Reducing anxiety and enhancing innovation in nurses: a psychological capital intervention study in China

Nurses are in a challenging work environment. Most nurses are dealing with a population of patients who are seriously ill [1]. In order to effectively save the health of patients, most nurses are in a constant state of high pressure and need more innovation to keep up with the pace of medical development [2]. Stress impairs mental health and leads to many psychosomatic disorders such as anxiety, high blood pressure, insomnia, and weakened immune system [3].A study showed that at least 23.2% of healthcare workers have anxiety [4]. How to effectively reduce anxiety among nurses is also a considerable challenge for nurse managers [5].

Similarly, the stress in nursing care not only from patients but also from the rapid advances in medical technology [6]. In particular, the role of nurses has become increasingly prominent as the medical community recognizes the importance of patient care. As a result, the importance of innovation in nursing is becoming increasingly evident [7]. The American Nurses Association(ANA) [8] defines innovation as putting new ideas into practice or putting existing ideas into practice in new ways, and it points out that addressing the complexity of healthcare services requires innovative solutions and creative approaches to the status quo. Effective implementation of clinical innovation can help nurses perform better clinical work, reduce work stress, and, in turn, alleviate the anxiety condition of nursing staff.

Literature on anxiety relief and enhancement of innovative behavior has shown that personal psychological capital plays an important role in nurses’ anxiety and innovative behavior [9, 10]. Based on the Conservation of Resources Theory (COR) [11], we sought to investigate the effect of psychological capital (PsyCap) on anxiety and innovative behavior of clinical nursing staff. Recognizing the development of positive psychology and its potential, Luthans et al. [12] conceptualized the PsyCap construct in a work setting. PsyCap is defined as "a state of positive psychological development in an individual characterized by i: Confidence (self-efficacy) to take on and put forth the effort necessary to succeed in challenging tasks. ii: Positive attributions for present and future success (Optimism). iii: Adherence to goals and redirecting the path of goals when necessary to achieve success (Hope). And iv: Sustaining and bouncing back or even surpassing to achieve success when plagued by problems and adversity (Resilience) [12]. When a person has the psychological resources (self-efficacy, optimism, hope, and resilience), they are said to be PsyCap.

The PsyCap intervention (PCI) is a two-hour intervention [13]. The delivery of the PCI training program is based on active participation and adult learning. Luthans et al. [13] argued that the PCI program is advantageous because it is short and minimises work schedule interruptions. Additionally, this short training is consistent with a short-term goal identification program.The PCI training includes discussions, reflection exercises, and writing exercises. The development of each component of PsyCap is based on sound theoretical principles. For example, hope is developed through multiple pathway planning [14]. Self-efficacy is developed through task mastery, alternative learning (observing experts), and social persuasion [15]. Resilience is developed through increased awareness of participants' assets [16]. Optimism is developed through the principles of positive expectations and positive attributions [17]. PCI is based on the positive psychology literature (the principle of "intentional activity"). Lyubomirsky et al. [18], a prominent positive psychology scholar, suggests that 40% of positivity is developed through "conscious activity" development. This positive intentional activity helps to foster positive emotions and develop positive cognitions and behaviours [19].

Many studies have focused on the factors that influence PsyCap and the outcomes it leads to [20], but have not examined PsyCap interventions. Luthans et al. [12] proposed the intervention model to operationalize and implement PsyCap interventions. Previous PsyCap intervention studies have several commonalities. First, they are based mainly on the PCI model. Second, they provide one to three hours of intensive training. Third, they focused primarily on the effectiveness of the PsyCap intervention but neglected its impact on other work-related outcomes, with only one study testing the impact of the intervention on on-the-job performance [21]. Fourth, the participants were all from Western countries. Fifth, most of the main population it intervened with were employees of companies.

However, due to the unique demands and flexible nature of nursing work schedules, implementing a centralized training approach in the workplace poses significant challenges, particularly in China. Nursing staff often have varying shifts and responsibilities, making it difficult to identify a universally suitable time for training sessions. Moreover, urgent or unpredictable work duties may prevent nurses from participating in interventions as scheduled, further complicating centralized implementation.To address these challenges, this study aimed to adapt and expand the application of the PsyCap intervention to better align with the cultural and professional context of mainland China, focusing on both theoretical and practical enhancements. Firstly, the intervention incorporated innovative objectives designed to complement and enrich the existing Psychological Capital Intervention (PCI) model, tailoring it to the unique needs of the nursing profession. Secondly, the study shifted from a traditional in-person training approach to a flexible, daily online self-study format, allowing nurses to engage with the intervention at their convenience, regardless of their work schedules.Furthermore, grounded in the Conservation of Resources (COR) theory, this study sought to explore the broader impact of the intervention on both PsyCap and other critical work-related outcomes. In particular, the study examined the intervention's effects on anxiety levels and innovative behavior, which are vital components of professional resilience and adaptability in the demanding field of nursing. By addressing these aspects, the study aimed to provide a more practical and accessible approach to PsyCap development while contributing to a deeper understanding of its implications in the healthcare sector.

This study aimed to examine the impact of a psychological capital intervention on improving clinical nurses' psychological anxiety and enhancing psychological capital and innovative behaviors. Since Luthans proposed the psychological capital intervention model in 2006 [13], many scholars have explored its effects on positive and negative psychological factors. Many studies have explored the role of psychological capital interventions in improving psychological conditions in research. For example, Patnaik et al. [27] among telecom employees in India. Song et al. [28] among depressed patients in China and Liang et al. [29] among left-behind children in China. The results of the present study were similar to the above studies in that the experimental group reported significantly higher levels of PsyCap after PCI compared to pre-intervention. However, the waiting-list control group did not report any significant increase in PsyCap levels after the intervention. Similarly, participants in the treatment group had significantly lower anxiety significantly higher innovative behavior scores. However, the waiting-list control group did not report any significant changes in anxiety or innovative behavior scores. Thus, these findings suggest that an increase in PsyCap over time helped participants reduce anxiety and elevate levels of psychological capital.

Specifically, PsyCap may focused more on difficulties at work and helping people deal with or overcome these difficulties [30], which may be caregivers’ leading cause of anxiety. Caregivers tend to view problems from a negative perspective, caregivers are susceptible to long-term exposure to patients suffering from illness [31], and PCI can help them adjust their emotions and improve their work [32]. Given its potential to reduce anxiety and improve emotional adjustment, interventions that aim to enhance PsyCap may be a valuable tool for caregiver support programs. Training caregivers to strengthen their PsyCap through targeted interventions, such as resilience training, hope-building exercises, and self-efficacy-enhancing activities, can foster long-term psychological well-being and reduce the risk of caregiver burnout. Research has shown that PsyCap interventions can lead to tangible improvements in both psychological outcomes and job satisfaction, suggesting that such approaches can also help caregivers feel more competent and less stressed in their roles [32]. Given these academic insights, PsyCap is a positive psychological resource that can serve as one of the critical psychological resources needed to cope and positively assess situations in challenging situations successfully [33, 34]. Thus, PsyCap may help reduce anxiety [35].

In addition, the literature on innovative behavior suggests that while innovative behavior is objective and external, it is also external to subjectivity in nature [38]. Subjective factors are likely to be positively influenced by the positive attributes of PsyCap individuals. Drawing on Hobfoll 's [27] COR Theory, people with a high PsyCap were likely to show more innovation because they believe they had positive psychological resources to cope with adversity [39]. Therefore, PsyCap can assist to enhance innovative behavior. Drawing from the research of Yan et al. [9] and integrating COR theory with PsyCap, a causal relationship between PsyCap, anxiety, and innovative behavior emerges. According to this view, PsyCap can reduce anxiety by providing individuals with the necessary psychological resources to cope with stressors effectively. The reduction in anxiety enables individuals to focus more on creative problem-solving and innovation, as they are less preoccupied with negative emotions or the fear of failure.

Although this study was conducted online, participants demonstrated good compliance [36]. Compared to traditional education, online education has the advantages of high satisfaction, efficient learning, and more autonomous learning [37]. The intervention form of online training can maximize the time and space constraints, and the study participants can complete the video task point learning according to their personal free time [38], which does not increase the burden of clinical nurses. Although the psychological capital intervention cannot change the nursing work itself, it can help the nurses to sort out the existing available resources and help them to control their work better so that they are willing to look at work and life with a more optimistic mindset and alleviate anxiety. According to the social exchange theory [39], the more internal resources an individual has at his or her disposal will correspondingly promote the individual's sense of control at work so that the individual will be more willing to produce external outputs and perform behaviors that benefit the organization, and innovative behaviors will increase.

About the limitations of this study. The research sample of this study is limited to one organization, the sample size of this study is small, and the results cannot be generalized. Therefore, we recommend designing further studies with larger sample sizes in China. In addition, our use of self-report methods to measure all variables may lead to common method bias. Additionally, this study did not collect changes in indicators after three months of nurse intervention as nurses were overwhelmed with the workload caused by the disease as a result of the three-month defense that began in Shanghai due to the novel coronavirus. Future studies of PsyCap interventions should consider examining the effect of duration through longer follow-up.

The development and application of psychological capital (PsyCap) interventions have seen considerable evolution since their inception in 2006 [14]. Initially focused on corporate employees and students, the scope of PsyCap interventions has expanded to a broader range of sectors. However, there is still limited exploration of how these interventions can be effectively applied in healthcare settings, particularly among nurses and other healthcare workers. Our study highlights the beneficial effects of psychological capital interventions for caregivers. Specifically, such interventions have been shown to alleviate anxiety, enhance psychological capital (comprising hope, efficacy, resilience, and optimism), and improve innovative behavior. Online PsyCap interventions empower nurses by fostering a positive mindset that can better equip them to manage stress, cope with challenges, and engage in creative problem-solving. This leads to improved job performance, better patient care, and the cultivation of a more resilient healthcare workforce. Psychological capital interventions offer a promising solution to reduce anxiety, enhance resilience, and foster innovative behaviors among nurses. Nursing managers play a crucial role in embedding these interventions into their practice, promoting a culture of psychological health, and ensuring that nurses are not only equipped to handle the emotional demands of their work but are also empowered to contribute to the ongoing innovation in healthcare delivery.