Nurses’ self-care levels and its related factors: a cross-sectional study

The nurses’ self-care score is (144.63 ± 22.53). More than half of the nurses have a self-care score lower than the mean score. The results imply that nurses’ self-care ability requires improvement, which is in line with the findings reported by Chang Hong-Juan [7] and Gao Xia [26]. Previous studies have demonstrated that low self-care levels are closely associated with depression, anxiety, and the like. Meanwhile, improving self-care ability aids in improving care quality, increasing job satisfaction, and reducing the turnover rate [7, 27]. Therefore, it is of utmost importance to improve clinical nurses’ self-care ability. Identifying the factors related to nurses’ self-care and implementing corresponding measures is a good approach to promoting nurses’ self-care ability.

In this study, the quality of sleep exhibited a strong correlation with nurses’ self-car. Nurses with better sleep quality tended to have a higher level of self-care (P = 0.002), which was consistent with the findings of Chang Hong-Juan [7]. This might be because good sleep quality and adequate sleep can facilitate the rapid recovery of body functions, thereby enhancing nurses’ mental health and self-care ability [7]. Furthermore, previous studies have indicated that continuous sleep deprivation and poor sleep quality can lead to individual cognitive decline, which may result in clinical errors such as incorrect medication administration, thus affecting the quality of clinical care [28, 29]. It is crucial to ensure good sleep quality. It has been reported that frequency of night shifts, working department, emotional labor, occupational stress, and coping ability can affect sleep quality [29‐31]. Therefore, nursing managers should pay attention to the sleep quality of nurses, investigate the reasons for poor sleep quality, and take targeted interventions to improve nurses’ sleep quality and thereby enhancing their self-care ability. For example, they can rationally arrange nurses’ shifts and create a relaxing and harmonious working atmosphere.

Relationship with colleagues is another independent factor affecting nurses’ self-care. A better relationship with colleagues suggests a higher self-care level, as has been discovered in other studies [10, 16, 32]. According to Longo [32], in daily clinical practice, the relationships that nurses are in direct contact with have the greatest impact on them, including those with nurse managers and nurse peers. Thus, establishing a harmonious, trusting, supportive and caring-healing working environment is vital for nurses’ self-care [10, 33]. Harmonious colleague relationships also assist nurses in generating altruistic concepts and caring for patients better, as “caring begets caring” [32]. Nurses can be inspired by others’ care, thereby fully developing their potential and providing better care for patients. The better nurses are cared for, the better they can take care of themselves and their patients. Therefore, nurse managers should be more actively concerned about nurses. For instance, they can investigate what peer caring means for nurses, and explore what hinders nurses’ self-care, such as environmental barriers (e.g., time, workload) or personal barriers (e.g., poor acceptance of others’ caring) [2, 32]. Then, take measures to improve nurses’ caring ability by reducing the impact of impeding factors, encouraging nurses to care for each other.

Last but not least, the flourishing level is highly related to nurses’ self-care. The higher the nurses’ flourishing level, the better their self-care ability is. Keyes [34] and Eraydın [35] reported similar results in their research. The reason might be that the higher the flourishing level, the stronger the sense of purpose [34], and the more positive role a person can play in work [35], which will benefit the person’s career development and self-care [36]. This applies to nurses, high flourishing levels encourage them to work passionately, improve nursing quality and care for patients better. According to previous studies, the education level, marital status, employment mode, and attitudes toward death [37] can affect an individual’s flourishing level [38, 39]. Therefore, nurses should set clear goals and strive for them in their work, for instance, further studying to improve their education level, actively participating in mental health promotion training, reading psychological books, and so on. Nurse managers need to take measures to improve nurses’ flourishing level [38]. They can help nurses set clear career development goals and assist them in realizing these goals. They could care more about nurses with low flourishing levels and organize peer nurses with high flourishing levels and their family members to support these nurses. Inviting psychological experts to give lectures on death education and intimate relationships. Psychological counseling is also a good approach to help improve nurses’ flourishing levels.

However, the difference between male and female nurses was not statistically significant in this study. This is not consistent with the results reported by Udoudo [20], which showed significant differences between males and females and that males are less likely to practice self care than females. This could potentially be attributed to the fact that this research did not involve enough male samples. More male nurses could be recruited to further explore this aspect in future studies. Additionally, the results showed that the employment mode was not an independent factor influencing nurses’ self-care. It is inconsistent with a previous study [26], which reported significant differences among nurses with different employment modes. The likely reason for the discrepancy is that currently in China, nurses with different employment modes have similar working contents, incomes, and career development opportunities. Several other factors in this study did not manifest significant differences either. These include educational level, professional position, religious belief, and significant other death within a year. The cause for this might be that the majority of the samples in this study were general nurses with an undergraduate degree and without religious beliefs, who did not experience significant others’ death within one year. Consequently, the samples with other educational levels, professional positions, religious beliefs, or those who had experienced the death of a significant other in a year were not sufficient in number to identify a difference. Furthermore, whether being born in a one-child family was not significantly related to nurses’ self-care. This might be due to the rapid economic and social development of China as well as the improvement in parenting styles. As a result, children can receive nearly equal amounts of love from their parents regardless of the number of children in the family. Reading psychological books was not found to be an influencing factor. This may be because there are numerous ways for nurses to enhance their psychological-related knowledge. Moreover, excess workload, lack of time, lack of resources were reported as factors influencing nurses’ self-care in previous studies [20, 40], whereas in this research these factors were not well considered. In future studies, factors such as resources and support for nurses’ self-care, workload and the like need to be taken into account.

It requires the joint efforts of all the stakeholders to improve nurses’ self-care abilities. At the national level, laws and regulations need to be enacted to safeguard the legitimate rights and interests of clinical nurses [41]. As per El-Osta [42], a favorable self-care environment can be facilitated by policy, organizations or workplaces. Hospitals should focus more on clinical nurses’ mental health and self-care ability, implementing relevant norms and regulations to ensure nurses’ interests. Moreover, creating a harmonious working atmosphere and striving for nurses’ benefits from the perspective of salary, welfare, and career development are also effective initiatives that hospitals can adopt [2]. Furthermore, the establishment of hospital-based self-care programs may boost self care abilities of nurses [20]. In a word, hospitals and institutions could offer more support and resources to improve nurses’ self-care. For nurse managers, more attention ought to be given to nurses with low self-care scores. They need to analyze the reasons for their low self-care level, and help them improve their self-care ability in appropriate ways. For instance, arranging nurses’ shifts appropriately to enable nurses have sufficient time and energy to care for themselves and establishing peer group for nurses to support each other [20, 33]. Chipu [33] suggested that self-care activities comprised physical self-care activities (e.g. exercise, proper nutrition, adequate sleep, etc.), emotional self-care activities (e.g. stress management strategies, time management, decision-making, problem-solving, etc.) and spiritual self-care activities (e.g. meditation, etc.). Therefore, nurse managers could invite experts to deliver lectures and conduct workshops concerning stress management, problem-solving and related topics to promote nurses’ self-care abilities. They could organize nurses to meditate during rest, etc. For nurses themselves, they could improve their self-care ability through various means, such as physical exercise, good sleep, timely relaxation, meditation, maintaining hobbies, making a gratitude list, and learning, etc. [2, 20, 33]. Adopting a healthy lifestyle through a balanced diet, appropriate exercise, and regulating sleep patterns to maintain physical and psychological health is particularly crucial for improving self-care ability [2]. Watson believes that employing intentional caring-healing modalities like yoga, communication with nature, and prayer will restore harmony and well-being for nurses [33]. Meanwhile, developing trustful interpersonaI relationships plays a vital role in self-care enhancement [33]. In addition to maintain good relationship with colleagues, nurse could keep good interpersonal relationships through the following ways: taking part in volunteer services, keeping regular contacts with friends, spending quality time with loved ones, joining interest groups, etc [2, 33].