Design and sample
This was a descriptive cross-sectional study. A convenience sample of nurses was recruited from 3 tertiary hospitals in Wuhan, China from October2020 to Januray2021. Inclusion criteria required: (1) registered nurses, (2) to be willing to participate in the study. Nurses who were on vacation, came to the hospital for further study and training temporarily during the period of data collection were excluded. A total of 1096 nurses submitted questionnaires. Of which, 79 incomplete questionnaires were excluded. Therefore, 1017 nurses (92.8%) were included in the analysis.
Procedures
The study was approved by the Ethics Committee of our school (NO.S161). The survey was anonymous and voluntary. Participants were informed that they were free to participate in the study or not and had the right to withdraw at any time. Only if the participants clicked through the consent form, could they gain access to the questionnaires designed on the website named Wenjuanxing, a professional online questionnaire survey, evaluation, and voting platform in China. Data collection on the Web has been used in other studies successfully21. This method of collecting data is efficient, reliable, and cost-effective22.
Instruments
Demographic characteristics
Demographic information was collected by a self-designed questionnaire. These included gender, age, marital status, education status professional title, and years of service.
The Emotional Labor Scale for Nurses
Nurses' emotional labor was measured using the Emotional Labor Scale for Nurses developed by Hong J and Oksoo K23 and translated into Chinese by Ying Y24. This scale includes three dimensions, namely “emotional control effort in profession,” (e.g., “I try to be kind to patients genuinely from my heart”); “patient-focused emotional suppression,” (e.g., “I suppress my anger when patients' words and behaviors are unfair”); “emotional pretense by norms,” (e.g., “I exaggerate expressions of interest in patients”). The scale constitutes 16 items. Each item was rated on a five-point Likert scale ranging from 1 (not at all) to 5 (very true). Higher scores on the scale indicate higher levels of emotional labor. Cronbach's alpha in Hong's study was 0.81 and the split-half coefficient was 0.84 and Cronbach's alpha in this study was 0.926.
The nurses' Perceived Organizational Support Scale
The nurses' Perceived Organizational Support Scale25 was used to measure the comprehensive perception of support from the organization, which has been proven to have good reliability and validity among Chinese nurses. The scale consists of 15 items and one dimension, (e.g., “Organization respects my goals and values”). All items were rated on a Likert scale, from 1 (strongly disagree) to 5 (strongly agree). Higher scores on the scale indicate higher levels of the perceived organizational support. In this study, Cronbach's alpha score of the total scale was 0.987.
The Nursing Professional Values Scale (NPVS-R)
The NPVS-R was adapted to the Chinese language and cultural context by Lin and Wang26 from Weis and Schank27. The scale consists of 26 items and five dimensions: “activism,” “social justice and human dignity,” “trust,” “professional obligations,” and “professionalism”. All items were rated on a Likert scale, from “1” (unimportant) to “5” (most important). The higher the score of this scale, the higher the nursing professional values. Cronbach's alpha in Li's study was 0.946. In the current study, Cronbach's alpha was 0.988.
Statistical analysis
The data were analyzed by the SPSS 22.0. Descriptive statistics were used to present participants’ demographic characteristics, such as means, standard deviations, quartile, median and proportions. Spearman correlation analysis was used to examine the correlation among perceived organizational support, emotional labor and professional values. Hierarchical multiple linear regression analysis was used to examine the influence of variables on the professional values. Mediation analyses were conducted with the Mplus Version 8.0 software and analyze the mediating effect of emotional labor between perceived organizational support and professional values. All analyses were two-tailed.