| Objectives:To investigate the current situation and influencing factors of clinical nurses’professional identity.From the perspective of psychological capital,social capital and human capital,the paper analyzes the influence of three kinds of capital on occupational identity and its action path.We interviewed some clinical nurses in grade III-A hospitals to understand the process of change of their professional identity and their real feelings,and to explore the factors that promote and hinder the formation of nurses’professional identity.In order to explore the feasible ways to improve nurses’professional identity by combining quantitative and qualitative research,and provide theoretical basis and practical guidance for formulating effective intervention strategies to stabilize the nursing team.Methods:This study uses a mixed research approach,combining quantitative and qualitative research.Quantitative research:The survey was conducted from March to June,2022 by means of cross-sectional survey.Using the convenient sampling method,662 nurses from four grade III-A hospitals in Shandong Province were selected to conduct an online questionnaire survey.The questionnaires include the general information questionnaire,Nursing Professional Identity Scale,Psychological Capital Questionnaire,Workplace Social Capital Scale and Human Capital Scale.Databases were created and statistical analyses were performed using SPSS 26.0 and AMOS 23.0 software.General information and variable scores were analyzed by descriptive statistics using frequencies,percentages,means,and standard deviations.The effects of different characteristics on professional identity were analyzed by independent samples t test,one-way ANOVA,and multiple linear stepwise regression.The correlations between professional identity,psychological capital,social capital and human capital were analyzed by Pearson correlation analysis.The effects of psychological capital,social capital and human capital on professional identity were analyzed by multiple linear stepwise regression.Structural equation models were constructed with psychological capital as the mediating variable and estimated using the Maximum Likelihood Estimate for model fitting,and the Bootstrap Confidence Interval was used to assess the mediating effect of psychological capital between social capital and professional identity,and between human capital and professional identity.Results:1.The total score of clinical nurses’professional identity was(111.96±21.11)points,and the average item score was(3.73±0.70)points.The scores of the 5 dimensions from low to high were as follows:Professional cognitive evaluation was(3.59±0.80),professional social skill was(3.63±0.75),professional social support was(3.85±0.70),professional frustration coping was(3.86±0.70)and professional self-reflection was(3.90±0.75).Among the 618 clinical nurses in grade III-A hospitals,2 have low professional identity(0.32%),127 have slightly low professional identity(20.55%),315 have medium professional identity(50.97%)and 174 have high professional identity(28.16%).2.The total score of psychological capital was(107.68±20.08)points,and the average item score was(4.49±0.84)points.The scores of the 4 dimensions from low to high were as follows:optimism(4.43±0.84),resiliency(4.46±0.86),hope(4.51±0.94)and self-efficacy(4.55±0.91).The total score of workplace social capital was(32.41±5.80)points,and the average item score was(4.05±0.72)points.The scores of the 2 dimensions from low to high were as follows:non-linked social capital(4.03±0.74),linking social capital(4.09±0.78).The total score of human capital was(12.63±2.40)points.The item scores from low to high were as follows:compared with my colleagues,my professional theoretical knowledge is richer(4.20±0.83),compared with my colleagues,I have more work experience(4.20±0.87),compared with my colleagues,my professional skills are higher(4.23±0.95).3.Independent samples t test and one-way ANOVA showed that age,working years of nurses,marital status,work department,average number of night shifts per month,motivation of nursing work,and work satisfaction were factors influencing the professional identity level of clinical nurses.(P<0.05).Multiple linear stepwise regression analysis showed that age,average number of night shifts per month,motivation of nursing work and work satisfaction were significant factors of the level of professional identity(P<0.05).4.Pearson correlation analysis showed that occupational identity was significantly and positively correlated with psychological capital,social capital,and human capital(r=0.876,0.733,0.592,P<0.01).Social capital and human capital were significantly and positively correlated with psychological capital(r=0.690,0.553,P<0.01).Multiple linear stepwise regression analysis showed that psychological capital,social capital and human capital were significant factors of the level of professional identity(P<0.05).5.A structural equation model was constructed with psychological capital as an mediating variable,social capital and human capital as independent variables,and professional identity as a dependent variable.The fitted indicators wereχ~2/df=3.567(<5),GFI=0.949(>0.9),AGFI=0.918(>0.9),TLI=0.978(>0.9),NFI=0.979(>0.9),IFI=0.985(>0.9),CFI=0.985(>0.9),RMSEA=0.065(<0.08),RMR=0.0371(<0.05).The Bootstrap method yielded 95%confidence interval for indirect effect of social capital on professional identity of(0.273,0.401)and 95%confidence interval for direct effect of(0.265,0.396).95%confidence interval for the indirect effect of human capital on professional identity of(0.142,0.227)and 95%confidence interval for the direct effect of(0.064,0.189).Standardized effect values of 0.331 and 0.121 for social capital and human capital to directly and positively predict professional identity.The standardized effect value of social capital indirectly predicting professional identity with psychological capital as a mediating variable was 0.604×0.557≈0.336,and the total effect of social capital on professional identity was 0.331+0.336=0.667.The standardized effect value for human capital to indirectly predict occupational identity with psychological capital as a mediating variable was 0.323×0.557≈0.180,and the total effect of human capital on occupational identity was 0.121+0.180=0.301,with the mediating effect accounting for 59.80%of the total effect.6.The results of the distilled qualitative interviews identified three themes that influence nurses’professional identity:facilitators,hindrances,and bidirectional influencing factor.Facilitators included 3 subthemes:personal attributes of nurses,perceived professional characteristics of nurses,and nurse career navigators.Barriers include 2subthemes:work-family conflict,and heavy nursing workload.The Bidirectional influencing factor included four subthemes:workplace climate,nurses’career development,others’attitudes toward nursing,and nurses’compensation packages.Conclusion:1.The professional identity of clinical nurses in grade III-A hospitals is at a medium level and there is still room for improvement,and there are differences in the level of professional identity of clinical nurses with different individual background characteristics.There were significant correlations between psychological capital,social capital,human capital and professional identity,and age,monthly number of night shifts,motivation to engage in nursing,satisfaction with current job,psychological capital,social capital and human capital were significant predictors of nurses’professional identity level.2.Psychological capital plays a partially mediating effect between social capital and professional identity and between human capital and professional identity.Social capital and human capital can directly influence the level of professional identity of clinical nurses,and psychological capital can play a strengthening role in the above relationships.3.The qualitative study found that nurses’personal abilities and characteristics,nurses’perceived professional characteristics and nurse career navigators are facilitators of nurses’professional identity,work-family conflict and heavy nursing workload are barriers to nurses’professional identity,and workplace climate,nurses’career development and nurses’remuneration packages can both facilitate and hinder nurses’professional identity.It is particularly important to increase facilitators,reduce barriers,and bring into play the positive effects of bidirectional influencing factors to enhance nurses’professional identity. |
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