ObjectiveBehavioral intentions to care for patients with infectious diseases are crucial for improving quality of care. However, there have been few studies of the behavioral intentions and factors influencing patient care by clinical nurses during the COVID-19 pandemic. This study aims to explore cognition, attitudes, subjective norms, self-efficacy, and behavioral intentions of clinical nurses while caring for COVID-19 patients and to explore any influencing factors.MethodA cross-sectional survey was conducted of nurses through convenience sampling in southeast China from February 2020 to March 2020. The questionnaire was developed based on the theory of planned behavior and self-efficacy.ResultsA total of 774 nurses completed the survey. Of these, 69.12% (535/774) reported positive behavioral intentions, 75.58% (585/774) reported a positive attitude, and 63.82% (494/774) reported having the confidence to care for patients. However, the lack of support from family and friends and special allowance affected their self-confidence. Attitude, self-efficacy, subjective norms, and ethical cognition were significantly positively correlated with behavioral intentions (r = 0.719, 0.690, 0.603, and 0.546, respectively, all P < 0.001). Structural equation model showed that self-efficacy, attitude, ethical cognition, and subjective norms had positive effects on behavioral intentions (β = 0.402, 0.382, 0.091, and 0.066, respectively, P < 0.01). The total effect of behavioral intentions was influenced by attitude, ethical cognition, self-efficacy, and subjective norms (β = 0.656, 0.630, 0.402, and 0.157, respectively, P < 0.01). In addition, ethical cognition had a positive mediating effect on behavioral intentions (β = 0.539, P < 0.001).ConclusionThe study results indicated that attitude, ethical cognition, and self-efficacy were the main factors influencing nurses' behavioral intention. Efforts should be made to improve nurses' attitude and self-efficacy through ethical education and training to increase behavioral intentions to care for patients with infectious diseases, which will improve the quality of nursing care.

BackgroundHealthcare systems had an exceptionally difficult time during the early COVID-19 pandemic. Nurse managers in particular made enormous contributions to ensuring the safety of patients and front-line nurses while being under excessive psychological stress. However, little is known about their experiences during this time.ObjectiveThe aim of this study was thus to assess the level of stress overload and psychological feelings of nurse managers during the early COVID-19 pandemic.MethodsA mixed methods sequential explanatory design study with non-random convenience sampling was performed, following the STROBE and COREQ checklists. The study was conducted at the Affiliated Dongyang Hospital, Wenzhou Medical University, with data collected from six provinces in southern China (Zhejiang, Hubei, Shanghai, Jiangsu, Hunan and Jiangxi) during March 2020 and June 2020. A total of 966 nurse managers completed the Stress Overload Scale and Work-Family Support Scale. In addition, a nested sample of nurse managers participated in semi-structured face-to-face interviews. The data were then analyzed using qualitative content analysis, Pearson correlation, and multiple linear regression.ResultsThe quantitative results showed that nurse managers experienced a moderate level of stress load. There was a significant negative correlation between work-family support and stress load (r = −0.551, p < 0.01). Concerns about protecting front-line nurses and work-family support were the main factors affecting the stress load, which accounted for 34.0% of the total variation. Qualitative analysis identified four main thematic analyses that explained stress load: (1) great responsibility and great stress, (2) unprecedented stress-induced stress response, (3) invisible stress: the unknown was even more frightening, and (4) stress relief from love and support. Taken together these findings indicate that concern about protecting front-line nurses and negative work-family support of nurse managers were the main factors causing stress overload.ConclusionImplementing measures focused on individual psychological adjustment combined with community and family support and belongingness is one potential strategy to reduce psychological stress among nurse managers.