The dual effect of work rumination in the relationship between challenge stress and innovative behavior: A moderated mediation model of information literacy

The dual effect of work rumination in the relationship between challenge stress and innovative behavior: A moderated mediation model of information literacy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The dual effect of work rumination in the relationship between challenge stress and innovative behavior: A moderated mediation model of information literacy lifeng yao, siqi li, liping yao, qin jia, jing dai This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4466653/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Nurses encounter significant challenge stress, which has the potential to influence their innovative behavior. However, the precise mechanisms underlying this phenomenon remain unclear. This study sought to examine the mediating role of work rumination in the relationship between challenge stress and innovative behavior. Additionally, it aimed to explore the moderating role of information literacy in the association between work rumination and innovative behavior among Chinese nurses. Methods A cross-sectional survey was conducted among 533 nurses from 25 hospitals in China in May 2024. Participants were instructed to complete an online questionnaire designed to measure challenge stress, work rumination, information literacy, and innovative behavior. The data collected from the questionnaire was subsequently analyzed using mediation and moderated mediation analyses, carried out with the aid of the PROCESS macro in SPSS. Results Challenge stress was positively associated with innovative behavior (r = 0.142, p < 0.01) and work rumination (r = 0.348, p < 0.01). Work rumination partially mediated the relationship between challenge stress and innovative behavior (indirect effect: 0.279, 95% CI [0.199, 0.362]). Affective rumination had a negative indirect effect (Effect=-0.135, 95% CI [-0.222, -0.043]), while problem-solving pondering had a positive indirect effect (Effect = 0.121, 95% CI [0.064, 0.182]). Information literacy moderated the relationship between work rumination and innovative behavior (interaction term β = 0.069, p = 0.019), with the mediating effect being stronger among nurses with higher information literacy (Effect = 0.204, 95% CI [0.121, 0.287]). Conclusion Work rumination plays a mediating role in the relationship between challenge stress and nurses' innovative behavior. Specifically, problem-solving pondering exerts a positive influence, while affective rumination exerts a negative influence. Information literacy enhances the positive mediating effect of work rumination. These findings underscore the significance of promoting positive work rumination and information literacy to cultivate innovative behavior among nurses who encounter challenge stress. Challenge stress Work rumination Information literacy Innovative behavior Nurses Moderated mediation Figures Figure 1 Figure 2 Background Innovation in healthcare is of paramount importance in enhancing patient care, boosting efficiency, and tackling the ever-changing demands of the healthcare system[ 1 ]. Nurses, being the largest cohort of healthcare professionals, assume a pivotal role in spearheading innovation within healthcare environments[ 2 ]. As the healthcare environment continues to grow in complexity and patient demands become increasingly diverse, nurses are faced with greater expectations in terms of their scientific knowledge and practical skills[ 3 ]. However, the demanding nature of nursing work often exposes nurses to elevated levels of stress, which can have an impact on their capacity to engage in innovative behavior [ 4 , 5 ]. Recent studies have primarily focused on the concept of challenge stress, which refers to a type of stress that can promote personal growth and achievement [ 6 ]. Several studies have established a positive correlation between stress induced by challenges and innovative behavior [ 7 , 8 ]. Nevertheless, some researchers have proposed that the dynamics of this relationship may exhibit greater complexity [ 9 ]. Work rumination, which is defined as the inclination to contemplate work-related issues beyond normal working hours [ 10 ], has been proposed as a potential mediator in the relationship between stress resulting from challenges and job performance [ 9 ]. Furthermore, the substantial progress of information technology has instigated a revolution in diverse facets of the healthcare sector, encompassing nursing practice. However, despite the augmented accessibility of online library resources in the professional environment, nurses frequently encounter obstacles in fully harnessing the capabilities of these resources [ 11 ]. This constraint inhibits nurses' ability to access the most recent research findings and hampers the implementation of the best available evidence in clinical practice [ 12 ]. Nurses' information literacy, a critical component in addressing this challenge, pertains to their capacity to identify information needs, explore and assess information, and utilize it ethically to achieve optimal nursing practice goals[ 13 ]. One study has identified nurses' information literacy as a critical factor influencing their innovative behavior, with higher levels of information literacy positively predicting nurses' innovation performance [ 14 ]. Nurses with a high level of information literacy possess greater capabilities to effectively navigate the ever-expanding reservoir of knowledge, critically assess evidence, and translate research discoveries into novel strategies that augment the quality of patient care[ 15 ]. However, the correlation between information literacy and innovative behavior among nurses remains insufficiently comprehended, especially within the framework of work-related stress. Nurses commonly encounter work rumination, a type of perseverative cognition marked by repetitive contemplations about work-related matters. This phenomenon can exert both positive and negative impacts on their well-being and performance[ 16 ]. While a study suggests that work rumination has the potential to enhance problem-solving skills and creativity [ 9 ], contrasting research indicates that it may also lead to emotional exhaustion and decreased innovation [ 17 ]. Nevertheless, the degree to which information literacy can moderate the relationship between work rumination and innovative behavior remains largely unexplored in the nursing context. This study aims to examine the role of work rumination in mediating the relationship between challenge stress and innovative behavior among nurses, as well as the moderating effect of information literacy on the association between work rumination and innovative behavior. Through an examination of these relationships, our aim is to offer valuable insights into the determinants that impact the innovative behavior of nurses and to provide guidance on strategies that can be employed to facilitate and encourage innovation within healthcare environments. Figure 1 presents the proposed model for the study. We propose the following hypotheses based on previous studies and their findings. Hypothesis 1 There will be a positive relationship between challenge stress and innovative behavior among nurses. Hypothesis 2 Work rumination will mediate the relationship between challenge stress and innovative behavior. Hypothesis a: Problem-solving pondering will positively mediate the relationship between challenge stress and innovative behavior. Hypothesis b: Affective rumination will negatively mediate the relationship between challenge stress and innovative behavior. Hypothesis 3 Information literacy will moderate the relationships among challenge stress, work rumination, and innovative behavior. Methods Study Design and Participants We conducted a cross-sectional study to examine the influence of challenge stress on the innovative behavior of nurses and to explore the underlying mechanisms.The Kendall sample size estimation method was adopted to determine the sample size according to 5–10 times the survey entry items[ 48 ]. This survey comprised 46 entry items. Considering 10% inefficiency, the appropriate sample size of this study was determined to be 256–512. In May 2024, a stratified cluster sampling approach was employed to recruit nurses from 25 hospitals situated in different provincial and municipal regions throughout China. The inclusion criteria were: (1) registered nurses who possessed their professional qualification certificates, (2) nurses involved in frontline clinical nursing duties, and (3) nurses who granted informed consent and willingly took part in the study.Nurses were excluded if they were (1) nursing interns; (2) absent from their positions during the survey period due to health issues, family matters, or other personal reasons. Data Collection and Measures An anonymous online survey was administered through Questionnaire Star ( https://www.wjx.cn/ ), a professional online questionnaire platform. The survey link and QR code were distributed to Chinese nurse online groups via WeChat, allowing participants to respond at their convenience. The survey began with an informed consent form detailing the study objectives. Participants were asked, "Would you like to participate in this study?" with response options of "Yes" or "No." Choosing "Yes" indicated voluntary consent, and participants then proceeded to complete the questionnaire. In this study, a self-designed questionnaire was employed to gather data on various sociodemographic variables. These variables included gender, age, marital status, educational background (excluding current students), years of experience in nursing, professional title, frequency of night shifts per month, workplace, hospital level, department, interest in scientific research, requirement for promotion (such as innovative achievements), patent application, participation in clinical nursing quality improvement projects, involvement in clinical nursing innovation projects or competitions, publication of papers, as well as application and participation in research projects as either the principal investigator or collaborator. The Challenge Stress Scale, which was adapted from Cavanaugh et al.[ 18 ], was utilized to measure the extent of stress encountered by individuals in response to the situations delineated in the statements. The scale consists of six items that are rated on a 5-point Likert scale (1 = not at all, 5 = very high stress), with higher scores indicating a greater perception of stress. The Chinese version of the scale demonstrated a Cronbach's α of 0.92, signifying a high level of internal consistency reliability[ 19 ]. The Nurse Innovation Behavior Scale, which was adapted from Bao Ling et al.[ 20 ], was utilized to assess the innovative behavior of nurses. This scale consists of three dimensions: idea generation (3 items), obtaining support (4 items), and idea implementation (3 items). It employs a Likert 5-point rating scale, ranging from "never" to "very frequently," with scores ranging from 1 to 5. Higher total scores indicate a greater level of innovative behavior among nurses. The original scale demonstrates a high level of internal consistency reliability, with an overall Cronbach's α coefficient of 0.912. Additionally, other studies have revealed that the Cronbach's α for the Chinese version of the scale ranges from 0.907 to 0.94 [ 14 , 21 ]. The Work-Related Rumination Questionnaire (WRRQ), developed by Cropley et al.[ 10 ], was utilized to assess work rumination. The questionnaire includes two subscales, namely affective rumination and problem-solving pondering, each consisting of five items. A Likert 5-point scoring system was employed, with 1 representing "almost never" and 5 representing "always." Higher scores indicate higher levels of work rumination. In the present study, the internal consistency of the affective rumination subscale was measured at α = 0.89, while the problem-solving pondering subscale demonstrated α = 0.86[ 9 ]. The Information Literacy Questionnaire (ILQ), which was developed by Chinese scholar Shu Yan in 2009 [ 22 ], was utilized to assess the information literacy of nurses. The scale encompasses four dimensions: information awareness (4 items), information abilities (6 items), information knowledge (6 items), and information ethics (4 items), resulting in a total of 20 items. Respondents rated each item on a Likert 5-point scale, with 1 indicating "strongly disagree" and 5 indicating "strongly agree." The total score ranges from 20 to 100, with higher scores denoting greater information literacy among nurses. The overall Cronbach's α coefficient for the scale is 0.904, with Cronbach's α coefficients for each dimension ranging from 0.603 to 0.839. In the present study, the Cronbach's α coefficient for the Chinese-ILQ is 0.906 [ 14 ]. A total of 560 questionnaires were received, out of which 27 incomplete or invalid responses were excluded. Consequently, 533 questionnaires were deemed valid for analysis, resulting in an effective response rate of 95.18%. Statistical Analysis Descriptive statistics were utilized to summarize the demographic characteristics and study variables. Pearson correlation analysis was conducted to explore the associations between challenge stress, work rumination, information literacy, and innovative behavior. The study employed the PROCESS macro (version 3.5) developed by Hayes (2018)[ 23 ] in SPSS (version 26.0) to examine the mediating effect of work rumination and the moderating effect of information literacy on the relationship between challenge stress and innovative behavior. Specifically, Model 4 was utilized to test the mediating effect of work rumination, while Model 14 was employed to test the moderating effect of information literacy. The significance of the regression coefficients was assessed using the bias-corrected bootstrap method with 5,000 resamples and a 95% confidence interval (CI). Statistical significance was determined when the 95% CI did not contain zero. Results Sociodemographic Characteristics A total of 533 nurses participated in the study, with an average age of 36.2 years (SD = 8.4). The majority of the participants were female (96.2%), married (77.5%), and held a bachelor's degree (87.1%). The average duration of nursing experience was 14.3 years (SD = 8.7), with 42.8% of the participants having 12–21 years of experience. Almost half of the participants (49.5%) had less than two night shifts per month, while 8.8% had ten or more night shifts per month. Most of the participants held the professional title of supervisor nurse (48.6%), followed by nurse practitioner (23.1%), associate chief nurse (17.1%), chief nurse (3.9%), and nurse (7.3%). The majority of the participants worked in municipal hospitals (57.6%) and tertiary Grade A hospitals (77.7%). The most common department was general wards (73.9%), followed by ICU (15.9%), outpatient (5.6%), emergency (2.8%), and operating room (1.7%). Regarding research and innovation, 64.9% of the participants expressed an interest in scientific research, and 80.5% reported having promotion requirements related to innovative achievements. However, only 36.8% had applied for patents, and 71.1% had participated in clinical nursing quality improvement projects. Table 1 presents the detailed sociodemographic characteristics of the study participants. Table 1 Sociodemographic characteristics of the study participants (N = 533) . Variable Category Frequency Percentage Valid Percentage Cumulative Percentage Gender Male 20 3.8 3.8 3.8 Female 513 96.2 96.2 100 Age < 26 30 5.6 5.6 5.6 26–30 113 21.2 21.2 26.8 31–35 104 19.5 19.5 46.3 36–40 146 27.4 27.4 73.7 ≥ 41 140 26.3 26.3 100 Years of Nursing Experience <2 49 9.2 9.2 9.2 2–11 161 30.2 30.2 39.4 12–21 228 42.8 42.8 82.2 ≥ 22 95 17.8 17.8 100 Frequency of Night Shifts per Month <2 264 49.5 49.5 49.5 2–5 112 21 21 70.5 6–9 110 20.6 20.6 91.2 ≥ 10 47 8.8 8.8 100 Marital Status Single 96 18 18 18 Unmarried 24 4.5 4.5 22.5 Married 413 77.5 77.5 100 Education (excluding current enrollment) Below College 16 3 3 3 Bachelor's 464 87.1 87.1 90.1 Master's and above 53 9.9 9.9 100 Professional Title Nurse 39 7.3 7.3 7.3 Senior Nurse 123 23.1 23.1 30.4 Charge Nurse 259 48.6 48.6 79 Deputy Chief Nurse 91 17.1 17.1 96.1 Chief Nurse 21 3.9 3.9 100 Workplace Provincial Hospital 210 39.4 39.4 39.4 Municipal Hospital 307 57.6 57.6 97 Private Hospital 16 3 3 100 Hospital Level Tertiary Grade A 414 77.7 77.7 77.7 Tertiary Grade B 59 11.1 11.1 88.7 Secondary and below 60 11.3 11.3 100 Department ICU 85 15.9 15.9 15.9 Emergency Department 15 2.8 2.8 18.8 Operating Room 9 1.7 1.7 20.5 General Ward 394 73.9 73.9 94.4 Outpatient Department 30 5.6 5.6 100 Interest in Research Yes 346 64.9 64.9 64.9 No 187 35.1 35.1 100 Desire for Promotion(e.g., innovative achievements) Yes 429 80.5 80.5 80.5 No 104 19.5 19.5 100 Patent Application Yes 196 36.8 36.8 36.8 No 337 63.2 63.2 100 Participation in Clinical Nursing Quality Improvement Projects Yes 379 71.1 71.1 71.1 No 154 28.9 28.9 100 Participation in clinical nursing innovation projects or competitions Yes 214 40.2 40.2 40.2 No 319 59.8 59.8 100.0 Publication of research papers Yes 371 69.6 69.6 69.6 No 162 30.4 30.4 100.0 Application, leadership, or participation in research projects Yes 248 46.5 46.5 46.5 No 285 53.5 53.5 100.0 Correlations among Innovative Behavior, Challenge Stress, Work Rumination, and Information Literacy Table 2 presents the correlations among the variables studied. Innovative behavior exhibited positive correlations with challenge stress (r = 0.142, p < 0.01), work rumination (r = 0.348, p < 0.01), and information literacy (r = 0.589, p < 0.01). Information literacy demonstrated significant positive correlations with education level (r = 0.187, p < 0.01), department (r = 0.091, p < 0.05), challenge stress (r = 0.087, p < 0.05), and work rumination (r = 0.251, p < 0.01). However, a negative correlation was observed between information literacy and hospital level (r = -0.090, p < 0.05). Work rumination was positively correlated with gender (r = 0.085, p < 0.05) and challenge stress (r = 0.627, p < 0.01). A negative correlation was found between challenge stress and hospital level (r = -0.093, p < 0.05). Table 2 Correlations among study variables 1 2 3 4 5 6 7 8 9 1.Gender 1 2.Education 0.011 1 3.Workplace 0.031 − .173** 1 4.Hospital Level 0.055 − .130** .349** 1 5.Department .253** -0.008 0 0.071 1 6.challenge stress -0.019 0.08 0.012 − .093* -0.057 1 7.work rumination .085* 0.003 0.001 -0.031 0.024 .627** 1 8.information literacy -0.028 .187** -0.08 − .090* .091* .087* .251** 1 9.Innovative behavior -0.011 0.066 -0.034 -0.047 0.058 .142** .348** .589** 1 Predictors of Innovative Behavior and Work Rumination The results of regression analyses (Tables 3 ) indicate that challenge stress has a positive association with innovative behavior (β = 0.14, p < 0.001) and is significantly correlated with work rumination (β = 0.637, p < 0.001) as well as its affective (β = 0.703, p < 0.001) and problem-solving dimensions (β = 0.215, p < 0.001). Table 3.Regression Analyses Predicting Innovative Behavior and Different Dimensions of Work Rumination Outcome Variable Predictor Variable β SE t P LLCI ULCI Innovative Behavior Challenge Stress 0.14 0.043 3.218 0.001 0.054 0.225 Work Rumination Challenge Stress 0.637 0.034 18.81 0.000 0.571 0.704 Innovative Behavior Challenge Stress -0.14 0.053 -2.652 0.008 -0.244 -0.036 Work Rumination 0.438 0.052 8.355 0.000 0.335 0.541 Affective Rumination Challenge Stress 0.703 0.031 22.515 0.000 0.642 0.765 Innovative Behavior Challenge Stress 0.274 0.06 4.555 0.000 0.156 0.393 Affective Rumination -0.192 0.06 -3.196 0.001 -0.31 -0.074 problem-solving pondering Challenge Stress 0.215 0.043 5.011 0.000 0.131 0.299 Innovative Behavior Challenge Stress 0.019 0.037 0.503 0.615 -0.054 0.091 problem-solving pondering 0.564 0.037 15.359 0.000 0.492 0.636 Table 4. Mediation Analysis: The Role of Different Dimensions of Rumination in the Relationship Between Challenge Stress and Innovative Behavior Effect SE t p LLCI ULCI Total 0.14 0.043 3.218 0.001 0.054 0.225 Direct work rumination -0.14 0.053 -2.652 0.008 -0.244 -0.036 affective rumination 0.274 0.06 4.555 0.000 0.156 0.393 problem-solving pondering 0.019 0.037 0.503 0.615 -0.054 0.091 Indirect work rumination 0.279 0.042 / / 0.199 0.362 affective rumination -0.135 0.045 / / -0.222 -0.043 problem-solving pondering 0.121 0.03 / / 0.064 0.182 Regarding the predictive models for innovative behavior, challenge stress has a negative direct effect (β=-0.14, p = 0.008), while work rumination demonstrates a positive influence (β = 0.438, p < 0.001). Affective rumination is found to have a negative prediction for innovative behavior (β=-0.192, p = 0.001), in contrast to the positive prediction by problem-solving pondering (β = 0.564, p < 0.001). Notably, the direct effect of challenge stress on innovative behavior is non-significant in the problem-solving pondering model (β = 0.019, p = 0.615). An academic mediation analysis was conducted using the PROCESS macro (Model 4) to investigate the role of work rumination in the association between challenge stress and innovative behavior. The results indicated that work rumination played a significant mediating role in the relationship between challenge stress and innovative behavior (indirect effect: 0.279, 95% CI [0.199, 0.362]). Affective rumination exhibited a significantly negative indirect effect (Effect = -0.135, 95% CI [-0.222, -0.043]), whereas problem-solving pondering exhibited a significantly positive indirect effect (Effect = 0.121, 95% CI [0.064, 0.182]). The overall effect of challenge stress on innovative behavior remained consistently significant in all mediation models (Effect = 0.14, 95% CI [0.054, 0.225]). (Table 4) Testing for the moderated mediation effect An analysis of moderation was performed using the PROCESS macro (Model 14) to investigate the role of information literacy in the relationship between work rumination and innovative behavior among nurses (Table 5 ). Work rumination (β = 0.251, p < 0.001) and information literacy (β = 0.546, p < 0.001) were observed as significant positive predictors of innovative behavior, while challenge stress was not (β= -0.064, p = 0.15). The interaction between work rumination and information literacy was found to be significant (β = 0.069, p = 0.019). Table 5 Moderation analysis: The role of information literacy in the relationship between work rumination and innovative behavior Innovative Behavior coeff se t p LLCI ULCI constant 0.387 0.425 0.911 0.363 -0.447 1.221 Challenge Stress -0.064 0.045 -1.44 0.15 -0.152 0.023 Work Rumination 0.251 0.046 5.483 0.000 0.161 0.341 Information Literacy 0.546 0.037 14.924 0.000 0.474 0.618 Int_1 0.069 0.029 2.346 0.019 0.011 0.127 Gender -0.12 0.186 -0.646 0.519 -0.486 0.246 Education -0.089 0.1 -0.894 0.372 -0.286 0.107 Workplace -0.003 0.068 -0.051 0.959 -0.137 0.13 Hospital Rank 0.012 0.055 0.212 0.832 -0.096 0.12 Department 0.002 0.03 0.068 0.946 -0.057 0.061 R² 0.399 F 38.631*** Moderated mediation analysis revealed that the indirect impact of challenge stress on innovative behavior, mediated by work rumination, was subject to moderation by information literacy. The mediating effect was found to be more pronounced among nurses with higher levels of information literacy (Effect = 0.204, 95% CI [0.121, 0.287]) compared to those with average (Effect = 0.16, 95% CI [0.096, 0.227]) or lower levels (Effect = 0.116, 95% CI [0.044, 0.19]). The significant index of moderated mediation (Index = 0.044, 95% CI [0.003, 0.086]) confirmed that information literacy strengthens the mediating effect of work rumination between challenge stress and innovative behavior.(Table 6 ) Table 6 Moderated mediation analysis: The role of information literacy in the mediation of work rumination between challenge stress and innovative behavior information literacy Effect SE BootLLCI BootULCI -0.7953 0.116 0.037 0.044 0.19 0 0.16 0.034 0.096 0.227 0.7953 0.204 0.042 0.121 0.287 Index of Moderated Mediation 0.044 0.021 0.003 0.086 To further explore the moderating influence of information literacy, the variable was categorized into high and low groups using a standard deviation above and below the mean (M ± SD). A simple slope analysis was performed to assess the interaction effect (Fig. 2 ). The association between work rumination and innovative behavior was found to be more pronounced among nurses with high information literacy levels, in contrast to those with low information literacy levels. Discussion In this study, we provide significant insights into the complex interrelationships among challenge stress, work rumination, information literacy, and innovative behavior among Chinese nurses. Our study elucidates the multifaceted influence of challenge stress on innovation, and sheds light on the divergent consequences of affective rumination and problem-solving pondering. Furthermore, we underscore the significance of information literacy in moderating these associations. Consistent with prior research, we have identified a positive correlation between challenge stress and the manifestation of innovative behavior. This finding suggests that, under moderate levels of stress, creativity and innovation can be effectively amplified [ 24 ]. Our regression analysis revealed that, when considering the mediating effect of work rumination, there exists a detrimental direct impact of challenge stress on innovative behavior. This highlights the fact that challenge stress can have both positive and negative impacts on innovation, contingent upon its intensity and duration [ 25 , 26 ]. Healthcare organizations must strive to strike a delicate equilibrium whereby they foster a stimulating environment for nurses that presents them with ample challenges, all while implementing measures to mitigate the adverse consequences of excessive stress on their overall well-being and capacity for innovation. Work rumination has been identified as a noteworthy mediating factor in the relationship between challenge stress and innovative behavior. Affective rumination was found to have a negative indirect impact, while problem-solving pondering had a positive indirect impact. These findings align with recent studies that highlight the diverse impacts of various forms of work-related rumination on employee outcomes [ 41 , 42 ]. Affective rumination, characterized by negative emotional experiences, hinders innovative behavior by depleting cognitive resources and fostering a pessimistic outlook [ 27 , 43 ]. In contrast, engaging in problem-solving deliberation, which involves thoughtful reflection on work-related issues, can contribute to the development of innovative behavior by facilitating creative problem-solving and idea generation [ 9 , 28 ]. Encouraging nurses to assume ownership of problem-solving processes, along with providing them with essential resources and dedicated time, can facilitate the development of sustainable solutions to recurrent issues in patient care [ 30 ]. The moderated mediation analysis revealed that information literacy plays a pivotal role in enhancing the relationship between work rumination and innovative behavior. Nurses with a higher degree of information literacy demonstrated a more pronounced correlation between work rumination and innovative behavior, in contrast to individuals with lower levels of information literacy. This finding underscores the importance of equipping nurses with the requisite abilities to effectively process and utilize work-related information. This, in turn, will bolster their capacity for innovation [ 31 , 32 ]. Information literacy enables nurses to effectively identify, evaluate, and apply relevant knowledge, thereby enhancing their problem-solving capabilities and fostering creative thinking in challenging situations. In today's constantly evolving healthcare landscape, nurses must possess the essential skill of information literacy. This skill is of paramount importance in effectively implementing evidence-based practice, particularly as healthcare technologies continue to progress [ 33 ]. In order to enhance the information literacy skills of nurses, it is recommended that nursing programs give priority to integrating information literacy into practice. This can be accomplished by fostering collaboration between nursing educators and librarians [ 34 , 35 ]. This integration should be considered a vital component of the nursing curriculum, placing emphasis on the cultivation of skills and their practical implementation [ 36 ]. To improve proficiency in these skills, one can adopt strategies such as engaging in interdisciplinary collaborations and utilizing online tools for database searching [ 37 , 38 ]. The information practices of professional nurses should also inform the content and delivery of information literacy education [ 39 ]. This study carries substantial implications for both the practice of nursing and healthcare organizations. Managers should acknowledge the potential advantages of challenge stress in promoting innovative behavior, but they should also be aware of its negative consequences when it becomes excessive or prolonged [ 25 ]. Interventions aimed at promoting problem-solving reflection among employees, as opposed to becoming entrenched in negative emotions, can contribute to the establishment of a work environment that is more conducive to innovation [ 46 ]. Investing in training programs and providing sustained support can significantly enhance the information literacy skills of nurses. Consequently, this can empower them to effectively navigate intricate information environments and foster the development of innovative practices [ 47 ]. Our study has several limitations that warrant consideration. First, the utilization of a cross-sectional design in this study precludes us from establishing causal inferences regarding the interplay between challenge stress, work rumination, information literacy, and innovative behavior. In order to ascertain the causal and temporal dynamics of these relationships, it is imperative for future research to employ longitudinal or experimental designs. Second, although we have effectively recruited a substantial number of nurses from different regions and hospital settings in China, the implications of our findings in various healthcare contexts and cultures remain uncertain. To establish the reliability and generalizability of our results, it is imperative to undertake replication studies encompassing diverse populations and settings. Third, our study relied on self-reported measures, which may be subject to response bias, social desirability, and common method variance. While we assured participants of anonymity and confidentiality to minimize these biases, future research could benefit from incorporating objective measures of innovative behavior and work performance.Fourth, although our study found that work rumination acts as a mediator and information literacy functions as a moderator in the link between challenge stress and innovative behavior, we did not examine other potential variables that could have a mediating or moderating role. It is recommended that future research investigates additional individual, interpersonal, and organizational factors that may impact the relationship between stress and innovation among nurses. Conclusion This study aims to examine the complex correlation between challenge stress, work rumination, information literacy, and innovative behavior, with a specific focus on the nursing profession. The findings underscore the importance of fostering positive self-reflection regarding work and enhancing information literacy skills to effectively leverage the benefits of challenge stress for promoting innovation. Healthcare organizations should prioritize efforts aimed at improving the well-being of nurses, cultivating problem-solving capabilities, and promoting a culture of information literacy to foster innovation within the nursing practice. Declarations Funding None. Data availability statement The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ethical Approval The study protocol received approval from the Zhejiang Provincial People’s Hospital (Affliated People’s Hospital, Hangzhou Medical College). (No. 20240523124529298). Ethical Approval The study protocol was approved by the Ethics Committee of the Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College) (No. 20240523124529298). This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethics and Consent to Participate: This was an online survey study, and the Ethics Committee approved a waiver of the requirement for written informed consent. Participants provided electronic informed consent by clicking to proceed with the online survey. References Bates D W, Levine D, Syrowatka A, et al. The potential of artificial intelligence to improve patient safety: A scoping review[J]. NPJ Digit Med, 2021, 4(1): 54. Drennan V M, Ross F. Global nurse shortages-the facts, the impact and action for change[J]. 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Kingsville U, Kingsville U, Kingsville U. Does stress lead to creativity?: The relationship between occupational stress and individual innovative behavior[J]. Studies in Business and Economics, 2020, 15(1): 21-30. Zoupanou Z, Rydstedt L W. The mediating and moderating role of affective rumination between work interruptions and well-being[J]. Work, 2019, 62(4): 553-561. Alescio-Lautier B, Chambon C, Deshayes C, et al. Problem-solving training modifies cognitive functioning and related functional connectivity in healthy adults[J]. Neuropsychol Rehabil, 2023, 33(1): 103-138. Toscano F, Giusino D, Diana R, et al. The role of emotional regulation in the relationship between nurses' creative style and innovation behaviors: A cross-sectional study[J]. Nurs Rep, 2023, 13(2): 811-822. Sem V, Melissa D R, Yves V N, et al. Barriers and enablers of second-order problem-solving behavior: How nurses can break away from the workaround culture[J]. Quality Management in Health Care, 2022. Ayvaz M Y, Akyol Y E, Demiral M. Innovation in nursing and innovative attitudes of nurses[C], 2019. Development and validation of an instrument to measure nursing information literacy competency[J]. Journal of Korean Academy of Community Health Nursing, 2019, 30(1): 25-37. Jamileh F, Somayeh J, Farhad F, et al. Improving nurses' readiness for evidence-based practice in critical care units: Results of an information literacy training program[J]. BMC Nurs, 2021, 20(1): 79-79. Almarwani A M, Yacoub M I. Examining the effect of an educational program on nursing students' informatics competencies[J]. Nurs Educ Perspect, 2023, 44(6): E59-e61. McGowan B S, Cantwell L P, Conklin J L, et al. Evaluating nursing faculty's approach to information literacy instruction: A multi-institutional study[J]. J Med Libr Assoc, 2020, 108(3): 378-388. Bergren M D, Maughan E D. Data and information literacy: A fundamental nursing competency[J]. NASN Sch Nurse, 2020, 35(3): 140-142. Pleshkan V, Singarella I. Advancing nursing students' transition to scholarship: Embedding a librarian into the advanced nursing research course[J]. J Med Libr Assoc, 2022, 110(2): 228-232. Lokmic-Tomkins Z, Cochrane L, Celeste T, et al. An interdisciplinary partnership approach to improving the digital literacy skills of nursing students to become digitally fluent, work-ready graduates[J]. Stud Health Technol Inform, 2021, 284: 103-107. Diekema A R, Hopkins E B S, Patterson B J, et al. Using information practices of nurses to reform information literacy instruction in baccalaureate nursing programs[J]. Evidence Based Library and Information Practice, 2019. Montani F, Vandenberghe C, Khedhaouria A, et al. Examining the inverted u-shaped relationship between workload and innovative work behavior: The role of work engagement and mindfulness[J]. Human Relations, 2020, 73(1): 59-93. Kinnunen U, Feldt T, de Bloom J. Testing cross-lagged relationships between work-related rumination and well-being at work in a three-wave longitudinal study across 1 and 2 years[J]. Journal of Occupational and Organizational Psychology, 2019, 92(3): 645-670. Vahle-Hinz T, Mauno S, Bloom J d, et al. Rumination for innovation? Analysing the longitudinal effects of work-related rumination on creativity at work and off-job recovery[J]. Work & Stress, 2017, 31(4): 315-337. Cropley M, Collis H. The association between work-related rumination and executive function using the behavior rating inventory of executive function[J]. Front Psychol, 2020, 11: 821. Middleton L, Hall H. Workplace information literacy: A bridge to the development of innovative work behaviour[J]. Journal of Documentation, 2021, 77(6): 1343-1363. D’Souza P, George A, Nair S, et al. Effectiveness of an evidence-based practice training program for nurse educators: A cluster-randomized controlled trial[J]. Worldviews on Evidence-Based Nursing, 2021, 18(4): 261-271. Pauli R, Gaum P M, Cropley M, et al. Antecedents, outcomes and measurement of work related-cognition in non-work time: A multistudy report using the work-related rumination questionnaire in two languages[J]. Front Psychol, 2023, 14: 1013744. Rylee T L, Cvanagh S J. Innovation in nursing practice: A scoping review[J]. ANS Adv Nurs Sci, 2023, 46(4): E115-e131. Fang JQ. Statistical methods for biomedical research. Beijing: Higher Education Press; 2007. p. 283–8. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial.pdf GraphicalAbstract.png Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4466653","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":307570408,"identity":"d28720f5-fc30-45ab-8ab3-da52453fb124","order_by":0,"name":"lifeng yao","email":"","orcid":"","institution":"Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"lifeng","middleName":"","lastName":"yao","suffix":""},{"id":307570410,"identity":"22bf3c51-91ce-4b8e-b771-f388dd78a2e6","order_by":1,"name":"siqi li","email":"","orcid":"","institution":"School of Nursing, Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"siqi","middleName":"","lastName":"li","suffix":""},{"id":307570411,"identity":"4c72eb49-51ff-464b-b50f-d9c7da77c473","order_by":2,"name":"liping yao","email":"","orcid":"","institution":"School of Nursing, Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"liping","middleName":"","lastName":"yao","suffix":""},{"id":307570413,"identity":"a3404b83-36a1-4c3e-9c1c-9c7e1abef356","order_by":3,"name":"qin jia","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College","correspondingAuthor":false,"prefix":"","firstName":"qin","middleName":"","lastName":"jia","suffix":""},{"id":307570416,"identity":"21ca447a-2cc0-440e-a793-7b2402931111","order_by":4,"name":"jing 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11:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4466653/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4466653/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57936911,"identity":"7a6a272b-d261-4adb-bf8d-a0983d7daf2f","added_by":"auto","created_at":"2024-06-07 17:31:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33744,"visible":true,"origin":"","legend":"\u003cp\u003eHypothesized model of the relationship of study variables\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4466653/v1/7d7e9539228117991717a4b1.png"},{"id":57937549,"identity":"318683f2-5aff-45d3-915b-621eb99380c9","added_by":"auto","created_at":"2024-06-07 17:39:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":49920,"visible":true,"origin":"","legend":"\u003cp\u003eSimple slope analysis of the interaction effect between work rumination and innovative behavior\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4466653/v1/aa570767998bed683b759b28.png"},{"id":59631056,"identity":"ebf6f1b3-eb4d-4f6b-8842-c0703f771338","added_by":"auto","created_at":"2024-07-04 05:22:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":971353,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4466653/v1/0534159e-e43a-4671-94b0-2714112b3911.pdf"},{"id":57936908,"identity":"2db8faea-5090-4502-8885-b26c67280bcc","added_by":"auto","created_at":"2024-06-07 17:31:36","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":65103,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4466653/v1/648a2c752d08e398370cf3c7.pdf"},{"id":57936909,"identity":"01445ce4-2a51-487c-9752-382c1d7fec47","added_by":"auto","created_at":"2024-06-07 17:31:36","extension":"png","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":105529,"visible":true,"origin":"","legend":"","description":"","filename":"GraphicalAbstract.png","url":"https://assets-eu.researchsquare.com/files/rs-4466653/v1/2b33c07e469eda3e6d5da6df.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"The dual effect of work rumination in the relationship between challenge stress and innovative behavior: A moderated mediation model of information literacy","fulltext":[{"header":"Background","content":"\u003cp\u003eInnovation in healthcare is of paramount importance in enhancing patient care, boosting efficiency, and tackling the ever-changing demands of the healthcare system[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Nurses, being the largest cohort of healthcare professionals, assume a pivotal role in spearheading innovation within healthcare environments[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As the healthcare environment continues to grow in complexity and patient demands become increasingly diverse, nurses are faced with greater expectations in terms of their scientific knowledge and practical skills[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, the demanding nature of nursing work often exposes nurses to elevated levels of stress, which can have an impact on their capacity to engage in innovative behavior [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recent studies have primarily focused on the concept of challenge stress, which refers to a type of stress that can promote personal growth and achievement [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Several studies have established a positive correlation between stress induced by challenges and innovative behavior [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Nevertheless, some researchers have proposed that the dynamics of this relationship may exhibit greater complexity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Work rumination, which is defined as the inclination to contemplate work-related issues beyond normal working hours [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], has been proposed as a potential mediator in the relationship between stress resulting from challenges and job performance [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Furthermore, the substantial progress of information technology has instigated a revolution in diverse facets of the healthcare sector, encompassing nursing practice. However, despite the augmented accessibility of online library resources in the professional environment, nurses frequently encounter obstacles in fully harnessing the capabilities of these resources [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This constraint inhibits nurses' ability to access the most recent research findings and hampers the implementation of the best available evidence in clinical practice [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nurses' information literacy, a critical component in addressing this challenge, pertains to their capacity to identify information needs, explore and assess information, and utilize it ethically to achieve optimal nursing practice goals[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. One study has identified nurses' information literacy as a critical factor influencing their innovative behavior, with higher levels of information literacy positively predicting nurses' innovation performance [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Nurses with a high level of information literacy possess greater capabilities to effectively navigate the ever-expanding reservoir of knowledge, critically assess evidence, and translate research discoveries into novel strategies that augment the quality of patient care[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, the correlation between information literacy and innovative behavior among nurses remains insufficiently comprehended, especially within the framework of work-related stress. Nurses commonly encounter work rumination, a type of perseverative cognition marked by repetitive contemplations about work-related matters. This phenomenon can exert both positive and negative impacts on their well-being and performance[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. While a study suggests that work rumination has the potential to enhance problem-solving skills and creativity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], contrasting research indicates that it may also lead to emotional exhaustion and decreased innovation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Nevertheless, the degree to which information literacy can moderate the relationship between work rumination and innovative behavior remains largely unexplored in the nursing context. This study aims to examine the role of work rumination in mediating the relationship between challenge stress and innovative behavior among nurses, as well as the moderating effect of information literacy on the association between work rumination and innovative behavior. Through an examination of these relationships, our aim is to offer valuable insights into the determinants that impact the innovative behavior of nurses and to provide guidance on strategies that can be employed to facilitate and encourage innovation within healthcare environments. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the proposed model for the study.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe propose the following hypotheses based on previous studies and their findings.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 1\u003c/strong\u003e \u003cp\u003eThere will be a positive relationship between challenge stress and innovative behavior among nurses.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 2\u003c/strong\u003e \u003cp\u003eWork rumination will mediate the relationship between challenge stress and innovative behavior.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis\u003c/strong\u003e \u003cp\u003ea: Problem-solving pondering will positively mediate the relationship between challenge stress and innovative behavior.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis\u003c/strong\u003e \u003cp\u003eb: Affective rumination will negatively mediate the relationship between challenge stress and innovative behavior.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypothesis 3\u003c/strong\u003e \u003cp\u003eInformation literacy will moderate the relationships among challenge stress, work rumination, and innovative behavior.\u003c/p\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional study to examine the influence of challenge stress on the innovative behavior of nurses and to explore the underlying mechanisms.The Kendall sample size estimation method was adopted to determine the sample size according to 5\u0026ndash;10 times the survey entry items[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. This survey comprised 46 entry items. Considering 10% inefficiency, the appropriate sample size of this study was determined to be 256\u0026ndash;512.\u003c/p\u003e \u003cp\u003eIn May 2024, a stratified cluster sampling approach was employed to recruit nurses from 25 hospitals situated in different provincial and municipal regions throughout China.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were: (1) registered nurses who possessed their professional qualification certificates, (2) nurses involved in frontline clinical nursing duties, and (3) nurses who granted informed consent and willingly took part in the study.Nurses were excluded if they were (1) nursing interns; (2) absent from their positions during the survey period due to health issues, family matters, or other personal reasons.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Collection and Measures\u003c/h2\u003e \u003cp\u003eAn anonymous online survey was administered through Questionnaire Star (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wjx.cn/\u003c/span\u003e\u003cspan address=\"https://www.wjx.cn/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), a professional online questionnaire platform. The survey link and QR code were distributed to Chinese nurse online groups via WeChat, allowing participants to respond at their convenience. The survey began with an informed consent form detailing the study objectives. Participants were asked, \"Would you like to participate in this study?\" with response options of \"Yes\" or \"No.\" Choosing \"Yes\" indicated voluntary consent, and participants then proceeded to complete the questionnaire.\u003c/p\u003e \u003cp\u003eIn this study, a self-designed questionnaire was employed to gather data on various sociodemographic variables. These variables included gender, age, marital status, educational background (excluding current students), years of experience in nursing, professional title, frequency of night shifts per month, workplace, hospital level, department, interest in scientific research, requirement for promotion (such as innovative achievements), patent application, participation in clinical nursing quality improvement projects, involvement in clinical nursing innovation projects or competitions, publication of papers, as well as application and participation in research projects as either the principal investigator or collaborator.\u003c/p\u003e \u003cp\u003eThe Challenge Stress Scale, which was adapted from Cavanaugh et al.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], was utilized to measure the extent of stress encountered by individuals in response to the situations delineated in the statements. The scale consists of six items that are rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;not at all, 5\u0026thinsp;=\u0026thinsp;very high stress), with higher scores indicating a greater perception of stress. The Chinese version of the scale demonstrated a Cronbach's α of 0.92, signifying a high level of internal consistency reliability[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Nurse Innovation Behavior Scale, which was adapted from Bao Ling et al.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], was utilized to assess the innovative behavior of nurses. This scale consists of three dimensions: idea generation (3 items), obtaining support (4 items), and idea implementation (3 items). It employs a Likert 5-point rating scale, ranging from \"never\" to \"very frequently,\" with scores ranging from 1 to 5. Higher total scores indicate a greater level of innovative behavior among nurses. The original scale demonstrates a high level of internal consistency reliability, with an overall Cronbach's α coefficient of 0.912. Additionally, other studies have revealed that the Cronbach's α for the Chinese version of the scale ranges from 0.907 to 0.94 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Work-Related Rumination Questionnaire (WRRQ), developed by Cropley et al.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], was utilized to assess work rumination. The questionnaire includes two subscales, namely affective rumination and problem-solving pondering, each consisting of five items. A Likert 5-point scoring system was employed, with 1 representing \"almost never\" and 5 representing \"always.\" Higher scores indicate higher levels of work rumination. In the present study, the internal consistency of the affective rumination subscale was measured at α\u0026thinsp;=\u0026thinsp;0.89, while the problem-solving pondering subscale demonstrated α\u0026thinsp;=\u0026thinsp;0.86[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Information Literacy Questionnaire (ILQ), which was developed by Chinese scholar Shu Yan in 2009 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], was utilized to assess the information literacy of nurses. The scale encompasses four dimensions: information awareness (4 items), information abilities (6 items), information knowledge (6 items), and information ethics (4 items), resulting in a total of 20 items. Respondents rated each item on a Likert 5-point scale, with 1 indicating \"strongly disagree\" and 5 indicating \"strongly agree.\" The total score ranges from 20 to 100, with higher scores denoting greater information literacy among nurses. The overall Cronbach's α coefficient for the scale is 0.904, with Cronbach's α coefficients for each dimension ranging from 0.603 to 0.839. In the present study, the Cronbach's α coefficient for the Chinese-ILQ is 0.906 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA total of 560 questionnaires were received, out of which 27 incomplete or invalid responses were excluded. Consequently, 533 questionnaires were deemed valid for analysis, resulting in an effective response rate of 95.18%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were utilized to summarize the demographic characteristics and study variables. Pearson correlation analysis was conducted to explore the associations between challenge stress, work rumination, information literacy, and innovative behavior. The study employed the PROCESS macro (version 3.5) developed by Hayes (2018)[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] in SPSS (version 26.0) to examine the mediating effect of work rumination and the moderating effect of information literacy on the relationship between challenge stress and innovative behavior. Specifically, Model 4 was utilized to test the mediating effect of work rumination, while Model 14 was employed to test the moderating effect of information literacy. The significance of the regression coefficients was assessed using the bias-corrected bootstrap method with 5,000 resamples and a 95% confidence interval (CI). Statistical significance was determined when the 95% CI did not contain zero.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eSociodemographic Characteristics\u003c/h2\u003e\n \u003cp\u003eA total of 533 nurses participated in the study, with an average age of 36.2 years (SD\u0026thinsp;=\u0026thinsp;8.4). The majority of the participants were female (96.2%), married (77.5%), and held a bachelor\u0026apos;s degree (87.1%). The average duration of nursing experience was 14.3 years (SD\u0026thinsp;=\u0026thinsp;8.7), with 42.8% of the participants having 12\u0026ndash;21 years of experience. Almost half of the participants (49.5%) had less than two night shifts per month, while 8.8% had ten or more night shifts per month.\u003c/p\u003e\n \u003cp\u003eMost of the participants held the professional title of supervisor nurse (48.6%), followed by nurse practitioner (23.1%), associate chief nurse (17.1%), chief nurse (3.9%), and nurse (7.3%). The majority of the participants worked in municipal hospitals (57.6%) and tertiary Grade A hospitals (77.7%). The most common department was general wards (73.9%), followed by ICU (15.9%), outpatient (5.6%), emergency (2.8%), and operating room (1.7%).\u003c/p\u003e\n \u003cp\u003eRegarding research and innovation, 64.9% of the participants expressed an interest in scientific research, and 80.5% reported having promotion requirements related to innovative achievements. However, only 36.8% had applied for patents, and 71.1% had participated in clinical nursing quality improvement projects. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the detailed sociodemographic characteristics of the study participants.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic characteristics of the study participants (N\u0026thinsp;=\u0026thinsp;533) .\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValid Percentage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCumulative Percentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u0026ndash;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u0026ndash;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYears of Nursing Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u0026ndash;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u0026ndash;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFrequency of Night Shifts per Month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u0026ndash;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u0026ndash;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation (excluding current enrollment)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBelow College\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026apos;s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026apos;s and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional Title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSenior Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCharge Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeputy Chief Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChief Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorkplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProvincial Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMunicipal Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospital Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary Grade A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary Grade B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency Department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOperating Room\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral Ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutpatient Department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterest in Research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDesire for Promotion(e.g., innovative achievements)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatent Application\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParticipation in Clinical Nursing Quality Improvement Projects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParticipation in clinical nursing innovation projects or competitions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublication of research papers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eApplication, leadership, or participation in research projects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eCorrelations among Innovative Behavior, Challenge Stress, Work Rumination, and Information Literacy\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the correlations among the variables studied. Innovative behavior exhibited positive correlations with challenge stress (r\u0026thinsp;=\u0026thinsp;0.142, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), work rumination (r\u0026thinsp;=\u0026thinsp;0.348, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and information literacy (r\u0026thinsp;=\u0026thinsp;0.589, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Information literacy demonstrated significant positive correlations with education level (r\u0026thinsp;=\u0026thinsp;0.187, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), department (r\u0026thinsp;=\u0026thinsp;0.091, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), challenge stress (r\u0026thinsp;=\u0026thinsp;0.087, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and work rumination (r\u0026thinsp;=\u0026thinsp;0.251, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). However, a negative correlation was observed between information literacy and hospital level (r = -0.090, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Work rumination was positively correlated with gender (r\u0026thinsp;=\u0026thinsp;0.085, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and challenge stress (r\u0026thinsp;=\u0026thinsp;0.627, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). A negative correlation was found between challenge stress and hospital level (r = -0.093, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelations among study variables\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.Gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.Workplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.173**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.Hospital Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.130**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.349**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.Department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.253**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.challenge stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.093*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.work rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.085*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.627**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.information literacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.187**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.090*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.091*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.087*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.251**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.Innovative behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.142**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.348**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.589**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003ePredictors of Innovative Behavior and Work Rumination\u003c/h2\u003e\n \u003cp\u003eThe results of regression analyses (Tables \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) indicate that challenge stress has a positive association with innovative behavior (\u0026beta;\u0026thinsp;=\u0026thinsp;0.14, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and is significantly correlated with work rumination (\u0026beta;\u0026thinsp;=\u0026thinsp;0.637, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as well as its affective (\u0026beta;\u0026thinsp;=\u0026thinsp;0.703, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and problem-solving dimensions (\u0026beta;\u0026thinsp;=\u0026thinsp;0.215, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\"\u003e\n \u003cp\u003eTable 3.Regression Analyses Predicting Innovative Behavior and Different Dimensions of Work Rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eOutcome Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003ePredictor Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003eLLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003eULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eInnovative Behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eChallenge Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e3.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eWork Rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eChallenge Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e18.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.704\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eInnovative Behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eChallenge Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e-2.652\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e-0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eWork Rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e8.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eAffective Rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eChallenge Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e22.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.765\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eInnovative Behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eChallenge Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e4.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eAffective Rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e-0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e-3.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e-0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eproblem-solving pondering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eChallenge Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e5.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eInnovative Behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eChallenge Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e-0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eproblem-solving pondering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e15.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.183673469387756%\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"bottom\"\u003e\u003cbr\u003e\u0026nbsp; Table 4. Mediation Analysis: The Role of Different Dimensions of Rumination in the Relationship Between Challenge Stress and Innovative Behavior\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.309278350515465%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.649484536082475%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"bottom\"\u003e\n \u003cp\u003eEffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"bottom\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"bottom\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"bottom\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"bottom\"\u003e\n \u003cp\u003eLLCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\" valign=\"bottom\"\u003e\n \u003cp\u003eULCI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.309278350515465%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.649484536082475%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e3.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.309278350515465%\" rowspan=\"3\"\u003e\n \u003cp\u003eDirect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.649484536082475%\"\u003e\n \u003cp\u003ework rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e-2.652\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e-0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.137931034482758%\"\u003e\n \u003cp\u003eaffective rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e4.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.137931034482758%\"\u003e\n \u003cp\u003eproblem-solving pondering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e-0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.309278350515465%\" rowspan=\"3\"\u003e\n \u003cp\u003eIndirect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.649484536082475%\"\u003e\n \u003cp\u003ework rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.137931034482758%\"\u003e\n \u003cp\u003eaffective rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e-0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e-0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e-0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.137931034482758%\"\u003e\n \u003cp\u003eproblem-solving pondering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRegarding the predictive models for innovative behavior, challenge stress has a negative direct effect (\u0026beta;=-0.14, p\u0026thinsp;=\u0026thinsp;0.008), while work rumination demonstrates a positive influence (\u0026beta;\u0026thinsp;=\u0026thinsp;0.438, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Affective rumination is found to have a negative prediction for innovative behavior (\u0026beta;=-0.192, p\u0026thinsp;=\u0026thinsp;0.001), in contrast to the positive prediction by problem-solving pondering (\u0026beta;\u0026thinsp;=\u0026thinsp;0.564, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Notably, the direct effect of challenge stress on innovative behavior is non-significant in the problem-solving pondering model (\u0026beta;\u0026thinsp;=\u0026thinsp;0.019, p\u0026thinsp;=\u0026thinsp;0.615).\u003c/p\u003e\n \u003cp\u003eAn academic mediation analysis was conducted using the PROCESS macro (Model 4) to investigate the role of work rumination in the association between challenge stress and innovative behavior. The results indicated that work rumination played a significant mediating role in the relationship between challenge stress and innovative behavior (indirect effect: 0.279, 95% CI [0.199, 0.362]).\u003c/p\u003e\n \u003cp\u003eAffective rumination exhibited a significantly negative indirect effect (Effect = -0.135, 95% CI [-0.222, -0.043]), whereas problem-solving pondering exhibited a significantly positive indirect effect (Effect\u0026thinsp;=\u0026thinsp;0.121, 95% CI [0.064, 0.182]). The overall effect of challenge stress on innovative behavior remained consistently significant in all mediation models (Effect\u0026thinsp;=\u0026thinsp;0.14, 95% CI [0.054, 0.225]). (Table\u0026nbsp;4)\u003c/p\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003eTesting for the moderated mediation effect\u003c/h2\u003e\n \u003cp\u003eAn analysis of moderation was performed using the PROCESS macro (Model 14) to investigate the role of information literacy in the relationship between work rumination and innovative behavior among nurses (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e). Work rumination (\u0026beta;\u0026thinsp;=\u0026thinsp;0.251, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and information literacy (\u0026beta;\u0026thinsp;=\u0026thinsp;0.546, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were observed as significant positive predictors of innovative behavior, while challenge stress was not (\u0026beta;= -0.064, p\u0026thinsp;=\u0026thinsp;0.15). The interaction between work rumination and information literacy was found to be significant (\u0026beta;\u0026thinsp;=\u0026thinsp;0.069, p\u0026thinsp;=\u0026thinsp;0.019).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eModeration analysis: The role of information literacy in the relationship between work rumination and innovative behavior\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInnovative Behavior\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ecoeff\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ese\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLLCI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eULCI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003econstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.221\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChallenge Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWork Rumination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.341\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInformation Literacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInt_1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorkplace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospital Rank\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepartment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eR\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.631***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eModerated mediation analysis revealed that the indirect impact of challenge stress on innovative behavior, mediated by work rumination, was subject to moderation by information literacy. The mediating effect was found to be more pronounced among nurses with higher levels of information literacy (Effect\u0026thinsp;=\u0026thinsp;0.204, 95% CI [0.121, 0.287]) compared to those with average (Effect\u0026thinsp;=\u0026thinsp;0.16, 95% CI [0.096, 0.227]) or lower levels (Effect\u0026thinsp;=\u0026thinsp;0.116, 95% CI [0.044, 0.19]). The significant index of moderated mediation (Index\u0026thinsp;=\u0026thinsp;0.044, 95% CI [0.003, 0.086]) confirmed that information literacy strengthens the mediating effect of work rumination between challenge stress and innovative behavior.(Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e)\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eModerated mediation analysis: The role of information literacy in the mediation of work rumination between challenge stress and innovative behavior\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003einformation literacy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEffect\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBootLLCI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBootULCI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.7953\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7953\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIndex of Moderated Mediation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eTo further explore the moderating influence of information literacy, the variable was categorized into high and low groups using a standard deviation above and below the mean (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD). A simple slope analysis was performed to assess the interaction effect (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The association between work rumination and innovative behavior was found to be more pronounced among nurses with high information literacy levels, in contrast to those with low information literacy levels.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we provide significant insights into the complex interrelationships among challenge stress, work rumination, information literacy, and innovative behavior among Chinese nurses. Our study elucidates the multifaceted influence of challenge stress on innovation, and sheds light on the divergent consequences of affective rumination and problem-solving pondering. Furthermore, we underscore the significance of information literacy in moderating these associations. Consistent with prior research, we have identified a positive correlation between challenge stress and the manifestation of innovative behavior. This finding suggests that, under moderate levels of stress, creativity and innovation can be effectively amplified [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our regression analysis revealed that, when considering the mediating effect of work rumination, there exists a detrimental direct impact of challenge stress on innovative behavior. This highlights the fact that challenge stress can have both positive and negative impacts on innovation, contingent upon its intensity and duration [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Healthcare organizations must strive to strike a delicate equilibrium whereby they foster a stimulating environment for nurses that presents them with ample challenges, all while implementing measures to mitigate the adverse consequences of excessive stress on their overall well-being and capacity for innovation.\u003c/p\u003e \u003cp\u003eWork rumination has been identified as a noteworthy mediating factor in the relationship between challenge stress and innovative behavior. Affective rumination was found to have a negative indirect impact, while problem-solving pondering had a positive indirect impact. These findings align with recent studies that highlight the diverse impacts of various forms of work-related rumination on employee outcomes [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Affective rumination, characterized by negative emotional experiences, hinders innovative behavior by depleting cognitive resources and fostering a pessimistic outlook [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In contrast, engaging in problem-solving deliberation, which involves thoughtful reflection on work-related issues, can contribute to the development of innovative behavior by facilitating creative problem-solving and idea generation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Encouraging nurses to assume ownership of problem-solving processes, along with providing them with essential resources and dedicated time, can facilitate the development of sustainable solutions to recurrent issues in patient care [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe moderated mediation analysis revealed that information literacy plays a pivotal role in enhancing the relationship between work rumination and innovative behavior.\u003c/p\u003e \u003cp\u003eNurses with a higher degree of information literacy demonstrated a more pronounced correlation between work rumination and innovative behavior, in contrast to individuals with lower levels of information literacy. This finding underscores the importance of equipping nurses with the requisite abilities to effectively process and utilize work-related information. This, in turn, will bolster their capacity for innovation [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Information literacy enables nurses to effectively identify, evaluate, and apply relevant knowledge, thereby enhancing their problem-solving capabilities and fostering creative thinking in challenging situations.\u003c/p\u003e \u003cp\u003eIn today's constantly evolving healthcare landscape, nurses must possess the essential skill of information literacy. This skill is of paramount importance in effectively implementing evidence-based practice, particularly as healthcare technologies continue to progress [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In order to enhance the information literacy skills of nurses, it is recommended that nursing programs give priority to integrating information literacy into practice. This can be accomplished by fostering collaboration between nursing educators and librarians [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This integration should be considered a vital component of the nursing curriculum, placing emphasis on the cultivation of skills and their practical implementation [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. To improve proficiency in these skills, one can adopt strategies such as engaging in interdisciplinary collaborations and utilizing online tools for database searching [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The information practices of professional nurses should also inform the content and delivery of information literacy education [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study carries substantial implications for both the practice of nursing and healthcare organizations. Managers should acknowledge the potential advantages of challenge stress in promoting innovative behavior, but they should also be aware of its negative consequences when it becomes excessive or prolonged [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Interventions aimed at promoting problem-solving reflection among employees, as opposed to becoming entrenched in negative emotions, can contribute to the establishment of a work environment that is more conducive to innovation [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Investing in training programs and providing sustained support can significantly enhance the information literacy skills of nurses. Consequently, this can empower them to effectively navigate intricate information environments and foster the development of innovative practices [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study has several limitations that warrant consideration. First, the utilization of a cross-sectional design in this study precludes us from establishing causal inferences regarding the interplay between challenge stress, work rumination, information literacy, and innovative behavior. In order to ascertain the causal and temporal dynamics of these relationships, it is imperative for future research to employ longitudinal or experimental designs. Second, although we have effectively recruited a substantial number of nurses from different regions and hospital settings in China, the implications of our findings in various healthcare contexts and cultures remain uncertain. To establish the reliability and generalizability of our results, it is imperative to undertake replication studies encompassing diverse populations and settings. Third, our study relied on self-reported measures, which may be subject to response bias, social desirability, and common method variance. While we assured participants of anonymity and confidentiality to minimize these biases, future research could benefit from incorporating objective measures of innovative behavior and work performance.Fourth, although our study found that work rumination acts as a mediator and information literacy functions as a moderator in the link between challenge stress and innovative behavior, we did not examine other potential variables that could have a mediating or moderating role. It is recommended that future research investigates additional individual, interpersonal, and organizational factors that may impact the relationship between stress and innovation among nurses.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study aims to examine the complex correlation between challenge stress, work rumination, information literacy, and innovative behavior, with a specific focus on the nursing profession. The findings underscore the importance of fostering positive self-reflection regarding work and enhancing information literacy skills to effectively leverage the benefits of challenge stress for promoting innovation. Healthcare organizations should prioritize efforts aimed at improving the well-being of nurses, cultivating problem-solving capabilities, and promoting a culture of information literacy to foster innovation within the nursing practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol received approval from the Zhejiang Provincial People\u0026rsquo;s Hospital (Affliated People\u0026rsquo;s Hospital, Hangzhou Medical College). (No. 20240523124529298).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of the Zhejiang Provincial People\u0026apos;s Hospital (Affiliated People\u0026apos;s Hospital, Hangzhou Medical College) (No. 20240523124529298). This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethics and Consent to Participate:\u003c/p\u003e\n\u003cp\u003eThis was an online survey study, and the Ethics Committee approved a waiver of the requirement for written informed consent. Participants provided electronic informed consent by clicking to proceed with the online survey.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBates D W, Levine D, Syrowatka A, et al. The potential of artificial intelligence to improve patient safety: A scoping review[J]. 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An interdisciplinary partnership approach to improving the digital literacy skills of nursing students to become digitally fluent, work-ready graduates[J]. Stud Health Technol Inform, 2021, 284: 103-107.\u003c/li\u003e\n \u003cli\u003eDiekema A R, Hopkins E B S, Patterson B J, et al. Using information practices of nurses to reform information literacy instruction in baccalaureate nursing programs[J]. Evidence Based Library and Information Practice, 2019.\u003c/li\u003e\n \u003cli\u003eMontani F, Vandenberghe C, Khedhaouria A, et al. Examining the inverted u-shaped relationship between workload and innovative work behavior: The role of work engagement and mindfulness[J]. Human Relations, 2020, 73(1): 59-93.\u003c/li\u003e\n \u003cli\u003eKinnunen U, Feldt T, de Bloom J. Testing cross-lagged relationships between work-related rumination and well-being at work in a three-wave longitudinal study across 1 and 2 years[J]. 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Worldviews on Evidence-Based Nursing, 2021, 18(4): 261-271.\u003c/li\u003e\n \u003cli\u003ePauli R, Gaum P M, Cropley M, et al. Antecedents, outcomes and measurement of work related-cognition in non-work time: A multistudy report using the work-related rumination questionnaire in two languages[J]. Front Psychol, 2023, 14: 1013744.\u003c/li\u003e\n \u003cli\u003eRylee T L, Cvanagh S J. Innovation in nursing practice: A scoping review[J]. ANS Adv Nurs Sci, 2023, 46(4): E115-e131.\u003c/li\u003e\n \u003cli\u003eFang JQ. Statistical methods for biomedical research. Beijing: Higher Education Press; 2007. p. 283\u0026ndash;8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Challenge stress, Work rumination, Information literacy, Innovative behavior, Nurses, Moderated mediation","lastPublishedDoi":"10.21203/rs.3.rs-4466653/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4466653/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNurses encounter significant challenge stress, which has the potential to influence their innovative behavior. However, the precise mechanisms underlying this phenomenon remain unclear. This study sought to examine the mediating role of work rumination in the relationship between challenge stress and innovative behavior. Additionally, it aimed to explore the moderating role of information literacy in the association between work rumination and innovative behavior among Chinese nurses.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was conducted among 533 nurses from 25 hospitals in China in May 2024. Participants were instructed to complete an online questionnaire designed to measure challenge stress, work rumination, information literacy, and innovative behavior. The data collected from the questionnaire was subsequently analyzed using mediation and moderated mediation analyses, carried out with the aid of the PROCESS macro in SPSS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eChallenge stress was positively associated with innovative behavior (r\u0026thinsp;=\u0026thinsp;0.142, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and work rumination (r\u0026thinsp;=\u0026thinsp;0.348, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Work rumination partially mediated the relationship between challenge stress and innovative behavior (indirect effect: 0.279, 95% CI [0.199, 0.362]). Affective rumination had a negative indirect effect (Effect=-0.135, 95% CI [-0.222, -0.043]), while problem-solving pondering had a positive indirect effect (Effect\u0026thinsp;=\u0026thinsp;0.121, 95% CI [0.064, 0.182]). Information literacy moderated the relationship between work rumination and innovative behavior (interaction term β\u0026thinsp;=\u0026thinsp;0.069, p\u0026thinsp;=\u0026thinsp;0.019), with the mediating effect being stronger among nurses with higher information literacy (Effect\u0026thinsp;=\u0026thinsp;0.204, 95% CI [0.121, 0.287]).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWork rumination plays a mediating role in the relationship between challenge stress and nurses' innovative behavior. Specifically, problem-solving pondering exerts a positive influence, while affective rumination exerts a negative influence. Information literacy enhances the positive mediating effect of work rumination. These findings underscore the significance of promoting positive work rumination and information literacy to cultivate innovative behavior among nurses who encounter challenge stress.\u003c/p\u003e","manuscriptTitle":"The dual effect of work rumination in the relationship between challenge stress and innovative behavior: A moderated mediation model of information literacy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-07 17:31:30","doi":"10.21203/rs.3.rs-4466653/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d527db1-566a-46ce-8462-a2533fd314bf","owner":[],"postedDate":"June 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-04T05:06:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-07 17:31:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4466653","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4466653","identity":"rs-4466653","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}