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. 2024 Sep 6;103(36):e39570. doi: 10.1097/MD.0000000000039570

Analysis of influencing factors of risk perception among emergency nurses in China: An observational study

Fu-Yan Liu a, Jia-Xi Sun a, Wen-Nv Hao a,*
PMCID: PMC11383721  PMID: 39252216

Abstract

To understand the current saturation of emergency nurses’ risk perception and its influencing factors, and to explore the correlation between emergency nurses’ risk perception and nurse’s safety behavior. This study is a cross-sectional study. From January 2024 to February 2024 using the questionnaire star online survey method. The convenience sampling method was used to survey nurses in the emergency departments of 5 hospitals in China. Male and female emergency nurses (n = 189) from China were included in the final sample. Nursing risk perception questionnaire and nurses safety behavior scale were used for evaluation. The collected data were comprehensively analyzed using various statistical methods, including descriptive analysis, 2 independent samples t-test mean comparison, 1-way analysis of variance for differences, multiple linear regression analysis to identify influencing factors, and Pearson correlation analyze correlations. All analyses were performed using SPSS version 26.0, and P < .05 was considered statistically significant (2-sided). The emergency nurses score was (87.08 ± 20.18) on the risk perception scale, scoring rate 62.2%. The results of multiple regression showed that age, marital status, education level, professional title, monthly income level, and safety behaviors were the main factors influencing the risk perception of emergency nurses (P < .05). The results of correlation analysis showed a positive correlation between the dimensions of nurses’ risk perception and safety behaviors (R = 0.636, P < .01). Age, marriage, education level, years of work experience, professional title, duties. engagement type, monthly income level, participation in teaching work, safety training, and no adverse events were the influencing factors of risk perception. The research results emphasize that risk perception of emergency nurses has a positive prediction effect on safe behavior. It is suggested that nursing managers should optimize nursing workflow and human resource allocation, strategically add occupational risk training to vocational training, and strengthen nurses’ safety behaviors.

Keywords: analysis of influencing factors, emergency nurses, nursing care, risk perception, safety behaviors

1. Introduction

Risk perception originated from the “perceived risk” proposed by Bauer of Harvard University in the United States,[1] Risk perception is people’s subjective feelings of objective risk things and their intuitive judgment of the possibility of risk occurrence and the severity of the consequences. Nursing staff engaged in nursing activities or in their work environment, due to exposure to physical, chemical, biological and other harmful substances, or under pressure from organizations, society, and make their physical and mental damage.[2]

The reports on the medical field began to explore the impact of risk perception on screening for certain diseases in 1990 by American scholars Blalock et al[3] With the deepening of clinical nurses’ risk perception abroad, the research on risk perception is relatively mature. The domestic research is relatively lacking.[4] Effectively identifying nurses’ risk perception levels is crucial for nursing managers to implement appropriate interventions to help nurses cope with nursing risks and patient safety. In this regard, the commonly used risk perception measurement questionnaire is the Nursing Risk Perception Questionnaire developed by Zhang.[2] It has been tested to have good reliability and validity and can be used to analyze the current situation of clinical nurses’ risk perception.

Nursing safety is an important part of hospital diagnosis and treatment safety issues,[5] Nurses’ safety behavior is influenced by the hospital, nurses’ social beliefs and attitudes towards safety, which can reduce the occurrence of errors and accidents and affect the implementation of patient safety goals.[68] The prerequisite for changing nurses’ unsafe behaviors is to understand the current status of their safety behaviors,[9] Nurses’ perception of risk is an important factor in their unsafe behaviors at work.[10] The risk perception of nurses may affect their work attitude, behavior, and then affect the safety of nursing work.[2]

With the development of medical technology and the increasingly complex medical environment, nurses play a key role in providing clinical care.[11] Emergency nursing work is characterized by urgency, uncertainty and high risk.[12] Therefore, emergency nursing personnel should understand their own risk perception level, accurately understand and judge various risks in the nursing environment, actively learn the relevant knowledge and methods of risk management, and strengthen the awareness of risk prevention. At present, research on risk perception mainly focuses on doctors and clinical nurses. However, there are few studies on the risk perception of emergency nurses, a special group. Therefore, It is crucial to investigate the risk perception and safety behavior among emergency nurses.

This study investigated the risk perception of emergency nurses in China hospitals, aiming to understand the current situation of risk perception of emergency nurses and analyze the influencing factors, to provide the basis for taking targeted measures.

2. Methods

2.1. Study design

This was a cross-sectional research. Guidelines for reporting results using observational descriptive studies (STROBE statement) checklist were used.

2.2. Setting and sample

From January 2024 to February 2024 using the questionnaire star online survey method. The convenience sampling method was used to survey nurses in the emergency departments of 5 hospitals in Shenzhen Hospital of Traditional Chinese Medicine, Zhuhai Hospital affiliated to Guangdong, Joint Logistic Support Force 903 Hospital, Zhengzhou Pingle Orthopedics Hospital, Dancheng County Hospital of Traditional Chinese Medicine. Inclusion criteria: Emergency nurses who have worked in the hospital for more than 1 year and obtained informed consent. Exclusion criteria: external nurses who need further training and internship, emergency nurses who do not work in the unit due to various reasons such as sick leave, personal leave, etc.

In this study, the sample size estimation method of multiple linear regression analysis is proposed, and the sample content is at least 10 to 20 times the number of variables.[13] Since the variables involved in this study were 15 (14 general information and 1 nurse safety behavior scale), the sample size was increased by 20% to estimate the need for a sample of 180 to 360 people, taking into account missing data and other circumstances. This survey collected 197 questionnaires, recovered 189 valid questionnaires, valid questionnaire recovery rate of 95.9%.

2.3. Data collection

By a uniformly trained investigator the survey was conducted, and the questionnaire was administered to the nurses who met the inclusion criteria. In order to ensure the quality of the questionnaire, the purpose, meaning and filling method of the survey were explained to the research subjects before the survey, and the questionnaire was distributed after obtaining informed consent. All questionnaires were anonymous, and all questions were set as required answers, returned and exported. The above measures ensure the validity and authenticity of data.

2.4. Measures

2.4.1. Social-demographic information questionnaire

The social-demographic information questionnaire included gender, age, Ethnic Group, marital status, education level, years of work experience, professional title, duties, employment type, monthly income level, hospital grade, and participation in teaching duties training, participated in safety training, occurs adverse events, with a total of 14 items.

2.4.2. Nurse risk perception questionnaire

The questionnaire was developed by Zhang[2] and is suitable for assessing the risk perception level of emergency nurses in the Chinese cultural context. The Cronbach α coefficient of this questionnaire of 0.947 and a content validity index of 0.928, with good reliability and validity. The questionnaire consisted of 6 dimensions physical safety risk (5 items), physical functioning risk (4 items), occupational exposure risk (4 items), psychosocial risk (5 items), organizational factors risk (4 items), and temporal risk (6 items) with a total of 28 entries. The questionnaire is rated on a 5-point Likert scale, ranging from 1 to 5 as never, rarely, sometimes, often and always. The total score of the questionnaire was 140 points, and the higher the nurse score rate, the higher the level of risk recognition.

2.4.3. Nurse safe behavior scale

This scale is a Chinese version of the Nurse Safety Behaviour Scale (NSSBS) developed by Yen-Fu Rong,[14] which is used to understand the behavior of nurses when they are trying to avoid or minimize harm to patients in nursing care. The α coefficient of Cronbach is 0.915, which has good credit validity and is suitable for the evaluation of the safe behavior level of emergency nurses in China. The questionnaire is single dimension and a total of 12 items. The 5-point Likert scale is adopted, and the scales from “never” to “always” are 1 to 5, with a total score of 12 to 60 points, the higher the score, the better the nurse’s safety behavior.

2.5. Data analysis

All analyses were performed using SPSS version 26.0. Descriptive statistics are used to describe the general demographic characteristics of the research subjects. Results were summarized using frequencies and percentages. Nurses’ risk perception and safety behavior levels were described using means ± standard deviations (SD). For the analysis of quantitative data, 2 independent samples t-test and 1-way analysis of variance were used. Multiple stepwise linear regression was used to determine the influencing factors of risk perception. Pearson correlation analysis was used to test the correlation between nurses’ risk perception and nurses’ safety behaviors. P < .05 was considered statistically significant (2-sided).

2.6. Ethical consideration

This study was approved by the Ethics Committee of the Affiliated Hospital of Inner Mongolia Medical University (Approval Number: WZ2024009).Participants were informed that their participation in the study was completely voluntary and that they were free to decide whether to participate. To ensure participant privacy and confidentiality, the questionnaires used in this study were completely anonymous. These measures are implemented to uphold ethical standards throughout the research process and protect the rights and well-being of research participants.

3. Results

3.1. Participant characteristics and factor associated with risk perception

Of the 189 emergency nurses in this study, 72.5% were female and 27.5% were male. The majority of nurses had bachelor degree (65.1%), Independent samples t-test and 1-way ANOVA revealed that showed the risk perception scores of emergency nurses were statistically significant (P < .05) for different ages, marital status, education level, years of work experience, professional title, duties, employment type, monthly income level, hospital grade, participation in teaching duties training, participated in safety training, and occurs adverse events, as detailed in Table 1.

Table 1.

Demographic characteristics and the distribution of risk perception (N = 189).

Variables N (%) Mean (SD) t/F P
Gender -.785 .433
 Male 52 (27.5) 85.21 ± 21.09
 Female 137 (72.5) 87.80 ± 19.86
Age (yr) 30.905 <.001
 20 to 29 112 (59.2) 80.74 ± 18.92
 30 to 39 51 (27) 89.02 ± 13.00
 ≥40 26 (13.8) 110.62 ± 19.29
Ethnic group -.156 .876
 Han 180 (95.2) 87.03 ± 20.31
 Others 9 (4.8) 88.11 ± 18.46
Marital status -3.980 <.001
 Unmarried 109 (57.7)
80 (42.3)
82.17 ± 18.24
 Married 93.78 ± 20.87
Education level 4.046 .019
 Junior college or below 32 (16.9)
123 (65.1)
34 (18)
80.13 ± 21.50
 Undergraduate 86.98 ± 17.87
 Postgraduate and above 94.03 ± 24.66
Years of work experience 18.927 <.001
 ≤5 82 (43.4)
58 (30.7)
21 (11.1)
28 (14.8)
79.18 ± 18.09
 6 to 10 85.69 ± 17.11
 11 to 15 94.76 ± 13.68
 ≥16 107.36 ± 20.75
Professional title 30.794 <.001
 Nurse 64 (33.9)
68 (36)
45 (23.8)
12 (6.3)
76.19 ± 18.45
 Senior nurse 86.37 ± 16.51
 Supervisor nurse 94.02 ± 15.12
 Co-chief nurse and above 123.25 ± 10.85
Duties -5.568 <.001
 Nurse 154 (81.5)
35 (18.5)
83.15 ± 17.86
 Nursing manager 104.4 ± 20.91
Engagement type 3.135 .046
 Staffing of government affiliated institutions 42 (22.2) 93.76 ± 21.53
 Contract 123 (65.1) 85.52 ± 19.62
 Labor dispatch 24 (12.7) 83.42 ± 18.77
Monthly income level (CNY) 37.712 <.001
 <6000 53 (28)
67 (35.5)
69 (36.5)
71.04 ± 17.83
 6000 to 8000 88.48 ± 14.22
 >8000 98.06 ± 19.02
Hospital grade 4.82 .009
 Tertiary hospitals 129 (68.3)
42 (22.2)
18 (9.5)
88.25 ± 21.22
 Grade II hospitals 89.38 ± 15.23
 Grade I hospitals 73.39 ± 18.21
Participation in teaching duties training 4.071 <.001
 Yes
 No
89 (47.1)
100 (52.9)
93.25 ± 21.63
81.60 ± 17.12
Participation in safety training 2.071 .043
 Yes
 No
143 (75.7)
46 (24.3)
88.77 ± 20.15
81.85 ± 19.58
Occurs adverse events 2.164 .031
 Yes
 No
96 (50.8)
93 (49.2)
90.19 ± 18.55
83.88 ± 21.36

SD = standard deviation.

3.2. Risk perception score for emergency nurses

The total risk perception score of 189 emergency nurses was (87.08 ± 20.18). The score rate was 62.20%. The scores of each dimension are shown in Table 2.

Table 2.

Risk perception scores of emergency nurses (N = 189).

Variables Total Total score Total mean (SD) Scoring rate (%)
Personal safety risks 5 25 14.53 ± 4.05 58.12
Physical functional risks 4 20 13.54 ± 3.43 67.70
Occupational exposure risk 4 20 12.58 ± 3.25 62.90
Psychosocial risks 5 25 14.97 ± 4.09 59.88
Organisational factor risk 4 20 11.68 ± 3.51 58.40
Times risk 6 30 19.79 ± 5.37 65.97
Total risk perception score 28 140 87.08 ± 20.18 62.20

SD = standard deviation.

3.3. Multiple linear regression analysis

With nurse risk perception score as dependent variables and the single factor of meaningful variables multiple linear regression analysis. Result showed that age, marital status, education level, professional title, monthly income level, safety behavior entry regression equation which explained 59.5% of the total variance (Table 3).

Table 3.

Multiple linear regression of risk perception among emergency nurses (N = 189)

B SE Beta t P
(Constant) -18.434 11.59 -1.59 .114
Age 6.919 3.007 0.249 2.301 .023
Marital status -5.666 2.702 -0.139 -2.097 .037
Education level 3.915 1.756 0.115 2.23 .027
Professional title 4.048 1.931 0.183 2.097 .037
Monthly income level 5.106 1.707 0.203 2.991 .003
Total safety behavior score 1.097 0.126 0.485 8.678 <.001

F = 22.216, P < .001, R2= 0.623, adjusted R2 = 0.595, SE = standard error.

3.4. Correlation analysis of risk perception and safety behaviors among emergency nurses

The scores of the 6 dimensions of the Nurses’ Perceived Risk Scale, namely, physical safety risk, physical functioning risk, occupational exposure risk, psychosocial risk, organizational factors risk, and temporal risk, were positively correlated with the scores of the Nurses’ Safe Behaviour Scale (P < .001) (Table 4).

Table 4.

Correlation analysis between nurses’ risk perception and nurses’ safety behaviour.

1 2 3 4 5 6 7
Personal safety risks
Physical function risks .651**
Occupational exposure risks .680** .697**
Psychosocial risks .639** .577** .691**
Organisational factor risks .696** .610** .694** .753**
Times risk .620** .688** .718** .647** .679**
Safety behavior total score .543** .513** .552** .544** .480** .590**
Risk perception total score .837** .819** .868** .843** .862** .873** .636**
**

P < .001.

4. Discussion

4.1. The risk perception of emergency department nurses

The results of this survey showed that the risk perception score of emergency department nurses (87.08 ± 20.18), The score rate was 62.20%, at a moderate level, which was consistent with the results of the studies conducted by Chen et al[12] and Zhang et al.[15] The reason may be that the country has paid more attention to the occupational risks of nursing staff in recent years. For example, the Opinions of The State Council on the Implementation of Healthy China Action especially emphasize the prevention and control of occupational hazards and promote occupational health and safety.[16]

The top 1 dimensions of the score rate were physical function risk, This is consistent with the findings of Zhang et al.[15] The reason may be due to the special nature of the working environment and work demands, the body of nursing staff is inevitably threatened. In nursing work, nursing staff need to be in a certain bad posture for a long period of time to complete nursing operations, which may lead to lower back pain, cervical spondylosis and other diseases; they need to stand for a long period, time at work, and the incidence of varicose veins is relatively high; nursing staff’s working hours are not fixed, and they often need to work overtime, and their diets are irregular, which makes them prone to suffer from digestive diseases.[1719] Thus caregivers scored the highest physical function risk dimension.

The dimension with the lowest score is personal safety risk, which is inconsistent with the study of Zhang et al,[15] and the reasons may be emergency nursing is a fast-paced, heavy-duty, highly stressful and busy department with many clinical diagnoses and nursing operations.[20] They receive the necessary training for enhancing their stress management capabilities and psychological resilience and to learn how to express their feelings and emotions.[21]

4.2. Factors influencing risk perception of emergency nurses

4.2.1. Age

The results of the study show that perceived occupational risk increases significantly with age, which is consistent with the study by Gu et al.[22] Age produces a significant positive relationship with perceived risk. As nurses grow older and accumulate work experience, nursing staff tend to have more professional clinical knowledge and risk judgement, and have a higher perception of nursing risk. Young nursing staff have heavy tasks in the department, and the probability of occupational risk is higher,[23] so nursing managers should pay more attention to young nursing staff, optimize nurse allocation, and match old nurses with new nurses in the work, to improve the safety behaviors of young nurses and reduce the probability of risk occurrence.

4.2.2. Marital status

The results of the study showed that married nursing staff perceived higher occupational risks, inconsistent with the results of Ge study,[24] the reasons may be related to the otherness of study subjects, which may be related to the fact that married nurses have a more mature mindset and a stronger sense of responsibility than unmarried nurses, which may make them more focused and serious about their work,[25] and more aware of the risks they face in their profession. Married nurses can get material and emotional support from their partners to cope with stress and negative emotions, and the marital experience also enables nurses to gain more experience and skills in interpersonal relationships.[26] As a result, married nurses may have a higher perception of occupational risks.

4.2.3. Education level

The results of the study show that there is a close relationship between nurses’ risk perception and nurses’ academic qualifications, the higher the nurses’ academic qualifications, the higher the total score of risk perception and the scores of various dimensions, which is inconsistent with the study by Zhang et al.[15] Studies have shown that caregivers with a diploma, bachelor, master or PhD perform differently in the face of difficulties.[27] The reason is presumed to be that the nurses with high academic qualifications take on more work in the clinical, and their work performance is more prominent,[28] so that their work experience is enhanced and they have a higher perception in the face of occupational risks. They can achieve self-regulation and better learning by controlling and guiding their own behavior.[29] This suggests that hospital managers should focus on different levels of nurses, so that nurses at all levels of education can give full play to the value of their abilities in their positions.

4.2.4. Professional titles

The result study shows that there is a close relationship between nurses’ risk perception and nurses’ title, the higher the nurses’ title, the higher the total score of risk perception and the scores of each dimension, which is consistent with the results of the study of Gu et al,[22] the analysis of the reason may be that the nurses with lower titles are mostly in the learning stage when they set foot in the workplace, and the learning focuses mainly on the rules and regulations of hospitals, the core work system, and the operation of the basic skills, whereas the nurses with higher titles are usually responsible for the teaching, the nursing team leader, and management etc, with rich clinical experience and more cases of coping with emergencies or occupational risk time.[30] Hospitals can strengthen risk training for junior nurses to improve their risk perception ability.

4.2.5. Monthly income level

The results of the study showed that nurses with high monthly income had higher risk perception scores and higher scores in each dimension, which was consistent with the result that the higher the monthly income of the nurses studied by Zeng,[31] the higher the perception level of the work environment, and the reasons for this may be analyzed as the a high or low monthly income can directly affect the quality of life of nurses, and income is the main motivating factor for nurses. High monthly income can stimulate nurses’ sense of responsibility and self-efficacy, and senior nurses are responsible for more complex work tasks, so if work and income are disproportionate it may negatively affect the work,[31] which in turn affects nurses’ perception of occupational risk.

4.2.6. Safe behavior

In this study, the total safety behavior score (48.57 ± 8.93), full marks 60 points, overall considerable. Consistent with the findings of Xie et al,[32] the lowest scores on the Safety Behaviour Scale were found for the items “I will pay attention to whether my colleagues comply with safety rules” and “I will still pay attention to remind senior nurses even if they do not comply with safety rules,” which are consistent with the results of the studies conducted by Xie et al,[32] Chu,[33] Yang et al.[34] This may be due to the urgency of the emergency work, the high workload, and the lack of communication between nursing staff, who do not have the time to pay attention to their colleagues’ compliance with safety regulations.

In addition, senior nurses have more seniority and power, and junior nurses have less voice in the department, and seldom question and testify about their safety behavior.[35] This suggests that hospital administrators should establish an equal and harmonious environment, which may increase the nursing staff’s concern about unsafe behaviors, regulate safe behaviors within the unit, enhance nurses’ ability to perceive risks, and promote the harmonious development of nursing.

4.3. Correlation between risk perception and safety behaviors among emergency nurses

The results of Pearson correlation analysis showed that the risk perception were positively correlated with nurses’ safe behaviors (R = 0.636, P < .001), which was consistent with the results of the studies conducted by Zhang et al.[36] The reasons may be that nurses with higher risk perception have more accurate understanding and assessment of potential risk, timely detection of potential risk factors, and take corresponding safety measures, and this result indicated that the nurses’ risk perception predicted nurses’ behaviors. Nurse’ risk perception can provide reference for managers to guide and standardize nurses’ safety behavior. Nursing managers can enhance the risk perception, enhance their safety belief, standardize the operation process and restrain their behavior, so as to improve the safety of nurses’ profession.[36]

4.4. Strengths and limitations

Our study underwent a rigorous survey design. First, our data collection undergoes strict quality control to ensure the accuracy and validity of the results. Secondly, the results produced by the data analysis are scientific and provide clear insights into the research topic. However, we acknowledge that there are certain limitations to the study. First, the specific influencing paths and mechanisms of risk perception and safety behavior have not been explored in depth. Secondly, the dynamic changes and potential relationships between nurses’ risk perceptions and safety behaviors over time cannot be measured. In the future, we can try to conduct research using research methods such as longitudinal studies.

5. Conclusion

The results of this study showed that the risk perception of emergency nurses is at a moderate level and needs to be further improved. Age, marital status, education level, professional title, monthly income level, and safety behaviors are the influencing factors of risk perception of emergency nursing staff. Hospital management and nursing managers should according to different age, marital status, education level, monthly income level, safety behavior of emergency nursing staff risk perception characteristics, take measures to improve the ability of nursing staff to identify and avoid risk, actively carry out nursing occupational risk identification, expand nursing staff gain to risk knowledge channels, improve the ability of scientific and effective to avoid risk. Secondly, nurses with low seniority should also strengthen nursing occupational safety education and improve their nursing safety awareness and sensitivity of nursing risks. Finally, nursing managers should pay attention to humanized management, and arrange their work reasonably according to the ability level and demand level of nursing staff at different stages. Nursing managers should pay attention to the risk perception of low seniority nurses, which can be done by strengthening nurses’ occupational risk training and creating a safe and harmonious atmosphere to promote emergency nurses’ risk perception ability and safety behaviors, which will in turn safeguard nursing safety issues in the clinic.

Acknowledgments

We thank all the participants who took part in the study.

Author contributions

Conceptualization: Fu-Yan Liu, Jia-Xi Sun, Wen-Nv Hao.

Data curation: Fu-Yan Liu, Jia-Xi Sun, Wen-Nv Hao.

Formal analysis: Fu-Yan Liu, Jia-Xi Sun, Wen-Nv Hao.

Investigation: Fu-Yan Liu, Jia-Xi Sun, Wen-Nv Hao.

Methodology: Fu-Yan Liu, Jia-Xi Sun, Wen-Nv Hao.

Project administration: Wen-Nv Hao.

Resources: Fu-Yan Liu, Jia-Xi Sun, Wen-Nv Hao.

Software: Fu-Yan Liu, Jia-Xi Sun, Wen-Nv Hao.

Validation: Fu-Yan Liu, Wen-Nv Hao.

Writing – original draft: Fu-Yan Liu.

Writing – review & editing: Fu-Yan Liu, Jia-Xi Sun, Wen-Nv Hao.

Abbreviation:

SD
standard deviation

In this study, all methods were performed in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Affiliated Hospital of Inner Mongolia Medical University (Number:WZ2024009). All participants adhered to ethical principles and committed to voluntarily participate in the study. Additionally, our study was anonymous. During the survey process, we only collect questionnaire information and not personal information.

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Liu F-Y, Sun J-X, Hao W-N. Analysis of influencing factors of risk perception among emergency nurses in China: An observational study. Medicine 2024;103:36(e39570).

F-YL and J-XS equally contributed to the work.

Contributor Information

Fu-Yan Liu, Email: 15549458002@163.com.

Jia-Xi Sun, Email: 15720356783@139.com.

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