| BACKGROUNDWith the advancement of Internet technology and the acceleration of the aging process in China,the potential demand of "Internet+nursing services" is increasing,but the current supply of such services falls short of meeting this demand.Nurses are the main providers of these services and improving their professional identity is conducive to mobilizing their enthusiasm for engaging in "Internet+nursing services".However,"Internet+nursing services" in China are still in the pilot stage,and there is no target tool available to assess the level of professional identity among online nurses,and there is also a lack of research on the factors that affect professional identity in this context.OBJECTIVES1.To develop a professional identity scale for online nurses and to test its reliability and validity.2.To conduct a sequential explanatory mixed methods study aimed at exploring the level of professional identity among online nurses and its influencing factors,as well as identifying the reasons for low professional identity among this group.METHODS1.Development and validation of a scale:First,based on social identity theory,a pool of items was formed through literature review and group discussion.Next,relevant experts were invited to use the Delphi expert consultation method to conduct inquiry on the preliminary professional identity scale for online nurses.Thirdly,a preliminary survey was carried out to conduct item analysis and exploratory factor analysis.Finally,,the scale was revised,and a formal survey was carried out to conduct confirmatory factor analysis for validation.2.Quantitative study:A cross-sectional study was conducted.Online nurses from"Internet+nursing service" pilot hospitals nationwide were selected by convenience sampling method from March to April 2022.The survey tools included a general information questionnaire,a professional identity scale for online nurses,a nurse organizational support scale,and a job stress scale.SPSS 25.0 software was used to analyze the online data collected by Question Star.The statistical methods included descriptive analysis,t-tests,ANOVA,and multiple linear regressions.3.Qualitative study:A phenomenological study was conducted.Online nurses with professional identity scale scores below 75 points and voluntarily participated in the study were interviewed on a one-on-one basis through Tencent Meeting from May to June 2022.The Colaizzi’s seven-step content analysis method was used to analyze data and extract themes.RESULTS1.Development and validation of a scale:This scale consists of 4 dimensions including professional attachment,professional status,professional cognition,professional support,and 25 items,all with positive scoring.Each item is scored using 5-point Likert scale.The total score ranges from 25 to 125 points.Scores of 25 to 50 are considered low,scores of 50 to 75 are considered moderately low,scores of 75 to 100 are considered medium,and scores of 101 to 125 are considered high.Exploratory factor analysis extracted four common factors,and the cumulative contribution rate of variance was 86.543%.The Cronbach’s a coefficient of the scale was 0.987,the splithalf reliability was 0.957,and the test-retest reliability was 0.876.Confirmatory factor analysis showed that the first-order four-factor model fit well(x2/df=2.216,GFI=0.904,RMSEA=0.041,RMR=0.035,CFI=0.916 and NFI=0.928).2.Quantitative study:This study collected 417 valid questionnaires from online nurses.Descriptive analysis results showed that the total score of professional identity among online nurses was(102.59±19.92)and the average scores of the four dimensions from high to low were professional support(4.85±1.04),professional status(4.73±2.13),professional cognition(4.46±1.76)and professional attachment(4.21±2.53).One-way ANOVA results showed significant differences in professional identity scores among online nurses with different educational levels,marital status,job titles,average monthly income,and clinical specialized nurses(P<0.05).Pearson correlation analysis showed a strongly positive correlation between professional identity and organizational support(r=0.793,P<0.01)and a medium negative correlation between professional identity and job stress(r=-0.421,P<0.01).Multiple linear regression analysis showed that educational level,job title,clinical specialized nurses,organizational support,and job stress were linearly correlated with the professional identity of online nurses(P<0.05).64.10%of the variation in the score of professional identity for online nurses(R2=0.641)is explained by these five variables.Among them,educational level,professional title,clinical specialized nurses,organizational support were linearly positively related to the professional identity(B>0).while job stress was linearly negatively related to the professional identity(B<0).The organizational support had the greatest effect on the professional identity of online nurses(P=0.787,P<0.01),and educational level had the least effect(β=0.105,P<0.05).3.Qualitative study:Seven online nurses with low professional identity were interviewed to explore the underlying reasons.Three primary themes and eight secondary themes were extracted through a step-by-step process.Theme one was"heavy nursing role load",with two secondary themes:high job role pressure and workfamily role conflict.Theme two was "high professional risk",with three secondary themes:personal safety risks during travel,operational environmental risks,and responsibility risks.Theme three was "the immature related guarantee mechanism",with three secondary themes:legal protection,human resource,financial and material protection,and medical insurance coverage.CONCLUSIONS1.The professional identity scale for online nurses based on social identity theory demonstrates good reliability and validity,making it suitable for evaluating the professional identity of online nurses in China.2.The overall level of professional identity among online nurses is high,and its influencing factors include educational level,professional title,being a clinical specialized nurse,sense of organizational support and job pressure.3.The primary factors contributing to low professional identity among online nurses include heavy nurse role loads,high practice risks and immature support mechanisms. |
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