The impact of social support and self- efficacy on resilience in nurses exposed to workplace violence: a cross-sectional study in Southwest China

The impact of social support and self- efficacy on resilience in nurses exposed to workplace violence: a cross-sectional study in Southwest China | 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 Article The impact of social support and self- efficacy on resilience in nurses exposed to workplace violence: a cross-sectional study in Southwest China Tengfei ZHANG, Zhengyi HU, Renping GU, Dongmei ZHANG, Chengxiu CAO, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7879963/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim: This study aims to investigate the current situation of workplace violence, social support, and resilience among nurses in underdeveloped regions of China, and explore the mediating role of social support, as well as the influencing factors on the resilience of nurses who have experienced workplace violence. Methods: Personal Information Form, Hospital Workplace Violence Questionnaire, Resilience Assessment Scale for Medical Staff, GSES and SSRS were used to collect data. Descriptive statistics, t-tests, analysis of variance, Pearson's correlation analysis, multiple regression analysis, and mediating effect analysis were used to analyze the data. Results: The research data showed that the incidence of WPV was 50.1% in two regions of Yunnan Province. There are multiple personal basic characteristic factors that affect the social support of nurses exposed to WPV. However, self-efficacy, marital status, and social support were the main influencing factors on resilience among nurses exposed to workplace violence. Social support partially mediated the impact of self-efficacy on resilience (indirect path: 17.86%). Conclusions: Social support and self-efficacy can significantly positively affect the resilience of nurses exposed to workplace violence, and social support plays a certain mediating role. In addition, marital status is one of the important factors affecting the resilience of nurses exposed to workplace violence, and attention should be paid to giving nurses more family time. Health sciences/Health care Health sciences/Health occupations Biological sciences/Psychology Social science/Psychology Health sciences/Risk factors workplace violence nurse resilience social support self- efficacy Figures Figure 1 1 Introduction Workplace violence refers to any type of acts, such as verbal and physical abuse, that employees experience in their professional environment [ 1 ]. As a healthcare facility closely related to human health, it is a high-risk area for workplace violence. Among the frontline medical service personnel, nurses have become a high-risk group for workplace violence because they spend more time on patient care. According to American research, the incidence of workplace violence among American nurses was 43% from 2020 to 2022[ 2 ]. A large-scale study in Australia reported that over 75% of nurses and related staff have suffered workplace violence in the past 6 months. [ 3 ]. Another cross-sectional study of nurses in five European countries showed that 54% of nurses have experienced workplace violence in the past 12 months. [ 4 ], In Africa, a survey on workplace violence among 9831 nurses revealed that 62.3% of nurses had experienced workplace violence [ 5 ]. A study on workplace violence suffered by emergency nurses in China showed that the incidence of workplace violence among Chinese nurses within 12 months was 79.39% [ 6 ]. In addition, another study on the incidence of workplace violence among nurses in China's tertiary hospitals showed that 26.6% of nurses had experienced workplace violence in the past 12 months [ 7 ]. A meta-analysis on workplace violence among Chinese nurses showed that the incidence of workplace violence among Chinese nurses was 71% in the past 12 months [ 8 ]. In summary, workplace violence against nurses has become a common social problem in countries around the world. Workplace violence is one of the sources of stress for nurses and has a profound impact on their physical, mental, and professional development. A multicenter study has shown that strong resilience can significantly reduce mental health problems caused by workplace violence [ 9 ]. Studies have shown that since 1980, a series of measures such as laws, hospital working environments, and nursing capabilities have been taken both domestically and internationally to improve and reduce the incidence of workplace violence in hospitals [ 10 – 12 ]. However, the incidence of workplace violence among nurses remains high, and countries around the world are still striving to improve this situation from various aspects. Domestic and foreign scholars are trying different methods to reduce the incidence of workplace violence among nurses. A review study shows that social support has a significant improvement effect on enhancing nurses' professional identity and promoting occupational health development [ 13 ]. A study by Xue et al. pointed out that creating a socially supportive work environment is one of the important guarantees for promoting high work enthusiasm among psychiatric nurses [ 14 ]. In addition, multiple studies have shown that improving nurses' self-efficacy can significantly reduce job stress and occupational burnout, as well as significantly enhance resilience [ 15 – 17 ]. However, there is limited research on the relationship between self-efficacy, social support, and nurse resilience among clinical nurses exposed to workplace violence. Therefore, this study aims to investigate the relationship between social support, self-efficacy, and resilience of nurses exposed to workplace violence, and analyze their influencing factors, in order to provide theoretical basis for improving the working environment of nurses and promoting their physical and mental health development. 2 Methods 2.1 Study design and settings The STROBE checklist was used in this cross-sectional descriptive study. By using the convenience sampling method, nurses from hospitals (including primary, secondary, and tertiary hospitals) participated in the study in Kunming and Qujing, Yunnan, China. The hospital grades comply with China's current “Hospital Classification and Management Measures”, etc. 2.2 Participants and data collection The participants to be included must meet the following conditions: Nurses with a qualification certificate and more than 1 year of work experience. Nurses who were exposed to WPV in the past 12 months. Voluntary completion. The exclusion criterion is having or having had depression, bipolar disorder, or other organic or mental illness. Online electronic questionnaires were administered, from April 2025 to June 2025. Prior to data collection, the researchers contacted the nursing departments of the participating hospitals to obtain consent. The researchers sent a link to the questionnaire to nurses. Before the questionnaire begins, the purpose of this study will be introduced and nurses will be asked to participate voluntarily or not. All questionnaire items were required to be completed before submission, and each IP address was limited to one submission. If the answers were incomplete or all options were the same, the questionnaire was considered invalid. 2.3 Instrument and Measurement General information form A demographic information form was constructed to collect general information, including gender, age, marital status, education level, professional title, working years, position, and department. Workplace Violence Scale The prevalence and frequency of WPV experienced in the past 12 months were measured using the Chinese version of the Modified Hospital Workplace Violence Questionnaire (Part 2), developed by the WHO, which has demonstrated good reliability and validity among Chinese healthcare workers[ 7 ]. The questionnaire consists of four items: verbal abuse, threats, physical assault, and sexual harassment. Each item can be responded to as zero times (scored 0), one time (scored 1), two or three times (scored 2), or more than three times (scored 3). A higher sum score indicated a more severe level of WPV. Resilience Scale This scale was used to measure the level of resilience of medical staff [ 18 ]. The scale contains four dimensions, including decision-making coping (six items), interpersonal connection (four items), rational thinking (four items), and flexible self-adaptation (four items). A 5-level Likert scale was used, with scores ranging from 1 to 5, representing 'completely inconsistent' to 'completely consistent,' with a total score ranging from 18 to 90. The higher the score, the better the individual's resilience. General self-efficacy scale Self-efficacy was measured by the Chinese version of the General Self-Efficacy Scale (GSES)[ 19 ]. The GSES was originally developed in German and has been translated into many languages. The scale is composed of 10 items. A 4-level Likert scale was used, scored from 1 point 'completely incorrect' to 4 points 'completely correct.' The total GSES score is the sum of all items, ranging from 10 to 40. A higher score indicated better self-efficacy. Social support rating scale The Social Support Rating Scale was used to measure social support for nurses [ 20 ]. The scale includes objective support (three items), subjective support (four items), and utilization of support (three items). A 4-level Likert scale was used. The higher the score of each dimension, the better the social support. 2.4 Ethical considerations This study was approved by the Ethics Committee of the University (No. 2023-bkskt-02-321088200212157523). All methods were carried out in accordance with relevant guidelines and regulations. Participants were informed of the study's purpose, purpose, method, and significance before completing the questionnaire. Data collection in this study was anonymized, and all data were strictly confidential. 2.5 Statistical analysis The SPSS 21.0 program was used to statistically analyze the data. Mean and standard deviation were used to describe quantitative variables, and the frequency distribution and percentage were used to describe qualitative variables. Independent sample T-test and one-way analysis of variance were used. Pearson’s correlation analysis was used to examine associations between variables. Mediation analysis or multiple regression was used to analyze the relationship among self-efficacy, social support, and resilience. The bootstrapping procedure (resamples = 5000) was used to evaluate the significance of the mediating effects in the model. All statistical tests were two-tailed, and a p-value of < 0.05 was considered statistically significant. 3 Results 3.1 Demographic characteristics A total of 651 nurses completed the questionnaire, excluding 13 responses with answers less than 180 seconds and 9 invalid questionnaires, ultimately retaining 629 valid responses. The questionnaire response efficiency was 96.6%. In the past 12 months, 314 questionnaires answered 'no' regarding exposure to workplace violence. Therefore, 315 questionnaires were included in the data analysis, and the incidence of workplace violence in the survey region was 50.1%. Specific general information and the results of the scales are shown in attachment (Table 1 ). 3.2 The situation of nurses exposed to WPV The incidence of WPV was 53.1% (315 / 651), with verbal violence being the most frequent form. In the past 12 months, the frequency of occurrence was 52.7%, and the frequency of occurrence 2–3 times was 27.3%. The second is threats, the frequency of occurrence was 22.9%, and the frequency of occurrence 2–3 times was 5.7%. Specific general information and the results of the scales are shown in attachment (Table 2 ). 3.3 One-way analysis of variance of resilience, self-efficacy, social support, and demographic characteristics Table 1 shows the average values of resilience, self-efficacy and social support for different demographic characteristics. According to t-test and one-way ANOVA, the resilience scores of nurses exposed to workplace violence showed significant differences in age, marital status, and hospital level (P < 0.05). In terms of social support, there are significant differences in age, marital status, years of work experience, position, and professional title (P < 0.05). However, in terms of self-efficacy, there are only differences in region and hospital grade (P < 0.05). Table 1 Difference analysis of resilience, self- efficacy, and social support of nursing staff with different demographic characteristics ( n = 315 ) ( ±s) No. Stress resistance Self efficacy Social support Gender Male 25 72.5 ± 20.10 22.4 ± 6.05 34.7 ± 8.77 Female 290 73.9 ± 13.30 23.9 ± 5.09 40.3 ± 9.23 t/P − .329/ .744 -1.476/ .141 -2.915/ .004 Age 20ཞ30 165 72.4 ± 14.95 23.4 ± 5.11 41.4 ± 9.83 31ཞ40 102 76.1 ± 11.61 & 24.2 ± 4.94 44.5 ± 8.76 # 41ཞ50 40 73.4 ± 14.67 24.7 ± 5.80 44.3 ± 9.64 >50 8 73.9 ± 13.60 22.4 ± 6.44 45.4 ± 6.95 F/P 1.523/0.208 0.751/0.522 2.835/0.038 Marital status Unmarried 96 70.2 ± 15.18 23.4 ± 5.35 34.3 ± 8.48 Married 209 75.3 ± 13.06 b 24.0 ± 5.13 42.5 ± 8.41 a Divorce 10 75.1 ± 13.98 24.9 ± 4.84 38.4 ± 11.50 F/P 4.577/0.011 0.626/0.535 30.512/<0.001 Education Level Less than junior college 4 72.0 ± 12.68 27.0 ± 4.08 43.5 ± 9.26 Junior college 69 73.7 ± 15.57 25.8 ± 6.59 43.7 ± 9.16 Undergraduate 242 73.8 ± 13.49 25.3 ± 6.57 42.6 ± 9.62 F/P 0.034/0.967 0.269/0.765 0.360/0.698 Working years Less than 5 years 94 72.3 ± 15.80 23.2 ± 5.22 37.7 ± 9.31 6ཞ10 years 102 73.5 ± 13.99 23.9 ± 4.95 40.1 ± 9.02 11ཞ20 years 89 75.0 ± 11.96 24.4 ± 5.20 41.0 ± 9.34 c More than 21 years 30 75.5 ± 12.89 23.9 ± 5.82 42.7 ± 9.14 d F/P 0.754/0.521 0.840/0.473 3.134/0.026 Position None 265 73.3 ± 13.96 23.7 ± 5.18 39.3 ± 9.16 Group leader 46 76.3 ± 13.84 24.2 ± 5.12 43.5 ± 9.61 e Head nurse 4 76.8 ± 11.44 26.8 ± 6.85 38.5 ± 7.56 F/P 1.006/0.367 0.777/0.461 4.161/0.016 Professional title Primary 71 73.8 ± 14.70 23.1 ± 4.79 38.6 ± 8.48 Intermediate 220 73.6 ± 13.81 23.9 ± 5.18 39.8 ± 9.44 Advanced 24 75.6 ± 12.92 25.6 ± 6.01 u 44.7 ± 9.19 gh F/P 0.239/0.787 2.257/0.106 3.994/0.019 Capital 163 73.0 ± 14.78 23.1 ± 5.22 39.8 ± 9.42 District Prefecture-level city 152 74.6 ± 12.94 24.6 ± 5.05 40.0 ± 9.20 F/P -1.03/0.304 -2.602/0.01 -0.203/0.840 Hospital grade Grade I 38 74.6 ± 11.31 23.0 ± 5.01 41.3 ± 9.02 Grade II 150 71.8 ± 15.03 m 23.6 ± 5.01 n 39.6 ± 9.44 Grade III 127 75.8 ± 13.00 24.4 ± 5.41 39.7 ± 9.26 F/P 2.946/0.054 1.386/0.252 0.530/0.589 Note: On resistance &: 20-30-year-old group and the 31-40-year-old group P < 0.05; b: Unmarried group and Married group P = 0.003; m: Grade I group and Grade II group P = 0.017. On Social support #: 20–30-year-old group and the 31–40-year-old group P < 0.05; a: Unmarried group and Married group P = 0.003; c: Less than 5 years group and 11–20 years group P = 0.016; d: Less than 5 years group and More than 21 years group P = 0.01; e: None group and group leader group P = 0.004; g: Primary group and Advanced group P = 0.005; h: Intermediate group and Advanced group P = 0.014. On Self efficacy n: Grade I group and Grade II group P < 0.05; u: Primary group and Advanced group P = 0.036. 3.4 Correlation analysis The correlation analysis of demographic characteristics, self-efficacy, social support, and resilience reveals a significant correlation between age, marital status, position, professional title, and social support. There is a significant correlation between marital status and resilience, There is a significant correlation between region and resilience, and also has a significant correlation with self-efficacy. However, the hospital grade is negatively correlated with age, working years, and professional title of nurses exposed to WPV attachment (Table 1 ). 3.5 Regression analyses As shown in Table 2 , multiple linear regression analyses were conducted with resilience as the dependent variable, and professional title, hospital grade, age, education level as predictor variables, along with social support and self-efficacy as predictors, of which, dummy variable settings were made for unordered variables. The results indicated a significant correlation between demographic variables and resilience, revealing that being married had a positive impact on the resilience of nurses exposed to WPV (β = 0.174, p = 0.003). The professional title had a significant negative impact on the perception of resilience (β = -0.126, p < 0.05). Self-efficacy and social support explained 29.9% of the variation in resilience, and the difference was statistically significant (p < 0.001). Table 2 Multiple linear regression analysis Variables Non-standardized coefficient Standard coefficient t P Colinearity statistics R R 2 F β SE β allowance VIF Constant 37.512 4.957 7.567 .000 0.547 0.299 16.319 *** Age-group 1.064 0.986 0.061 1.079 0.281 1.000 1.000 Hospital grade -1.601 1.041 − .077 -1.539 .125 .923 1.084 Position 1.118 1.719 .033 .650 .516 .897 1.115 Professional title -3.320 1.643 − .126 -2.020 .044 .588 1.700 Work years .891 1.387 .062 .642 .521 .248 4.040 Self-efficacy .890 .134 .331 6.664 .000 .929 1.076 Social support .521 .081 .348 6.431 .000 .782 1.278 Constant 72.219 1.405 49.988 .000 Married 5.107 1.697 .174 3.009 .003 .935 1.069 0.169 0.029 4.577 * divorced 4.881 4.573 .062 1.067 .287 .935 1.069 β: Regression Coefficient, SE: Standard Error, *P < 0.05, ***P < 0.001 3.6 The impact of social support and self efficacy in nurses exposed to WPV: a mediation analysis of self-efficacy As shown in Fig. 1 , the study findings indicate that social support has a significant positive direct effect on self-efficacy (β = 0.132, p < 0.001) and resilience (β = 0.526, p < 0.001). Self-efficacy positively affects resilience (β = 0.870, p < 0.001) and mediates the relationship between social support and resilience (β = 0.114, Bootstrap 95% CI: 0.055–0.184). Self-efficacy partially mediates the relationship between social support and resilience, accounting for approximately 17.86% of the total effect (Table 6). Table 3 Mediating effect analysis Relationship effect size SE t p LLCI ULCI Social Support → Self-efficacy 0.132 0.03 4.023 < 0.001 0.067 0.196 Social Support → Resilience 0.526 0.07 6.699 < 0.001 0.372 0.680 Self-efficacy → Resilience 0.869 0.133 6.553 < 0.001 0.609 1.131 Total effect 0.640 0.082 7.854 < 0.001 0.480 0.801 Relationship Effect BootSE BootLLCI BootULCI Social Support → Self-efficacy → Resilience 0.114 0.033 0.055 0.184 Note: SE: Standard error 4 Discussions This study aims to assess the relationship between the resilience of clinical nurses exposed to workplace violence and their social support, self-efficacy, as well as general demographic characteristics in hospitals of varying grades within economically underdeveloped regions, and to thoroughly investigate the influencing factors. The study findings indicate that hospital grade and marital status have a significant effect on resilience. Self-efficacy serves as a mediating factor in the relationship between resilience and social support among nurses exposed to WPV. The WPV rate among nurses in this study was 50.1%, which is lower than the rates reported by Liu et al. in a meta-analysis about Chinese nurses [ 8 ]. However, it is significantly higher than the rate reported by Yuan et al. in mainland China (26.6%) [ 7 ]. This study showed that verbal aggression had the highest incidence (96.8%), followed by threats and third was physical assault. In addition, the incidence of sexual harassment was 8.3%. Verbal violence is the most prevalent form. Its high incidence may be linked to poor doctor-patient communication, emotional outbursts from patients, or resource shortages. In these findings, the lower rate of physical assault and sexual harassment, may be attributed to a minority of patients having low legal awareness and moral standards. ‌On the other hand, the government and hospitals should formulate corresponding laws and measures to actively protect the legitimate rights and interests of clinical nurses. This study indicates that factors such as gender, education level, professional title, position, working years, and region do not significantly affect the resilience of nurses exposed to WPV. This contrasts with the results of a study by Kim, which focused on workplace violence and resilience among Korean emergency nurses and revealed that education level, professional title, and working years significantly impact resilience [ 21 ]. Another study also demonstrated notable differences in resilience among nurses with education level and professional titles [ 22 ]. However, our study found significant differences in resilience concerning marital status, and Kim's study also supported this finding. Furthermore, there were significant differences in nurses' resilience in terms of age and hospital grade. This may be related to the research subjects of this study, which primarily targeted frontline clinical nurses, with the majority of the final sample for data analysis being young nurses with relatively low positions and professional titles. Additionally, there are differences in hospital grade, along with a trend of inter-group differences, which may be linked to the resource allocation of hospital grades in China and impacts various aspects of healthcare personnel [ 23 ]. Regarding self-efficacy, the study's findings indicate that there were differences between groups only in regions, and the self-efficacy of nurses exposed to WPV in prefecture-level cities was higher. This could be attributed to the high-intensity work environment of Chinese nurses, and research has demonstrated that self-efficacy and marital status significantly influence nurses' empathy fatigue. Regional disparities are associated with China's three-tier medical system and the level of regional economic development [ 24 ]. Moreover, social support is affected by many aspects. This study reveals significant inter-group differences in social support based on gender, age, marital status, working years, job position, and professional title (Table 1 ). Dziedzic found the same result in his research. The study indicated that nurses' work environment and family significantly impact their social support, subsequently affecting their mental health [ 25 ]. This study conducted a correlational analysis of the basic characteristic factors influencing resilience, social support, and self-efficacy among nurses exposed to WPV, along with a multiple linear regression analysis. The results demonstrate that self-efficacy and social support exert a significant positive influence on nurses' resilience, while marital and professional title emerge as other crucial factors. The mediating effect found in this study highlights the role of social support as a “bridge” between self-efficacy and resilience. Social support partially mediated the impact of self-efficacy on resilience (indirect path: 17.86%). Self-efficacy not only directly enhances resilience, but also indirectly enhances it by enhancing social support. In addition, there exists a certain synergistic relationship between self-efficacy and social support. After encountering adversities, nurses eventually acquired the ability to manage violent incidents through corresponding adjustments, both internal and external [ 26 ]. Finally, this study indicates that social support plays a moderating role in nurses' resilience and self-efficacy, as well as in how factors such as marriage, professional title, and hospital resources affect the resilience and social support of nurses exposed to WPV. Limitations This study has a few limitations. First, due to research conditions, convenience sampling was used to recruit participants, which limited to some extent the ability to explain causal relationships between variables. Second, data collection employed a retrospective approach, where participants recalled events from the past 12 months, which to some extent increased the risk of bias in the results. 5 Conclusion Workplace violence against clinical nurses remains prevalent. Although this study shows that the resilience of nurses exposed to WPV is at an upper-middle level, it still requires further improvement. The research reveals that social support mediates the relationship between workplace violence exposure and nurses' resilience and self-efficacy. Moreover, social support and self-efficacy significantly and positively influence the resilience of nurses exposed to WPV. Additionally, factors such as region, professional title, and marital status exert a certain impact on social support, self-efficacy, and resilience, with marital status being particularly influential. Therefore, while continuously improving nurses' remuneration, the government and hospitals should also focus on nurses' family harmony. Especially in China, where the workload is relatively heavy, it is crucial to guarantee adequate rest for nurses to foster the sound development of the nursing profession. Declarations Acknowledgments Thanks to all the nurses and hospital staff who participated in this survey on exposure to workplace violence. Author contributions Tengfei ZHANG: Conceptualization, Methodology, Data curation, Writing original draft, Writing—review & editing. Zhengyi HU: Data curation. Renping GU: Methodology, Data curation. Dongmei ZHANG: Data curation. Chengxiu CAO: Data curation. Jie XIA: Conceptualization, Methodology, Funding acquisition, Supervision, Project administration, Writing—review & editing. Data availability The datasets analyzed during the current study are available from the corresponding author on reasonable request. Conflicts of Interest The authors declare no conflict of interest. References Chen M, Xie H, Liao X, Ni J: Workplace violence and turnover intention among Chinese nurses: the mediating role of compassion fatigue and the moderating role of psychological resilience . BMC public health 2024, 24 (1):2437. Potera C: Violence Against Nurses in the Workplace . The American journal of nursing 2016, 116 (6):20-21. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhengyi","middleName":"","lastName":"HU","suffix":""},{"id":549516844,"identity":"74d2518e-62c0-492b-a572-14d4d3ccf946","order_by":2,"name":"Renping GU","email":"","orcid":"","institution":"Shanghai University of Medicine and Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Renping","middleName":"","lastName":"GU","suffix":""},{"id":549516845,"identity":"da3cf9b8-686b-44f2-9ad8-fa20463112cf","order_by":3,"name":"Dongmei ZHANG","email":"","orcid":"","institution":"会泽县中医医院","correspondingAuthor":false,"prefix":"","firstName":"Dongmei","middleName":"","lastName":"ZHANG","suffix":""},{"id":549516846,"identity":"aab3f939-7247-441a-ae2f-6bdb5bf125ec","order_by":4,"name":"Chengxiu CAO","email":"","orcid":"","institution":"Putuo People’s Hospital, School of Medicine, Tongji 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1","display":"","copyAsset":false,"role":"figure","size":39817,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMediating model of self-efficacy between resilience and social support in nurses exposed to WPV\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7879963/v1/b8a033f0c5b2ecaa549841e5.jpg"},{"id":99307649,"identity":"62636b7f-cc1d-4415-97c7-36ff7a0f56da","added_by":"auto","created_at":"2025-12-31 16:06:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2122286,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7879963/v1/2dd2ddb9-13ed-4310-8171-dd8c860203dd.pdf"},{"id":96605915,"identity":"f8471eba-b3ce-411c-9d43-2b4aee042e17","added_by":"auto","created_at":"2025-11-24 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violence refers to any type of acts, such as verbal and physical abuse, that employees experience in their professional environment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As a healthcare facility closely related to human health, it is a high-risk area for workplace violence. Among the frontline medical service personnel, nurses have become a high-risk group for workplace violence because they spend more time on patient care. According to American research, the incidence of workplace violence among American nurses was 43% from 2020 to 2022[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A large-scale study in Australia reported that over 75% of nurses and related staff have suffered workplace violence in the past 6 months. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Another cross-sectional study of nurses in five European countries showed that 54% of nurses have experienced workplace violence in the past 12 months. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], In Africa, a survey on workplace violence among 9831 nurses revealed that 62.3% of nurses had experienced workplace violence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A study on workplace violence suffered by emergency nurses in China showed that the incidence of workplace violence among Chinese nurses within 12 months was 79.39% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In addition, another study on the incidence of workplace violence among nurses in China's tertiary hospitals showed that 26.6% of nurses had experienced workplace violence in the past 12 months [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A meta-analysis on workplace violence among Chinese nurses showed that the incidence of workplace violence among Chinese nurses was 71% in the past 12 months [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In summary, workplace violence against nurses has become a common social problem in countries around the world.\u003c/p\u003e\u003cp\u003eWorkplace violence is one of the sources of stress for nurses and has a profound impact on their physical, mental, and professional development. A multicenter study has shown that strong resilience can significantly reduce mental health problems caused by workplace violence [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Studies have shown that since 1980, a series of measures such as laws, hospital working environments, and nursing capabilities have been taken both domestically and internationally to improve and reduce the incidence of workplace violence in hospitals [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, the incidence of workplace violence among nurses remains high, and countries around the world are still striving to improve this situation from various aspects. Domestic and foreign scholars are trying different methods to reduce the incidence of workplace violence among nurses. A review study shows that social support has a significant improvement effect on enhancing nurses' professional identity and promoting occupational health development [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A study by Xue et al. pointed out that creating a socially supportive work environment is one of the important guarantees for promoting high work enthusiasm among psychiatric nurses [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In addition, multiple studies have shown that improving nurses' self-efficacy can significantly reduce job stress and occupational burnout, as well as significantly enhance resilience [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, there is limited research on the relationship between self-efficacy, social support, and nurse resilience among clinical nurses exposed to workplace violence.\u003c/p\u003e\u003cp\u003eTherefore, this study aims to investigate the relationship between social support, self-efficacy, and resilience of nurses exposed to workplace violence, and analyze their influencing factors, in order to provide theoretical basis for improving the working environment of nurses and promoting their physical and mental health development.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design and settings\u003c/h2\u003e\u003cp\u003eThe STROBE checklist was used in this cross-sectional descriptive study. By using the convenience sampling method, nurses from hospitals (including primary, secondary, and tertiary hospitals) participated in the study in Kunming and Qujing, Yunnan, China. The hospital grades comply with China's current \u0026ldquo;Hospital Classification and Management Measures\u0026rdquo;, etc.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Participants and data collection\u003c/h2\u003e\u003cp\u003eThe participants to be included must meet the following conditions: Nurses with a qualification certificate and more than 1 year of work experience. Nurses who were exposed to WPV in the past 12 months. Voluntary completion. The exclusion criterion is having or having had depression, bipolar disorder, or other organic or mental illness. Online electronic questionnaires were administered, from April 2025 to June 2025. Prior to data collection, the researchers contacted the nursing departments of the participating hospitals to obtain consent. The researchers sent a link to the questionnaire to nurses. Before the questionnaire begins, the purpose of this study will be introduced and nurses will be asked to participate voluntarily or not. All questionnaire items were required to be completed before submission, and each IP address was limited to one submission. If the answers were incomplete or all options were the same, the questionnaire was considered invalid.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Instrument and Measurement\u003c/h2\u003e\u003cp\u003eGeneral information form\u003c/p\u003e\u003cp\u003eA demographic information form was constructed to collect general information, including gender, age, marital status, education level, professional title, working years, position, and department.\u003c/p\u003e\u003cp\u003eWorkplace Violence Scale\u003c/p\u003e\u003cp\u003eThe prevalence and frequency of WPV experienced in the past 12 months were measured using the Chinese version of the Modified Hospital Workplace Violence Questionnaire (Part 2), developed by the WHO, which has demonstrated good reliability and validity among Chinese healthcare workers[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The questionnaire consists of four items: verbal abuse, threats, physical assault, and sexual harassment. Each item can be responded to as zero times (scored 0), one time (scored 1), two or three times (scored 2), or more than three times (scored 3). A higher sum score indicated a more severe level of WPV.\u003c/p\u003e\u003cp\u003eResilience Scale\u003c/p\u003e\u003cp\u003eThis scale was used to measure the level of resilience of medical staff [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The scale contains four dimensions, including decision-making coping (six items), interpersonal connection (four items), rational thinking (four items), and flexible self-adaptation (four items). A 5-level Likert scale was used, with scores ranging from 1 to 5, representing 'completely inconsistent' to 'completely consistent,' with a total score ranging from 18 to 90. The higher the score, the better the individual's resilience.\u003c/p\u003e\u003cp\u003eGeneral self-efficacy scale\u003c/p\u003e\u003cp\u003eSelf-efficacy was measured by the Chinese version of the General Self-Efficacy Scale (GSES)[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The GSES was originally developed in German and has been translated into many languages. The scale is composed of 10 items. A 4-level Likert scale was used, scored from 1 point 'completely incorrect' to 4 points 'completely correct.' The total GSES score is the sum of all items, ranging from 10 to 40. A higher score indicated better self-efficacy.\u003c/p\u003e\u003cp\u003eSocial support rating scale\u003c/p\u003e\u003cp\u003eThe Social Support Rating Scale was used to measure social support for nurses [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The scale includes objective support (three items), subjective support (four items), and utilization of support (three items). A 4-level Likert scale was used. The higher the score of each dimension, the better the social support.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Ethical considerations\u003c/h2\u003e\u003cp\u003eThis study was approved by the Ethics Committee of the University (No. 2023-bkskt-02-321088200212157523). All methods were carried out in accordance with relevant guidelines and regulations. Participants were informed of the study's purpose, purpose, method, and significance before completing the questionnaire. Data collection in this study was anonymized, and all data were strictly confidential.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Statistical analysis\u003c/h2\u003e\u003cp\u003eThe SPSS 21.0 program was used to statistically analyze the data. Mean and standard deviation were used to describe quantitative variables, and the frequency distribution and percentage were used to describe qualitative variables. Independent sample T-test and one-way analysis of variance were used. Pearson\u0026rsquo;s correlation analysis was used to examine associations between variables. Mediation analysis or multiple regression was used to analyze the relationship among self-efficacy, social support, and resilience. The bootstrapping procedure (resamples\u0026thinsp;=\u0026thinsp;5000) was used to evaluate the significance of the mediating effects in the model. All statistical tests were two-tailed, and a p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Demographic characteristics\u003c/h2\u003e\u003cp\u003eA total of 651 nurses completed the questionnaire, excluding 13 responses with answers less than 180 seconds and 9 invalid questionnaires, ultimately retaining 629 valid responses. The questionnaire response efficiency was 96.6%. In the past 12 months, 314 questionnaires answered 'no' regarding exposure to workplace violence. Therefore, 315 questionnaires were included in the data analysis, and the incidence of workplace violence in the survey region was 50.1%. Specific general information and the results of the scales are shown in attachment (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2 The situation of nurses exposed to WPV\u003c/h2\u003e\u003cp\u003eThe incidence of WPV was 53.1% (315 / 651), with verbal violence being the most frequent form. In the past 12 months, the frequency of occurrence was 52.7%, and the frequency of occurrence 2\u0026ndash;3 times was 27.3%. The second is threats, the frequency of occurrence was 22.9%, and the frequency of occurrence 2\u0026ndash;3 times was 5.7%. Specific general information and the results of the scales are shown in attachment (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3 One-way analysis of variance of resilience, self-efficacy, social support, and demographic characteristics\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the average values of resilience, self-efficacy and social support for different demographic characteristics. According to t-test and one-way ANOVA, the resilience scores of nurses exposed to workplace violence showed significant differences in age, marital status, and hospital level (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In terms of social support, there are significant differences in age, marital status, years of work experience, position, and professional title (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, in terms of self-efficacy, there are only differences in region and hospital grade (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\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\u003eDifference analysis of resilience, self- efficacy, and social support of nursing staff with different demographic characteristics ( n\u0026thinsp;=\u0026thinsp;315 ) (\u003cdiv description=\"\" class=\"Drawing\" id=\"2000701846\" name=\"图片 2000701846\"\u003e\u003c/div\u003e\u0026plusmn;s)\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=\"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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStress resistance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSelf efficacy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSocial support\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72.5\u0026thinsp;\u0026plusmn;\u0026thinsp;20.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e34.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e40.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003et/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.329/ .744\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1.476/ .141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-2.915/ .004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e20ཞ30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e41.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e31ཞ40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e76.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.61\u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e44.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.76\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e41ཞ50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e44.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u0026gt;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e45.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eF/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.523/0.208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.751/0.522\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.835/0.038\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e70.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.06\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e42.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.41\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eDivorce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.1\u0026thinsp;\u0026plusmn;\u0026thinsp;13.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e38.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eF/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.577/0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.626/0.535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30.512/\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eEducation Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eLess than junior college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eJunior college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e43.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eUndergraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e242\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eF/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.034/0.967\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.269/0.765\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.360/0.698\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eWorking years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eLess than 5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e37.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e6ཞ10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e11ཞ20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e41.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.34\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eMore than 21 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e42.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.14\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eF/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.754/0.521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.840/0.473\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.134/0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePosition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e39.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eGroup leader\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e76.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.61 \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHead nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e76.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e38.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eF/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.006/0.367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.777/0.461\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.161/0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eProfessional title\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e38.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e39.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eAdvanced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.01\u003csup\u003eu\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e44.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.19\u003csup\u003egh\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eF/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.239/0.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.257/0.106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.994/0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCapital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73.0\u0026thinsp;\u0026plusmn;\u0026thinsp;14.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e39.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDistrict\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrefecture-level city\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e74.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e40.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eF/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.03/0.304\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-2.602/0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.203/0.840\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHospital grade\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGrade I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e74.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e41.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGrade II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71.8\u0026thinsp;\u0026plusmn;\u0026thinsp;15.03\u003csup\u003em\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.01\u003csup\u003en\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e39.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGrade III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e39.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eF/P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.946/0.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.386/0.252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.530/0.589\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: On resistance \u0026amp;: 20-30-year-old group and the 31-40-year-old group P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; b: Unmarried group and Married group P\u0026thinsp;=\u0026thinsp;0.003; m: Grade I group and Grade II group P\u0026thinsp;=\u0026thinsp;0.017. On Social support #: 20\u0026ndash;30-year-old group and the 31\u0026ndash;40-year-old group P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; a: Unmarried group and Married group P\u0026thinsp;=\u0026thinsp;0.003; c: Less than 5 years group and 11\u0026ndash;20 years group P\u0026thinsp;=\u0026thinsp;0.016; d: Less than 5 years group and More than 21 years group P\u0026thinsp;=\u0026thinsp;0.01; e: None group and group leader group P\u0026thinsp;=\u0026thinsp;0.004; g: Primary group and Advanced group P\u0026thinsp;=\u0026thinsp;0.005; h: Intermediate group and Advanced group P\u0026thinsp;=\u0026thinsp;0.014. On Self efficacy n: Grade I group and Grade II group P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; u: Primary group and Advanced group P\u0026thinsp;=\u0026thinsp;0.036.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Correlation analysis\u003c/h2\u003e\u003cp\u003eThe correlation analysis of demographic characteristics, self-efficacy, social support, and resilience reveals a significant correlation between age, marital status, position, professional title, and social support. There is a significant correlation between marital status and resilience, There is a significant correlation between region and resilience, and also has a significant correlation with self-efficacy. However, the hospital grade is negatively correlated with age, working years, and professional title of nurses exposed to WPV attachment (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Regression analyses\u003c/h2\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, multiple linear regression analyses were conducted with resilience as the dependent variable, and professional title, hospital grade, age, education level as predictor variables, along with social support and self-efficacy as predictors, of which, dummy variable settings were made for unordered variables. The results indicated a significant correlation between demographic variables and resilience, revealing that being married had a positive impact on the resilience of nurses exposed to WPV (β\u0026thinsp;=\u0026thinsp;0.174, p\u0026thinsp;=\u0026thinsp;0.003). The professional title had a significant negative impact on the perception of resilience (β = -0.126, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Self-efficacy and social support explained 29.9% of the variation in resilience, and the difference was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\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\u003eMultiple linear regression analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNon-standardized coefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandard coefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eColinearity statistics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eallowance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eVIF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.512\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.957\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.567\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e0.547\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e0.299\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e16.319\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge-group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.986\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.281\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital grade\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.601\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.539\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.923\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.084\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePosition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.719\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.650\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.516\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.897\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.115\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional title\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-3.320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.643\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.044\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.588\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.700\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.891\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.642\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.040\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.890\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.664\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.929\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.348\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.431\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.782\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.278\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72.219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.405\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49.988\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.697\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.935\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e4.577\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003edivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.881\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.573\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.935\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003eβ: Regression Coefficient, SE: Standard Error, *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e3.6 The impact of social support and self efficacy in nurses exposed to WPV: a mediation analysis of self-efficacy\u003c/p\u003e\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the study findings indicate that social support has a significant positive direct effect on self-efficacy (β\u0026thinsp;=\u0026thinsp;0.132, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and resilience (β\u0026thinsp;=\u0026thinsp;0.526, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Self-efficacy positively affects resilience (β\u0026thinsp;=\u0026thinsp;0.870, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and mediates the relationship between social support and resilience (β\u0026thinsp;=\u0026thinsp;0.114, Bootstrap 95% CI: 0.055\u0026ndash;0.184). Self-efficacy partially mediates the relationship between social support and resilience, accounting for approximately 17.86% of the total effect (Table\u0026nbsp;6).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMediating effect analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eeffect size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLLCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eULCI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial Support \u0026rarr; Self-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.196\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial Support \u0026rarr; Resilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.699\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.372\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.680\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-efficacy \u0026rarr; Resilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.869\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.609\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.131\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.640\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.854\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.480\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.801\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship\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\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEffect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBootSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBootLLCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBootULCI\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial Support \u0026rarr; Self-efficacy \u0026rarr; Resilience\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\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: SE: Standard error\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussions","content":"\u003cp\u003eThis study aims to assess the relationship between the resilience of clinical nurses exposed to workplace violence and their social support, self-efficacy, as well as general demographic characteristics in hospitals of varying grades within economically underdeveloped regions, and to thoroughly investigate the influencing factors. The study findings indicate that hospital grade and marital status have a significant effect on resilience. Self-efficacy serves as a mediating factor in the relationship between resilience and social support among nurses exposed to WPV.\u003c/p\u003e\u003cp\u003eThe WPV rate among nurses in this study was 50.1%, which is lower than the rates reported by Liu et al. in a meta-analysis about Chinese nurses [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, it is significantly higher than the rate reported by Yuan et al. in mainland China (26.6%) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This study showed that verbal aggression had the highest incidence (96.8%), followed by threats and third was physical assault. In addition, the incidence of sexual harassment was 8.3%. Verbal violence is the most prevalent form. Its high incidence may be linked to poor doctor-patient communication, emotional outbursts from patients, or resource shortages. In these findings, the lower rate of physical assault and sexual harassment, may be attributed to a minority of patients having low legal awareness and moral standards. \u0026zwnj;On the other hand, the government and hospitals should formulate corresponding laws and measures to actively protect the legitimate rights and interests of clinical nurses.\u003c/p\u003e\u003cp\u003eThis study indicates that factors such as gender, education level, professional title, position, working years, and region do not significantly affect the resilience of nurses exposed to WPV. This contrasts with the results of a study by Kim, which focused on workplace violence and resilience among Korean emergency nurses and revealed that education level, professional title, and working years significantly impact resilience [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Another study also demonstrated notable differences in resilience among nurses with education level and professional titles [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, our study found significant differences in resilience concerning marital status, and Kim's study also supported this finding. Furthermore, there were significant differences in nurses' resilience in terms of age and hospital grade. This may be related to the research subjects of this study, which primarily targeted frontline clinical nurses, with the majority of the final sample for data analysis being young nurses with relatively low positions and professional titles. Additionally, there are differences in hospital grade, along with a trend of inter-group differences, which may be linked to the resource allocation of hospital grades in China and impacts various aspects of healthcare personnel [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRegarding self-efficacy, the study's findings indicate that there were differences between groups only in regions, and the self-efficacy of nurses exposed to WPV in prefecture-level cities was higher. This could be attributed to the high-intensity work environment of Chinese nurses, and research has demonstrated that self-efficacy and marital status significantly influence nurses' empathy fatigue. Regional disparities are associated with China's three-tier medical system and the level of regional economic development [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Moreover, social support is affected by many aspects. This study reveals significant inter-group differences in social support based on gender, age, marital status, working years, job position, and professional title (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Dziedzic found the same result in his research. The study indicated that nurses' work environment and family significantly impact their social support, subsequently affecting their mental health [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This study conducted a correlational analysis of the basic characteristic factors influencing resilience, social support, and self-efficacy among nurses exposed to WPV, along with a multiple linear regression analysis. The results demonstrate that self-efficacy and social support exert a significant positive influence on nurses' resilience, while marital and professional title emerge as other crucial factors.\u003c/p\u003e\u003cp\u003eThe mediating effect found in this study highlights the role of social support as a \u0026ldquo;bridge\u0026rdquo; between self-efficacy and resilience. Social support partially mediated the impact of self-efficacy on resilience (indirect path: 17.86%). Self-efficacy not only directly enhances resilience, but also indirectly enhances it by enhancing social support. In addition, there exists a certain synergistic relationship between self-efficacy and social support. After encountering adversities, nurses eventually acquired the ability to manage violent incidents through corresponding adjustments, both internal and external [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Finally, this study indicates that social support plays a moderating role in nurses' resilience and self-efficacy, as well as in how factors such as marriage, professional title, and hospital resources affect the resilience and social support of nurses exposed to WPV.\u003c/p\u003e\u003cp\u003eLimitations This study has a few limitations. First, due to research conditions, convenience sampling was used to recruit participants, which limited to some extent the ability to explain causal relationships between variables. Second, data collection employed a retrospective approach, where participants recalled events from the past 12 months, which to some extent increased the risk of bias in the results.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eWorkplace violence against clinical nurses remains prevalent. Although this study shows that the resilience of nurses exposed to WPV is at an upper-middle level, it still requires further improvement. The research reveals that social support mediates the relationship between workplace violence exposure and nurses' resilience and self-efficacy. Moreover, social support and self-efficacy significantly and positively influence the resilience of nurses exposed to WPV. Additionally, factors such as region, professional title, and marital status exert a certain impact on social support, self-efficacy, and resilience, with marital status being particularly influential. Therefore, while continuously improving nurses' remuneration, the government and hospitals should also focus on nurses' family harmony. Especially in China, where the workload is relatively heavy, it is crucial to guarantee adequate rest for nurses to foster the sound development of the nursing profession.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThanks to all the nurses and hospital staff who participated in this survey on exposure to workplace violence.\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eTengfei ZHANG: Conceptualization, Methodology, Data curation, \u0026nbsp;Writing original draft, Writing\u0026mdash;review \u0026amp; editing. Zhengyi HU: Data curation. Renping GU: Methodology, Data curation. Dongmei ZHANG: Data curation. Chengxiu CAO: Data curation. Jie XIA: Conceptualization, Methodology, Funding acquisition, Supervision, Project administration, Writing\u0026mdash;review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eConflicts of Interest\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChen M, Xie H, Liao X, Ni J: \u003cstrong\u003eWorkplace violence and turnover intention among Chinese nurses: the mediating role of compassion fatigue and the moderating role of psychological resilience\u003c/strong\u003e. \u003cem\u003eBMC public health \u003c/em\u003e2024, \u003cstrong\u003e24\u003c/strong\u003e(1):2437.\u003c/li\u003e\n\u003cli\u003ePotera C: \u003cstrong\u003eViolence Against Nurses in the Workplace\u003c/strong\u003e. \u003cem\u003eThe American journal of nursing \u003c/em\u003e2016, \u003cstrong\u003e116\u003c/strong\u003e(6):20-21.\u003c/li\u003e\n\u003cli\u003ePich J, Roche M: \u003cstrong\u003eViolence on the Job: The Experiences of Nurses and Midwives with Violence from Patients and Their Friends and Relatives\u003c/strong\u003e. \u003cem\u003eHealthcare (Basel, Switzerland) \u003c/em\u003e2020, \u003cstrong\u003e8\u003c/strong\u003e(4).\u003c/li\u003e\n\u003cli\u003eBabiarczyk B, Turbiarz A, Tomagov\u0026aacute; 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Descriptive statistics, t-tests, analysis of variance, Pearson's correlation analysis, multiple regression analysis, and mediating effect analysis were used to analyze the data.\u003c/p\u003e\u003cp\u003eResults: The research data showed that the incidence of WPV was 50.1% in two regions of Yunnan Province. There are multiple personal basic characteristic factors that affect the social support of nurses exposed to WPV. However, self-efficacy, marital status, and social support were the main influencing factors on resilience among nurses exposed to workplace violence. Social support partially mediated the impact of self-efficacy on resilience (indirect path: 17.86%).\u003c/p\u003e\u003cp\u003eConclusions: Social support and self-efficacy can significantly positively affect the resilience of nurses exposed to workplace violence, and social support plays a certain mediating role. In addition, marital status is one of the important factors affecting the resilience of nurses exposed to workplace violence, and attention should be paid to giving nurses more family time.\u003c/p\u003e","manuscriptTitle":"The impact of social support and self- efficacy on resilience in nurses exposed to workplace violence: a cross-sectional study in Southwest China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-24 05:44:04","doi":"10.21203/rs.3.rs-7879963/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4742a10c-2321-4faf-afc8-9473583025df","owner":[],"postedDate":"November 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58466430,"name":"Health sciences/Health care"},{"id":58466431,"name":"Health sciences/Health occupations"},{"id":58466432,"name":"Biological sciences/Psychology"},{"id":58466433,"name":"Social science/Psychology"},{"id":58466434,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-12-22T17:08:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-24 05:44:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7879963","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7879963","identity":"rs-7879963","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}