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Journal of nursing management · 2026

From Stress to Safety: The Chain Mediating Role of Cognitive Reappraisal and Work Engagement in the Influence of Nurses' Work Stress on Safety Behavior.

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Zhang Kai, Chen Changchang, Zha Ning, Xu Huan, Wu Chao, Zhang Jiayi, Wang Yifei, Lang Hongjuan

Аннотация

BACKGROUND: Nurses face multiple work stress in clinical practice, and the relationship between work stress and safety behavior has attracted much attention. However, no research has explored the chain-mediating role of cognitive reappraisal and work engagement in this relationship.

AIM: This study aimed to examine the roles of work stress on safety behavior in nurses, along with the mediating effects of cognitive reappraisal and work engagement.

METHODS: A cross-sectional study was conducted among 677 nurses in Shaanxi Province, China, from September to October 2025. The Chinese Nurses Stressor Scale, the Emotion Regulation Questionnaire, the Work Engagement Scale, and the Nurse Safety Behavior Questionnaire were used. IBM SPSS Statistics 26.0 and IBM SPSS AMOS 29.0 were used to analyze data and construct a structural equation model. The research complied with the STROBE checklist.

RESULTS: Nurses' scores were as follows: work stress (86.09 ± 18.44), cognitive reappraisal (27.75 ± 6.59), work engagement (46.89 ± 13.10), and safety behavior (53.41 ± 6.42). Work stress had a significant negative effect on safety behavior (r = -0.200, p < 0.001). Cognitive reappraisal and work engagement separately mediated the link between safety behavior and work stress, accounting for 25.12% and 13.95% of the total effect. Furthermore, cognitive reappraisal and work engagement served as chain mediators between work stress and safety behavior, accounting for 7.91% of the total effect.

CONCLUSION: Work stress among nurses can affect their safety behavior through the mediating role of cognitive reappraisal and work engagement. Future efforts should focus on alleviating nurses' work stress and cultivating their cognitive reappraisal strategies to enhance work engagement, which may help improve and strengthen nurses' safety behaviors.

IMPLICATIONS: Nurses need to be fully empowered to ensure patient safety. Hospital managers should prioritize optimizing workload distribution and providing psychological support to reduce nurses' work stress. Additionally, integrating cognitive reappraisal training into routine nursing education may enhance nurses' active stress management and engagement.

Предметные рубрики MeSH

ИП Урсолов Владлен Сергеевич

ИНН 500118482352 · ОГРНИП 314500117700049

Реквизиты и контакты