causal pathways identified in this study and to evaluate the efficacy of targeted interventions Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (Approval No. ZZ2025-237-01). The research was conducted in strict accordance with fundamental ethical principles, including respect for autonomy, beneficence, honesty, confidentiality, and justice. Prior to participation, written informed consent was obtained from all participants. All data collected were treated with strict confidentiality, and measures were implemented throughout the study to protect the privacy and security of participant information. Availability of data The datasets generated and/or analyzed during the current study are not publicly available due to protecting the confidentiality of the participants, but are available from the corresponding author upon reasonable request. Conflicts of interest statement The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding This study was supported by the Higher Education Research Project of the Chongqing Higher Education Association (2023–2024), under Grant No. cqgj23011B, and received additional funding from the 2025 Municipal Subsidy for Deepening Healthcare System Reform, under Grant No. 56-20257802. 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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-8002801","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":578442470,"identity":"917cdc1e-06df-4bcb-8d25-5488ff1be045","order_by":0,"name":"Hong Jiang","email":"","orcid":"","institution":"The First Affiliated Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Jiang","suffix":""},{"id":578442473,"identity":"f0452658-bcfe-424f-bfd1-fecbb4914ec7","order_by":1,"name":"Chao Zeng","email":"","orcid":"","institution":"The First Affiliated Hospital of 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20:42:09","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":97857,"visible":true,"origin":"","legend":"","description":"","filename":"3e1800414ac244d48b656bed1def70781structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8002801/v1/a01dd365b569be5039d3b679.xml"},{"id":101013313,"identity":"598dbef2-fb88-4b9f-a891-f7111c5210d0","added_by":"auto","created_at":"2026-01-23 20:42:09","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110086,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8002801/v1/78958203973ea8979c4ec706.html"},{"id":101207804,"identity":"38d1abca-ab28-4020-8581-59b16271cc06","added_by":"auto","created_at":"2026-01-27 10:07:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":888648,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8002801/v1/e40dfa8a-da4c-4d08-a86a-3f78fcc52a92.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Professional Identity as a Protective Resource: A Cross-Sectional Study of Workplace Negative Behaviors and Psychological Distress Among Chinese Nursing Interns","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWorkplace negative behavior in healthcare settings refers to persistent hostile actions occurring among healthcare professionals. These behaviors typically present as nonverbal gestures, relational manipulation, and verbal aggression [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The hierarchical structure of healthcare organizations facilitates both horizontal and vertical manifestations of such conduct [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], creating complex interpersonal dynamics that profoundly influence the workplace atmosphere.\u003c/p\u003e\u003cp\u003eHealthcare environments report higher rates of workplace negative behavior compared to other professional fields [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Nurses are particularly vulnerable due to their central role in patient care and intermediate position within the organizational hierarchy [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Substantial evidence associates exposure to such behaviors with negative professional outcomes, including increased job insecurity, emotional exhaustion, and higher turnover intention [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Studies also consistently report adverse effects on professional satisfaction and psychological well-being [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Beyond individual repercussions, these behaviors jeopardize fundamental healthcare goals by undermining care quality and patient safety [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eClinical practicum constitutes a critical transitional stage in nursing education, bridging academic training and professional practice[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This period immerses nursing interns in workplace dynamics where negative behaviors are not uncommon [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Grounded in Conservation of Resources theory [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], this study frames workplace negative behavior as a salient stressor that depletes personal resources, potentially triggering psychological distress and activating coping responses. When internal and external resources are insufficient, this process may lead to anxiety, depression, and maladaptive coping.\u003c/p\u003e\u003cp\u003eAlthough the prevalence of workplace negative behavior is well-documented, the mechanisms through which it affects nursing interns remain inadequately understood. Prior research often suffers from imprecise operational definitions and limited theoretical integration [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], constraining both practical application and intervention design.\u003c/p\u003e\u003cp\u003eThis study addresses these gaps through three main objectives: establishing clear operational definitions of key constructs using validated instruments; analyzing their interrelationships within a theoretical framework; and proposing evidence-based strategies to support nursing interns\u0026rsquo; professional growth.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA cross-sectional design was employed to investigate the prevalence and correlates of workplace negative behavior among nursing interns. Using convenience sampling, 234 undergraduate nursing students were recruited from two Class A tertiary hospitals in Chongqing, China, yielding a response rate of 70.91%. While offering practical insights, this sampling method limits generalizability to wider populations.\u003c/p\u003e \u003cp\u003eEligible participants were full-time undergraduate nursing students actively completing clinical practicum during the study period. The only exclusion criterion was unwillingness to participate after receiving full study details.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures and Operational Definitions\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eWorkplace negative behavior was measured using the Chinese version of the Negative Acts Questionnaire-Revised [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This 22-item tool assesses three dimensions: personal-related, work-related, and physically intimidating behaviors. Items are rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;never to 5\u0026thinsp;=\u0026thinsp;daily), with total scores\u0026thinsp;\u0026ge;\u0026thinsp;33 indicating clinically significant exposure [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The scale has demonstrated strong psychometric properties in Chinese healthcare samples [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePsychological distress was evaluated using the Self-Rating Anxiety Scale and Self-Rating Depression Scale [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Each comprises 20 items rated on 4-point scales, with standard scores\u0026thinsp;\u0026ge;\u0026thinsp;50 (anxiety) and \u0026ge;\u0026thinsp;53 (depression) indicating clinically significant symptoms. Both instruments have shown excellent reliability in Chinese healthcare populations [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCoping styles were conceptualized based on transactional stress models [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and assessed via the Simplified Coping Style Questionnaire [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This 20-item instrument includes positive and negative coping subscales, rated on a 4-point frequency scale (0\u0026thinsp;=\u0026thinsp;never to 3\u0026thinsp;=\u0026thinsp;always). It has acceptable reliability in Chinese student samples [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditional data collected covered demographic variables, professional attitudes, perceived workload, and career planning.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eData Collection and Ethical Considerations\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eData were collected over 14 days in November 2024 using an electronic survey platform. Ethical approval was granted by the Institutional Review Board of the First Affiliated Hospital of Chongqing Medical University (Approval No. ZZ2025-237-01). Written informed consent was obtained from all participants after explaining study procedures and confidentiality safeguards.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAnalyses were performed using SPSS 26.0. Descriptive statistics summarized sample characteristics and key variables. Spearman\u0026rsquo;s correlation assessed bivariate relationships, and multiple linear regression identified significant predictors of outcomes. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-tailed). Variance inflation factors below 5.0 confirmed no multicollinearity.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u0026rsquo; Characteristics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe sample was predominantly female (90.17%), consistent with gender distributions in Chinese nursing education. Most participants were aged 21\u0026ndash;22 years (92.74%) and were non-only children (72.22%). Professional attitudes toward nursing were generally neutral (70.09%). A considerable proportion perceived hospital (41.03%) and departmental (37.61%) workloads as excessive (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eParticipants\u0026rsquo; Characteristics\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic of Participant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationship status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever been in love\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave been in love (broken up)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBe in love\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude towards the nursing profession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLike very much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLike\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot really\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital internship tasks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etoo heavy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etoo heavy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFuture career planning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngaged in nursing related work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo engage in non-nurse medical and health work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake a postgraduate exam in nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI'm tired. Take some time off and think about it.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI haven't decided yet. Let it be.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePrevalence of Key Variables\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe mean workplace negative behavior score (28.71\u0026thinsp;\u0026plusmn;\u0026thinsp;6.10) was below the clinical cutoff, indicating moderate but notable exposure. Anxiety (44.02\u0026thinsp;\u0026plusmn;\u0026thinsp;9.99) and depression (47.01\u0026thinsp;\u0026plusmn;\u0026thinsp;10.69) scores approached clinical thresholds, reflecting considerable psychological distress. Positive coping strategies (25.40\u0026thinsp;\u0026plusmn;\u0026thinsp;7.20) were more frequently reported than negative ones (11.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.49) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudents\u0026rsquo; workplace negative behaviors(WNB), SAS, SDS, and coping styles\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLowest Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHighest Score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWNB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ecoping styles\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enegative coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epositive coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eBivariate Relationships\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eCorrelation analyses indicated several significant associations (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Age correlated positively with workplace negative behavior (r\u0026thinsp;=\u0026thinsp;0.173, p\u0026thinsp;=\u0026thinsp;0.008), anxiety (r\u0026thinsp;=\u0026thinsp;0.234, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), depression (r\u0026thinsp;=\u0026thinsp;0.143, p\u0026thinsp;=\u0026thinsp;0.029), and positive coping (r\u0026thinsp;=\u0026thinsp;0.267, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Professional attitude showed the strongest correlation with workplace negative behavior (r\u0026thinsp;=\u0026thinsp;0.399, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Relationship status and perceived workload were also significantly associated with multiple outcome variables.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation for Students\u0026rsquo; demographic characteristics and WNB, SAS, SDS, and coping styles\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWNB\u003c/p\u003e \u003cp\u003ep-value(r)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSAS\u003c/p\u003e \u003cp\u003ep-value (r)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSDS\u003c/p\u003e \u003cp\u003ep-value (r)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003enegative coping\u003c/p\u003e \u003cp\u003ep-value (r)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003epositive coping\u003c/p\u003e \u003cp\u003ep-value (r)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.279\u003c/p\u003e \u003cp\u003e(\u0026minus;0.071)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003cp\u003e(\u0026minus;0.114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003cp\u003e(\u0026minus;0.011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003cp\u003e(\u0026minus;0.088)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003cp\u003e(\u0026minus;0.120)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.008**\u003c/p\u003e \u003cp\u003e(0.173)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**(0.234)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.029*\u003c/p\u003e \u003cp\u003e(\u0026minus;0.143)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.056(0.125)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**(0.267)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.424\u003c/p\u003e \u003cp\u003e(\u0026minus;0.052)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.075(0.116)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.027*\u003c/p\u003e \u003cp\u003e(\u0026minus;0.145)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003cp\u003e(0.069)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003cp\u003e(0.101)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelationship status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.002**\u003c/p\u003e \u003cp\u003e(0.202)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**(0.249)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003cp\u003e(0.033)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003**(0.196)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.004**(0.185)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude towards the nursing profession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003cp\u003e(0.399)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.037*(0.136)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**(0.392)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**(0.244)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**(\u0026minus;0.234)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital internship tasks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003cp\u003e(0.343)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**(0.312)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001**(0.215)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.365(0.059)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003cp\u003e(0.108)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepartment practice task\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003cp\u003e(0.378)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**(0.242)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003**(0.194)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003cp\u003e(0.101)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002**(0.203)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFuture career\u003c/p\u003e \u003cp\u003eplanning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003cp\u003e(0.224)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001**(0.232)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**(0.293)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.020*(0.152)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.637(\u0026minus;0.031)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: *P\u0026thinsp;\u0026le;\u0026thinsp;0.05, **P\u0026thinsp;\u0026le;\u0026thinsp;0.01.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate Analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eRegression analysis accounted for 34.3% of the variance in outcomes (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Depression (β\u0026thinsp;=\u0026thinsp;0.442, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), anxiety (β\u0026thinsp;=\u0026thinsp;0.229, p\u0026thinsp;=\u0026thinsp;0.001), and positive coping (β\u0026thinsp;=\u0026thinsp;0.218, p\u0026thinsp;=\u0026thinsp;0.002) were significant predictors. The direct effect of workplace negative behavior was non-significant in the multivariate model, suggesting possible mediation pathways.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation for Students\u0026rsquo; WNB, SAS, SDS, and coping styles\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStand. Estimate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWNB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.868\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;27.420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25.684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enegative coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epositive coping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote:R\u0026thinsp;=\u0026thinsp;.586; R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.343.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis investigation elucidates the psychological mechanisms through which workplace negative behaviors impact nursing interns, a population positioned at the critical juncture between academic preparation and professional practice. The observed levels of psychological distress, approaching clinical thresholds, underscore the significant emotional toll exacted by the clinical training environment. Within the conceptual framework of Conservation of Resources (COR) theory, our findings illustrate how exposure to negative acts functions as a salient psychosocial stressor that threatens personal resources and challenges adaptive coping capacities.\u003c/p\u003e \u003cp\u003eA pivotal finding of this study is the pronounced correlation between professional attitude and the experience of workplace negative behavior. COR theory posits that individuals are motivated to acquire, retain, and protect their valued resources. A positive professional attitude can be conceptualized as a key resource in itself\u0026mdash;a psychological asset that fosters resilience, provides a buffer against interpersonal adversity, and motivates active coping efforts [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Interns with a stronger professional identity may interpret negative encounters as less threatening to their core self-worth, thereby mitigating the depleting effects of such stressors. Conversely, a weaker professional identity may represent a state of resource scarcity, increasing vulnerability to the detrimental impacts of workplace negativity.\u003c/p\u003e \u003cp\u003eNotably, depression emerged as the most potent predictor in our multivariate model. While the cross-sectional design precludes causal inference, this robust association suggests a complex, likely bidirectional, relationship. Depression may operate through several pathways: it can amplify the perception of negative social interactions via cognitive biases such as increased vigilance to threat and negative interpretative tendencies [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Simultaneously, the chronic stress of enduring workplace negativity may deplete psychological resources, precipitating or exacerbating depressive symptomatology. The finding that the direct effect of workplace negative behavior was attenuated when psychological distress was accounted for in the model suggests that the relationship is substantially mediated through internalizing symptoms. This underscores that the primary harm of such behaviors may lie not merely in the events themselves, but in their internal psychological consequences.\u003c/p\u003e \u003cp\u003eFurthermore, the significant role of positive coping strategies reinforces the importance of resource investment and replenishment. COR theory proposes that effective coping involves strategically deploying resources to manage stressors. Our results indicate that the mere frequency of \"positive\" coping is less critical than its strategic application and contextual appropriateness [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Effective copers may be those who can flexibly employ different strategies\u0026mdash;such as problem-solving, seeking support, or cognitive reframing\u0026mdash;depending on the specific nature of the stressor, thereby conserving and rebuilding resources more efficiently.\u003c/p\u003e \u003cp\u003eThe association between perceived excessive workload and adverse outcomes further validates the transactional stress models. High clinical demands can consume substantial cognitive and emotional energy, leaving interns with diminished residual capacity to constructively manage interpersonal conflicts or setbacks [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This creates a precarious cycle wherein resource depletion from high workload increases susceptibility to the negative effects of interpersonal stressors, which in turn further depletes resources, heightening the risk of burnout and attrition.\u003c/p\u003e \u003cp\u003eIn summary, this study moves beyond documenting prevalence to propose a mechanistic model: workplace negative behaviors act as resource threats whose impact is filtered through the intern's existing resource pool (e.g., professional identity) and subsequently manifested through psychological distress (e.g., depression), with coping processes serving as critical, modifiable resource management strategies. This theoretical framing provides a coherent foundation for developing multifaceted interventions aimed at resource preservation and replenishment, which are essential for safeguarding the well-being and professional development of the next generation of nurses. Future longitudinal research is imperative to definitively establish temporal precedence and causality within this proposed model.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that the experience of workplace negative behaviors among nursing interns cannot be viewed in isolation, but rather represents a complex interplay between external stressors and internal psychological processes. Within the framework of Conservation of Resources theory, workplace negative behaviors function as significant resource depletion stressors, whose impact is substantially mediated through psychological distress, particularly depression. The identification of professional attitude as a key correlate and positive coping as a significant predictor reveals critical intervention points. These findings collectively suggest that the detrimental effects of workplace adversity are not inevitable, but can be mitigated through strategic resource preservation and enhancement. Healthcare institutions should therefore implement integrated support systems that simultaneously address mental health screening, cultivate adaptive coping competencies through resilience training, and foster professional identity development. Such multifaceted interventions are essential not only for supporting nursing interns during their critical transition to practice but also for promoting the long-term sustainability of the nursing workforce. Future longitudinal research is warranted to further elucidate the causal pathways identified in this study and to evaluate the efficacy of targeted interventions\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (Approval No. ZZ2025-237-01). The research was conducted in strict accordance with fundamental ethical principles, including respect for autonomy, beneficence, honesty, confidentiality, and justice. Prior to participation, written informed consent was obtained from all participants. All data collected were treated with strict confidentiality, and measures were implemented throughout the study to protect the privacy and security of participant information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to protecting the confidentiality of the participants, but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Higher Education Research Project of the Chongqing Higher Education Association (2023–2024), under Grant No. cqgj23011B, and received additional funding from the 2025 Municipal Subsidy for Deepening Healthcare System Reform, under Grant No. 56-20257802.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Design: Yan Hu, Hong Jiang. Data Collection: Yan Hu, Hong Jiang, Chao Zeng, Qian Wu. Data Analysis: Yan Hu, Chao Zeng . Research Supervision: Fulan Wang and Bizhen Liao. Manuscript Writing: Hong Jiang, Yan Hu. Revision of Key Ideological Content:Fulan Wang and Bizhen Liao.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all internship nursing students who participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLayne DM, Nemeth LS, Mueller M, Martin M. Negative Behaviors among Healthcare Professionals: Relationship with Patient Safety Culture. Healthc (Basel). 2019;7(1):23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeller JM. Hierarchy in surgeon-anaesthetist relationships. Br J Anaesth. 2025 Jan;134(1):23\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKays MN, Rupert DD, Negris O, et al. 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Expert Rev Pharmacoecon Outcomes Res. 2025;25(5):635\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu CS, Rong JR, Huang MZ. Factors associated with perceived stress of clinical practice among associate degree nursing students in Taiwan. BMC Nurs. 2021;20(1):89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrant-Smith D, de Zwaan L. Don't spend, eat less, save more: Responses to the financial stress experienced by nursing students during unpaid clinical placements. Nurse Educ Pract. 2019;35(2):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdelaziz EM, Abu-Snieneh HM. The impact of bullying on the mental health and academic achievement of nursing students. Perspect Psychiatr Care. 2022;58(2):623\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLivshiz-Riven I, Hurvitz N, Grinberg K, et al. 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Front Psychol. 2022;13:1007830.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCao J, Fu M, Liu J, et al. Nursing students' bullying experiences from instructors and nurses in the clinical practice: A qualitative systematic review and meta-synthesis. Nurse Educ Today. 2025;146:106511.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang J, Ye J, Zhang R, et al. High stress during clinical practicum placement is associated with bullying among nursing students: A mixed-method study. Nurse Educ Today. 2024;142:106327.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang L, Zeng Q, Wang Y, Zhou J, Zeng Y. Why nursing students do not report workplace bullying during clinical practice: A mixed methods systematic review. Nurse Educ Today. 2024;142:106341.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXun HJ, Liu HX, Tian ZL. 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J Soc Clin Psychol. 2010;29(1):23\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie YN. A preliminary study of the reliability and validity of the Simplified Coping Style Questionnaire [J]. Chin J Clin Psychol. 1998;6(2):53\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen G, Wang J, Huang Q, et al. Social support, psychological capital, multidimensional job burnout, and turnover intention of primary medical staff: a path analysis drawing on conservation of resources theory. Hum Resour Health. 2024;22(1):42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalak SA, Qassim AA. Unpacking the interplay between psychological capital and wellbeing in entrepreneurs: the mediating role of burnout through conservation of resources theory. Front Psychol. 2025;16:1590554.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVos LMW, Nieto I, Amanvermez Y, Smeets T, Everaert J. Do cognitive biases prospectively predict anxiety and depression? A multi-level meta-analysis of longitudinal studies. Clin Psychol Rev. 2025;116:102552.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVillalobos D, Pacios J, V\u0026aacute;zquez C. Cognitive Control, Cognitive Biases and Emotion Regulation in Depression: A New Proposal for an Integrative Interplay Model. Front Psychol. 2021;12:628416.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRomo-Gonz\u0026aacute;lez T, Barranca-Enr\u0026iacute;quez A, Le\u0026oacute;n-D\u0026iacute;az R, et al. Stress symptoms and positive coping during coronavirus disease 2019: The need to look at health from a gender perspective. PLoS ONE. 2023;18(7):e0287055.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo X, Peng Q, Wu S, et al. Perceived parenting style and Chinese nursing undergraduates' learning motivation: The chain mediating roles of self-efficacy and positive coping style. Nurse Educ Pract. 2023;68:103607.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWille E, Opheim HMS, Princeton DM, Kisa S, Hjerpaasen KJ. Building Resilience and Competence in Bachelor Nursing Students: A Narrative Review Based on Social Cognitive Theory. Nurs Rep. 2025;15(7):253.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindstr\u0026ouml;m C, Lindberg E, Karlsson J, Sandvik AH. Caring in uncertain territory.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNursing students' encounters. with patients' existential concerns during clinical placements. Nurse Educ Pract. 2025;86:104412.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Nursing education, Clinical internship, Workplace behavior, Psychological distress, Coping strategies","lastPublishedDoi":"10.21203/rs.3.rs-8002801/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8002801/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eBackground\u003c/b\u003e Nursing interns are particularly vulnerable to workplace negative behaviors during their clinical practicum, which can critically shape their professional development and the quality of patient care. However, the psychological mechanisms underlying this relationship remain inadequately explained within comprehensive theoretical frameworks.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e In this cross-sectional study, 234 undergraduate nursing interns were recruited from two tertiary hospitals in Southwest China. Participants completed validated measures including the Negative Acts Questionnaire-Revised, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Simplified Coping Style Questionnaire. Data analysis employed Spearman's correlation and multiple linear regression.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e The mean scores indicated moderate exposure to workplace negative behavior (28.71\u0026thinsp;\u0026plusmn;\u0026thinsp;6.10), with anxiety (44.02\u0026thinsp;\u0026plusmn;\u0026thinsp;9.99) and depression (47.01\u0026thinsp;\u0026plusmn;\u0026thinsp;10.69) levels approaching clinical significance. Regression analysis revealed that depression (β\u0026thinsp;=\u0026thinsp;0.442, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), anxiety (β\u0026thinsp;=\u0026thinsp;0.229, p\u0026thinsp;=\u0026thinsp;0.001), and positive coping strategies (β\u0026thinsp;=\u0026thinsp;0.218, p\u0026thinsp;=\u0026thinsp;0.002) were significant predictors, collectively explaining 34.3% of the variance. Professional attitude demonstrated the strongest correlation with exposure to workplace negative behavior (r\u0026thinsp;=\u0026thinsp;0.399, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e The impact of workplace negative behaviors on nursing interns is substantially mediated through psychological distress, while coping strategies and professional attitude serve as important moderating factors. These findings suggest that healthcare institutions should implement integrated support systems incorporating mental health screening, resilience training, and professional identity development to mitigate adverse effects and promote successful transition to professional practice.\u003c/p\u003e \u003cp\u003e \u003cb\u003eClinical trial number\u003c/b\u003e: not applicable.\u003c/p\u003e","manuscriptTitle":"Professional Identity as a Protective Resource: A Cross-Sectional Study of Workplace Negative Behaviors and Psychological Distress Among Chinese Nursing Interns","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-23 20:42:04","doi":"10.21203/rs.3.rs-8002801/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-27T07:54:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220812580964070558958376181385354156717","date":"2026-01-26T05:12:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-21T10:08:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-12T10:49:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-12T10:46:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-11-01T04:35:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"13f18300-67a8-4cf4-a1a9-5b55f9ae7fd2","owner":[],"postedDate":"January 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-23T20:42:04+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-23 20:42:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8002801","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8002801","identity":"rs-8002801","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}