Using the theory of planned behaviour to explain junior nurses' and final-year student nurses' intention to care for COVID-19 patients in China: A multisite cross-sectional study.

Publisher: Blackwell Scientific Publications Country of Publication: England NLM ID: 9306050 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2834 (Electronic) Linking ISSN: 09660429 NLM ISO Abbreviation: J Nurs Manag

Original Publication: Oxford : Blackwell Scientific Publications, c1993-

COVID-19*/epidemiology ; Students, Nursing* ; Nurses* ; Nursing Staff, Hospital*; Humans ; Cross-Sectional Studies ; Intention ; SARS-CoV-2 ; Attitude of Health Personnel ; Pandemics ; Surveys and Questionnaires ; China/epidemiology

Aim: To explore junior nurses' and final-year student nurses' intention to care for COVID-19 patients amidst the Delta COVID-19 variant outbreak in China using the theory of planned behaviour (TPB) as a framework.
Background: The COVID-19 pandemic has intensified global nursing shortage. Junior nurses and final-year student nurses represent the backbone of the future frontline nursing workforce. The TPB is a valid theoretical model for predicting nurses' caring behaviours.
Methods: A 47-item self-administered questionnaire was disseminated online to a convenience sample of 547 junior nurses and final-year student nurses located in 13 regions across mainland China.
Results: Approximately 63.4% of the participants intended to care for COVID-19 patients voluntarily and 65.6% by non-voluntary assignment. The TPB model significantly predicted 45% of the variance in behavioural intention, subjective norms being the strongest predictor. Gender, vaccination status and ethical perceptions regarding frontline work significantly correlated with the intention to provide care.
Conclusions: Our findings highlight the importance of social, organisational and family support underpinning future junior nurses' professional commitment in times of public health crisis.
Implications for Nursing Management: Pandemic-tailored workplace training programmes for nurses/student nurses that emphasize on self-care and ethical issue discussions are warranted. Hospital managers should collaborate with community partners to offer additional family support for nurses in need.
(© 2022 John Wiley & Sons Ltd.)

Ajzen, I. (2002). Constructing a TPB questionnaire: Conceptual and methodological considerations. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.601.956&rep=rep1&type=pdf.
Ajzen, I. (2011). The theory of planned behaviour: Reactions and reflections. Psychology & Health, 26(9), 1113-1127. https://doi.org/10.1080/08870446.2011.613995.
Alloubani, A., Khater, W., Akhu-Zaheya, L., Almomani, M., & Alashram, S. (2021). Nurses' ethics in the care of patients during the COVID-19 pandemic. Frontiers in Medicine, 8. https://doi.org/10.3389/fmed.2021.589550.
Bar-Tal, Y. (1992). The effect of the experience with attitude object on the relationships among cognitive and affective components of attitude and behavioural intentions. The Psychological Record, 42(1), 131-139. https://doi.org/10.1007/BF03399591.
Bo, W., Ahmad, Z., Alanzi, A. R., Al-Omari, A. I., Hafez, E. H., & Abdelwahab, S. F. (2022). The current COVID-19 pandemic in China: An overview and corona data analysis. Alexandria Engineering Journal, 61(2), 1369-1381. https://doi.org/10.1016/j.aej.2021.06.025.
Burki, T. (2020). China's successful control of COVID-19. The Lancet Infectious Diseases, 20(11), 1240-1241. https://doi.org/10.1016/S1473-3099(20)30800-8.
Cheng, J., Cui, J., Yu, W., Kang, H., Tian, Y., & Jiang, X. (2021). Factors influencing nurses behavioural intention toward caring for COVID-19 patients on mechanical ventilation: A cross-sectional study. PLoS ONE, 16(11), e0259658. https://doi.org/10.1371/journal.pone.0259658.
De Kock, J. H., Latham, H. A., Leslie, S. J., Grindle, M., Munoz, S. A., Ellis, L., Polson, R., & OMalley, C. M. (2021). A rapid review of the impact of COVID-19 on the mental health of healthcare workers: Implications for supporting psychological well-being. BMC Public Health, 21(1), 1-18.
Gebreheat, G., & Teame, H. (2021). Ethical challenges of nurses in COVID-19 pandemic: Integrative review. Journal of Multidisciplinary Healthcare, 14, 1029-1035. https://doi.org/10.2147/JMDH.S308758.
Godbold, R., Whiting, L., Adams, C., Naidu, Y., & Pattison, N. (2021). The experiences of student nurses in a pandemic: A qualitative study. Nurse Education in Practice, 56, 103186. https://doi.org/10.1016/j.nepr.2021.103186.
Gómez-Ibáñez, R., Watson, C., Leyva-Moral, J. M., Aguayo-González, M., & Granel, N. (2020). Final-year nursing students called to work: Experiences of a rushed labour insertion during the COVID-19 pandemic. Nurse Education in Practice, 49, 102920. https://doi.org/10.1016/j.nepr.2020.102920.
Hasuike, M., Hara, Y., Mori, H. M., Ideguchi, N., Shirai, F., Yoshimura, Y., Murakami, I., Kawahata, H., Aoki, M., & Ogihara, T. (2021). Influence of new coronavirus pandemic on behaviour and awareness of young nurses and nursing students in Japan. BMC Nursing, 20(1), 1-10. https://doi.org/10.1186/s12912-021-00724-x.
Hou, H., Pei, Y., Yang, Y., Lu, L., Yan, W., Gao, X., & Wang, W. (2021). Factors associated with turnover intention among healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic in China. Risk Management and Healthcare Policy, 14, 4953-4965. https://doi.org/10.2147/RMHp.S318106.
Hu, B., Guo, H., Zhou, P., & Shi, Z. L. (2021). Characteristics of SARS-CoV-2 and COVID-19. Nature Reviews Microbiology, 19(3), 141-154. https://doi.org/10.1038/s41579-020-00459-7.
Hu, D., Kong, Y., Li, W., Han, Q., Zhang, X., Zhu, L. X., Wan, S. W., Liu, Z., Shen, Q., Yang, J., He, H. G., & Zhu, J. (2020). Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine, 24, 100424. https://doi.org/10.1016/j.eclinm.2020.100424.
Jeong, S. A., & Kim, J. (2022). Factors influencing nurses intention to care for patients with COVID-19: Focusing on positive psychological capital and nursing professionalism. PLoS ONE, 17(1), e0262786. https://doi.org/10.1371/journal.pone.0262786.
Jeong, S. Y., Park, H. S., Wang, H. J., & Kim, M. (2015). Intentions to care for new influenza A (H 1 N 1) patients and influencing factors: An application of theory of planned behaviour. Journal of Korean Academic Society of Home Health Care Nursing, 22(1), 78-87.
Ke, Q., Chan, S. W. C., Kong, Y., Fu, J., Li, W., Shen, Q., & Zhu, J. (2021). Frontline nurses willingness to work during the COVID-19 pandemic: A mixed-methods study. Journal of Advanced Nursing, 77(9), 3880-3893. https://doi.org/10.1111/jan.14989.
Ko, N. Y., Feng, M. C., Chiu, D. Y., Wu, M. H., Feng, J. Y., & Pan, S. M. (2004). Applying theory of planned behaviour to predict nurses' intention and volunteering to care for SARS patients in southern Taiwan. The Kaohsiung Journal of Medical Sciences, 20(8), 389-398. https://doi.org/10.1016/S1607-551X(09)70175-5.
Lee, J., & Kang, S. J. (2020). Factors influencing nurses' intention to care for patients with emerging infectious diseases: Application of the theory of planned behaviour. Nursing & Health Sciences, 22(1), 82-90. https://doi.org/10.1111/nhs.12652.
Lord, H., Loveday, C., Moxham, L., & Fernandez, R. (2021). Effective communication is key to intensive care nurses' willingness to provide nursing care amidst the COVID-19 pandemic. Intensive & Critical Care Nursing, 62, 102946. https://doi.org/10.1016/j.iccn.2020.102946.
Luo, Y., Feng, X., Zheng, M., Zhang, D., Xiao, H., & Li, N. (2021). Willingness to participate in front-line work during the COVID-19 pandemic: A cross-sectional study of nurses from a province in south-west China. Journal of Nursing Management, 29(6), 1356-1365. https://doi.org/10.1111/jonm.13309.
Minuye, B., Alebachew, W., Melese Kebede, S. A., & Belay, D. M. (2021). Intention to care for COVID-19 patients among nurses working at health care institutions of Debre Tabor town, north central Ethiopia. Risk Management and Healthcare Policy, 14, 2475-2481. https://doi.org/10.2147/RMHp.S311830.
Miyawaki, C. E. (2016). Caregiving practice patterns of Asian, Hispanic, and non-Hispanic white American family caregivers of older adults across generations. Journal of Cross-Cultural Gerontology, 31(1), 35-55. https://doi.org/10.1007/s10823-016-9281-5.
Nie, A., Su, X., Zhang, S., Guan, W., & Li, J. (2020). Psychological impact of COVID-19 outbreak on frontline nurses: A cross-sectional survey study. Journal of Clinical Nursing, 29(21-22), 4217-4226. https://doi.org/10.1111/jocn.15454.
Rezaee, N., Mardani-Hamooleh, M., & Seraji, M. (2020). Nurses' perception of ethical challenges in caring for patients with COVID-19: A qualitative analysis. Journal of Medical Ethics and History of Medicine, 13. https://doi.org/10.18502/jmehm.v13i23.4954.
Rosa, W. E., Binagwaho, A., Catton, H., Davis, S., Farmer, P. E., Iro, E., Karanja, V., Khanyola, J., Moreland, P. J., Welch, J. C., & Aiken, L. H. (2020). Rapid investment in nursing to strengthen the global COVID-19 response. International Journal of Nursing Studies, 109, 103668. https://doi.org/10.1016/j.ijnurstu.2020.103668.
Seah, B., Ho, B., Liaw, S. Y., Ang, E. N. K., & Lau, S. T. (2021). To volunteer or not? Perspectives towards pre-registered nursing students volunteering frontline during COVID-19 pandemic to ease healthcare workforce: A qualitative study. International Journal of Environmental Research and Public Health, 18(12), 6668. https://doi.org/10.3390/ijerph18126668.
Sharif Nia, H., Arslan, G., Naghavi, N., Sivarajan Froelicher, E., Kaveh, O., Pahlevan Sharif, S., & Rahmatpour, P. (2021). A model of nurses intention to care of patients with COVID-19: Mediating roles of job satisfaction and organisational commitment. Journal of Clinical Nursing, 30(11-12), 1684-1693. https://doi.org/10.1111/jocn.15723.
Shaukat, N., Ali, D. M., & Razzak, J. (2020). Physical and mental health impacts of COVID-19 on healthcare workers: A scoping review. International Journal of Emergency Medicine, 13(1), 1-8. https://doi.org/10.1186/s12245-020-00299-5.
Tran, Q. A., Nguyen, H. T. T., Van Bui, T., Tran, N. T., Nguyen, N. T., Nguyen, T. T., Nguyen, H. T., & Nguyen, S. H. (2021). Factors associated with the intention to participate in coronavirus disease 2019 frontline prevention activities among nursing students in Vietnam: An application of the Theory of Planned Behaviour. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.699079.
Twohig, K. A., Nyberg, T., Zaidi, A., Thelwall, S., Sinnathamby, M. A., Aliabadi, S., Seaman, S. R., Harris, R. J., Hope, R., Lopez-Bernal, J., Gallagher, E., Charlett, A., De Angelis, D., Presanis, A. M., Dabrera, G., & COVID-19 Genomics UK (COG-UK) consortium. (2022). Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: A cohort study. The Lancet. Infectious Diseases, 22(1), 35-42. https://doi.org/10.1016/S1473-3099(21)00475-8.
World Health Organization. (2020). Ethics and COVID-19: Resource allocation and priority-setting. https://www.who.int/ethics/publications/ethics-covid-19-resource-allocation.pdf?ua=1.
World Health Organization. (2022a). Weekly epidemiological update on COVID-19 Accessed January 6, 2022. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---6-january-2022.
World Health Organization. (2022b). China: WHO coronavirus disease (COVID-19) dashboard. https://covid19.who.int/region/wpro/country/cn.
Wu, B., Zhao, Y., Xu, D., Wang, Y., Niu, N., Zhang, M., Zhi, X., Zhu, P., & Meng, A. (2020). Factors associated with nurses' willingness to participate in care of patients with COVID-19: A survey in China. Journal of Nursing Management, 28(7), 1704-1712. https://doi.org/10.1111/jonm.13126.
Zhang, S., Wang, Z., Chang, R., Wang, H., Xu, C., Yu, X., Tsamlag, L., Dong, Y., Wang, H., & Cai, Y. (2020). COVID-19 containment: China provides important lessons for global response. Frontiers of Medicine, 14(2), 215-219. https://doi.org/10.1007/s11684-020-0766-9.
Zhu, J., Stone, T., & Petrini, M. (2021). The ethics of refusing to care for patients during the coronavirus pandemic: A Chinese perspective. Nursing Inquiry, 28(1), e12380. https://doi.org/10.1111/nin.12380.

Keywords: COVID-19; China; intention; nurses; patient care

SARS-CoV-2 variants

Date Created: 20220418 Date Completed: 20221207 Latest Revision: 20221207

20231215

PMC9115239

10.1111/jonm.13639

35434870