Job stress among home-visiting nurses in China: direct, moderating, and mediating pathways based on the job demands-resources model

Job stress among home-visiting nurses in China: direct, moderating, and mediating pathways based on the job demands-resources model | 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 Job stress among home-visiting nurses in China: direct, moderating, and mediating pathways based on the job demands-resources model Li Dai, Jiao Xiong, Yujiao Sun, Suyu Wei This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7496717/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 Home-visiting nurses in China face escalating job stress due to the growing demand for home-based services driven by the rapidly aging population, weakening family support structures, and ongoing national healthcare reforms. Their work is characterized by limited organizational support and exposure to workplace violence, yet the stress mechanisms in this group remain underexplored. This study applied the Job Demands-Resources (JD-R) model to examine (1) the direct effect of job demands, job resources, and workplace violence on job stress, (2) the moderating role of job resources, and (3) the mediating effect of workplace violence. Methods A cross-sectional survey was conducted among 434 home-visiting nurses from 13 institutions across two Chinese provinces. Measures included the Chinese versions of the Job Demand Scale (subjective job demands), weekly working hours (objective job demands), Job Resources Scale, and the Community Nurse Stress Scale, as well as five self-developed items assessing workplace violence. Path analysis using SPSS 26.0 and AMOS 22.0 examined direct, moderating, and mediating effects under different levels of job resources. Results Path analysis showed that subjective job demands (β = 0.54, p < 0.001) and workplace violence (β = 0.15, p < 0.001) significantly increased job stress, while job resources reduced it (β = −0.18, p 0.05). Job resources buffered the positive relationship between job demands and stress (β = −0.13, p < 0.001). Workplace violence mediated the effect of job demands on stress (β = 0.18, p < 0.001; β = 0.15, p < 0.001). The final model demonstrated excellent fit (χ²=3.73, df = 3, p = 0.29, Comparative Fit Index [CFI] = 1.00; Root Mean Square Error of Approximation [RMSEA] = 0.02), and results were consistent across different levels of job resources. Conclusions Our findings highlight the protective and moderating roles of job resources, and the mediating role of workplace violence on job stress among home-visiting nurses. Targeted interventions should focus on strengthening organizational resources and preventing workplace violence to reduce job stress and improve workforce sustainability. Job stress job demands job resources workplace violence home-visiting nurses JD-R model China moderation mediation Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Healthcare services are increasingly shifting from institutional settings to home-based environments driven by demographic changes, rising healthcare costs, and patient preferences for receiving care at home. In China, the population aged 65 years and older has reached approximately 220 million, accounting for 15.4% of the total population, with an elderly dependency ratio of 22.6%. At the same time, traditional extended-family support structures continue to erode. Between 2013 and 2023, the total number of households increased by 145,000, with one- and two-person households accounting for 57,873 (39.9%) of this growth. One-person households alone surged by 37,692, representing a 71.4% increase (National Bureau of Statistics, 2025). These sociodemographic changes have substantially intensified the demand for home-based nursing services. In response, national initiatives explicitly encourage nurses to deliver clinical, rehabilitation, medicine, and educational care in patients’ homes (National Health Commission, 2022; National Health Commission General Office, 2024). Despite a growing demand, high job stress discourages many nurses from participating in the home visit profession, resulting in a limited workforce and restricting service expansion (Dai et al., 2024; Yin et al., 2025; Zhang et al., 2025) Job stress is a state of emotional unease triggered by job demands that are considered threatening (McCraty & Tomasino, 2006). Job stress is a major global concern in nursing, leading to detrimental consequences. It increases burnout (Hetzel-Riggin et al., 2020; Lee & Oh, 2023; Singh et al., 2021) and turnover intention (Baek et al., 2019; Cao et al., 2021; Lee & Oh, 2023), reduces job engagement (Tsen et al., 2023), deteriorates physical health(Chang et al., 2021), and negatively affects quality of life (Babapour et al., 2022). Home-visiting nurses face a challenging work environment compared to their hospital-based counterparts, largely owing to the independent nature of the work, unpredictable home environments, and limited access to immediate support (Grasmo et al., 2021; Kim et al., 2020; Wipfli et al., 2012). Thus, high job stress is prevalent among home-visiting nurses worldwide (Kaihlanen et al., 2023; Karakaya & Uçar, 2023; Kim et al., 2021; Lee & Oh, 2023; Muramatsu et al., 2019; Singh et al., 2021; Tsen et al., 2023). In China, stress levels among home healthcare nurses are significantly higher than those among hospital nurses (Yang, 2009), with 34.6% of home-visiting nurses reporting substantial job stress (Dai et al., 2024). Given these unique stressors, it is essential to understand the potential mechanisms of job stress in this workforce and identify the risk factors to mitigate job stress. The Job Demands-Resources (JD-R) model provides a useful theoretical framework for understanding job stress and wellbeing (Bakker & Demerouti, 2007). This model posits that employee well-being results from the balance between job demands and job resources, with two key psychological processes: a health impairment process, in which high job demands (e.g., workload, emotional labor, and role conflict) deplete physical and emotional resources, leading to exhaustion and health problems, and a motivational process, in which job resources (e.g., social support, autonomy, and feedback) buffer job demands and enhance engagement (Bakker & Demerouti, 2007). In the JD-R model, job demands are a key factor influencing job stress. They encompass the physical, psychological, social, and organizational aspects of work that require sustained cognitive, emotional, or physical effort, leading to physiological and psychological costs (Bakker & Demerouti, 2007). Job demands can be subjective, and include an excessive workload, role ambiguity, emotional strain, time pressure, and work–family conflict. The excessive job demands in home care settings are strongly linked to job stress (Kaihlanen et al., 2023; Ruotsalainen et al., 2020; Tsen et al., 2023). Moreover, objective job demands, such as long working hours, are associated with elevated risks of chronic fatigue, stress, and even depression (Lee & Oh, 2023; Yoon et al., 2018). The second key component of the JD-R model is job resources. These are the physical, psychological, social, and organizational aspects of work that help people reach their goals, ease job demands and the strain they cause, and support personal growth and learning (Bakker & Demerouti, 2007). The indicators of appropriate job resources include social support, autonomy, and opportunity development. Such resources have been shown to lower stress among home-visiting nurses and boost job satisfaction and engagement (Kaihlanen et al., 2023; Tsen et al., 2023). However, their protective effects have rarely been explored in home care settings. Workplace violence, including verbal abuse, threats, physical assault, and intimidation by humans or animals, is another important factor contributing to stress among nurses who conduct home visits (National Institute for Occupational Safety and Health (NIOSH), 2010). In China, safety-related resource support has been identified as the primary need for healthcare workers engaged in home visiting services (Zhou et al., 2024). Studies have revealed that high job demands may directly increase the likelihood of violent incidents (Wu et al., 2015). Exposure to workplace violence can jeopardize physical safety, impose psychological burdens, and elevate job stress (Magnavita et al., 2020; Pariona-Cabrera et al., 2024; Sayin et al., 2023; Sun et al., 2021). This suggests a potential health impairment pathway within the JD-R framework, in which excessive job demands may increase the risk of workplace violence, which in turn mediates the relationship between demands and job stress. However, this specific mediating mechanism has not been examined in the context of home care nursing. In China, home healthcare services are still in the early stages of development, and nurses constitute the majority of the workforce in this field (Xiang et al., 2023; Zhou et al., 2024). Community health service centers serve as the primary providers of home-visiting nursing services. In addition, nurses from tertiary and secondary hospitals are encouraged to deliver home-based care, particularly under policy initiatives promoting “Internet Plus Nursing Services” (National Health Commission & National Administration of Traditional Chinese Medicine., 2023). These home-visiting nurses often work alone during off-duty hours (Dai et al., 2024; Gao et al., 2022; Yin et al., 2025). They also operate in a context lacking clear policies, norms, and standards, as well as insufficient organizational support (Huang et al., 2020; Yin et al., 2025; Zhao et al., 2023; Zhou et al., 2024). Collectively, these contextual factors create a high-pressure environment for Chinese home-visiting nurses. Prior work by Liu et al. (2025) revealed that high job demands, inadequate support, and safety concerns contribute to stress and reduced willingness to provide services. Building on the JD-R model and the hypothesized theoretical framework (Figure 1), this study aimed to: 1. Examine the direct effects of job demands, job resources, and workplace violence on job stress among home-visiting nurses. 2. Test the moderating effect of job resources on the relationship between job demands and job stress. 3. Explore the mediating role of workplace violence in the relationship between job demands and job stress. METHODS Design A cross-sectional study design was employed to test the three main aims of the study. Setting This study was conducted in 13 healthcare institutions in China between March 2024 and June 2024. Including 10 tertiary hospitals (5 of which were integrated with community health service centers), 1 secondary hospital (integrated with a community health service center), and 2 community health service centers. Twelve institutions were in Guangdong Province, and one was in the Guangxi Zhuang Autonomous Region. Sampling and sample size Home-visiting nurses were recruited through convenience sampling. The inclusion criteria were: (1) possession of a valid nursing license, (2) participation in home-visiting services within the past year, and (3) provision of informed consent with a willingness to voluntarily participate. Nurses not employed in hospital settings were excluded from the study. While 1,527 nurses provided home healthcare services in these hospitals, the exact number of home visits actively conducted within the past year was unavailable because of the dynamic workforce allocation. We conducted a pilot study with 38 home-visiting nurses to assess item clarity. Based on the pilot data, the standard deviation of the job stress scores was 0.35. Using the sample size estimation formula ( \(\:n=\frac{{Z}_{1-\alpha\:/2}^{2}.{SD}^{2}}{{d}^{2}})\) (Charan & Biswas, 2013 ) for cross-sectional studies, setting a 95% confidence level (Z = 1.96) and a permissible error of 0.035 (10% of the standard deviation), the minimum sample size required was calculated to be 385. Accounting for an estimated invalid response rate of 10%, the final target sample size was 424. Data collection Data were collected using both online and paper-based questionnaires. Before distribution, the number of home-visiting nurses in each hospital was verified with the head nurses. The questionnaires were first distributed electronically via the hospital WeChat groups using the Questionnaire Star applet. To enhance participation, reminders were sent every week, up to a maximum of two times.. In hospitals where the online response rate remained below 10% after these reminders, paper-based questionnaires were administered in person. For online responses, each IP address was restricted to one submission, all questions were mandatory, and screening questions were placed at the beginning of the survey. If a participant indicated that they had not engaged in home-visit nursing within the past year, the system automatically terminated the survey with an “Exit” message. Questionnaires with completion times of less than three minutes were excluded. For paper-based responses, researchers provided on-site clarification as needed. Completed forms were immediately reviewed for missing or illogical answers, and these errors were corrected prior to submission. Measurements The questionnaire consisted of four parts: general information, job demands, job resources, and job stress. General information Questionnaire : A self-designed general information questionnaire was developed based on a literature review and the objectives of this study. The questionnaire included 14 items, including sex, age, years of experience in home-visit nursing, workplace setting, marital status, education level, professional title, total years of nursing experience, number of home-visit training sessions attended in the past year, employment type, average number of home visits per month over the past year, average monthly income, whether the nurse conducted visits alone, and experiences of workplace violence. Workplace violence in the past 12 months was assessed with five items: one general item (no experience vs. any experience) and four items addressing specific subtypes (physical violence, verbal abuse, sexual harassment, and animal threats). Job Demands Job demands were assessed using two separate indicators to capture both subjective and objective aspects of job demands Subjective job demands were assessed using the Chinese version of the Job Demands Scale developed by Zhang ( 2008 ). The scale consists of 19 items across four dimensions: workload (five items), role ambiguity (five items), role conflict (five items), and work–family conflict (four items). A 7-point Likert scale was used, ranging from 1 (strongly disagree) to 7 (strongly agree), with total scores ranging from 19 to 133. Higher scores indicated greater job demands. Items in the workload, role conflict, and work–family conflict dimensions were scored positively, whereas items in the role ambiguity dimension (items 6–10) were reverse-scored. The original scale demonstrated good reliability, with a Cronbach’s α of 0.874 and factor loadings ranging from 0.517 to 0.923. In the present study, Cronbach’s of the scale was 0.903. Objective job demands were measured using participants’ self-reported weekly working hours, categorized as < 50 h or ≥ 50 h. Job Resources : Job resources were measured using sing the Chinese version of the of Job Resources Scale by Zhang ( 2008 ). The scale comprised 22 items across four dimensions: job autonomy (nine items), social support (five items), performance feedback (four items), and career development opportunities (four items). A 7-point Likert scale was used, with scores ranging from 1 (strongly disagree) to 7 (strongly agree), resulting in a total score between 22 and 154. Higher scores reflected more abundant job resources. Items in the job autonomy and social support dimensions scored positively. The reverse-scored items included item 18 (performance feedback dimension) and items 21 and 22 (career development opportunities dimension). The original scale had a Cronbach’s α of 0.916, with subscale alphas ranging from 0.800 to 0.914 and factor loadings between 0.575 to 0.853. In this study, the Cronbach’s alpha was 0.911. Job Stress : Job stress was assessed using the Community Nurse Stress Scale developed by Zhu et al. ( 2020 ). The scale consists of 25 items across four dimensions: management and interpersonal relationships (eight items), patient care (seven items), work environment and resources (six items), and career advancement (four items). A 4-point Likert scale was used (1 = never, 2 = sometimes, 3 = often, and 4 = always), with total scores ranging from 25 to 100. Higher scores indicated higher levels of perceived stress. The original scale demonstrated excellent reliability (Cronbach’s α = 0.940), with subscale alphas ranging from 0.843 to 0.894, factor loadings from 0.507 to 0.835, and the satisfied confirmatory factor analysis indices. In the present study, the Cronbach’s alpha was 0.893. Statistical analysis The data were analyzed using SPSS 26.0 and AMOS 22.0. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the personal characteristics, job demands, job resources, and job stress. Pearson’s correlation and point-biserial correlation analyses were conducted to examine the associations between the core variables. Path analysis was conducted to test the main and interaction effects. The significance level was set at p < 0.05. The moderating effect of job resources on the relationship between job demands and stress was tested using an interaction term approach. Before the analysis, both job demands and resources were mean-centered and the interaction term was constructed by multiplying the centered variables (JD_centered × JR_centered). To further explore the significant moderating effect, we applied a pick-a-point approach to examine the conditional effects of job demands on job stress at low and high levels of job resources (i.e., one standard deviation (SD) below and above the mean of the centered moderator variable) (Collier, 2020 ). Ethical considerations This study was approved by the Institutional Review Board of Shenzhen Bao’an District People’s Hospital (approval no. BYL20231212). Permission was also obtained from the relevant authorities at each study site. An explanation letter describing the study purpose, procedures, and participants’ rights was presented at the beginning of the questionnaire. Participants indicated their consent implicitly by completing the survey. Those who did not wish to participate could simply exit the questionnaire. Participation was voluntary, and participants could withdraw at any time without penalty. All data were collected anonymously and stored securely in accordance with ethical guidelines. RESULTS General information about the participants A total of 511 participants completed the questionnaires. Of these, 77 participants reported no home-visiting experience in the past year, resulting in 434 valid and complete surveys (Table 1 ). The mean age of the home-visiting nurses was 38.41 years (SD = 6.55), and the majority were female (99.54%). Most participants worked in community health service centers (69.59%) and were married (87.33%). The average home healthcare experience was 5.33 years (SD = 4.70). Notably, 10.6% reported experiencing workplace violence, with animal threats (6.91%) being the most frequently reported. Approximately 80% of the nurses reported working alone during their visits. Table 1 Personal characteristics of home-visiting nurses (n = 434) Variables n %/Mean ± SD Age (years) 434 38.41 ± 6.55 Sex Male 2 0.46 Female 432 99.54 Workplace Tertiary hospital 99 22.81 Secondary hospital 33 7.60 Community health service center 302 69.59 Marital status Single 45 10.37 Married 379 87.33 Divorced 8 1.84 Other 2 0.46 Job title Nurse 17 3.92 Nurse practitioner 63 14.52 Nurse practitioner in charge 297 68.43 Associate chief nurse practitioner 54 12.44 Chief nurse practitioner 3 0.69 Educational level Vocational school 4 0.92 Associate degree 61 14.06 Bachelor’s degree 362 83.41 Master’s degree or above 7 1.61 Experience in home visiting nursing (years) 5.33 ± 4.70 Average number of home visits per month (times) 30 times 113 26.04 Average monthly income(CNY) 20000 13 3.00 Employment type Permanent 103 23.73 Contract 325 74.88 Temporary agency 6 1.38 Weekly working hours < 50 321 73.96 ≥ 50 113 26.04 Experienced workplace violence Yes 46 10.60 No 388 89.40 Experienced Workplace violence type Physical violence 3 0.69 Verbal abuse 9 2.07 Sexual harassment 4 0.92 Animal threat 30 6.91 Working alone Yes 341 78.57 No 93 21.43 Job demands, job resources and job stress scores among home-visiting nurses As shown in Table 2 , the overall mean scores for subjective job demands, job resources, and job stress among home visiting nurses were 3.84 ± 0.95, 4.54 ± 0.88, and 1.73 ± 0.35, respectively. Table 2 Job demands, job resources, and job stress scores of home-visiting nurses (n = 434) Variables Items Range Mean SD Subjetive job demands Overall 5.37 3.84 0.95 Work overload 6.00 4.33 1.38 Role ambiguity 6.00 3.06 0.95 Role conflict 6.00 3.51 1.28 Work-family conflict 6.00 4.64 1.59 Job resources Overall 5.09 4.54 0.88 Job autonomy 6.00 3.88 1.19 Social support 5.60 5.18 1.07 Performance feedback 4.75 5.10 0.90 Career development opportunities 6.00 4.65 1.17 Job stress Overall 2.28 1.73 0.35 Management and interpersonal relationships 2.75 1.48 0.41 Patient care 2.14 1.62 0.37 Environment and resources of work 2.67 1.83 0.51 Career promotion 3.00 2.29 0.68 Correlations among the main study variables As shown in Table 3 , Job stress was positively correlated with subjective job demands (r = 0.643, p < 0.001), workplace violence (r = 0.269, p < 0.001), and weekly working hours (r = 0.214, p < 0.001). A significant negative correlation was observed between job stress and job resources (r = − 0.464, p < 0.001). Additionally, subjective job demands and job resources were also negatively correlated (r = − 0.546, p < 0.001). Table 3 Correlation analysis among the five variables (n = 434) Variables 1 2 3 4 5 1 Job stress a 1 2 Subjective job demand a 0.643** 1 3 Job resources a −0.464** −0.546** 1 4 Workplace violence b 0.269** 0.179** −0.069 1 5 Weekly work b hours 0.214** 0.228** −0.141** 0.086 1 Note: ** p < 0.001 (2-tailed); a Pearson correlation; b point biserial correlation. Relationship between subjective job demand, job resources, and weekly work hours on job stress As shown in Fig. 2 , subjective Job demands had a significant positive relationship with job stress (β = 0.54, p < 0.001), whereas job resources had a significant negative effect on job stress (β=−0.18, p < 0.001).Workplace violence also had a positive direct effect on job stress (β = 0.15, p 0.05). The moderating effect of job resources on the relationship between job demands and job stress The interaction term of subjective job demands and job resources had a significant negative relationship with job stress (β=−0.13, p < 0.001) (Fig. 2 ). The mediating effect of the experience of workplace violence on the relationship between job demands and job stress The result showed that the workplace violence had a meditating effect on the relationship between subjective job demands and job stress (subjective job demands → workplace violence: β = 0.18, p < 0.001; workplace violence → job stress: β = 0.15, p < 0.001) (Fig. 2 ). Interaction between variables To probe the interaction effect, we tested the conditional effects of subjective job demands on job stress at different levels of job resources (± 1 SD from the mean). As shown in Fig. 3 , Fig. 4 , and Table 4 , under low job resources, the effect of subjective job demands on job stress was stronger (β = 0.64, p < 0.001), whereas under high job resources, this effect was significantly weaker (β = 0.44, p < 0.001). The path model of job stress As shown in Table 4 , the path model demonstrated a good overall fit with the data. The model fit indices were: χ²=3.73, df = 3, p = 0.29; Normed Fit Index (NFI) = 0.99, Comparative Fit Index (CFI) = 1.00, Incremental Fit Index (IFI) = 1.00, Relative Fit Index (RFI) = 0.96, Tucker-Lewis Index (TLI) = 0.99, and the Root Mean Square Error of Approximation (RMSEA) = 0.02. Similar fit indices were observed under both low and high job resource conditions. Table 4 Model fit indices with different levels of job resources (n = 434) Job Resources Level χ2 /ν NFI CFI IFI RFI TLI RMSEA Average level 1.24 0.99 1.00 1.00 0.96 0.99 0.02 Low level 1.24 1.00 1.00 1.00 0.98 1.00 0.02 High level 1.24 0.99 1.00 1.00 0.97 0.99 0.02 Reference standard 0.90 >0.90 >0.90 >0.90 >0.90 <0.08 DISCUSSION This study examined the direct effects of job demands, job resources, and workplace violence on job stress in home-visiting nurses. Additionally, it explored whether job resources moderate the impact of job demands on stress, and whether workplace violence mediates this relationship. These findings were interpreted using the JD-R model. A central finding of this study was the significant positive association between the subjective job demands and job stress, indicating that higher job demands lead to increased perceived job stress among home visiting nurses. This finding supports the core assumptions of the JD-R model. Job demands continuously deplete the physical and psychological resources of employees. If these resources are not replenished, they can directly lead to stress, burnout, and other health impairment outcomes (Bakker & Demerouti, 2007 , 2017 ). This result is also consistent with previous studies showing that factors such as high workload, emotional labor, time pressure, and complex care coordination are major predictors of home-visiting nurses' job stress (Kaihlanen et al., 2023 ; Ruotsalainen et al., 2020 ; Tsen et al., 2023 ) . Home-visiting nurses in China face excessive workloads, with demands such as substantial time pressure and frequent visits beyond regular working hours. Limited opportunities for rest lead to physical overload, which, in turn, causes significant physical and mental strain (Liu et al., 2025 ). Consequently, to meet increasing service demands, many nurses sacrifice personal and family time, thereby intensifying work–family conflict (Liu et al., 2025 ). Similarly, comparable patterns have been observed internationally, where excessive workload and insufficient recovery times contribute to burnout and stress among home care nurses (Kaihlanen et al., 2023 ; Ruotsalainen et al., 2020 ). In addition, the advanced age and complex health conditions of patients in home care settings require high levels of clinical expertise and communication skills, which may increase job stress (Zhao et al., 2023 ). Role conflict is another notable stressor as home-visiting nurses are expected to perform multiple roles, including clinical or primary nurses, professional caregivers, team members, and family consultants. When expectations across these roles are inconsistent or incompatible, nurses may experience confusion, frustration, and heightened stress (Liu et al., 2025 ). This finding was also reported by Kaihlanen et al. ( 2023 ) in Finland. Role ambiguity contributes to job stress. In China, the absence of clear statements regarding the rights and duties of home visiting nurses (Huang et al., 2020 ) parallels the challenges identified among hospital staff (Alyahya & AboGazalah, 2021 ). Under such circumstances, home visiting nurses may struggle to define responsibilities and allocate resources effectively, leaving them feeling helpless when problems arise. In addition, weekly working hours were examined as an objective indicator of job demand. Results showed that weekly working hours did not directly affect job stress among home-visiting nurses. This finding is not supported by the JD-R model hypothesis and differs from the results of Tsen et al. ( 2023 ). This null result can be explained by three key factors. First, the sample distribution was skewed, with over 70% of the participants working fewer than 50 hours/week, limiting the range of hours examined and potentially masking the associations. Second, weekly work hours may not capture the subjective experience of workload in home care, where time is often spent on non-clinical activities (e.g., travel and documentation) that are not reflected in simple hour counts. Prior studies have emphasized that perceived workload—not objective hours—more strongly predicts stress responses (Spector & Jex, 1998 ), and our findings align with this distinction. Third, job resources may have buffered potential stress from longer hours; resources such as peer support, autonomy, and flexible scheduling could have helped nurses maintain a sense of control and reduced the psychological impact of extended work time. Therefore, the non-significant relationship between weekly working hours and job stress in this study may reflect the complex interplay between workload perception and the buffering role of job resources, rather than the number of work hours alone. This finding indicates that conventional objective measures of workload may be insufficient to capture the nuanced pressures faced by home-visiting nurses. Future research using multi-dimensional assessments is required to better understand how time-related stressors operate. The current study found that job resources had a significant negative impact on job stress (β=−0.18, p < 0.001), indicating that sufficient job resources—such as managerial support, professional autonomy, peer collaboration, and training opportunities—can effectively mitigate stress among home visiting nurses. This finding supports the motivational pathway of the JD-R model (Bakker & Demerouti, 2007 ). Prior studies have demonstrated that both objective and subjective job resources can reduce job stress and turnover rates, while simultaneously enhancing job satisfaction and engagement (Kaihlanen et al., 2023 ; Tsen et al., 2023 ). In home healthcare, nurses often work alone, face unpredictable environments, make independent clinical decisions, and make job resources critical. Surveies (Liu et al., 2025 ; Zhao et al., 2023 ) in China identified three primary areas of resource needs among home-visiting nurses: (1) training and skill enhancement, including practical skills and communication abilities; (2) security improvement; and (3) greater managerial and peer support. Similar patterns have been reported internationally, where a lack of training, especially hands-on training, and insufficient supervisory support are common issues (Muramatsu et al., 2019 ). Among the job resources examined in this study, professional autonomy emerged as a key factor because it allowed home care nurses to manage workflows and respond flexibly to on-site challenges (Kaihlanen et al., 2023 ). Increased autonomy has been shown to significantly alleviates stress among nurses (Asl et al., 2022 ; Ghanayem et al., 2020 ). Social support from managers, peers, and teams helps to mitigate emotional exhaustion by fostering a sense of connection. For example, Izadi et al. ( 2023 ) found that stronger workplace social support reduced the psychological stress toll. Feedback is a key form of evaluative support that reduces uncertainty, clarifies role expectations and promotes professional growth (Bakker & Demerouti, 2007 ). Leadership guidance and feedback have also been linked to sustained lower stress in longitudinal studies (Backman et al., 2023 ). Finally, training and career development opportunities remain crucial for sustaining the workforce capacity. Sufficient training and growth prospects have been identified as essential for home care workers worldwide (Muramatsu et al., 2019 ; Tsen et al., 2023 ), underscoring the need for continued investment in the professional development of home-visiting nurses. Beyond the direct effect, job resources also buffered the impact of subjective job demands on job stress in this study, as evidenced by a significant negative interaction effect (β=-0.13, p < 0.001). This suggests that job resources not only replenish resources but also reshape how nurses perceive and cope with demands, either by mitigating physiological and emotional impacts or fostering more constructive appraisals. This study also found the effect of job demands on stress was stronger under low resource conditions (β = 0.64, p < 0.001) and weakened under high resource conditions (β = 0.44, p < 0.001), confirming the JD-R model’s buffer hypothesis, emphasizing that job resources play a protective role in high-pressure environments (Bakker & Demerouti, 2007 , 2017 ). This is consistent with the findings of Xanthopoulou et al. ( 2007 ) for the home healthcare sector. Evidence has also shown that Canadian scholar Lavoie-Tremblay et al.(2014) found that job resources buffer the impact of job demands on strain among public healthcare sector nurses, highlighting the importance of job resources. This moderating effect is particularly critical in home care, where nurses often work in physical and emotional isolation, which can intensify stress. Thus, the buffering role of job resources is particularly valuable. Another significant finding was that workplace violence mediated the relationship between subjective subjective job demands and job stress. Workplace violence can be seen as an extreme form of job demand that imposes significant psychological strain (Sayin et al., 2023 ). According to the JD-R model, high demand, combined with insufficient resources, increases exposure to complex and uncontrollable situations, triggering patient dissatisfaction and hostility (Bakker & Demerouti, 2017 ). Under resource-depleted conditions, nurses may experience emotional exhaustion, impaired communication, or judgment errors, all of which increase their risk of violent encounters. Such incidents can trigger prolonged stress reactions and burnout, thereby reinforcing a vicious cycle of stress accumulation. This pathway also aligns with the stressor-emotion model (Spector & Jex, 1998 ), which posits that environmental stressors, such as violence, provoke emotional responses, such as anxiety and exhaustion, while high job demands may further impair nurses’ ability to anticipate or manage aggression (Hegney et al., 2006 ). Our findings align with those of previous studies documenting the links among job demands, workplace violence, and stress (Magnavita et al., 2020 ; Sun et al., 2021 ; Tsukamoto et al., 2021 ; Wu et al., 2015 ). These findings have important theoretical implications for extending the JD-R model to home healthcare. They also offer practical guidance to home healthcare managers in designing targeted interventions to alleviate job stress among home visit nurses through two key strategies. First, enhancing job resources is essential to directly reduce job stress and buffer its impact under high demands. Healthcare institutions should implement flexible scheduling policies that promote professional autonomy. For example, nurses can adjust their visit times during adverse weather conditions and provide structured scenario-based training to strengthen clinical decision-making in unpredictable environments. Social support is a key source of support. Managers should regularly assess nurses’ physical and mental health, offer emotional support, and encourage peer collaboration. For instance, pairing less experienced home visiting nurses with seasoned mentors can foster confidence and reduce role strain. In addition, feedback resources such as consistent performance evaluations, open communication channels, and case-based discussions create a supportive work culture. Providing diverse career development opportunities can also improve nurses’ perceived value and promote long-term retention by reinforcing their sense of purpose and promoting professional growth. Second, given the mediating role of workplace violence in job stress, targeted violence prevention strategies should be prioritized. Organizations should adopt safety protocols tailored to the home care context, such as pre-visit risk assessments to screen high-risk assignments, safety equipment checks, and guidelines to maintain professional boundaries. Crisis response plans must be communicated and implemented routinely. Technical support tools such as GPS tracking, real-time check-in systems, and emergency communication devices can further protect nurses working alone in unfamiliar environments. Moreover, training should be provided on risk recognition, communication strategies for de-escalating tense situations, the appropriate use of safety equipment, and procedures for terminating unsafe visits. Encouraging teamwide sharing of safety-related experiences can foster a culture of vigilance and collective responsibility. This study had several limitations. First, the cross-sectional design restricts the ability to infer causal relationships as the data were collected at a single time point. Future studies should adopt longitudinal designs to better explore temporal dynamics and strengthen causal interpretations. Second, convenience sampling was used, and the participants were primarily home-visiting nurses from 13 healthcare institutions in two provinces, which may have introduced a selection bias and limited the generalizability of the findings. Future research should consider stratified or random sampling methods across diverse regions to enhance the representativeness. Third, self-report questionnaires may introduce social desirability or recall bias, potentially influencing participant reporting, particularly in socially sensitive domains. Future studies should consider incorporating social desirability scales or objective indicators to validate the self-reported data. CONCLUSIONS In summary, this study demonstrated that job demands significantly increased job stress among home-visiting nurses, whereas job resources played a buffering role. The interaction between these factors highlights the importance of maintaining adequate job resources in high-job demands settings. Additionally, the mediating role of workplace violence revealed a key pathway through which stress develops, emphasizing the need for violence prevention strategies. Overall, these findings emphasize the importance of implementing comprehensive organizational interventions to support the well-being of home-visiting nurses, who are an indispensable force in home healthcare services. Abbreviations Job Demands-Resources (JD-R); Standard deviation (SD); Normed Fit Index (NFI); Comparative Fit Index (CFI);Incremental Fit Index (IFI);, Relative Fit Index; Tucker-Lewis Index; Root Mean Square Error of Approximation (RMSEA). Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board of Shenzhen Bao’an District People’s Hospital (approval no. BYL20231212). Informed consent was obtained implicityfrom all participants who completed the survey. Consent for publication Not applicable Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests None of the authors have any disclosed conflicts of interest. Funding The study was funded by the Shenzhen Baoan District Medical Association's 2024 project, "Research on the Influencing Factors of Home-Visiting Nurses' Job Stress Based on the Job Demands-Resources Theory: Structural Equation Modeling Analysis" (BAYXH2024004). Authors' contributions Li Dai contributed to the concept and design of the study methodology, collected and analyzed the data, drafted, reviewed and editing the manuscript; Jiao Xiong contributed to collected data, analyzed and reviewed the data; Yu-Jiao Sun and Su-Yu Wei contributed critically reviewed the manuscript. All authors approved the manuscript. Acknowledgements We sincerely thank all participants for their valuable contributions to this study. We are grateful to Doctor Hla Myo New for her valuable advice on statistical analysis and reviewing the manuscript, and to Associate Professor Jiangyun Chen for her reviewing on statistical analysis. Authors' information (optional) Authors names Name- Li Dai Designation- Associate Professor of Nursing Gender- Female Work Address- Shenzhen Bao'an District People's Hospital (518101) Tel: 8613480862727 Email: [email protected] ORCID number: 0009-0001-9930-9715 Name- Jiao Xiong Designation- Nurse Gender- Female Work Address- Guangxi University of Chinese Medicine Tel: 8615279877918 Email: [email protected] ORCID number: 0009-0001-8600-0815 Name- Yu-Jiao Sun Designation- Nurse Gender- Female Work Address- Shenzhen Bao'an District People's Hospital (518101) Tel: 8615241426049 Email: [email protected] ORCID number: 0009-0008-9607-523X Name- Su-Yu Wei Designation- Associate Professor of Nursing Gender- Female Work Address- Youjiang Medical University for Nationalities(533000) Tel: 8615107860753 Email: [email protected] ORCID number: 0009-0003-1234-4257 Corresponding author Name- Li Dai Designation- Associate Professor of Nursing Gender- Female Work Address- Shenzhen Bao'an District People's Hospital Tel: 13480862727 Email: [email protected] ORCID number:0009-0001-9930-9715 References Alyahya, S., & AboGazalah, F. 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Psychometric properties of the short-form Chinese Community Nurses Stress Scale: A cross-sectional study. Medicine , 99 (32), e21607. https://doi.org/10.1097/MD.0000000000021607 Additional Declarations No competing interests reported. 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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11:35:29","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":177729,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7496717/v1/a377f1849d8b3bae64ce8979.html"},{"id":95540901,"identity":"ae83292d-18cc-4a2a-8e88-0037ff7f93c9","added_by":"auto","created_at":"2025-11-10 11:35:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":9898,"visible":true,"origin":"","legend":"\u003cp\u003eThe hypothesized model for this study based on the Job-Demand Resources Model\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7496717/v1/4a906717f1a5a01bd43b7d1a.png"},{"id":95540902,"identity":"c1925545-9566-43ba-90f6-6a5293cccb45","added_by":"auto","created_at":"2025-11-10 11:35:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":93120,"visible":true,"origin":"","legend":"\u003cp\u003eThe path model of job stress.\u003c/p\u003e\n\u003cp\u003eNote: Inter SJDcentered-JRcentered= Product of mean-centered subjective job demands and mean-centered job resources\u003cdel\u003e.\u003c/del\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7496717/v1/38ce9a2f44993e9d0c60c1e1.png"},{"id":95540903,"identity":"06a20c0d-2b2a-4412-87ff-2a4e4d9e0017","added_by":"auto","created_at":"2025-11-10 11:35:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":49349,"visible":true,"origin":"","legend":"\u003cp\u003eThe path model of job stress based on low job resources\u003c/p\u003e\n\u003cp\u003eNote: Low job resources centered= Mean-centered job resources + SD (since the variable was mean-centered, adding 1SD corresponds to one standard deviation below the original mean, i.e., the low job resources condition); LowJRcentered-SJDcentered = Product of low job resources centered and mean-centered subjective job demands.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7496717/v1/cdb5bed43b3455d0445da63c.png"},{"id":95654735,"identity":"e57f6bac-48ac-4f86-bd58-46ad1a31d431","added_by":"auto","created_at":"2025-11-11 16:12:51","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":54197,"visible":true,"origin":"","legend":"\u003cp\u003eThe path model of job stress based on high job resources\u003c/p\u003e\n\u003cp\u003eNote: High job resources centered = Mean-centered job resources − 1SD (since the variable was mean-centered, subtracting 1SD corresponds to one standard deviation above the original mean, i.e., the high job resources condition). HighJRcentered-SJDcentered = Product of high job resources centered and mean-centered subjective job demands.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7496717/v1/0f378e14668340b9260451fc.png"},{"id":101516641,"identity":"56e21f32-4b34-4543-a4dd-142d3623f171","added_by":"auto","created_at":"2026-01-30 16:13:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1344236,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7496717/v1/22ffdffb-9605-47fb-a681-a293a0f4c06a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Job stress among home-visiting nurses in China: direct, moderating, and mediating pathways based on the job demands-resources model","fulltext":[{"header":"Background","content":"\u003cp\u003eHealthcare services are increasingly shifting from institutional settings to home-based environments driven by demographic changes, rising healthcare costs, and patient preferences for receiving care at home. In China, the population aged 65 years and older has reached approximately 220 million, accounting for 15.4% of the total population, with an elderly dependency ratio of 22.6%. At the same time, traditional extended-family support structures continue to erode. Between 2013 and 2023, the total number of households increased by 145,000, with one- and two-person households accounting for 57,873 (39.9%) of this growth. One-person households alone surged by 37,692, representing a 71.4% increase (National Bureau of Statistics, 2025). These sociodemographic changes have substantially intensified the demand for home-based nursing services. In response, national initiatives explicitly encourage nurses to deliver clinical, rehabilitation, medicine,\u0026nbsp;and educational care in patients’ homes\u0026nbsp;(National Health Commission, 2022; National Health Commission General Office, 2024). Despite a growing demand, high job stress discourages many nurses from participating in the home visit profession, resulting in a limited workforce and restricting service expansion\u0026nbsp;(Dai et al., 2024; Yin et al., 2025; Zhang et al., 2025)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJob stress is a state of emotional unease triggered by job demands that are considered threatening (McCraty \u0026amp; Tomasino, 2006). Job stress is a major global concern in nursing, leading to detrimental consequences. It increases burnout \u0026nbsp;(Hetzel-Riggin et al., 2020; Lee \u0026amp; Oh, 2023; Singh et al., 2021) and turnover intention (Baek et al., 2019; Cao et al., 2021; Lee \u0026amp; Oh, 2023), reduces job engagement (Tsen et al., 2023), deteriorates physical health(Chang et al., 2021), and negatively affects quality of life (Babapour et al., 2022). Home-visiting nurses face a challenging work environment compared to their hospital-based counterparts, largely owing to the independent nature of the work, unpredictable home environments, and limited access to immediate support (Grasmo et al., 2021; Kim et al., 2020; Wipfli et al., 2012).\u0026nbsp;Thus, high job stress is prevalent among home-visiting nurses worldwide\u0026nbsp;(Kaihlanen et al., 2023; Karakaya \u0026amp; Uçar, 2023; Kim et al., 2021; Lee \u0026amp; Oh, 2023; Muramatsu et al., 2019; Singh et al., 2021; Tsen et al., 2023).\u0026nbsp;In China, stress levels among home healthcare nurses are significantly higher than\u0026nbsp;those among hospital nurses\u0026nbsp;(Yang, 2009), with 34.6%\u0026nbsp;of\u0026nbsp;home-visiting nurses reporting substantial job stress\u0026nbsp;(Dai et al., 2024). Given these unique stressors, it is essential to understand the potential mechanisms of job stress in this workforce and identify\u0026nbsp;the\u0026nbsp;risk factors to mitigate job stress.\u003c/p\u003e\n\u003cp\u003eThe Job Demands-Resources (JD-R) model provides a useful theoretical framework for understanding job stress and wellbeing (Bakker \u0026amp; Demerouti, 2007). This model posits that employee well-being results from the balance between job demands and job resources, with two key psychological processes: a health impairment process, in which high job demands (e.g., workload, emotional labor, and role conflict) deplete physical and emotional resources, leading to exhaustion and health problems, and a motivational process, in which job resources (e.g., social support, autonomy, and feedback) buffer job demands and enhance engagement (Bakker \u0026amp; Demerouti, 2007).\u003c/p\u003e\n\u003cp\u003eIn the JD-R model, job demands are a key factor influencing job stress. They encompass the physical, psychological, social, and organizational aspects of work that require sustained cognitive, emotional, or physical effort, leading to physiological and psychological costs (Bakker \u0026amp; Demerouti, 2007). Job demands can be subjective, and include an excessive workload, role ambiguity, emotional strain, time pressure, and work–family conflict. The excessive job demands in home care settings are strongly linked to job stress (Kaihlanen et al., 2023; Ruotsalainen et al., 2020; Tsen et al., 2023). Moreover, objective job demands, such as long working hours, are associated with elevated risks of chronic fatigue, stress, and even depression (Lee \u0026amp; Oh, 2023; Yoon et al., 2018).\u003c/p\u003e\n\u003cp\u003eThe second key component of the JD-R model is job resources. These are the physical, psychological, social, and organizational aspects of work that help people reach their goals, ease job demands and the strain they cause, and support personal growth and learning (Bakker \u0026amp; Demerouti, 2007). The indicators of appropriate job resources include social support, autonomy, and opportunity development. Such resources have been shown to lower stress among home-visiting nurses and boost job satisfaction and engagement (Kaihlanen et al., 2023; Tsen et al., 2023). However, their protective effects have rarely been explored in home care settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWorkplace violence, including verbal abuse, threats, physical assault, and intimidation by humans or animals, is another important factor contributing to stress among nurses who conduct home visits (National Institute for Occupational Safety and Health (NIOSH), 2010).\u0026nbsp;In China, safety-related resource support has been identified as the primary need for healthcare workers engaged in home visiting services (Zhou et al., 2024). Studies\u0026nbsp;have revealed that high job demands may directly increase the likelihood of violent incidents\u0026nbsp;(Wu et al., 2015). Exposure\u0026nbsp;to workplace violence can jeopardize physical safety, impose psychological burdens, and elevate job stress\u0026nbsp;(Magnavita et al., 2020; Pariona-Cabrera et al., 2024; Sayin et al., 2023; Sun et al., 2021). This suggests a potential health impairment pathway within the JD-R framework,\u0026nbsp;in which excessive job demands may increase the risk of workplace violence, which in turn mediates the relationship between demands and job stress. However, this specific mediating mechanism has not been examined in the context of home care nursing.\u003c/p\u003e\n\u003cp\u003eIn China, home healthcare services are still in the early stages of development, and nurses constitute the majority of the workforce in this field (Xiang et al., 2023; Zhou et al., 2024). Community health service centers serve as the primary providers of home-visiting nursing services. In addition, nurses from tertiary and secondary hospitals are encouraged to deliver home-based care, particularly under policy initiatives promoting “Internet Plus Nursing Services” (National Health Commission \u0026amp; National Administration of Traditional Chinese Medicine., 2023). \u0026nbsp;These home-visiting nurses often work alone during off-duty hours\u0026nbsp;(Dai et al., 2024; Gao et al., 2022; Yin et al., 2025). They\u0026nbsp;also operate in a context lacking clear policies, norms, and standards, as well as\u0026nbsp;insufficient organizational support\u0026nbsp;(Huang et al., 2020; Yin et al., 2025; Zhao et al., 2023; Zhou et al., 2024).\u0026nbsp;Collectively, these contextual factors create a high-pressure environment for Chinese home-visiting nurses. Prior work by\u0026nbsp;Liu et al. (2025)\u0026nbsp;revealed that high job demands, inadequate support, and safety concerns contribute to stress and reduced willingness to provide services. Building on the JD-R model and the hypothesized theoretical framework (Figure 1), this study aimed to:\u003c/p\u003e\n\u003cp\u003e1. Examine the direct effects of job demands, job resources, and workplace violence on job stress among home-visiting nurses.\u003c/p\u003e\n\u003cp\u003e2. Test the moderating effect of job resources on the relationship between job demands and job stress.\u003c/p\u003e\n\u003cp\u003e3. Explore the mediating role of workplace violence in the relationship between job demands and job stress.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDesign\u003c/h2\u003e\u003cp\u003eA cross-sectional study design was employed to test the three main aims of the study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSetting\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in 13 healthcare institutions in China between March 2024 and June 2024. Including 10 tertiary hospitals (5 of which were integrated with community health service centers), 1 secondary hospital (integrated with a community health service center), and 2 community health service centers. Twelve institutions were in Guangdong Province, and one was in the Guangxi Zhuang Autonomous Region.\u003c/p\u003e\n\u003ch3\u003eSampling and sample size\u003c/h3\u003e\n\u003cp\u003eHome-visiting nurses were recruited through convenience sampling. The inclusion criteria were: (1) possession of a valid nursing license, (2) participation in home-visiting services within the past year, and (3) provision of informed consent with a willingness to voluntarily participate. Nurses not employed in hospital settings were excluded from the study. While 1,527 nurses provided home healthcare services in these hospitals, the exact number of home visits actively conducted within the past year was unavailable because of the dynamic workforce allocation.\u003c/p\u003e\u003cp\u003eWe conducted a pilot study with 38 home-visiting nurses to assess item clarity. Based on the pilot data, the standard deviation of the job stress scores was 0.35. Using the sample size estimation formula (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n=\\frac{{Z}_{1-\\alpha\\:/2}^{2}.{SD}^{2}}{{d}^{2}})\\)\u003c/span\u003e\u003c/span\u003e(Charan \u0026amp; Biswas, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) for cross-sectional studies, setting a 95% confidence level (Z\u0026thinsp;=\u0026thinsp;1.96) and a permissible error of 0.035 (10% of the standard deviation), the minimum sample size required was calculated to be 385. Accounting for an estimated invalid response rate of 10%, the final target sample size was 424.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected using both online and paper-based questionnaires. Before distribution, the number of home-visiting nurses in each hospital was verified with the head nurses. The questionnaires were first distributed electronically via the hospital WeChat groups using the Questionnaire Star applet. To enhance participation, reminders were sent every week, up to a maximum of two times.. In hospitals where the online response rate remained below 10% after these reminders, paper-based questionnaires were administered in person.\u003c/p\u003e\u003cp\u003eFor online responses, each IP address was restricted to one submission, all questions were mandatory, and screening questions were placed at the beginning of the survey. If a participant indicated that they had not engaged in home-visit nursing within the past year, the system automatically terminated the survey with an \u0026ldquo;Exit\u0026rdquo; message. Questionnaires with completion times of less than three minutes were excluded. For paper-based responses, researchers provided on-site clarification as needed. Completed forms were immediately reviewed for missing or illogical answers, and these errors were corrected prior to submission.\u003c/p\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cp\u003eThe questionnaire consisted of four parts: general information, job demands, job resources, and job stress.\u003c/p\u003e\u003cp\u003e\u003cb\u003eGeneral information Questionnaire\u003c/b\u003e: A self-designed general information questionnaire was developed based on a literature review and the objectives of this study. The questionnaire included 14 items, including sex, age, years of experience in home-visit nursing, workplace setting, marital status, education level, professional title, total years of nursing experience, number of home-visit training sessions attended in the past year, employment type, average number of home visits per month over the past year, average monthly income, whether the nurse conducted visits alone, and experiences of workplace violence. Workplace violence in the past 12 months was assessed with five items: one general item (no experience vs. any experience) and four items addressing specific subtypes (physical violence, verbal abuse, sexual harassment, and animal threats).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eJob Demands\u003c/strong\u003e\u003cp\u003eJob demands were assessed using two separate indicators to capture both subjective and objective aspects of job demands\u003c/p\u003e\u003c/p\u003e\u003cp\u003eSubjective job demands were assessed using the Chinese version of the Job Demands Scale developed by Zhang (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). The scale consists of 19 items across four dimensions: workload (five items), role ambiguity (five items), role conflict (five items), and work\u0026ndash;family conflict (four items). A 7-point Likert scale was used, ranging from 1 (strongly disagree) to 7 (strongly agree), with total scores ranging from 19 to 133. Higher scores indicated greater job demands. Items in the workload, role conflict, and work\u0026ndash;family conflict dimensions were scored positively, whereas items in the role ambiguity dimension (items 6\u0026ndash;10) were reverse-scored. The original scale demonstrated good reliability, with a Cronbach\u0026rsquo;s α of 0.874 and factor loadings ranging from 0.517 to 0.923. In the present study, Cronbach\u0026rsquo;s of the scale was 0.903.\u003c/p\u003e\u003cp\u003eObjective job demands were measured using participants\u0026rsquo; self-reported weekly working hours, categorized as \u0026lt;\u0026thinsp;50 h or \u0026ge;\u0026thinsp;50 h.\u003c/p\u003e\u003cp\u003e\u003cb\u003eJob Resources\u003c/b\u003e: Job resources were measured using sing the Chinese version of the of Job Resources Scale by Zhang (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). The scale comprised 22 items across four dimensions: job autonomy (nine items), social support (five items), performance feedback (four items), and career development opportunities (four items). A 7-point Likert scale was used, with scores ranging from 1 (strongly disagree) to 7 (strongly agree), resulting in a total score between 22 and 154. Higher scores reflected more abundant job resources. Items in the job autonomy and social support dimensions scored positively. The reverse-scored items included item 18 (performance feedback dimension) and items 21 and 22 (career development opportunities dimension). The original scale had a Cronbach\u0026rsquo;s α of 0.916, with subscale alphas ranging from 0.800 to 0.914 and factor loadings between 0.575 to 0.853. In this study, the Cronbach\u0026rsquo;s alpha was 0.911.\u003c/p\u003e\u003cp\u003e\u003cb\u003eJob Stress\u003c/b\u003e: Job stress was assessed using the Community Nurse Stress Scale developed by Zhu et al. (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The scale consists of 25 items across four dimensions: management and interpersonal relationships (eight items), patient care (seven items), work environment and resources (six items), and career advancement (four items). A 4-point Likert scale was used (1\u0026thinsp;=\u0026thinsp;never, 2\u0026thinsp;=\u0026thinsp;sometimes, 3\u0026thinsp;=\u0026thinsp;often, and 4\u0026thinsp;=\u0026thinsp;always), with total scores ranging from 25 to 100. Higher scores indicated higher levels of perceived stress. The original scale demonstrated excellent reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.940), with subscale alphas ranging from 0.843 to 0.894, factor loadings from 0.507 to 0.835, and the satisfied confirmatory factor analysis indices. In the present study, the Cronbach\u0026rsquo;s alpha was 0.893.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe data were analyzed using SPSS 26.0 and AMOS 22.0. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the personal characteristics, job demands, job resources, and job stress. Pearson\u0026rsquo;s correlation and point-biserial correlation analyses were conducted to examine the associations between the core variables. Path analysis was conducted to test the main and interaction effects. The significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The moderating effect of job resources on the relationship between job demands and stress was tested using an interaction term approach. Before the analysis, both job demands and resources were mean-centered and the interaction term was constructed by multiplying the centered variables (JD_centered \u0026times; JR_centered). To further explore the significant moderating effect, we applied a pick-a-point approach to examine the conditional effects of job demands on job stress at low and high levels of job resources (i.e., one standard deviation (SD) below and above the mean of the centered moderator variable) (Collier, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e This study was approved by the Institutional Review Board of Shenzhen Bao\u0026rsquo;an District People\u0026rsquo;s Hospital (approval no. BYL20231212). Permission was also obtained from the relevant authorities at each study site. An explanation letter describing the study purpose, procedures, and participants\u0026rsquo; rights was presented at the beginning of the questionnaire. Participants indicated their consent implicitly by completing the survey. Those who did not wish to participate could simply exit the questionnaire. Participation was voluntary, and participants could withdraw at any time without penalty. All data were collected anonymously and stored securely in accordance with ethical guidelines.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eGeneral information about the participants\u003c/h2\u003e\u003cp\u003eA total of 511 participants completed the questionnaires. Of these, 77 participants reported no home-visiting experience in the past year, resulting in 434 valid and complete surveys (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age of the home-visiting nurses was 38.41 years (SD\u0026thinsp;=\u0026thinsp;6.55), and the majority were female (99.54%). Most participants worked in community health service centers (69.59%) and were married (87.33%). The average home healthcare experience was 5.33 years (SD\u0026thinsp;=\u0026thinsp;4.70). Notably, 10.6% reported experiencing workplace violence, with animal threats (6.91%) being the most frequently reported. Approximately 80% of the nurses reported working alone during their visits.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePersonal characteristics of home-visiting nurses (n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%/Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e434\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.41\u0026thinsp;\u0026plusmn;\u0026thinsp;6.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eSex\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eWorkplace\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity health service center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMarital status\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e379\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eJob title\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNurse practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNurse practitioner in charge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssociate chief nurse practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChief nurse practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eEducational level\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVocational school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssociate degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e362\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaster\u0026rsquo;s degree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eExperience in home visiting nursing (years)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAverage number of home visits per month (times)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;10 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;30 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eAverage monthly income(CNY)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5000\u0026ndash;10000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10000\u0026ndash;20000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eEmployment type\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePermanent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eContract\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e325\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTemporary agency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eWeekly working hours\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e321\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eExperienced workplace violence\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e388\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eExperienced Workplace violence type\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical violence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVerbal abuse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexual harassment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnimal threat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eWorking alone\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eJob demands, job resources and job stress scores among home-visiting nurses\u003c/h2\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the overall mean scores for subjective job demands, job resources, and job stress among home visiting nurses were 3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95, 4.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88, and 1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35, respectively.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eJob demands, job resources, and job stress scores of home-visiting nurses (n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubjetive job demands\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWork overload\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRole ambiguity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRole conflict\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWork-family conflict\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob resources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJob autonomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSocial support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerformance feedback\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCareer development opportunities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eManagement and interpersonal relationships\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEnvironment and resources of work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCareer promotion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eCorrelations among the main study variables\u003c/h2\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Job stress was positively correlated with subjective job demands (r\u0026thinsp;=\u0026thinsp;0.643, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), workplace violence (r\u0026thinsp;=\u0026thinsp;0.269, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and weekly working hours (r\u0026thinsp;=\u0026thinsp;0.214, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A significant negative correlation was observed between job stress and job resources (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.464, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, subjective job demands and job resources were also negatively correlated (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.546, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation analysis among the five variables (n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJob stress \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubjective job demand \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.643**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJob resources \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;0.464**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.546**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorkplace violence \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.269**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.179**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeekly work \u003csup\u003eb\u003c/sup\u003e hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.214**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.228**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;0.141**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (2-tailed); \u003csup\u003ea\u003c/sup\u003e Pearson correlation; \u003csup\u003eb\u003c/sup\u003e point biserial correlation.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eRelationship between subjective job demand, job resources, and weekly work hours on job stress\u003c/h2\u003e\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, subjective Job demands had a significant positive relationship with job stress (β\u0026thinsp;=\u0026thinsp;0.54, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas job resources had a significant negative effect on job stress (β=\u0026minus;0.18, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).Workplace violence also had a positive direct effect on job stress (β\u0026thinsp;=\u0026thinsp;0.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Weekly working hours showed no significant direct effect on job stress (β\u0026thinsp;=\u0026thinsp;0.05, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eThe moderating effect of job resources on the relationship between job demands and job stress\u003c/h2\u003e\u003cp\u003eThe interaction term of subjective job demands and job resources had a significant negative relationship with job stress (β=\u0026minus;0.13, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe mediating effect of the experience of workplace violence on the relationship between job demands and job stress\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe result showed that the workplace violence had a meditating effect on the relationship between subjective job demands and job stress (subjective job demands \u0026rarr; workplace violence: β\u0026thinsp;=\u0026thinsp;0.18, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; workplace violence \u0026rarr; job stress: β\u0026thinsp;=\u0026thinsp;0.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eInteraction between variables\u003c/h2\u003e\u003cp\u003eTo probe the interaction effect, we tested the conditional effects of subjective job demands on job stress at different levels of job resources (\u0026plusmn;\u0026thinsp;1 SD from the mean). As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, under low job resources, the effect of subjective job demands on job stress was stronger (β\u0026thinsp;=\u0026thinsp;0.64, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas under high job resources, this effect was significantly weaker (β\u0026thinsp;=\u0026thinsp;0.44, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eThe path model of job stress\u003c/h2\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the path model demonstrated a good overall fit with the data. The model fit indices were: χ\u0026sup2;=3.73, df\u0026thinsp;=\u0026thinsp;3, p\u0026thinsp;=\u0026thinsp;0.29; Normed Fit Index (NFI)\u0026thinsp;=\u0026thinsp;0.99, Comparative Fit Index (CFI)\u0026thinsp;=\u0026thinsp;1.00, Incremental Fit Index (IFI)\u0026thinsp;=\u0026thinsp;1.00, Relative Fit Index (RFI)\u0026thinsp;=\u0026thinsp;0.96, Tucker-Lewis Index (TLI)\u0026thinsp;=\u0026thinsp;0.99, and the Root Mean Square Error of Approximation (RMSEA)\u0026thinsp;=\u0026thinsp;0.02. Similar fit indices were observed under both low and high job resource conditions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eModel fit indices with different levels of job resources (n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob Resources Level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eχ2 /ν\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTLI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eRMSEA\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReference standard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026gt;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026gt;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026gt;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study examined the direct effects of job demands, job resources, and workplace violence on job stress in home-visiting nurses. Additionally, it explored whether job resources moderate the impact of job demands on stress, and whether workplace violence mediates this relationship. These findings were interpreted using the JD-R model.\u003c/p\u003e\u003cp\u003eA central finding of this study was the significant positive association between the subjective job demands and job stress, indicating that higher job demands lead to increased perceived job stress among home visiting nurses. This finding supports the core assumptions of the JD-R model. Job demands continuously deplete the physical and psychological resources of employees. If these resources are not replenished, they can directly lead to stress, burnout, and other health impairment outcomes (Bakker \u0026amp; Demerouti, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2007\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This result is also consistent with previous studies showing that factors such as high workload, emotional labor, time pressure, and complex care coordination are major predictors of home-visiting nurses' job stress (Kaihlanen et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ruotsalainen et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Tsen et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) .\u003c/p\u003e\u003cp\u003eHome-visiting nurses in China face excessive workloads, with demands such as substantial time pressure and frequent visits beyond regular working hours. Limited opportunities for rest lead to physical overload, which, in turn, causes significant physical and mental strain (Liu et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Consequently, to meet increasing service demands, many nurses sacrifice personal and family time, thereby intensifying work\u0026ndash;family conflict (Liu et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Similarly, comparable patterns have been observed internationally, where excessive workload and insufficient recovery times contribute to burnout and stress among home care nurses (Kaihlanen et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ruotsalainen et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In addition, the advanced age and complex health conditions of patients in home care settings require high levels of clinical expertise and communication skills, which may increase job stress (Zhao et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Role conflict is another notable stressor as home-visiting nurses are expected to perform multiple roles, including clinical or primary nurses, professional caregivers, team members, and family consultants. When expectations across these roles are inconsistent or incompatible, nurses may experience confusion, frustration, and heightened stress (Liu et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). This finding was also reported by Kaihlanen et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) in Finland. Role ambiguity contributes to job stress. In China, the absence of clear statements regarding the rights and duties of home visiting nurses (Huang et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) parallels the challenges identified among hospital staff (Alyahya \u0026amp; AboGazalah, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Under such circumstances, home visiting nurses may struggle to define responsibilities and allocate resources effectively, leaving them feeling helpless when problems arise.\u003c/p\u003e\u003cp\u003eIn addition, weekly working hours were examined as an objective indicator of job demand. Results showed that weekly working hours did not directly affect job stress among home-visiting nurses. This finding is not supported by the JD-R model hypothesis and differs from the results of Tsen et al. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This null result can be explained by three key factors. First, the sample distribution was skewed, with over 70% of the participants working fewer than 50 hours/week, limiting the range of hours examined and potentially masking the associations. Second, weekly work hours may not capture the subjective experience of workload in home care, where time is often spent on non-clinical activities (e.g., travel and documentation) that are not reflected in simple hour counts. Prior studies have emphasized that perceived workload\u0026mdash;not objective hours\u0026mdash;more strongly predicts stress responses (Spector \u0026amp; Jex, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1998\u003c/span\u003e), and our findings align with this distinction. Third, job resources may have buffered potential stress from longer hours; resources such as peer support, autonomy, and flexible scheduling could have helped nurses maintain a sense of control and reduced the psychological impact of extended work time. Therefore, the non-significant relationship between weekly working hours and job stress in this study may reflect the complex interplay between workload perception and the buffering role of job resources, rather than the number of work hours alone.\u003c/p\u003e\u003cp\u003eThis finding indicates that conventional objective measures of workload may be insufficient to capture the nuanced pressures faced by home-visiting nurses. Future research using multi-dimensional assessments is required to better understand how time-related stressors operate.\u003c/p\u003e\u003cp\u003eThe current study found that job resources had a significant negative impact on job stress (β=\u0026minus;0.18, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that sufficient job resources\u0026mdash;such as managerial support, professional autonomy, peer collaboration, and training opportunities\u0026mdash;can effectively mitigate stress among home visiting nurses. This finding supports the motivational pathway of the JD-R model (Bakker \u0026amp; Demerouti, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Prior studies have demonstrated that both objective and subjective job resources can reduce job stress and turnover rates, while simultaneously enhancing job satisfaction and engagement (Kaihlanen et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Tsen et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn home healthcare, nurses often work alone, face unpredictable environments, make independent clinical decisions, and make job resources critical. Surveies (Liu et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Zhao et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) in China identified three primary areas of resource needs among home-visiting nurses: (1) training and skill enhancement, including practical skills and communication abilities; (2) security improvement; and (3) greater managerial and peer support. Similar patterns have been reported internationally, where a lack of training, especially hands-on training, and insufficient supervisory support are common issues (Muramatsu et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong the job resources examined in this study, professional autonomy emerged as a key factor because it allowed home care nurses to manage workflows and respond flexibly to on-site challenges (Kaihlanen et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Increased autonomy has been shown to significantly alleviates stress among nurses (Asl et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ghanayem et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Social support from managers, peers, and teams helps to mitigate emotional exhaustion by fostering a sense of connection. For example, Izadi et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) found that stronger workplace social support reduced the psychological stress toll. Feedback is a key form of evaluative support that reduces uncertainty, clarifies role expectations and promotes professional growth (Bakker \u0026amp; Demerouti, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Leadership guidance and feedback have also been linked to sustained lower stress in longitudinal studies (Backman et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Finally, training and career development opportunities remain crucial for sustaining the workforce capacity. Sufficient training and growth prospects have been identified as essential for home care workers worldwide (Muramatsu et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Tsen et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), underscoring the need for continued investment in the professional development of home-visiting nurses.\u003c/p\u003e\u003cp\u003eBeyond the direct effect, job resources also buffered the impact of subjective job demands on job stress in this study, as evidenced by a significant negative interaction effect (β=-0.13, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This suggests that job resources not only replenish resources but also reshape how nurses perceive and cope with demands, either by mitigating physiological and emotional impacts or fostering more constructive appraisals. This study also found the effect of job demands on stress was stronger under low resource conditions (β\u0026thinsp;=\u0026thinsp;0.64, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and weakened under high resource conditions (β\u0026thinsp;=\u0026thinsp;0.44, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), confirming the JD-R model\u0026rsquo;s buffer hypothesis, emphasizing that job resources play a protective role in high-pressure environments (Bakker \u0026amp; Demerouti, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2007\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This is consistent with the findings of Xanthopoulou et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) for the home healthcare sector. Evidence has also shown that Canadian scholar Lavoie-Tremblay et al.(2014) found that job resources buffer the impact of job demands on strain among public healthcare sector nurses, highlighting the importance of job resources. This moderating effect is particularly critical in home care, where nurses often work in physical and emotional isolation, which can intensify stress. Thus, the buffering role of job resources is particularly valuable.\u003c/p\u003e\u003cp\u003eAnother significant finding was that workplace violence mediated the relationship between subjective subjective job demands and job stress. Workplace violence can be seen as an extreme form of job demand that imposes significant psychological strain (Sayin et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). According to the JD-R model, high demand, combined with insufficient resources, increases exposure to complex and uncontrollable situations, triggering patient dissatisfaction and hostility (Bakker \u0026amp; Demerouti, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Under resource-depleted conditions, nurses may experience emotional exhaustion, impaired communication, or judgment errors, all of which increase their risk of violent encounters. Such incidents can trigger prolonged stress reactions and burnout, thereby reinforcing a vicious cycle of stress accumulation. This pathway also aligns with the stressor-emotion model (Spector \u0026amp; Jex, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1998\u003c/span\u003e), which posits that environmental stressors, such as violence, provoke emotional responses, such as anxiety and exhaustion, while high job demands may further impair nurses\u0026rsquo; ability to anticipate or manage aggression (Hegney et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Our findings align with those of previous studies documenting the links among job demands, workplace violence, and stress (Magnavita et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sun et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tsukamoto et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Wu et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese findings have important theoretical implications for extending the JD-R model to home healthcare. They also offer practical guidance to home healthcare managers in designing targeted interventions to alleviate job stress among home visit nurses through two key strategies.\u003c/p\u003e\u003cp\u003eFirst, enhancing job resources is essential to directly reduce job stress and buffer its impact under high demands. Healthcare institutions should implement flexible scheduling policies that promote professional autonomy. For example, nurses can adjust their visit times during adverse weather conditions and provide structured scenario-based training to strengthen clinical decision-making in unpredictable environments. Social support is a key source of support. Managers should regularly assess nurses\u0026rsquo; physical and mental health, offer emotional support, and encourage peer collaboration. For instance, pairing less experienced home visiting nurses with seasoned mentors can foster confidence and reduce role strain. In addition, feedback resources such as consistent performance evaluations, open communication channels, and case-based discussions create a supportive work culture. Providing diverse career development opportunities can also improve nurses\u0026rsquo; perceived value and promote long-term retention by reinforcing their sense of purpose and promoting professional growth.\u003c/p\u003e\u003cp\u003eSecond, given the mediating role of workplace violence in job stress, targeted violence prevention strategies should be prioritized. Organizations should adopt safety protocols tailored to the home care context, such as pre-visit risk assessments to screen high-risk assignments, safety equipment checks, and guidelines to maintain professional boundaries. Crisis response plans must be communicated and implemented routinely. Technical support tools such as GPS tracking, real-time check-in systems, and emergency communication devices can further protect nurses working alone in unfamiliar environments. Moreover, training should be provided on risk recognition, communication strategies for de-escalating tense situations, the appropriate use of safety equipment, and procedures for terminating unsafe visits. Encouraging teamwide sharing of safety-related experiences can foster a culture of vigilance and collective responsibility.\u003c/p\u003e\u003cp\u003eThis study had several limitations. First, the cross-sectional design restricts the ability to infer causal relationships as the data were collected at a single time point. Future studies should adopt longitudinal designs to better explore temporal dynamics and strengthen causal interpretations. Second, convenience sampling was used, and the participants were primarily home-visiting nurses from 13 healthcare institutions in two provinces, which may have introduced a selection bias and limited the generalizability of the findings. Future research should consider stratified or random sampling methods across diverse regions to enhance the representativeness. Third, self-report questionnaires may introduce social desirability or recall bias, potentially influencing participant reporting, particularly in socially sensitive domains. Future studies should consider incorporating social desirability scales or objective indicators to validate the self-reported data.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIn summary, this study demonstrated that job demands significantly increased job stress among home-visiting nurses, whereas job resources played a buffering role. The interaction between these factors highlights the importance of maintaining adequate job resources in high-job demands settings. Additionally, the mediating role of workplace violence revealed a key pathway through which stress develops, emphasizing the need for violence prevention strategies. Overall, these findings emphasize the importance of implementing comprehensive organizational interventions to support the well-being of home-visiting nurses, who are an indispensable force in home healthcare services.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eJob Demands-Resources (JD-R); Standard deviation (SD); Normed Fit Index (NFI); Comparative Fit Index (CFI);Incremental Fit Index (IFI);, Relative Fit Index; Tucker-Lewis Index; Root Mean Square Error of Approximation (RMSEA).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of Shenzhen Bao’an District People’s Hospital (approval no. BYL20231212). Informed consent was obtained implicityfrom all participants who completed the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors have any disclosed conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was\u0026nbsp;funded by the Shenzhen Baoan District Medical Association's 2024 project, \"Research on the Influencing Factors of Home-Visiting Nurses' Job Stress Based on the Job Demands-Resources Theory: Structural Equation Modeling Analysis\" (BAYXH2024004).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLi Dai contributed to the concept and design of the study methodology, collected and analyzed the data, drafted, reviewed and editing the manuscript; Jiao Xiong contributed to collected data, analyzed and reviewed the data; Yu-Jiao Sun and Su-Yu Wei contributed critically reviewed the manuscript. \u0026nbsp;All authors approved the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all participants for their valuable contributions to this study. We are grateful to Doctor Hla Myo New for her valuable advice on statistical analysis and reviewing the manuscript, and to Associate Professor Jiangyun Chen for her reviewing on statistical analysis.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors names\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eName- Li Dai\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDesignation- Associate Professor of Nursing\u003c/p\u003e\n\u003cp\u003eGender- Female\u003c/p\u003e\n\u003cp\u003eWork Address- Shenzhen Bao'an District People's Hospital (518101)\u003c/p\u003e\n\u003cp\u003eTel: \u0026nbsp;8613480862727\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003eORCID number: 0009-0001-9930-9715\u003c/p\u003e\n\u003cp\u003eName- Jiao Xiong\u003c/p\u003e\n\u003cp\u003eDesignation- Nurse\u003c/p\u003e\n\u003cp\u003eGender- Female\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWork Address- Guangxi University of Chinese Medicine\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTel: 8615279877918\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003eORCID number: 0009-0001-8600-0815\u003c/p\u003e\n\u003cp\u003eName- Yu-Jiao Sun\u003c/p\u003e\n\u003cp\u003eDesignation- Nurse\u003c/p\u003e\n\u003cp\u003eGender- Female\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWork Address- Shenzhen Bao'an District People's Hospital (518101)\u003c/p\u003e\n\u003cp\u003eTel: 8615241426049\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003eORCID number: 0009-0008-9607-523X\u003c/p\u003e\n\u003cp\u003eName- Su-Yu Wei\u003c/p\u003e\n\u003cp\u003eDesignation- Associate Professor of Nursing\u003c/p\u003e\n\u003cp\u003eGender- Female\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWork Address- Youjiang Medical University for Nationalities(533000)\u003c/p\u003e\n\u003cp\u003eTel: 8615107860753\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003eORCID number: 0009-0003-1234-4257\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eName- Li Dai\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDesignation- Associate Professor of Nursing\u003c/p\u003e\n\u003cp\u003eGender- Female\u003c/p\u003e\n\u003cp\u003eWork Address- Shenzhen Bao'an District People's Hospital\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTel: \u0026nbsp;13480862727\u003c/p\u003e\n\u003cp\u003eEmail: \u0026nbsp; [email protected]\u003c/p\u003e\n\u003cp\u003eORCID number:0009-0001-9930-9715\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAlyahya, S., \u0026amp; AboGazalah, F. 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What are the home care needs of Chinese healthcare workers: A latent class analysis. \u003cem\u003eFrontiers in Public Health\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e, 1369456. https://doi.org/10.3389/fpubh.2024.1369456\u003c/li\u003e\n \u003cli\u003eZhu, W., Guo, H., \u0026amp; Li, J. (2020). Psychometric properties of the short-form Chinese Community Nurses Stress Scale: A cross-sectional study. \u003cem\u003eMedicine\u003c/em\u003e, \u003cem\u003e99\u003c/em\u003e(32), e21607. https://doi.org/10.1097/MD.0000000000021607\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"Job stress, job demands, job resources, workplace violence, home-visiting nurses, JD-R model, China, moderation, mediation","lastPublishedDoi":"10.21203/rs.3.rs-7496717/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7496717/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHome-visiting nurses in China face escalating job stress due to the growing demand for home-based services driven by the rapidly aging population, weakening family support structures, and ongoing national healthcare reforms. Their work is characterized by limited organizational support and exposure to workplace violence, yet the stress mechanisms in this group remain underexplored. This study applied the Job Demands-Resources (JD-R) model to examine (1) the direct effect of job demands, job resources, and workplace violence on job stress, (2) the moderating role of job resources, and (3) the mediating effect of workplace violence.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional survey was conducted among 434 home-visiting nurses from 13 institutions across two Chinese provinces. Measures included the Chinese versions of the Job Demand Scale (subjective job demands), weekly working hours (objective job demands), Job Resources Scale, and the Community Nurse Stress Scale, as well as five self-developed items assessing workplace violence. Path analysis using SPSS 26.0 and AMOS 22.0 examined direct, moderating, and mediating effects under different levels of job resources.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003ePath analysis showed that subjective job demands (β\u0026thinsp;=\u0026thinsp;0.54, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and workplace violence (β\u0026thinsp;=\u0026thinsp;0.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) significantly increased job stress, while job resources reduced it (β = \u0026minus;0.18, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Weekly working hours had no significant effect (β\u0026thinsp;=\u0026thinsp;0.05, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Job resources buffered the positive relationship between job demands and stress (β = \u0026minus;0.13, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Workplace violence mediated the effect of job demands on stress (β\u0026thinsp;=\u0026thinsp;0.18, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; β\u0026thinsp;=\u0026thinsp;0.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The final model demonstrated excellent fit (χ\u0026sup2;=3.73, df\u0026thinsp;=\u0026thinsp;3, p\u0026thinsp;=\u0026thinsp;0.29, Comparative Fit Index [CFI]\u0026thinsp;=\u0026thinsp;1.00; Root Mean Square Error of Approximation [RMSEA]\u0026thinsp;=\u0026thinsp;0.02), and results were consistent across different levels of job resources.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eOur findings highlight the protective and moderating roles of job resources, and the mediating role of workplace violence on job stress among home-visiting nurses. Targeted interventions should focus on strengthening organizational resources and preventing workplace violence to reduce job stress and improve workforce sustainability.\u003c/p\u003e","manuscriptTitle":"Job stress among home-visiting nurses in China: direct, moderating, and mediating pathways based on the job demands-resources model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 11:35:25","doi":"10.21203/rs.3.rs-7496717/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":"68ea331d-4ac4-4e42-8c46-f8c1bf0b8f58","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-30T16:11:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 11:35:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7496717","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7496717","identity":"rs-7496717","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}