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. 2022 Oct 17;30(8):4071–4079. doi: 10.1111/jonm.13855

Factors influencing caring behaviour among registered nurses during the COVID‐19 pandemic in China: A qualitative study using the COM‐B framework

Lai‐Kun Tong 1, Ming‐Xia Zhu 2, Si‐Chen Wang 2, Pak‐Leng Cheong 2, Iat‐Kio Van 2,✉
PMCID: PMC9874631  PMID: 36198011

Abstract

Aim

The aim of this work is to explore the influencing factors of nurses' caring behaviour during the COVID‐19 pandemic based on the Capability, Opportunity, Motivation as determinants of Behaviour (COM‐B) theoretical framework.

Background

Nurse caring behaviour is vital to reduce and speed up the healing process of COVID‐19 patients. It is important to understand the factors that influence caring behaviour among nurses during the COVID‐19 pandemic. Research suggests that when it comes to understanding behaviour, using a theoretical framework is likely to be most effective, and the COM‐B framework is a recommended approach.

Methods

Semistructured interviews with 42 nurses working in 11 Chinese cities were conducted, and their verbatim statements were transcribed and analysed using thematic analysis. The results were mapped to COM‐B framework.

Results

Ten key themes emerged: Capability (professional knowledge and skills, emotional intelligence, cross‐cultural care competence); opportunity (resources, organizational culture, social culture); motivation (past experience, character, role, beliefs).

Conclusions

Ten factors were found to influence nurses' caring behaviour. This study added two new influencing factors, social culture and past experiences, that further contributed to the understanding of nurses' care behaviours.

Implications for Nursing Management

Nurses' caring behaviour is influenced not only by themselves but also by institutions and society, so interventions aiming to improve their caring behaviour should consider these elements. The negative impact of the pandemic on capability factors that influence nurses' caring behaviour should be counteracted as soon as possible.

Keywords: capability, caring behaviour, COVID‐19, motivation, nurse, opportunity

1. BACKGROUND

Coronavirus Disease 2019 (COVID‐19) is a new infectious disease caused by a coronavirus that has morphed into a global pandemic in a short time (World Health Organization, 2020). As of 28 November 2021, 260 million people around the world have been diagnosed with COVID‐19, and over 5 million have died from it (World Health Organization, 2021). The high number of COVID‐19 patients has put enormous strain on the health care system and health workers (World Health Organization, 2020), and nurses have made an important contribution to the pandemic (Bartosiewicz et al., 2021; Treston, 2020). Nurses with higher caring cognition were more willing to participate in the fight against COVID‐19 (Tong et al., 2021). Nurse caring behaviour is vital to reduce and speed up the healing process of COVID‐19 patients (Kusuma et al., 2021; Sumarliyah et al., 2021). Nurse caring behaviour is beneficial not only to the patient but also to nurses themselves. Nurse caring behaviour is significantly correlated with job engagement (De Los Santos & Labrague, 2021), job satisfaction (De Los Santos & Labrague, 2021; Putra et al., 2021), and professional quality of life (Inocian et al., 2021). As a result, nurse caring behaviour is more important than ever during the COVID‐19 pandemic.

Many studies have focused on the influencing factors of nurses' caring behaviour. Previous studies have shown that nurses' caring behaviour is influenced by internal factors (emotional intelligence and spiritual intelligence, self‐efficacy, etc.) (Kaur et al., 2015; Zahroh et al., 2020) and external factors (colleague support, salary, etc.) (Putra et al., 2021). All of this research was done before COVID‐19, which is having a significant and continuing impact on the nursing profession and across industries around the world (Agu et al., 2021; Turale & Nantsupawat, 2021). The COVID‐19 pandemic has brought both medical and nonmedical challenges to the care environment, such as changes in practice guidelines, and language barriers (Gordon et al., 2021). In addition to worsening the shortage of nurses (Turale & Nantsupawat, 2021) and straining the supply of some medical supplies (Gordon et al., 2021), the COVID‐19 pandemic has psychologically negatively affected nurses in a way that has never been observed before (Gordon et al., 2021; Hu et al., 2020). In light of the changes brought about by the COVID‐19 pandemic, it is important to understand the factors influencing caring behaviour among nurses during the pandemic.

Research suggests that when it comes to understanding behaviour, using a theoretical framework is likely to be most effective, and the Behaviour Change Wheel is a recommended approach (Michie et al., 2011). The Behaviour Change Wheel includes behaviour system, intervention functions, and policy categories, of which behaviour system is at the centre. This system was designed to understand the Capability (both physical and psychological), Opportunity (both social and physical), and Motivation (both reflective and automatic) to engage in Behaviour, which is known as the COM‐B (Capability, Opportunity, Motivation as determinants of Behaviour) theoretical framework (Michie et al., 2011). According to the framework, to perform a specific behaviour (B) at a given moment, an individual must be physically and psychologically capable (C) as well as have the social and physical opportunities (O) to do so, and also desire or need it above any competing behaviour (M) (Michie et al., 2011). It has been effectively applied to understand nurses' behaviour, such as antibiotic prescribing (Courtenay et al., 2019), hospital‐acquired pressure ulcers prevention (Gaspar et al., 2021), implementing new models of care (Bull et al., 2019), as well as to design and measure interventions to improve nurses' clinical practice, such as appropriate antibiotic prescribing (Lim et al., 2020) and nurse–patient therapeutic engagement (McAllister et al., 2021). It is possible to systematically map these COM‐B factors to intervention functions and policy categories that can be best utilized to optimize behaviour change once they are identified. The purpose of this study was to explore the influencing factors of nurses' caring behaviour during the COVID‐19 pandemic based on the COM‐B theoretical framework.

2. METHODS

2.1. Ethical considerations

The research team obtained ethical approval from the Research Management and Development Department at the authors' college (Ref. 2019APR01) before conducting the interviews. Researcher contacted the interviewees to determine the time and place of interviews before their interview. Interviews were recorded after the informed consent was obtained. Interviewees could quit the interviews at any time without any influence.

2.2. Design

A qualitative approach using one‐to‐one semistructured interviews was used.

2.3. Recruitment and sampling

Nurses who worked in 11 Chinese cities including Dongguan, Foshan, Guangzhou, Hong Kong, Huizhou, Jiangmen, Macao, Shenzhen, Zhaoqing, Zhongshan, and Zhuhai between July and December 2020 and passed the probation period were the subjects of this study. According to researchers' previous experience and literature (Vasileiou et al., 2018), recruitment of three to eight nurses per city would be sufficient to achieve data saturation. Participants were recruited until saturation was achieved (no additional information was obtained). In order to select participants, we used purposive sampling, which took into consideration age, sex, and years in the nursing profession. To carry out recruitment in each city, the research team contacted a local institution, which promoted the study using materials provided by the team. Recruitment took place at hospitals, nursing schools, and nursing professional associations in 11 cities. Based on the contact information provided by local liaison agencies, the research team contacted qualified nurses who volunteered to participate in the interview, confirmed their participation, and scheduled appointments with them. Interviews were eventually conducted with 42 nurses.

2.4. Interview outline

Following a literature review and expert consultation, the research team selected three nurses for preinterview to create the interview outline. The questions were developed based on the COM‐B theoretical framework for understanding behaviour (Table 1). The interview outline included questions about how the COVID‐19 pandemic affected nurses' caring behaviour because it had such a significant impact on health systems and health workers.

TABLE 1.

Overview of the interview guide

Domain Interview question
Capability How do you think caring is implemented? Can you give me some examples?
Do you think you practice enough caring in your nursing work? On a scale of 1 to 10, where 1 is very not enough and 10 is very enough, how would you rate yourself? Why is that?
Opportunity Do you think you practice enough caring in your nursing work? On a scale of 1 to 10, where 1 is very not enough and 10 is very enough, how would you rate yourself? Why is that?
Motivation What is the most memorable event in your organization? How do you feel?
What can be improved about caring in your organization?
How has COVID‐19 affected your caring behaviour? Can you give me some examples?
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2.5. Data collection

The research team planned to conduct online or telephone interviews due to COVID‐19, but after preinterviews, neither of these two forms performed well. Finally, a nurse with more than 5 years of clinical experience who had been trained by the research team and was not affected by quarantine measures conducted face‐to‐face interviews. The research team developed detailed interview guidelines, and team member with over 15 years of clinical and teaching experience supported the interviewer by telephone. Nonverbal communication cues of the interviewees were recorded. The on‐site interviewer recorded facial and body expressions, whereas the telephone support member recorded tones of voice. Data were collected between July and December 2020. The average length of the interview was 28 min, with a range of 19 to 38 min.

2.6. Data analysis

Data were transcribed verbatim by trained professionals and compared with audio recordings by the research team for accuracy. The first author and the corresponding author developed a code book in accordance with the COM‐B domains after reading the transcripts several times. Once the code book became stable through discussions between the two authors, they coded all interviews together. A third author was consulted in case of discrepancies between the two authors. The coding process was discussed with a senior researcher and a senior nurse. The inductive method was used to draw conclusions based on thematic analysis (Braun & Clarke, 2006) by using qualitative analysis software Nvivo 12.0.

3. RESULTS

3.1. Participants

A total of 42 nurses were interviewed, mainly female (n = 31), married (n = 24), and bachelor degree (n = 29). The average age of respondents was 36.1 years, ranging from 23 to 66. Nursing work experience of respondents ranged between 1 and 45 years, with an average of 14.2 years (Table 2).

TABLE 2.

Summary of participants' characteristics

Participant Gender Age Education level Marital status Year in nursing profession
P1 Female 66 Diploma Married 45
P2 Female 60 Graduate Single 30
P3 Female 49 Graduate Married 22
P4 Female 54 Postgraduate Single 29
P5 Female 42 Postgraduate Single 20
P6 Female 29 Graduate Single 6
P7 Male 24 Graduate Single 1
P8 Female 53 Postgraduate Married 32
P9 Female 45 Graduate Married 24
P10 Female 37 Graduate Married 15
P11 Female 45 Postgraduate Widowed 23
P12 Female 31 Graduate Single 5.5
P13 Female 33 Graduate Married 11
P14 Male 33 Graduate Single 9
P15 Female 52 Postgraduate Married 33
P16 Female 26 Postgraduate Single 1
P17 Female 40 Graduate Married 18
P18 Male 31 Graduate Married 10
P19 Male 30 Graduate Married 7
P20 Female 35 Graduate Married 10
P21 Female 20 Diploma Single 2
P22 Female 24 Graduate Single 2
P23 Female 36 Graduate Married 16
P24 Male 36 Graduate Married 13
P25 Female 23 Graduate Single 1
P26 Male 34 Graduate Married 12
P27 Female 39 Diploma Married 20
P28 Female 25 Diploma Single 5
P29 Male 24 Graduate Single 1
P30 Female 46 Graduate Married 26
P31 Female 38 Graduate Married 20
P32 Female 31 Graduate Married 11
P33 Male 29 Graduate Single 5
P34 Female 30 Graduate Single 9
P35 Female 33 Graduate Married 12
P36 Female 25 Diploma Single 3
P37 Male 32 Graduate Married 13
P38 Male 29 Diploma Married 5
P39 Female 47 Graduate Married 29
P40 Female 33 Graduate Married 10
P41 Female 46 Graduate Married 28
P42 Male 23 Diploma Single 3
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3.2. Factors influencing caring behaviour

This study shows the relevant factors that influence caring behaviour among registered nurses during the COVID‐19 pandemic in China cannot be reduced to one key factor. The factors that the participants mentioned as relevant are summarized below (Figure 1).

FIGURE 1.

FIGURE 1

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Factors influencing caring behaviour among registered nurses

3.2.1. Capability

Professional knowledge and skills

Most (n = 30, 71.4%) of the participants agreed that caring behaviour requires the integration of nursing knowledge and skills. Some participants stated that their caring behaviour was limited by a lack of professional knowledge and skills. As one participant noted:

Since I just graduated, nursing technology is not skilled, in the care of patients only pay attention to nursing operations while ignoring communication with patients. (P25)

Emotional intelligence

According to the participants, it is crucial for nurses to control and regulate their emotions when caring for patients. Nurses with high emotional intelligence can resolve nurse–patient disputes and treat their patients fairly.

Some patients may be grumpy. […] You (nurse) should not let grumpy patients dictate your actions. (P36)

Cross‐cultural care competence

Nurses should be able to accommodate the different cultures of patients based on their languages, nationalities, customs, living habits, religions, and other factors.

Each family has its own problems, and each family is different. […] Those are the things we care about. (P11)

To be competent at cross‐cultural care, the participants mentioned they needed knowledge beyond nursing and continued learning.

As he (patient) speaks Cantonese, which is rare in our department, it is up to me to taking care of him. (P36)

3.2.2. Opportunity

Resources

The implementation of caring involves both medical and nonmedical resources, and participants admitted that it was sometimes difficult to implement caring due to resource constraints. Among them, excessive workload and insufficient time due to insufficient manpower in the working organization were mentioned by the most participants (n = 28, 66.7%).

Only 4 points of resources have allowed us to achieve 6 points of caring, which is remarkable. (P5)

Organizational culture

According to the participants, delivering caring should not only be a reflection of nurses' own quality or the leadership's will but also result in a standardized and institutionalized work mode in the work institutions and provide guarantee conditions, such as regular training, for nurses to practice caring.

The nursing department has launched a 5‐minute listening activity, which means talking with patients for 5 minutes every day about something other than their disease. (P25)

A positive caring atmosphere can effectively guide employees to carry out caring, and may make nurses more likely to observe and emulate their colleagues' caring behaviour.

Our director has a great influence on me, because he is very concerned about what kind of patients he treats. After his influence, I do the same. (P20)

Social culture

The public have higher trust in doctors than nurses, which makes it difficult for nurses to play their role in the first place. Some participants commented that as the public saw the role nurses played in fighting COVID‐19, their respect of nurses increased. However, the prejudice of some patients still exists, which makes nurses fall into ethical dilemma and hinders the practice of caring.

Some family members will require the patient's condition to be kept confidential, so it may be necessary to communicate with the family members. (P23)

3.2.3. Motivation

Past experience

The participants reported how the sickness and death of their own or family members gave them an entirely new perspective caring, which prompted them to pay more attention to it when caring for patients.

As a quarantined patient, I experienced the patients' anxiety about their conditions. (Then) I focus more on the patient's moods. (P11)

Nurses may be praised or disrespected when interacting with patients and their families, which affects how they will cope in similar situations in the future.

He said you (nurses) would all die if my son died, which was really frightening. Many colleagues were scared and did not want to care for the child. (P4)

Character

In regards to the implementation of caring, the participants agreed that nurses' ability to do it did not mean that they wanted to do it, and their caring behaviours stemmed from their personal characteristics.

Because I cannot witness others in pain, I will take the initiative to help the patient when he is uncomfortable. (P34)

Role

The participants' perceptions of nurses as social roles affect their caring behaviour. The nurse, as the executor of caring will implement caring in psychology and action if he/she possesses positive professional identity, which refers to admitting the importance and value of the nursing profession and integrating this with public expectations of the profession.

We, as health care workers, when you put on this nurse's uniform, you should take responsibility. (P35)

Beliefs

Nurses must believe that they can do it and that caring will benefit patients, so that they actively practice caring. In other words, nurses are motivated to apply caring by positive beliefs about their caring abilities and the practical consequences of caring.

They (colleagues fighting COVID‐19 on the front lines) did practical work that I believe patients can really relate to. […] This has more influence on my implementation of caring. (P38)

4. DISCUSSION

To our knowledge, this is the first study to examine factors influencing nurses' caring behaviour during a pandemic, and the first to employ a theoretical framework to identify these factors. In this study, the COM‐B framework was used to develop the interview guide and structure the analysis. The advantage of adopting the COM‐B theoretical framework as a systematic theory‐driven approach was that it allowed for a comprehensive theoretical analysis of nurses' capability, opportunity, and motivation, as well as their interaction to influence caring behaviour. The COM‐B theoretical framework provided a more holistic conceptualization of these findings based on capability, opportunity, and motivation. Inductive method may limit the interpretation of findings to COM‐B components, but thematic analysis allowed us to identify the overarching theme of factors influencing nurses' caring behaviour, which can serve as a basis for future intervention plans. According to this study, nurses' caring behaviour during the COVID‐19 pandemic was influenced by capability (professional knowledge and skills, emotional intelligence, and cross‐cultural care competence), opportunity (resources, organizational culture, and social culture), and motivation (past experience, character, role, and beliefs).

Regarding capability, our analysis using the COM‐B framework identified three themes, indicating that the caring behaviour of nurses in China during the COVID‐19 pandemic is influenced by professional knowledge and skills, emotional intelligence, and cross‐cultural care competence. However, these abilities of nurses have been compromised by the pandemic, which has limited their caring practice. First, COVID‐19 is an emerging infectious disease. A lack of knowledge at the beginning of the pandemic led nurses to be hesitant about working with COVID‐19 patients (Nashwan et al., 2021). Limited information about COVID‐19 hinders nurses' ability to practice caring (Joo & Liu, 2021). Second, nurses experienced negative emotions due to the infections and even deaths of health care workers as well as the increased workload during the fight against COVID‐19 (Gordon et al., 2021; Hu et al., 2020). Nurses are able to cope better with negative emotions by developing emotional intelligence. Nurses working in respiratory therapy had the lowest levels of emotional intelligence during the COVID‐19 outbreak (Alonazi, 2020), suggesting that the pandemic may negatively affect nurses' emotional intelligence. Considering how emotional intelligence impacts nurses' caring behaviour (Karimi et al., 2021), the negative impact of COVID‐19 pandemic may also negatively influence nurses' caring behaviour. Third, health recommendations and epidemic prevention measures in countries during the pandemic tend to conflict with cultural, religious, and leisure habits, such as social distance and the limitation of family members from visiting hospitalized COVID‐19 patients (Almeida et al., 2021), creating challenges for nurses in cross‐cultural care. Medical facilities and nursing managers should be concerned about the negative impact of the COVID‐19 pandemic on the capability factors of nurses to practice caring and take corresponding measures to reduce that impact.

Nurses are capable of providing caring to their patients, but they also need the opportunity to do so. Considering opportunity, one of the important components of COM‐B framework, nurses generally believed that the implementation of caring involves adequate resources, a strong explicit and implicit caring culture in institutions, and public recognition of nurses. The first two of which were recognized in other studies (Fradelos et al., 2022; Oluma & Abadiga, 2020), but the latter was relatively seldom considered. These opportunity factors were positively impacted by the COVID‐19 pandemic. Nurses received financial and honorary awards for their contributions during the epidemic, which made them feel valued and enhanced their social image (Sheng et al., 2020). According to the social identity theory, when nurses gain a good image from the society, nurses' professional identity will be improved (Tajfel & Turner, 1986). Developing nurses' professional identity leads to their improved caring behaviour (Qiu, 2014). Despite this, the COVID‐19 pandemic has also negatively affected these opportunity factors. The COVID‐19 pandemic worsens the shortage of nurses (Turale & Nantsupawat, 2021) and strains the supply of some medical supplies (Gordon et al., 2021), which makes it difficult to meet the physiological and safety needs of patients, let alone other higher‐level needs. Despite limited resources, nurses' caring behaviours during the COVID‐19 pandemic could be positively influenced by organizational culture. Similar results were found by Oluma and Abadiga (2020). A positive organizational culture can strengthen nurses' sense of meaning at work (Wu et al., 2020), which will increase their motivation to provide caring (Chattopadhyay & Khan, 2016). Nurses' caring practices were severely affected by the shortage of resources during the beginning of the pandemic (Zipf et al., 2022). Medical facilities may find it difficult to prepare sufficient resources in a short time period, but they can start by fostering a positive organizational culture.

Nursing requires the ability as well as the willingness to provide caring. In terms of motivation, another COM‐B framework component, the nurses were clearly motivated to provide caring since they believe it benefits patients. Furthermore, how nurses view their profession and their past experience are among the factors that motivate them to implement caring. Nurses feel like heroes (Deliktas Demirci et al., 2021) and have increased their understanding of the value of their profession as they cope with the COVID‐19 pandemic (Li et al., 2021; Zhang et al., 2021). This means that the pandemic has exhibited a positive impact on nurses' professional identity. Developing nurses' professional identity leads to their improved caring behaviour (Qiu, 2014). It is also important to note that the COVID‐19 pandemic has negatively affected nurses' motivation. Nurses face a high rate of workplace violence during the COVID‐19 pandemic (Ramzi et al., 2022), which negatively affected their psychological health as well as their caring behaviour (Jang et al., 2021). Nurses may have to spend a lot of energy dealing with conflicts between them and patients or coworkers, which takes them away from focusing on the patients. Nurses are more likely to practice caring if they have been treated in a caring manner (Enns & Sawatzky, 2016; Sarafis et al., 2016). Therefore, institutions should provide a supportive and positive working environment for nurses.

5. STRENGTHS AND LIMITATIONS

This study has several advantages. First, this study includes a wide sampling range. Hong Kong and Macao are generally excluded in Chinese studies, but in this study, 11 cities were taken into account, including Hong Kong and Macao. Furthermore, the gender, age, education level, and experience of the nurses interviewed is also varied. Second, the data collected in this study are rigorous. The research team conducted pilot study to determine the interview outline, interview method, and interview guidelines. Additionally, interviews were conducted by a trained, qualified interviewer. Third, to our knowledge, this is the first study to examine factors influencing nurses' caring behaviour during a pandemic, and the first to employ a theoretical framework to identify these factors.

However, there are some limitations to this study. First, this study only included nurses who had passed the probationary period, so it requires caution to apply the findings to newly licensed nurses. Second, due to the COVID‐19 quarantine policy, we cannot contact the nurses who are caring COVID‐19 patients as well as the nurses in quarantine and therefore cannot rule out the possibility that they may have different opinions. Third, the research team did not explain caring to the participants before the interview, which may lead to differing interpretations of caring by the respondents, resulting in response bias.

6. CONCLUSIONS

Nurses performing caring during the COVID‐19 pandemic is important but challenging. This study employed a theory‐based approach to identify factors related to capability, opportunity, and motivation that influenced caring behaviour among nurses in China during the COVID‐19 pandemic. Ten factors were found to influence nurses' caring behaviour. Previous studies have explored the influencing factors of nurses' caring behaviours; however, this study added two new influencing factors, social culture and past experiences, that further contributed to the understanding of nurses' care behaviours. To improve nurses' caring behaviour, medical facilities and nursing managers should take into consideration the influencing factors found in this study.

7. IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study can be used as a basis for developing caring behaviour interventions for nurses. We found that the factors of capability (professional knowledge and skills, emotional intelligence, and cross‐cultural care competence), opportunity (resources, organizational culture, and social culture), and motivation (past experience, character, role, and beliefs) influenced nurses' caring behaviour. The factors described above suggest that not only nurses themselves but also institutions and society have a role in influencing nurses' caring behaviour, so interventions to improve nurses' caring should consider these aspects.

The COVID‐19 pandemic has a negative impact on nurses' capability factors that influence their caring behaviour, which should be aware by medical facilities and nursing managers. Appropriate measures will be required as soon as possible to counteract these negative effects. In contrast to the capability factors, the COVID‐19 pandemic has had more positive effects than negative effects on the opportunity factors. Nurses' contribution during the pandemic has been recognized by institutions and society, and nurses' status is more prestigious than ever. This is a great opportunity for professional nursing organizations to increase public recognition of nurses. These organizations should take advantage of this opportunity to find ways to continue the positive effects of the pandemic on nurses' caring behaviour for a long time to come.

CONFLICTS OF INTEREST

The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

ETHICS STATEMENT

The Research Management and Development Department of Kiang Wu Nursing College of Macau provided ethical approval for the study (Ref. 2019APR01).

ACKNOWLEDGMENTS

Funding from Macao Foundation is gratefully acknowledged. We thank College of Nursing Hong Kong, Dongguan Nursing Society, Jiangmen Third People's Hospital, Nethersole Institute of Continuing Holistic Health Education, The Fifth Affiliated Hospital of Sun Yat‐sen University, Zhaoqing Medical College, Guisu Jiang, Jun Lin, Li Zhang, Lijing Hu, and Qun Wang for help with data collection. Thanks to Leung Luk for helping to modify the grammar and spelling errors in this manuscript.

Tong, L.‐K. , Zhu, M.‐X. , Wang, S.‐C. , Cheong, P.‐L. , & Van, I.‐K. (2022). Factors influencing caring behaviour among registered nurses during the COVID‐19 pandemic in China: A qualitative study using the COM‐B framework. Journal of Nursing Management, 30(8), 4071–4079. 10.1111/jonm.13855

Funding Information This research was funded by Macao Foundation, grant number 2964/DS/2019.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

REFERENCES

  1. Agu, C. F. , Stewart, J. , McFarlane‐Stewart, N. , & Rae, T. (2021). Covid‐19 pandemic effects on nursing education: Looking through the lens of a developing country. International Nursing Review, 68(2), 153–158. 10.1111/inr.12663 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Almeida, G. M. F. , Nascimento, T. F. , Silva, R. , Bello, M. P. , & Fontes, C. M. B. (2021). Theoretical reflections of Leininger's cross‐cultural care in the context of Covid‐19. Revista Gaúcha de Enfermagem, 42(spe), e20200209. 10.1590/1983-1447.2021.20200209 [DOI] [PubMed] [Google Scholar]
  3. Alonazi, W. B. (2020). The impact of emotional intelligence on job performance during Covid‐19 crisis: A cross‐sectional analysis. Psychology Research and Behavior Management, 13, 749–757. 10.2147/prbm.S263656 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bartosiewicz, A. , Harpula, K. , & Łuszczki, E. (2021). The year of the nurse during the Covid‐19 pandemic. Nursing Reports, 11(4), 753–757. 10.3390/nursrep11040071 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Braun, V. , & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. 10.1191/1478088706qp063oa [DOI] [Google Scholar]
  6. Bull, E. R. , Hart, J. K. , Swift, J. , Baxter, K. , McLauchlan, N. , Joseph, S. , & Byrne‐Davis, L. M. T. (2019). An organisational participatory research study of the feasibility of the behaviour change wheel to support clinical teams implementing new models of care. BMC Health Services Research, 19(1), 97. 10.1186/s12913-019-3885-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Chattopadhyay, D. , & Khan, S. (2016). Spiritual motivation in management: A case study on how spirituality in management can be used by a health‐care provider. Globsyn Management Journal, 10(1), 74–86. [Google Scholar]
  8. Courtenay, M. , Rowbotham, S. , Lim, R. , Peters, S. , Yates, K. , & Chater, A. (2019). Examining influences on antibiotic prescribing by nurse and pharmacist prescribers: A qualitative study using the theoretical domains framework and com‐B. BMJ Open, 9(6), e029177. 10.1136/bmjopen-2019-029177 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. De Los Santos, J. A. A. , & Labrague, L. J. (2021). Job engagement and satisfaction are associated with nurse caring behaviours: A cross‐sectional study. Journal of Nursing Management, 29(7), 2234–2242. 10.1111/jonm.13384 [DOI] [PubMed] [Google Scholar]
  10. Deliktas Demirci, A. , Oruc, M. , & Kabukcuoglu, K. (2021). ‘It was difficult, but our struggle to touch lives gave us strength’: The experience of nurses working on Covid‐19 wards. Journal of Clinical Nursing, 30(5–6), 732–741. 10.1111/jocn.15602 [DOI] [PubMed] [Google Scholar]
  11. Enns, C. L. , & Sawatzky, J.‐A. V. (2016). Emergency nurses' perspectives: Factors affecting caring. Journal of Emergency Nursing, 42(3), 240–245. 10.1016/j.jen.2015.12.003 [DOI] [PubMed] [Google Scholar]
  12. Fradelos, E. , Alexandropoulou, C.‐A. , Kontopoulou, L. , Papathanasiou, I. V. , & Tzavella, F. (2022). Factors affecting Greek nurses' caring behaviors: The role of nurses' spirituality and the spiritual climate of hospitals. Journal of Religion and Health., 61, 1816–1830. 10.1007/s10943-022-01503-x [DOI] [PubMed] [Google Scholar]
  13. Gaspar, S. , Botelho Guedes, F. , Vitoriano Budri, A. M. , Ferreira, C. , & Gaspar de Matos, M. (2021). Hospital‐acquired pressure ulcers prevention: What is needed for patient safety? The perceptions of nurse stakeholders. Scandinavian Journal of Caring Sciences, scs.12995. 10.1111/scs.12995 [DOI] [PubMed] [Google Scholar]
  14. Gordon, J. M. , Magbee, T. , & Yoder, L. H. (2021). The experiences of critical care nurses caring for patients with Covid‐19 during the 2020 pandemic: A qualitative study. Applied Nursing Research, 59, 151418. 10.1016/j.apnr.2021.151418 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. 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. 10.1016/j.eclinm.2020.100424 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Inocian, E. P. , Cruz, J. P. , Saeed Alshehry, A. , Alshamlani, Y. , Ignacio, E. H. , & Tumala, R. B. (2021). Professional quality of life and caring behaviours among clinical nurses during the Covid‐19 pandemic. Journal of Clinical Nursing. 10.1111/jocn.15937 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jang, S. J. , Son, Y. J. , & Lee, H. (2021). Prevalence, associated factors and adverse outcomes of workplace violence towards nurses in psychiatric settings: A systematic review. International Journal of Mental Health Nursing., 31, 450–468. 10.1111/inm.12951 [DOI] [PubMed] [Google Scholar]
  18. Joo, J. Y. , & Liu, M. F. (2021). Nurses' barriers to caring for patients with Covid‐19: A qualitative systematic review. International Nursing Review, 68(2), 202–213. 10.1111/inr.12648 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Karimi, L. , Leggat, S. G. , Bartram, T. , Afshari, L. , Sarkeshik, S. , & Verulava, T. (2021). Emotional intelligence: Predictor of employees' wellbeing, quality of patient care, and psychological empowerment. BMC Psychology, 9(1), 93. 10.1186/s40359-021-00593-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kaur, D. , Sambasivan, M. , & Kumar, N. (2015). Impact of emotional intelligence and spiritual intelligence on the caring behavior of nurses: A dimension‐level exploratory study among public hospitals in Malaysia. Applied Nursing Research, 28(4), 293–298. 10.1016/j.apnr.2015.01.006 [DOI] [PubMed] [Google Scholar]
  21. Kusuma, E. , Nastiti, A. D. , Handayani, D. , & Puspitasari, R. H. (2021). The relationship between nurse caring behavior and anxiety levels among Covid‐19 patients. Nurse Holistic Care, 1(2), 82–88. 10.33086/nhc.v1i2.2309 [DOI] [Google Scholar]
  22. Li, Z. , Zuo, Q. , Cheng, J. , Zhou, Y. , Li, Y. , Zhu, L. , & Jiang, X. (2021). Coronavirus disease 2019 pandemic promotes the sense of professional identity among nurses. Nursing Outlook, 69(3), 389–398. 10.1016/j.outlook.2020.09.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Lim, R. , Courtenay, M. , Deslandes, R. , Ferriday, R. , Gillespie, D. , Hodson, K. , Reid, N. , Thomas, N. , & Chater, A. (2020). Theory‐based electronic learning intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers: An acceptability and feasibility experimental study using mixed methods. BMJ Open, 10(6), e036181. 10.1136/bmjopen-2019-036181 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. McAllister, S. , Simpson, A. , Tsianakas, V. , Canham, N. , De Meo, V. , Stone, C. , & Robert, G. (2021). Developing a theory‐informed complex intervention to improve nurse–patient therapeutic engagement employing experience‐based co‐design and the behaviour change wheel: An acute mental health ward case study. BMJ Open, 11(5), e047114. 10.1136/bmjopen-2020-047114 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Michie, S. , van Stralen, M. M. , & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 42. 10.1186/1748-5908-6-42 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Nashwan, A. J. , Abujaber, A. A. , Mohamed, A. S. , Villar, R. C. , & Al‐Jabry, M. M. (2021). Nurses' willingness to work with Covid‐19 patients: The role of knowledge and attitude. Nursing Open, 8(2), 695–701. 10.1002/nop2.674 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Oluma, A. , & Abadiga, M. (2020). Caring behavior and associated factors among nurses working in Jimma University specialized hospital, Oromia, Southwest Ethiopia, 2019. BMC Nursing, 19(1), 19. 10.1186/s12912-020-0407-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Putra, K. R. , Andayani, T. , & Ningrum, E. H. (2021). Job satisfaction and caring behavior among nurses in a military hospital: A cross‐sectional study. Journal of Public Health Research, 10(2), 2212. 10.4081/jphr.2021.2212 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Qiu, P. (2014). Correlation between the nurses' caring behaviors and professional identity. Chinese Nursing Managment, 14(8), 870–872. [Google Scholar]
  30. Ramzi, Z. S. , Fatah, P. W. , & Dalvandi, A. (2022). Prevalence of workplace violence against healthcare workers during the Covid‐19 pandemic: A systematic review and meta‐analysis. Frontiers in Psychology, 13, 896156. 10.3389/fpsyg.2022.896156 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Sarafis, P. , Rousaki, E. , Tsounis, A. , Malliarou, M. , Lahana, L. , Bamidis, P. , Niakas, D. , & Papastavrou, E. (2016). The impact of occupational stress on nurses' caring behaviors and their health related quality of life. BMC Nursing, 15(1), 56. 10.1186/s12912-016-0178-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Sheng, Q. , Zhang, X. , Wang, X. , & Cai, C. (2020). The influence of experiences of involvement in the Covid‐19 rescue task on the professional identity among Chinese nurses: A qualitative study. Journal of Nursing Management, 28(7), 1662–1669. 10.1111/jonm.13122 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Sumarliyah, E. , Nurlaela, L. , Mariono, A. , Nasrullah, D. , Purnamasari, I. , & Choliq, I. (2021). The impact of nurse caring on the recovery of Covid‐19 patients: A systematic review. Systematic Reviews in Pharmacy, 12(1), 1506–1513. [Google Scholar]
  34. Tajfel, H. , & Turner, J. C. (1986). The social identity theory of intergroup behavior. In Worchel S. & Austin G. (Eds.), Psychology of intergroup relations. Nelson‐Hall. [Google Scholar]
  35. Tong, L. K. , Zhu, M. X. , Wang, S. C. , Cheong, P. L. , & Van, I. K. (2021). Nurses who are more willing to participate in the fight against Covid‐19: Evidence from China. International Journal of Environmental Research and Public Health, 18(14), 7357. 10.3390/ijerph18147357 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Treston, C. (2020). Covid‐19 in the year of the nurse. The Journal of the Association of Nurses in AIDS Care: JANAC, 31(3), 359–360. 10.1097/JNC.0000000000000173 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Turale, S. , & Nantsupawat, A. (2021). Clinician mental health, nursing shortages and the Covid‐19 pandemic: Crises within crises. International Nursing Review, 68(1), 12–14. 10.1111/inr.12674 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Vasileiou, K. , Barnett, J. , Thorpe, S. , & Young, T. (2018). Characterising and justifying sample size sufficiency in interview‐based studies: Systematic analysis of qualitative health research over a 15‐year period. BMC Medical Research Methodology, 18(1), 148. 10.1186/s12874-018-0594-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. World Health Organization . (2020). Covid‐19 strategy update. World Health Organization. [Google Scholar]
  40. World Health Organization . (2021). Weekly operational update on Covid‐19‐30 November 2021. https://www.who.int/publications/m/item/weekly-operational-update-on-covid-19-30-november-2021
  41. Wu, X. , Hayter, M. , Lee, A. J. , Yuan, Y. , Li, S. , Bi, Y. , Zhang, L. , Cao, C. , Gong, W. , & Zhang, Y. (2020). Positive spiritual climate supports transformational leadership as means to reduce nursing burnout and intent to leave. Journal of Nursing Management, 28(4), 804–813. 10.1111/jonm.12994 [DOI] [PubMed] [Google Scholar]
  42. Zahroh, R. , Qomariah, S. N. , Ningsih, S. U. , & Bakar, A. (2020). Self efficacy associated with nurse caring behavior in nursing services in private hospitals. International Journal of Psychosocial Rehabilitation, 24(9), 2710–2714. [Google Scholar]
  43. Zhang, F. , Zuo, Q. , Cheng, J. , Li, Z. , Zhu, L. , Li, Y. , Xuan, L. , Zhou, Y. , & Jiang, X. (2021). Professional identity during the Covid‐19 pandemic: A cross‐sectional survey of nurses in China. American Journal of Critical Care, 30(3), 203–211. 10.4037/ajcc2021245 [DOI] [PubMed] [Google Scholar]
  44. Zipf, A. L. , Polifroni, E. C. , & Beck, C. T. (2022). The experience of the nurse during the Covid‐19 pandemic: A global meta‐synthesis in the year of the nurse. Journal of Nursing Scholarship, 54(1), 92–103. 10.1111/jnu.12706 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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