Influencing factors of moral resilience among psychiatric nurses: a cross-sectional survey

Influencing factors of moral resilience among psychiatric nurses: a cross-sectional survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Influencing factors of moral resilience among psychiatric nurses: a cross-sectional survey Li Tao, Jie Liu, Qiao Lin, Jing Gu, Huanhuan Deng, Mei Tang, Jinlan Dai, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7137545/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective This study investigates the level of moral resilience among psychiatric nurses and the factors influencing it. The aim is to provide foundational insights for developing targeted interventions to enhance moral resilience within this nursing specialty. Background Psychiatric nurses face unique ethical challenges due to their exposure to complex moral dilemmas, workplace violence, and coercive practices in mental health settings. These challenges can lead to moral distress, impacting both their well-being and the quality of patient care. Understanding the factors influencing moral resilience—such as psychological traits, organizational support, and coping strategies is crucial for developing targeted interventions to enhance their ethical decision-making and professional sustainability. Design A cross-sectional survey. Methods Five hundred and ninety-two psychiatric nurses from the psychiatric departments of five tertiary-level general hospitals, one tertiary-level psychiatric hospital, and three municipal psychiatric hospitals in Sichuan Province from June to September 2024, and they were assessed using a general information questionnaire, the Rushton moral resilience scale, and the hospital ethical climate survey. Results The total moral resilience score of psychiatric nurses was (41.84 ± 6.22) and the hospital ethical climate score was (105.42 ± 13.04). The results of univariate analysis showed that the effects of education, position, years of experience in psychiatry, whether or not a national counselor, whether or not a psychiatric nurse, and whether or not a psychiatric nurse had received medical ethics education and training on the moral resilience score of psychiatric nurses were statistically significant (all P < 0.05); Pearson correlation analysis showed that the correlation coefficient of the moral resilience score of psychiatric nurses with the score of the ethical climate of hospitals was 0.55 ( P < 0.05); multiple regression analysis showed that education, years of experience in psychiatry, qualification of psychiatric nurses, receiving medical ethics education and hospital ethical climate score were the main influences on psychiatric nurses’ moral resilience, explaining 34.9% of the total variance. Conclusion The level of moral resilience of psychiatric nurses is in urgent need of improvement, and it is significantly influenced by professional qualification, training experience and organizational ethical environment. It is recommended to improve the moral resilience of nurses by constructing an ethical support system, improving the function of ethics committees, incorporating medical ethics into the mandatory curriculum of continuing education, implementing a tiered training program for psychiatric nurses, and at the same time establishing an ethical decision-making case base and a multidisciplinary collaboration platform. Impact This study proposes that educators and administrators provide psychiatric nurses with targeted interventions to enhance moral resilience, thereby improving clinical practice and long-term career sustainability. Clinical trial number Not applicable. Psychiatric nurse Moral resilience Hospital ethical climate Introduction Moral resilience refers to the ability of an individual to maintain, restore, or enhance their physical and mental health when facing moral or ethical dilemmas. This ability can transform moral or ethical dilemmas from negative experiences into hope and positive motivation [ 1 ]. As a protective factor in the event of ethical harm, moral resilience helps to reduce the negative impact on individuals [ 2 ]. Research shows that nurses with low moral resilience are more likely to have an intention to leave their jobs and experience job burnout [ 3 ], and it is closely related to higher levels of stress, anxiety, and depression [ 4 ]. Psychiatric nurses mainly take care of patients with mental illnesses at different disease stages, especially those in the acute phase of mental disorders. These patients have limited self-awareness and cognitive abilities, and issues such as involuntary hospitalization and restraint are sometimes involved. In addition, the families of these patients are more sensitive than those of patients with other diseases [ 5 ]. Therefore, psychiatric nurses often face more and more complex moral and ethical dilemmas compared to nurses in other departments [ 6 ]. Currently, research in China mainly focuses on the ethical decision-making ability [ 5 ] and humanistic care ability [ 7 ] of psychiatric nurses, while research on their moral resilience is relatively scarce. Thus, this study investigated the current status of the moral resilience of psychiatric nurses and explored its influencing factors, aiming to provide a basis for nursing managers to implement intervention measures and further improve the moral resilience and psychological state of psychiatric nurses. Methods Research design This cross-sectional study investigated moral resilience levels and key determinants among practicing psychiatric nurses in mental health settings between June to September 2024. Participants The study was conducted at the psychiatric departments of 5 tertiary-level general hospitals, 1 tertiary-level psychiatric hospital, and 3 municipal psychiatric hospitals (all of which are secondary-level hospitals) in Sichuan Province as the research subjects. The inclusion criteria were as follows: (1) Actively practicing registered nurses working in the psychiatric department; (2) Having worked in the psychiatric department for ≥ 1 year; (3) Providing informed consent and volunteering to participate in the study. The exclusion criteria were: (1) Non-hospital-based nurses such as visiting nurses; (2) Nurses on further study or leave during the survey period. According to the sample size calculation formula, the sample size should be 20 times the number of independent variables. A total of 24 variables were involved in this study (including 16 items of general information, 3 dimensions of the Nurse Moral Resilience Scale, and 5 dimensions of the Hospital Ethical Climate Scale). The calculated sample size was 480. Considering a 20% invalid sample, the final sample size was determined to be 576. In this study, 600 nurses were actually surveyed, and finally 592 valid data were obtained. Instruments The General Information Questionnaire was designed by the research team based on literature review and discussion. It includes 16 items such as gender, age, ethnicity, educational background, professional title, position, marital status, monthly personal income, hospital type, employment form, whether being a psychiatric-psychological specialist nurse, and whether having received medical ethics education and training. The study assessed the moral resilience of psychiatric nurses using the Nurse Moral Resilience Scale (RMRS). The RMRS was developed by Rushton et al.[ 8 ] in 2021 and translated into Chinese by Chen Xuelei et al. in 2024. The scale contains 3 dimensions: personal integrity (2 items), ethical dilemma coping and relationship integrity (10 items), and ethical efficacy (5 items), with a total of 17 items. A Likert 4-point scoring method (1–4 points) is used, and 11 items are reverse-scored. The total score ranges from 17 to 68 points, and the higher the score, the better the moral resilience. The Cronbach’s α coefficient of the Chinese version of RMRS among Chinese clinical nurses is 0.829 [ 9 ], and it is 0.860 in this study. The psychiatric nurses’ perceptions of the ethical climate in hospitals was assessed using the Hospital Ethical Climate Scale (HECS). The HECS was developed by Olson et al.[ 10 ] in 1998 and translated into Chinese by Wang Lu et al. in 2018. The scale includes 5 dimensions: relationships with the hospital (6 items), nurses (4 items), patients (4 items), doctors (5 items), and managers (6 items), with a total of 25 items. A Likert 5-point scoring method (1–5 points) is used. The Cronbach’s α coefficient of the Chinese version of HECS among Chinese clinical nurses is 0.915 [ 11 ], and it is 0.968 in this study. Data collection and ethical consideration This study conducted a questionnaire survey through the “Wenjuanxing” platform. The research document covered the research background, purpose, content, significance, and filling instructions. After obtaining the consent of the directors of the nursing departments of the selected hospitals, they were invited to forward the “Wenjuanxing” link to the hospital head nurses’ group, and then the head nurses forwarded it to the department nurses’ group to ensure that eligible subjects participated in the questionnaire filling under the premise of informed consent. The research protocol has been reviewed and approved by the Medical Ethics Committee of Deyang People’s Hospital, and all survey subjects provided informed consent. Data analysis The data were entered through Epidata 3.0 and analyzed using SPSS 25.0. Measurement data were expressed as mean ± standard deviation, and count data were described by frequency and composition ratio. The t-test or analysis of variance was used for mean comparison, the Pearson correlation analysis was used for correlation analysis, and the multiple linear regression analysis was used for influencing factor analysis. P < 0.05 was considered statistically significant. Results Demographic information of the participants A total of 592 psychiatric nurses participated in this study (Table 1 ). 90.4% (535) were of Han ethnicity, 82.9% (491) had a bachelor’s degree or above, 63.3% (373) worked in closed-ward areas, 15.0% (89) held the national psychological counselor qualification, 26.0% (154) were psychiatric-psychological specialist nurses, and 49.3% (292) had received medical ethics education and training. Psychiatric nurses with higher educational level had higher moral resilience ( F = 8.639, P < 0.001). Head nurses had higher moral resilience scores than general nurses ( t = 3.215, P = 0.001). Psychiatric nurses with longer service periods demonstrated higher moral resilience scores ( F = 3.012, P = 0.030). Nurses who hold a national psychological counseling certificate had higher moral resilience scores than other nurses( t = 3.085, P = 0.002). Psychiatric specialist nurse had higher moral resilience scores than general nurses ( t = 2.737, P = 0.002). Nurses who have received medical ethics training had higher moral resilience scores than nurses who have not received such training ( t = 3.804, P < 0.001). Table 1 General information and univariate analysis of participants (n = 592) Characteristics N(%) RMRS’s Score (Mean ± SD) t/F P Gender 0.287 0.775 Male 50(8.4%) 41.60 ± 7.64 Female 542(91.6%) 41.86 ± 6.07 Age (years old) 0.045 0.956 20–30 259(43.8%) 41.90 ± 6.26 31–40 300 (50.7%) 41.82 ± 6.35 > 40 33(5.5%) 41.58 ± 4.49 Ethnicity 1.319 0.188 Han 535(90.4%) 41.72 ± 6.01 Others 57(9.6%) 42.77 ± 7.56 Educational Background 8.639 < 0.001 Junior College 273(46.1%) 40.77 ± 5.97 Undergraduate 242(40.9%) 42.51 ± 6.17 Master’s Degree and Above 77(13.0%) 43.56 ± 6.58 Professional Title 0.341 0.795 Nurse 255(43.1%) 41.63 ± 6.13 Senior Nurse 175(29.5%) 42.23 ± 6.78 Head Nurse 97(16.4%) 41.69 ± 5.64 Deputy Chief Nurse and Above 65(11.0%) 41.85 ± 5.84 Position 3.215 0.001 None 524(88.5%) 41.55 ± 6.28 Head Nurse 68(11.5%) 44.10 ± 5.19 Monthly Personal Income (yuan/month) 2.159 0.116 8000 198(33.4%) 41.52 ± 6.58 Marital Status 0.637 0.529 Unmarried 123(20.8%) 41.32 ± 5.47 Married 426(71.9%) 42.02 ± 6.52 Divorced or Widowed 43(7.3%) 41.60 ± 4.99 Hospital Type 0.837 0.403 General Hospital 156(26.4%) 42.20 ± 5.81 Specialized Hospital 436(73.6%) 41.71 ± 6.35 Ward Area 0.476 0.634 Open-ward 219(37.0%) 42.00 ± 6.13 Closed-ward 373(63.0%) 41.75 ± 6.27 Years of Experience in Psychiatry 3.012 0.030 20 59(10.0%) 41.22 ± 6.22 Employment Form 0.574 0.563 Institution-based Staff 175(29.6%) 41.55 ± 6.70 Contract-based Staff 348(58.8%) 42.07 ± 6.26 Temporary Employment 69(11.6%) 41.43 ± 4.48 Religious Belief 0.005 0.996 Yes 21(3.5%) 41.85 ± 6.37 No 571(96.5%) 41.84 ± 6.21 Whether a National Psychological Counselor 3.085 0.002 Yes 154(26.0%) 43.01 ± 5.06 No 438(74.0%) 41.43 ± 6.53 Whether a Psychiatric-Psychological Specialist Nurse 2.737 0.002 Yes 89(15%) 41.55 ± 6.24 No 503(85%) 43.49 ± 5.82 Whether Received Medical Ethics Education and Training 3.804 < 0.001 Yes 292(49.3%) 42.82 ± 7.44 No 300(50.7%) 40.89 ± 4.55 Moral resilience and hospital ethical climate Descriptive statistics are presented in Table 2 . The total score of moral resilience of 592 psychiatric nurses was (41.84 ± 6.22) points, and the total score of the hospital ethical climate was (105.42 ± 13.04) points. The scores for each dimension are detailed in Table 1 . Table 2 The score of moral resilience and hospital ethical climate (n = 592) Variables Item Score (Mean ± SD) Items mean score Moral Resilience 17 41.84 ± 6.22 2.46 ± 0.37 Coping with Nursing Ethical Dilemmas and Relationship Integrity 10 22.19 ± 4.82 2.22 ± 0.48 Personal Integrity 2 5.55 ± 1.40 2.78 ± 0.70 Nursing Ethical Efficacy 5 14.10 ± 2.37 2.82 ± 0.47 Hospital Ethical Climate 25 105.42 ± 13.04 4.22 ± 0.52 Relationship with the Hospital 6 25.27 ± 3.45 4.21 ± 0.57 Relationship with Nurses 4 16.97 ± 2.13 4.24 ± 0.53 Relationship with Patients 4 12.71 ± 1.66 3.18 ± 0.41 Relationship with Doctors 5 20.51 ± 3.02 4.10 ± 0.60 Relationship with Managers 6 25.84 ± 3.54 4.31 ± 0.59 The relationship between moral resilience and hospital ethical climate The correlation coefficient between the scores of psychiatric nurses’ moral resilience and the hospital ethical climate was 0.551, with P < 0.01. Multiple linear regression analysis of moral resilience Taking the scores of nurses’ moral resilience as the dependent variable, and the variables with statistical significance in the univariate analysis (educational background, position, years of experience in psychiatry, whether being a national psychological counselor, whether being a psychiatric specialist nurse, whether having received medical ethics education, and the scores of the hospital ethical climate) as the independent variables, a multiple linear regression analysis was carried out. The results showed that educational background, years of experience in psychiatry, whether being a psychiatric specialist nurse, whether having received medical ethics education, and the scores of the hospital ethical climate were the influencing factors of psychiatric nurses’ moral resilience, explaining 34.9% of the total variance, as shown in Table 3 . Table 3 Multiple linear regression analysis of moral resilience (n = 592) Variables B SE β t P Educational Background 1.297 0.384 0.145 3.377 < 0.001 Years of Experience in Psychiatry -0.756 0.279 -0.111 -2.711 0.007 Whether a Psychiatric Specialist Nurse 1.444 0.707 0.074 2.041 0.042 Whether Received Medical Ethics Education -1.753 0.416 -0.141 -4.218 < 0.001 Score of Hospital Ethical Climate 0.254 0.016 0.532 15.933 < 0.001 Constant 14.563 1.983 - 7.345 < 0.001 Note: R 2 = 0.357, Adjusted R 2 = 0.349, F = 46.222, P < 0.001 Discussion In the field of mental health nursing, conducting a systematic study on the current state of nurses’ moral resilience and its influencing factors holds significant practical urgency. Psychiatric nursing practice faces unique ethical challenges, including dilemmas surrounding informed consent due to patients’ limited autonomy, conflicts between compulsory treatment measures and humanistic care, and contradictions between confidentiality obligations and risk management [ 12 , 13 ]. These complex situations place higher demands on nurses’ moral judgment and professional competence. In this context, moral resilience-the core competency enabling nurses to uphold professional standards, effectively resolve ethical conflicts, and achieve professional growth in moral dilemmas-directly impacts the scientific rigor of ethical decision-making, the extent of patient rights protection, and the safety and quality of nursing services. The level of moral resilience of psychiatric nurses is relatively low In this study, the total score of moral resilience was (41.84 ± 6.22) points, which was at a medium level. Since the nursing objects are mostly patients with mental symptoms or combined physical diseases, these patients often exhibit behaviors such as suicide, impulsivity, running away, and severe drug reactions under the influence of mental symptoms, and unexpected events may occur at any time. Psychiatric nurses need to respond promptly to various emergencies and try their best to meet the patients’ needs. Such a working environment makes it easy for nurses to fall into ethical dilemmas, leading to an increase in job burnout and thus a higher turnover rate [ 14 , 15 ]. As a protective factor in ethical dilemmas [ 16 ], this study will further explore its influencing factors to provide a reference for managers to optimize human resource management. Hospital Ethical Climate were positively correlated with moral resilience There is a significant positive correlation between the hospital ethical climate and the moral resilience of psychiatric nurses. This finding is of central importance for understanding and improving the ethical quality of nursing practice. A positive hospital ethical atmosphere, characterized by senior management’s high priority on ethical issues, open channels for ethical discussion, mutual respect and support among colleagues, clear ethical decision making processes, and institutional support for nurses’ moral courage, provides crucial environmental safeguards for nurses to address the inevitable ethical dilemmas they encounter in their work [ 17 ]. This supportive environment reinforces nurses’ moral flexibility through multiple mechanisms: it reduces nurses’ feelings of isolation and helplessness when facing ethical conflicts, encouraging them to actively seek guidance and collaboration when confused; it enhances nurses’ confidence and ability to identify ethical issues, engage in ethical reasoning, and uphold moral principles by providing clear ethical frameworks and exemplary role models; it acknowledges and supports the challenges nurses may face when advocating for patient rights, reducing moral silence caused by fear of retaliation or misunderstanding [ 18 ]. When nurses perceive the organization as a strong backing for upholding ethical principles, they are better able to effectively regulate their emotions, engage in reflective learning, and restore moral agency after experiencing moral distress, rather than falling into moral numbness, burnout, or resignation tendencies [ 19 ]. Therefore, fostering a positive, open, and supportive hospital ethical atmosphere is a key organizational intervention strategy to enhance nurses’ moral resilience, alleviate their moral distress, reduce the risk of occupational burnout, promote their adherence to ethical standards to provide high quality humane care, and ultimately ensure patient safety and well-being. Researching and optimizing the ethical atmosphere is a core component of building a more ethically resilient healthcare system. Several factors influence the moral resilience of psychiatric nurses Psychiatric nurses with higher educational level have higher moral resilience This study showed that the moral resilience of psychiatric nurses with a bachelor’s degree or above was significantly higher than that of junior college nurses ( P < 0.05), indicating that the educational level is a protective factor for moral resilience. This may be because nurses with a high educational level have systematically studied courses such as nursing psychology and nursing ethics in higher medical colleges, and can better apply theoretical knowledge and skills to meet professional requirements, thus showing a higher level of moral resilience. This result is consistent with previous studies [ 20 ], that is, nurses who have received higher education have stronger coping abilities and can better handle problems in clinical practice. For the group of junior college nurses, nursing managers should innovate diversified education and training mechanisms to provide them with opportunities for further education and in-depth learning, so as to improve their educational level and moral resilience. Psychiatric nurses with longer service periods demonstrated higher moral resilience scores This study found that there was a positive correlation between the years of experience of psychiatric nurses and their moral resilience level. This may be because with the accumulation of clinical work experience, nurses’ knowledge reserves and coping abilities gradually increase, enabling them to better handle emergencies, keenly identify clinical problems and the ethical dilemmas behind them, and make decisions that are beneficial to patients’ treatment [ 21 ]. This result suggests that hospital management should strengthen the theoretical training of junior-level nurses and implement hierarchical training according to different work stages of nurses, so as to comprehensively improve their clinical thinking ability and professional ethical knowledge level. In addition, a learning platform can be built to provide personalized training programs to achieve individualized education and further optimize the career development path of nurses. Nurses who hold a national psychological counseling certificate had higher moral resilience scores than other nurses This study showed that psychiatric nurses who have obtained the national psychological counselor certificate had a significantly higher level of moral resilience. This may be related to their systematic study of ethics-related courses during the training process and long-term supervision and guidance by superior psychological counselors. Although the national psychological counselor professional qualification examination has been cancelled, managers can encourage psychiatric nurses to participate in the psychological therapist professional qualification examination organized by the National Health Commission to further improve their moral resilience level. This helps nurses to make better ethical decisions when facing sudden ethical problems in psychiatry and avoid falling into ethical dilemmas. Psychiatric specialist nurse had higher moral resilience scores than general nurses This study found that the moral resilience level of psychiatric specialist nurses was significantly higher than that of non-psychiatric specialist nurses. This may be due to the fact that psychiatric specialist nurses have more solid specialized theoretical knowledge, longer working years, and higher professional abilities, enabling them to skillfully deal with clinical ethical problems. For the group of non-psychiatric specialist nurses, nursing managers should strengthen specialized theoretical and practical training, improve their comprehensive abilities, and encourage them to become psychiatric specialist nurses through certification. Nurses who have received medical ethics training had higher moral resilience scores than nurses who have not received such training This study showed that psychiatric nurses who had received medical ethics education and training had a significantly higher level of moral resilience, indicating that medical ethics education and training play an important role in improving moral resilience [ 22 ]. However, currently, the ethics education in medical colleges in China is relatively weak. Relevant courses are mostly elective courses, with limited class hours and a lack of close integration with clinical practice, making it difficult to meet actual needs. In addition, the clinical ethics training mechanism is imperfect, lacking systematicness and continuity. Therefore, nursing educators and managers should pay attention to this issue: at the college level, strengthen the construction of medical ethics education courses and increase educational investment; at the clinical level, establish and improve the training mechanism and standardize the in-service ethics training of psychiatric nurses, so as to comprehensively improve the moral resilience level of nursing staff. Conclusion This study found that the moral resilience of psychiatric nurses is at a medium level, and educational background, years of experience, whether being a national psychological counselor, whether being a psychiatric specialist nurse, whether having received medical ethics education and training, and the hospital ethical climate score are important influencing factors of psychiatric nurses’ moral resilience. Nursing managers can improve the moral resilience level of psychiatric nurses by strengthening relevant training for junior-level nurses. However, this study only focused on 5 tertiary-level general hospitals and selected samples by convenience sampling, so the representativeness of the samples was limited. Follow-up studies can conduct multi-center and large-sample research to improve the generalizability of the research results. This study found that the moral resilience of psychiatric nurses is at a medium level, and its influencing factors include educational background, years of experience, whether holding the national psychological counselor qualification, whether being a psychiatric specialist nurse, whether having received medical ethics education and training, and the hospital ethical climate score. Nursing managers can enhance the moral resilience level of psychiatric nurses by strengthening relevant training for junior-level nurses. However, this study only sampled in some hospitals in Sichuan Province, and the sample representativeness is limited. Future studies can carry out multi-center and large-sample research to enhance the universality and promotion value of the research results. Declarations Acknowledgements Thanks to all the psychiatric nurses who participated in this study. Author contributions Li Tao: Conceptualization, Methodology, Software, Investigation, Formal Analysis, Writing-Original Draft; Jie Liu: Conceptualization, Methodology, Software, Investigation, Formal Analysis, Resources, Supervision, Writing-Reveiw & Editing; Qiao Lin: Visualization, Conceptualization; Jing Gu: Resources, Supervision; Huanhuan Deng: Software, Validation; Mei Tang: Investigation, Supervision; Jinlan Dai: Supervision, Validation; Mengting Zhu: Writing-Reveiw & Editing. Funding This study was funded by Sichuan Provincial Mental Health Education Research Center, China (XLJKJY2357C) Data availability Data generated and/or analysed in this study are not publicly available butcan be obtained from the corresponding author upon reasonable request Ethics approval and consent to participate The study was approved by the Medical Ethics Committee of Deyang People’s Hospital. All methods were performed in accordance with relevant guidelines and regulations (Declaration of Helsinki) and informed consent was obtained from all participants. Patient or public contribution None. Competing interests The authors declare no competing interests. Author details 1 Department of Psychosomatic Medicine, Deyang People’s Hospital, Deyang, China 2 School of Basic Medical Sciences & School of Nursing, Chengdu University, Chengdu, China References Young PD, Rushton CH. A concept analysis of moral resilience[J]. 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CHINESE NURSING RESEARCH (China); 2018. pp. 2194–7. 1410.12102/j.issn.1009-6493.2018.14.012. Antonsdottir I, Rushton CH, Nelson KE, et al. Burnout and moral resilience in interdisciplinary healthcare professionals[J]. J Clin Nurs. 2022;31(1–2):196–208. 10. 1111/jocn.15896. Clark P, Crawford TN, Hulse B et al. Resilience, Moral Distress, and Workplace Engagement in Emergency Department Nurses[J]. Western Journal of Nursing Research, 2021, 43(5): 442–451. DOI: 10. 1177/0193945920956970. Wald HS, Monteverde S. COVID-19 era healthcare ethics education: Cultivating educational and moral resilience[J]. Nursing Ethics, 2021, 28(1): 58–65. DOI: 10. 1177/0969733020976188. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 02 Sep, 2025 Reviewers agreed at journal 14 Aug, 2025 Reviewers invited by journal 10 Aug, 2025 Editor invited by journal 17 Jul, 2025 Editor assigned by journal 16 Jul, 2025 Submission checks completed at journal 16 Jul, 2025 First submitted to journal 16 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7137545","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500597678,"identity":"ee53296e-5549-441e-96d7-ee20029ee5ef","order_by":0,"name":"Li Tao","email":"","orcid":"","institution":"Deyang People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Tao","suffix":""},{"id":500597681,"identity":"72e6d229-a3e6-4a1f-a564-4d99d81924ee","order_by":1,"name":"Jie Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIie3QMUvEMBTA8QeRdHl32aRHpd9AeLVQnK5fJeXAW24ouHToUBBuOnAVFL+DCJ1TAp3uAwg6VATnjg4iNgo3CI2OwuU/hZAfLwmAy/UPmzIAksARGGu6vlBfu6qzEL4jHl9EV1sFaIi0kd1KYBJM1t8ErMRDyrtieiQYJv7k9ilMD/XzMGUeHldjF0MiueU4u+Dnp7P6NcbgjAayiBNlIdmaI2l29xDVOtsE0hCV1VbywTHVQH52Y8iy/wOphins4MRvKkNWv03hOcmWo6+HT65aHePjKleSxt8ihK6jt7JNxaVuXt5LHXrXy/u+L+bhGDGDCKD9uUmjx02sAyitJ1wul2vP+wSHxViqTz0C0AAAAABJRU5ErkJggg==","orcid":"","institution":"Deyang People’s Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jie","middleName":"","lastName":"Liu","suffix":""},{"id":500597685,"identity":"1632f220-4723-4640-ad2f-b4c899fca66b","order_by":2,"name":"Qiao Lin","email":"","orcid":"","institution":"Deyang People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qiao","middleName":"","lastName":"Lin","suffix":""},{"id":500597686,"identity":"618c6578-f022-4175-ae5c-5768a59a415d","order_by":3,"name":"Jing Gu","email":"","orcid":"","institution":"Deyang People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Gu","suffix":""},{"id":500597687,"identity":"14b5deeb-347b-4113-a098-df245d3539f0","order_by":4,"name":"Huanhuan Deng","email":"","orcid":"","institution":"Deyang People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huanhuan","middleName":"","lastName":"Deng","suffix":""},{"id":500597688,"identity":"6a1f2d7a-2c4c-4a5c-861b-f2affdeccce4","order_by":5,"name":"Mei Tang","email":"","orcid":"","institution":"Deyang People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mei","middleName":"","lastName":"Tang","suffix":""},{"id":500597689,"identity":"db13e04c-5328-4546-98bc-7a32590e1a82","order_by":6,"name":"Jinlan Dai","email":"","orcid":"","institution":"Deyang People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jinlan","middleName":"","lastName":"Dai","suffix":""},{"id":500597690,"identity":"c6fd7169-1432-4954-afed-bbdb5efb839d","order_by":7,"name":"Mengting Zhu","email":"","orcid":"","institution":"Chengdu University","correspondingAuthor":false,"prefix":"","firstName":"Mengting","middleName":"","lastName":"Zhu","suffix":""}],"badges":[],"createdAt":"2025-07-16 08:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7137545/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7137545/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89285158,"identity":"69a0be82-06e8-4f6e-8072-bfbe89be9453","added_by":"auto","created_at":"2025-08-18 11:15:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1178286,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7137545/v1/baeb78b9-84c0-4744-a192-611bc1eb561d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Influencing factors of moral resilience among psychiatric nurses: a cross-sectional survey","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMoral resilience refers to the ability of an individual to maintain, restore, or enhance their physical and mental health when facing moral or ethical dilemmas. This ability can transform moral or ethical dilemmas from negative experiences into hope and positive motivation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As a protective factor in the event of ethical harm, moral resilience helps to reduce the negative impact on individuals [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Research shows that nurses with low moral resilience are more likely to have an intention to leave their jobs and experience job burnout [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and it is closely related to higher levels of stress, anxiety, and depression [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Psychiatric nurses mainly take care of patients with mental illnesses at different disease stages, especially those in the acute phase of mental disorders. These patients have limited self-awareness and cognitive abilities, and issues such as involuntary hospitalization and restraint are sometimes involved. In addition, the families of these patients are more sensitive than those of patients with other diseases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, psychiatric nurses often face more and more complex moral and ethical dilemmas compared to nurses in other departments [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Currently, research in China mainly focuses on the ethical decision-making ability [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and humanistic care ability [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] of psychiatric nurses, while research on their moral resilience is relatively scarce. Thus, this study investigated the current status of the moral resilience of psychiatric nurses and explored its influencing factors, aiming to provide a basis for nursing managers to implement intervention measures and further improve the moral resilience and psychological state of psychiatric nurses.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eResearch design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis cross-sectional study investigated moral resilience levels and key determinants among practicing psychiatric nurses in mental health settings between June to September 2024.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study was conducted at the psychiatric departments of 5 tertiary-level general hospitals, 1 tertiary-level psychiatric hospital, and 3 municipal psychiatric hospitals (all of which are secondary-level hospitals) in Sichuan Province as the research subjects. The inclusion criteria were as follows: (1) Actively practicing registered nurses working in the psychiatric department; (2) Having worked in the psychiatric department for \u0026ge;\u0026thinsp;1 year; (3) Providing informed consent and volunteering to participate in the study. The exclusion criteria were: (1) Non-hospital-based nurses such as visiting nurses; (2) Nurses on further study or leave during the survey period. According to the sample size calculation formula, the sample size should be 20 times the number of independent variables. A total of 24 variables were involved in this study (including 16 items of general information, 3 dimensions of the Nurse Moral Resilience Scale, and 5 dimensions of the Hospital Ethical Climate Scale). The calculated sample size was 480. Considering a 20% invalid sample, the final sample size was determined to be 576. In this study, 600 nurses were actually surveyed, and finally 592 valid data were obtained.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInstruments\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe General Information Questionnaire was designed by the research team based on literature review and discussion. It includes 16 items such as gender, age, ethnicity, educational background, professional title, position, marital status, monthly personal income, hospital type, employment form, whether being a psychiatric-psychological specialist nurse, and whether having received medical ethics education and training.\u003c/p\u003e\u003cp\u003eThe study assessed the moral resilience of psychiatric nurses using the Nurse Moral Resilience Scale (RMRS). The RMRS was developed by Rushton et al.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] in 2021 and translated into Chinese by Chen Xuelei et al. in 2024. The scale contains 3 dimensions: personal integrity (2 items), ethical dilemma coping and relationship integrity (10 items), and ethical efficacy (5 items), with a total of 17 items. A Likert 4-point scoring method (1\u0026ndash;4 points) is used, and 11 items are reverse-scored. The total score ranges from 17 to 68 points, and the higher the score, the better the moral resilience. The Cronbach\u0026rsquo;s α coefficient of the Chinese version of RMRS among Chinese clinical nurses is 0.829 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and it is 0.860 in this study.\u003c/p\u003e\u003cp\u003eThe psychiatric nurses\u0026rsquo; perceptions of the ethical climate in hospitals was assessed using the Hospital Ethical Climate Scale (HECS). The HECS was developed by Olson et al.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] in 1998 and translated into Chinese by Wang Lu et al. in 2018. The scale includes 5 dimensions: relationships with the hospital (6 items), nurses (4 items), patients (4 items), doctors (5 items), and managers (6 items), with a total of 25 items. A Likert 5-point scoring method (1\u0026ndash;5 points) is used. The Cronbach\u0026rsquo;s α coefficient of the Chinese version of HECS among Chinese clinical nurses is 0.915 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and it is 0.968 in this study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection and ethical consideration\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study conducted a questionnaire survey through the \u0026ldquo;Wenjuanxing\u0026rdquo; platform. The research document covered the research background, purpose, content, significance, and filling instructions. After obtaining the consent of the directors of the nursing departments of the selected hospitals, they were invited to forward the \u0026ldquo;Wenjuanxing\u0026rdquo; link to the hospital head nurses\u0026rsquo; group, and then the head nurses forwarded it to the department nurses\u0026rsquo; group to ensure that eligible subjects participated in the questionnaire filling under the premise of informed consent. The research protocol has been reviewed and approved by the Medical Ethics Committee of Deyang People\u0026rsquo;s Hospital, and all survey subjects provided informed consent.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe data were entered through Epidata 3.0 and analyzed using SPSS 25.0. Measurement data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and count data were described by frequency and composition ratio. The t-test or analysis of variance was used for mean comparison, the Pearson correlation analysis was used for correlation analysis, and the multiple linear regression analysis was used for influencing factor analysis. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eDemographic information of the participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 592 psychiatric nurses participated in this study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). 90.4% (535) were of Han ethnicity, 82.9% (491) had a bachelor\u0026rsquo;s degree or above, 63.3% (373) worked in closed-ward areas, 15.0% (89) held the national psychological counselor qualification, 26.0% (154) were psychiatric-psychological specialist nurses, and 49.3% (292) had received medical ethics education and training. Psychiatric nurses with higher educational level had higher moral resilience (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.639, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Head nurses had higher moral resilience scores than general nurses (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.215, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). Psychiatric nurses with longer service periods demonstrated higher moral resilience scores (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.012, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030). Nurses who hold a national psychological counseling certificate had higher moral resilience scores than other nurses(\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.085, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). Psychiatric specialist nurse had higher moral resilience scores than general nurses (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.737, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). Nurses who have received medical ethics training had higher moral resilience scores than nurses who have not received such training (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.804, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e General information and univariate analysis of participants (n\u0026thinsp;=\u0026thinsp;592)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRMRS\u0026rsquo;s Score (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003et/F\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.775\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50(8.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.60\u0026thinsp;\u0026plusmn;\u0026thinsp;7.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e542(91.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.86\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years old)\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.956\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e259(43.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.90\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e300 (50.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33(5.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.58\u0026thinsp;\u0026plusmn;\u0026thinsp;4.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthnicity\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.319\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.188\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e535(90.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.72\u0026thinsp;\u0026plusmn;\u0026thinsp;6.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57(9.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.77\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Background\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.639\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior College\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e273(46.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e40.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUndergraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e242(40.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.51\u0026thinsp;\u0026plusmn;\u0026thinsp;6.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMaster\u0026rsquo;s Degree and Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77(13.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e43.56\u0026thinsp;\u0026plusmn;\u0026thinsp;6.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.795\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e255(43.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.63\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSenior Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e175(29.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.23\u0026thinsp;\u0026plusmn;\u0026thinsp;6.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHead Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e97(16.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.69\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDeputy Chief Nurse and Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65(11.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.85\u0026thinsp;\u0026plusmn;\u0026thinsp;5.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e524(88.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.55\u0026thinsp;\u0026plusmn;\u0026thinsp;6.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHead Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68(11.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e44.10\u0026thinsp;\u0026plusmn;\u0026thinsp;5.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonthly Personal Income (yuan/month)\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.116\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101(17.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.01\u0026thinsp;\u0026plusmn;\u0026thinsp;6.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5000\u0026ndash;8000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e293(49.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;8000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e198(33.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.637\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.529\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e123(20.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e426(71.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.02\u0026thinsp;\u0026plusmn;\u0026thinsp;6.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced or Widowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43(7.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.60\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital Type\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.837\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.403\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e156(26.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpecialized Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e436(73.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.71\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWard Area\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.634\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpen-ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e219(37.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClosed-ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e373(63.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.75\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of Experience in Psychiatry\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e168(28.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e279(47.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.21\u0026thinsp;\u0026plusmn;\u0026thinsp;6.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86(14.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e43.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59(10.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.22\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployment Form\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.574\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.563\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInstitution-based Staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e175(29.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.55\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContract-based Staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e348(58.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTemporary Employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69(11.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligious Belief\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.996\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21(3.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.85\u0026thinsp;\u0026plusmn;\u0026thinsp;6.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e571(96.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether a National Psychological Counselor\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e154(26.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e43.01\u0026thinsp;\u0026plusmn;\u0026thinsp;5.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e438(74.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether a Psychiatric-Psychological Specialist Nurse\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.737\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89(15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e41.55\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e503(85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e43.49\u0026thinsp;\u0026plusmn;\u0026thinsp;5.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether Received Medical Ethics Education and Training\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\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.804\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e292(49.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e42.82\u0026thinsp;\u0026plusmn;\u0026thinsp;7.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e300(50.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e40.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eMoral resilience and hospital ethical climate\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDescriptive statistics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e The total score of moral resilience of 592 psychiatric nurses was (41.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22) points, and the total score of the hospital ethical climate was (105.42\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04) points. The scores for each dimension are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e The score of moral resilience and hospital ethical climate (n\u0026thinsp;=\u0026thinsp;592)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScore (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eItems mean score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMoral Resilience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e41.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoping with Nursing Ethical Dilemmas and Relationship Integrity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e22.19\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonal Integrity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e5.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNursing Ethical Efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e14.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHospital Ethical Climate\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e105.42\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship with the Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e25.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship with Nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship with Patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship with Doctors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e20.51\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship with Managers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e25.84\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e4.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe relationship between moral resilience and hospital ethical climate\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe correlation coefficient between the scores of psychiatric nurses\u0026rsquo; moral resilience and the hospital ethical climate was 0.551, with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultiple linear regression analysis of moral resilience\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTaking the scores of nurses\u0026rsquo; moral resilience as the dependent variable, and the variables with statistical significance in the univariate analysis (educational background, position, years of experience in psychiatry, whether being a national psychological counselor, whether being a psychiatric specialist nurse, whether having received medical ethics education, and the scores of the hospital ethical climate) as the independent variables, a multiple linear regression analysis was carried out. The results showed that educational background, years of experience in psychiatry, whether being a psychiatric specialist nurse, whether having received medical ethics education, and the scores of the hospital ethical climate were the influencing factors of psychiatric nurses\u0026rsquo; moral resilience, explaining 34.9% of the total variance, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple linear regression analysis of moral resilience (n\u0026thinsp;=\u0026thinsp;592)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\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=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Background\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of Experience in Psychiatry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.756\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.279\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.711\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether a Psychiatric Specialist Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.444\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.707\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhether Received Medical Ethics Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.753\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.416\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-4.218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScore of Hospital Ethical Climate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.933\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\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\u003e14.563\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.983\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eNote: \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.357, Adjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.349, \u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;46.222, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the field of mental health nursing, conducting a systematic study on the current state of nurses\u0026rsquo; moral resilience and its influencing factors holds significant practical urgency. Psychiatric nursing practice faces unique ethical challenges, including dilemmas surrounding informed consent due to patients\u0026rsquo; limited autonomy, conflicts between compulsory treatment measures and humanistic care, and contradictions between confidentiality obligations and risk management [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These complex situations place higher demands on nurses\u0026rsquo; moral judgment and professional competence. In this context, moral resilience-the core competency enabling nurses to uphold professional standards, effectively resolve ethical conflicts, and achieve professional growth in moral dilemmas-directly impacts the scientific rigor of ethical decision-making, the extent of patient rights protection, and the safety and quality of nursing services.\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe level of moral resilience of psychiatric nurses is relatively low\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, the total score of moral resilience was (41.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22) points, which was at a medium level. Since the nursing objects are mostly patients with mental symptoms or combined physical diseases, these patients often exhibit behaviors such as suicide, impulsivity, running away, and severe drug reactions under the influence of mental symptoms, and unexpected events may occur at any time. Psychiatric nurses need to respond promptly to various emergencies and try their best to meet the patients\u0026rsquo; needs. Such a working environment makes it easy for nurses to fall into ethical dilemmas, leading to an increase in job burnout and thus a higher turnover rate [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. As a protective factor in ethical dilemmas [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], this study will further explore its influencing factors to provide a reference for managers to optimize human resource management.\u003c/p\u003e\u003cp\u003e\u003cb\u003eHospital Ethical Climate were positively correlated with moral resilience\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere is a significant positive correlation between the hospital ethical climate and the moral resilience of psychiatric nurses. This finding is of central importance for understanding and improving the ethical quality of nursing practice. A positive hospital ethical atmosphere, characterized by senior management\u0026rsquo;s high priority on ethical issues, open channels for ethical discussion, mutual respect and support among colleagues, clear ethical decision making processes, and institutional support for nurses\u0026rsquo; moral courage, provides crucial environmental safeguards for nurses to address the inevitable ethical dilemmas they encounter in their work [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This supportive environment reinforces nurses\u0026rsquo; moral flexibility through multiple mechanisms: it reduces nurses\u0026rsquo; feelings of isolation and helplessness when facing ethical conflicts, encouraging them to actively seek guidance and collaboration when confused; it enhances nurses\u0026rsquo; confidence and ability to identify ethical issues, engage in ethical reasoning, and uphold moral principles by providing clear ethical frameworks and exemplary role models; it acknowledges and supports the challenges nurses may face when advocating for patient rights, reducing moral silence caused by fear of retaliation or misunderstanding [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. When nurses perceive the organization as a strong backing for upholding ethical principles, they are better able to effectively regulate their emotions, engage in reflective learning, and restore moral agency after experiencing moral distress, rather than falling into moral numbness, burnout, or resignation tendencies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, fostering a positive, open, and supportive hospital ethical atmosphere is a key organizational intervention strategy to enhance nurses\u0026rsquo; moral resilience, alleviate their moral distress, reduce the risk of occupational burnout, promote their adherence to ethical standards to provide high quality humane care, and ultimately ensure patient safety and well-being. Researching and optimizing the ethical atmosphere is a core component of building a more ethically resilient healthcare system.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSeveral factors influence the moral resilience of psychiatric nurses\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePsychiatric nurses with higher educational level have higher moral resilience\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study showed that the moral resilience of psychiatric nurses with a bachelor\u0026rsquo;s degree or above was significantly higher than that of junior college nurses (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that the educational level is a protective factor for moral resilience. This may be because nurses with a high educational level have systematically studied courses such as nursing psychology and nursing ethics in higher medical colleges, and can better apply theoretical knowledge and skills to meet professional requirements, thus showing a higher level of moral resilience. This result is consistent with previous studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], that is, nurses who have received higher education have stronger coping abilities and can better handle problems in clinical practice. For the group of junior college nurses, nursing managers should innovate diversified education and training mechanisms to provide them with opportunities for further education and in-depth learning, so as to improve their educational level and moral resilience.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePsychiatric nurses with longer service periods demonstrated higher moral resilience scores\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study found that there was a positive correlation between the years of experience of psychiatric nurses and their moral resilience level. This may be because with the accumulation of clinical work experience, nurses\u0026rsquo; knowledge reserves and coping abilities gradually increase, enabling them to better handle emergencies, keenly identify clinical problems and the ethical dilemmas behind them, and make decisions that are beneficial to patients\u0026rsquo; treatment [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This result suggests that hospital management should strengthen the theoretical training of junior-level nurses and implement hierarchical training according to different work stages of nurses, so as to comprehensively improve their clinical thinking ability and professional ethical knowledge level. In addition, a learning platform can be built to provide personalized training programs to achieve individualized education and further optimize the career development path of nurses.\u003c/p\u003e\u003cp\u003e\u003cb\u003eNurses who hold a national psychological counseling certificate had higher moral resilience scores than other nurses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study showed that psychiatric nurses who have obtained the national psychological counselor certificate had a significantly higher level of moral resilience. This may be related to their systematic study of ethics-related courses during the training process and long-term supervision and guidance by superior psychological counselors. Although the national psychological counselor professional qualification examination has been cancelled, managers can encourage psychiatric nurses to participate in the psychological therapist professional qualification examination organized by the National Health Commission to further improve their moral resilience level. This helps nurses to make better ethical decisions when facing sudden ethical problems in psychiatry and avoid falling into ethical dilemmas.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePsychiatric specialist nurse had higher moral resilience scores than general nurses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study found that the moral resilience level of psychiatric specialist nurses was significantly higher than that of non-psychiatric specialist nurses. This may be due to the fact that psychiatric specialist nurses have more solid specialized theoretical knowledge, longer working years, and higher professional abilities, enabling them to skillfully deal with clinical ethical problems. For the group of non-psychiatric specialist nurses, nursing managers should strengthen specialized theoretical and practical training, improve their comprehensive abilities, and encourage them to become psychiatric specialist nurses through certification.\u003c/p\u003e\u003cp\u003e\u003cb\u003eNurses who have received medical ethics training had higher moral resilience scores than nurses who have not received such training\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study showed that psychiatric nurses who had received medical ethics education and training had a significantly higher level of moral resilience, indicating that medical ethics education and training play an important role in improving moral resilience [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, currently, the ethics education in medical colleges in China is relatively weak. Relevant courses are mostly elective courses, with limited class hours and a lack of close integration with clinical practice, making it difficult to meet actual needs. In addition, the clinical ethics training mechanism is imperfect, lacking systematicness and continuity. Therefore, nursing educators and managers should pay attention to this issue: at the college level, strengthen the construction of medical ethics education courses and increase educational investment; at the clinical level, establish and improve the training mechanism and standardize the in-service ethics training of psychiatric nurses, so as to comprehensively improve the moral resilience level of nursing staff.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study found that the moral resilience of psychiatric nurses is at a medium level, and educational background, years of experience, whether being a national psychological counselor, whether being a psychiatric specialist nurse, whether having received medical ethics education and training, and the hospital ethical climate score are important influencing factors of psychiatric nurses\u0026rsquo; moral resilience. Nursing managers can improve the moral resilience level of psychiatric nurses by strengthening relevant training for junior-level nurses. However, this study only focused on 5 tertiary-level general hospitals and selected samples by convenience sampling, so the representativeness of the samples was limited. Follow-up studies can conduct multi-center and large-sample research to improve the generalizability of the research results.\u003c/p\u003e\u003cp\u003eThis study found that the moral resilience of psychiatric nurses is at a medium level, and its influencing factors include educational background, years of experience, whether holding the national psychological counselor qualification, whether being a psychiatric specialist nurse, whether having received medical ethics education and training, and the hospital ethical climate score. Nursing managers can enhance the moral resilience level of psychiatric nurses by strengthening relevant training for junior-level nurses. However, this study only sampled in some hospitals in Sichuan Province, and the sample representativeness is limited. Future studies can carry out multi-center and large-sample research to enhance the universality and promotion value of the research results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to all the psychiatric nurses who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLi Tao: Conceptualization, Methodology, Software, Investigation, Formal Analysis, Writing-Original Draft; Jie Liu: Conceptualization, Methodology, Software, Investigation, Formal Analysis, Resources, Supervision, Writing-Reveiw \u0026amp; Editing; Qiao Lin: Visualization, Conceptualization; Jing Gu: Resources, Supervision; Huanhuan Deng: Software, Validation; Mei Tang: Investigation, Supervision; Jinlan Dai: Supervision, Validation; Mengting Zhu: Writing-Reveiw \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Sichuan Provincial Mental Health Education Research Center, China (XLJKJY2357C)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData generated and/or analysed in this study are not publicly available butcan be obtained from the corresponding author upon reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Medical Ethics Committee of Deyang People\u0026rsquo;s Hospital. All methods were performed in accordance with relevant guidelines and regulations (Declaration of Helsinki) and informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient or public contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Psychosomatic Medicine, Deyang People\u0026rsquo;s Hospital, Deyang, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eSchool of Basic Medical Sciences \u0026amp; School of Nursing, Chengdu University, Chengdu, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYoung PD, Rushton CH. A concept analysis of moral resilience[J]. 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The influence of hospital magnetie elements and hospital ethical atmosphere on the humanistie practice ability of nurses (China), 2025. 25(1): 1\u0026ndash;5. 10.3969/j. issn. 1671-315x. 2025. 01. 001.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYuwei Wu Y, Wu C, Li et al. Analysis of the Current Status and Influencing Factors of Moral Courage Among 247 New Nurses in Grade III Class A Hospitals[J]. ournal of Nursing (China), 2023, 30(16):68\u0026ndash;72. DOI: 10. 16460/j. issn1008-9969. 2023. 16. 068.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLu Wang W, Wei Z, Liu, et al. Research progress on hospital ethical atmosphere perception of clinical nurses[J]. Volume 32. CHINESE NURSING RESEARCH (China); 2018. pp. 2194\u0026ndash;7. 1410.12102/j.issn.1009-6493.2018.14.012.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAntonsdottir I, Rushton CH, Nelson KE, et al. Burnout and moral resilience in interdisciplinary healthcare professionals[J]. J Clin Nurs. 2022;31(1\u0026ndash;2):196\u0026ndash;208. 10. 1111/jocn.15896.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eClark P, Crawford TN, Hulse B et al. Resilience, Moral Distress, and Workplace Engagement in Emergency Department Nurses[J]. Western Journal of Nursing Research, 2021, 43(5): 442\u0026ndash;451. DOI: 10. 1177/0193945920956970.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWald HS, Monteverde S. COVID-19 era healthcare ethics education: Cultivating educational and moral resilience[J]. Nursing Ethics, 2021, 28(1): 58\u0026ndash;65. DOI: 10. 1177/0969733020976188.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Psychiatric nurse, Moral resilience, Hospital ethical climate","lastPublishedDoi":"10.21203/rs.3.rs-7137545/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7137545/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study investigates the level of moral resilience among psychiatric nurses and the factors influencing it. The aim is to provide foundational insights for developing targeted interventions to enhance moral resilience within this nursing specialty.\u003c/p\u003e\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePsychiatric nurses face unique ethical challenges due to their exposure to complex moral dilemmas, workplace violence, and coercive practices in mental health settings. These challenges can lead to moral distress, impacting both their well-being and the quality of patient care. Understanding the factors influencing moral resilience\u0026mdash;such as psychological traits, organizational support, and coping strategies is crucial for developing targeted interventions to enhance their ethical decision-making and professional sustainability.\u003c/p\u003e\u003ch2\u003eDesign\u003c/h2\u003e\u003cp\u003eA cross-sectional survey.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e Five hundred and ninety-two psychiatric nurses from the psychiatric departments of five tertiary-level general hospitals, one tertiary-level psychiatric hospital, and three municipal psychiatric hospitals in Sichuan Province from June to September 2024, and they were assessed using a general information questionnaire, the Rushton moral resilience scale, and the hospital ethical climate survey.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe total moral resilience score of psychiatric nurses was (41.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22) and the hospital ethical climate score was (105.42\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04). The results of univariate analysis showed that the effects of education, position, years of experience in psychiatry, whether or not a national counselor, whether or not a psychiatric nurse, and whether or not a psychiatric nurse had received medical ethics education and training on the moral resilience score of psychiatric nurses were statistically significant (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); Pearson correlation analysis showed that the correlation coefficient of the moral resilience score of psychiatric nurses with the score of the ethical climate of hospitals was 0.55 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05); multiple regression analysis showed that education, years of experience in psychiatry, qualification of psychiatric nurses, receiving medical ethics education and hospital ethical climate score were the main influences on psychiatric nurses\u0026rsquo; moral resilience, explaining 34.9% of the total variance.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe level of moral resilience of psychiatric nurses is in urgent need of improvement, and it is significantly influenced by professional qualification, training experience and organizational ethical environment. It is recommended to improve the moral resilience of nurses by constructing an ethical support system, improving the function of ethics committees, incorporating medical ethics into the mandatory curriculum of continuing education, implementing a tiered training program for psychiatric nurses, and at the same time establishing an ethical decision-making case base and a multidisciplinary collaboration platform.\u003c/p\u003e\u003ch2\u003eImpact\u003c/h2\u003e\u003cp\u003e This study proposes that educators and administrators provide psychiatric nurses with targeted interventions to enhance moral resilience, thereby improving clinical practice and long-term career sustainability.\u003c/p\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Influencing factors of moral resilience among psychiatric nurses: a cross-sectional survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-18 10:59:28","doi":"10.21203/rs.3.rs-7137545/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-09-03T00:54:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21903912788031853491776451682322145430","date":"2025-08-14T14:29:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-10T20:56:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-17T17:51:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-16T11:02:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-16T11:01:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-07-16T08:12:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"da430b63-d7f1-4c75-a53b-d751cd5d8f43","owner":[],"postedDate":"August 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-18T10:59:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-18 10:59:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7137545","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7137545","identity":"rs-7137545","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}