The mediating and moderating role of nursing information competence between nurses’ creative self-efficacy and innovation behavior in a specialized oncology hospital
verfasst von:
Lu Liu, Man Liu, Zhuoheng Lv, Feng yan Ma, Yousheng Mao, Yan Liu
This study aims to examine the impact of nurses’ nursing information competence on their creative self-efficacy and innovation behavior, and to investigate its role as a mediating factor between these two elements.
Methods
A survey was conducted from July to September 2023 involving 1,200 nurses from two tertiary-level oncology specialty hospitals in Beijing, selected through convenience sampling. Instruments used included the Creative Self-Efficacy Scale, Nursing Information Competence Assessment Scale, and Nurses’ Innovative Behavior Scale. Data analysis was conducted using SPSS 25.0 and R 4.1.2; AMOS26 was used to construct structural equation models and Bootstrap method was used to test the mediating hypotheses.
Results
Out of the distributed questionnaires, 1,166 were valid, yielding an effective response rate of 97.16%. Pearson correlation analysis revealed significant correlations between innovation self-efficacy, nursing information competence, and nurses’ innovative behaviors (P < 0.001). The Bootstrap method indicated that nursing information competence serves as a mediating factor in the relationship between creative self-efficacy and innovative behaviors, contributing to 24.5% of the observed effect. Additionally, regression analysis suggested that nursing information competence moderates the relationship between creative self-efficacy and innovation behavior.
Conclusion
The findings suggest that nursing information competence not only mediates but also moderates the relationship between creative self-efficacy and innovative behavior. Enhancing nurses’ information competence could therefore foster creative self-efficacy, leading to an increase in innovative behavior and, subsequently, improvements in the quality of oncology nursing care.
Hinweise
Lu Liu, Man Liu and Zhuoheng Lv co-first authors.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Background
Innovation stands as the lifeblood of societal advancement and constitutes a vital force propelling nations and communities forward. The advent of artificial intelligence, mobile health applications, and big data technologies, among others, has ushered in a new era for the nursing profession, presenting both unprecedented opportunities and formidable challenges [1]. The rapid development of medical diagnosis and treatment technology requires nursing staff to actively innovate and act in thinking, knowledge, and technology to adapt to the development of medicine and the needs of the public. Nurses’ innovative behavior refers to the process of seeking or developing new methods, technologies, and ways of working in clinical nursing to prevent disease, promote health and improve the quality of nursing care [2]. Globally, the emphasis on nurses’ innovative conduct has seen a marked rise, hailing it as a pivotal catalyst for advancements in healthcare. This focus extends beyond technological breakthroughs in nursing practices; it encompasses novel nursing philosophies, transformative care delivery models, and progressive strategies in nursing administration [3]. Innovative behavior among nurses bolsters the efficacy and caliber of nursing care and fosters heightened professional fulfillment and a reinforced sense of accomplishment [4]. Nursing as integral components of medical teams, wield immeasurable significance in enhancing the overall quality of healthcare provisions and propelling the progression of healthcare technology via their creative endeavors. Whether in developed or developing countries, behind the innovative behavior of nurses lies the pursuit of more efficient, safer, and more humane nursing services, and this pursuit drives nurses to continuously explore new nursing methods, technologies, and models in clinical practice [5]. Studies have shown [6] that nurses can directly improve patient outcomes and hospitalization experiences and enhance the quality of care through innovations in workflow and nursing technology. such as the invention of new nursing tools improved medication administration processes [7], or the use of information technology to reduce medical errors [8], which significantly improve the quality and safety of care. Nurses reduce hospitalization days by designing new care pathways or develop remote monitoring systems to reduce unnecessary outpatient visits, all of which can be effective in reducing healthcare costs [9, 10]. Innovations demonstrated by nurses during the epidemic, such as the use of digital tools for remote monitoring and the creation of new types of protective equipment, greatly enhanced the speed and effectiveness of the global response to the public health crisis and reduced the impact of the epidemic on the health of the population [11]. Nurse-led innovation programs, such as remote community health interventions, home-based care models, and innovations in continuity of care for elderly discharged patients, can effectively reach remote and vulnerable populations, narrowing the accessibility gap in health services and promoting global health equity [12]. Therefore, innovation has become an inevitable choice for the development of the nursing discipline and nursing profession.And with the increasing morbidity and mortality of tumors and the constant changes in treatment modalities, it also makes oncology nursing more complex and specialized compared to other general hospitals, and also puts forward requirements and challenges to the development of oncology nursing scope of work and roles, and it is worth noting that innovative nursing methods can help oncology nurses to alleviate the psychological and physical pains of patients with tumors, ensure patient safety, better enhance the quality of care, and improve the quality of life of patients [13, 14]. In this context, it is crucial to understand the factors and key points that influence the innovative behavior of nursing staff creative self-efficacy refers to an individual’s confidence in his or her ability to overcome work difficulties and accomplish work tasks, and reflects the self-beliefs and expectations that an individual shows towards himself or herself in innovation activities [15]. Creative self-efficacy has been found to play an important role in emotion regulation, cognitive appraisal, and subjective career success [16]. Creative self-efficacy is a key antecedent to motivate nursing staff to implement innovative behaviors, and plays a crucial role in stimulating nurses’ innovative potential and facilitating the implementation of innovative behaviors. A study from China found that nurses’ innovation self-efficacy was strongly associated with their behavior in implementing patient safety improvements [17]. A study from Malaysia showed that creative self-efficacy was positively correlated with their behavior in introducing new technologies in the workplace [18]. At the same time, creative self-efficacy is the specific embodiment of self-efficacy in the field of innovation, self-efficacy is an important concept in psychology, which refers to the individual’s confidence in his or her ability to complete a certain task or activity, in oncology nursing practice, the level of self-efficacy has a direct impact on the nursing staff’s work performance and nursing effect [19]. Oncology nursing is faced with complex and changing diseases, and each patient’s disease progression, treatment response and psychological state are different, which requires nursing staff to have a high degree of professionalism and resilience, and creative self-efficacy is precisely an important manifestation of this resilience. With the increasing variety of oncology treatments, including surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, creative self-efficacy can help caregivers better adapt to the new technologies and methods, and provide comprehensive care support for patients [20]. Although numerous studies have shown that nurses with a high sense of creative self-efficacy are more inclined to take on challenges, try new approaches, and demonstrate a higher level of creative energy in nursing practice [21]. However, there is a lack of reports on what factors and variables regulate the process by which creative self-efficacy generates innovative behavior and what the mechanisms involved are.
Nursing informatics (NI) is defined as “the science and practice of integrating nursing, nursing information and knowledge with information and communication technology management to promote the health of people, families, and communities globally, nursing informatics competence is broadly defined as a comprehensive set of essential and important knowledge, skills and attitudes of nurses in nursing informatics activities [22]. Today, with the expanding use of information and communication technologies (ICTs) in healthcare and the ongoing digital revolution in healthcare systems, developing informatics competencies among nursing staff has become a major priority for policymakers and educators worldwide [23]. Nursing informatics competency is crucial for nurses to effectively access, integrate and apply nursing information in the information technology era, which not only helps nurses adapt faster to changes in healthcare technology and improves the science and accuracy of nursing decision-making, but also facilitates knowledge sharing and collaboration among nurses, and promotes the continuous improvement and development of nursing practice [24]. In a scoping review from Australia, it was shown that nurses with higher nursing information competencies were able to use electronic medical record systems more effectively to optimize the nursing process, thereby improving efficiency and quality of care [25], this increased efficiency provides nurses with more time and energy to explore new nursing methods and techniques, which in turn promotes the development of innovative behaviors. A study of nurses in an oncology hospital found that improved nursing information competency helped nurses better grasp patient information and develop personalized care plans, which in turn fostered nursing innovation [26]. Oncology care is complex and nuanced, requiring a high level of professional knowledge and skills and informatics among caregivers. A study from South Korea, which provided rehabilitation exercises to patients with hepatocellular carcinoma through mobile medical apps and wearable devices, showed significant improvements in physical fitness, body composition and physical activity, and quality of life after a 12-week intervention [27]. Results of a systematic review suggest that the use of wearable activity monitoring technology can promote physical activity and have a positive impact on the behavior of cancer survivors [28]. Cheong et al. utilized big data to design a multifunctional mobile medical app that relieved patients’ symptoms related to cancer treatment and improved their lower limb muscle strength and cardiorespiratory endurance [29]. Subni et al. developed an app called AM Mindful to support individualized positive thinking practice for colorectal cancer survivors through guided meditations, audio lectures, self-meditation timers, and logging features, which can save healthcare costs and meet the psychological needs of patients, and provide a new platform for continuity of psychological interventions for cancer survivors [30]. Hanna et al. conducted weight monitoring and reporting of nutritional symptoms such as diarrhea and nausea for homebound gastric, esophageal, and pancreatic cancer patients by means of a tablet computer combined with My Pace APP, and constructed an early personalized nutritional management plan for patients based on information technology monitoring. It can be seen that the information competence of nursing staff is an important way to improve the quality of oncology care and promote the recovery of patients, and at the same time provides a solid foundation and strong support for innovative behavior [31]. However, no study has explored the relationship between creative self-efficacy and innovative behavior from the perspective of fostering the development of information competence among nursing staff, In particular, the role of nursing information competencies in both creative self-efficacy and innovation behavior.
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Theoretical basis
Tierney and Farmer (2002) first proposed creative self-efficacy in the field of innovativeness and defined it as “an individual’s beliefs about whether he or she can achieve innovative results”. Since then, more and more scholars have begun to put their eyes on the study of innovation self-efficacy, and the theory of creative self-efficacy has been expanded from the initial enterprises to schools and covers many different levels such as elementary and middle schools, high schools, universities, and graduate schools [32]. A study by Hernaus et al. [33] found that innovation efficacy beliefs are a key motivational factor that influences individuals to think innovatively and seek challenges. A study validated the relationship between creative self-efficacy and innovative behavior among college students, which noted that students with high creative self-efficacy have a more positive view of themselves, which contributes to innovative practice and empirical evidence, and it also noted that creative self-efficacy is a better predictor of an individual’s innovative behavior and performance than work efficacy [34]. Rogers’ diffusion of innovation theory (DIT) considers the process by which information is transferred to people or organizations over time, a process that can lead to the application of innovation [35]. Diffusion of innovations is the theory of persuading people to accept new ideas, things, and products through the media, which focuses on the impact of mass communication on society and culture. According to Rogers, the diffusion of something new often goes through a series of processes such as the cognitive stage, the persuasive stage, the decision-making stage, the implementation stage, and the final confirmation of the adoption stage. The diffusion process of innovation needs to satisfy four basic conditions: innovation, communication channels, time, and social system [36]. Good information competence can be used throughout the stages of novelty diffusion and can connect the four basic conditions of the novelty diffusion process. Therefore, this study proposes the hypothesis that nursing information competence can play a mediating role in moderating the relationship between creative self-efficacy and innovation behavior.
Objects and methods
A cross-sectional design was used to collect data in this study. To improve the quality of research, we carried out the study in line with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist.
Participants
This study employed convenience sampling to select nurses from two tertiary-level A hospitals in Beijing between July and September 2023. Inclusion criteria included: (1) possession of a nursing qualification certificate, (2) unrestricted working time, and (3) voluntary participation. Exclusion criteria encompassed nurses on maternity leave, sick leave, internships, rotations, or refresher training. Based on a previous study [37], sample size was calculated using the PASS2020 software, considering a two-sided test, α = 0.05, standard deviation of 33.15, and a margin of error of 1. Accounting for a 10% rate of invalid responses, the required sample size was determined to be 1,160. To enhance the study’s robustness, 1,200 participants were targeted.
Instruments
Creative self-efficacy scale
The assessment tool was compiled by Gu Yuandong et al. in 2010 [38]. Initially, it was used to assess the corporate population, with a Cronbach’s alpha coefficient of 0.901. Ju Yongxia et al. also used it to assess the nurse population [39], and obtained a Cronbach’s alpha coefficient of 0.932, and split-half reliability was 0.811. This unidimensional scale consists of 8 items rated on a 5-point Likert scale. It ranges from strongly disagree (1) to strongly agree (5), with total scores between 8–40. Higher scores indicate stronger creative self-efficacy.
Nurses’ innovative behavior scale
Developed by Bao Ling et al. [40], this scale assesses nurses’ innovative behaviors across three dimensions: idea generation, support procurement, and idea realization. It comprises 10 items rated on a 5-point Likert scale. Higher scores signify more pronounced innovative behaviors. The Cronbach’s alpha coefficient for the scale was 0.879.The content validity was 0.91.
Nurses’ information competency assessment scale
Created by Cai Zhenzhen [41], this scale evaluates nurses’ information competence across three dimensions: computer competency, information competency, and integrated application competency, with 26 items rated on a 5-point Likert scale. Higher scores indicate greater nursing information competence. And the Cronbach’s alpha coefficient for the scale was 0.976, the reliability was 0.805, the content validity is 0.923.
Data collection
After obtaining consent from hospital nursing departments, data was collected using the online platform “Questionnaire Star”. Participants were informed about the study’s purpose, anonymity, voluntary nature, and data privacy. To prevent duplicate responses, the questionnaire was restricted to one submission per IP address. Completion time was set between 5–10 min with mandatory questions. Out of 1,200 distributed questionnaires, 1,166 valid responses were obtained, yielding an effective response rate of 97.16%. Ethical approval for this study was obtained from the ethics committee of the Cancer Hospital Chinese Academy of Medical Sciences (23/313–4055).
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Data analysis
Data analysis was conducted using SPSS 25.0 and R 4.1.2. Participant characteristics were presented as frequencies and percentages, while variables like innovation self-efficacy, innovative behavior, and nursing information competence were presented as mean ± standard deviation. ANOVA was used to compare these variables across different demographic groups. Pearson’s correlation coefficient assessed the interrelationships among these variables. Stepwise regression and Bootstrap methods evaluated the mediating and moderating effects of information competence. Latent variable models were employed before regression analysis to minimize measurement error, and tests for normality, homogeneity of variance, and absence of common method bias were conducted to ensure data suitability for regression analysis.
Results
Basic demographic characteristics
① Basic Demographic Characteristics: In this study, 1166 nursing staff were surveyed, 94.1% were female and 5.9% were male. 93.70% were Han Chinese, Marital status showed that more than half (50.9%) of the respondents were unmarried, Regarding health status, 85.8% of the caregivers assessed themselves as being in good health, and very few (0.6%) considered it poor. 49% of the participants were extroverted, while 51% were introverted. 57.00% of participants had no children, 2.30% reported low support, while 64.70% felt they received high support.
② Education and Career Development:73.6% of the participants were undergraduates, and only 1.2% had a master’s degree or higher. 60.10% of the participants expressed a desire for further study. 20.50% of the participants served as lead teachers. 40.50% of participants were general nurses, 31.90% were nursing specialists, 26.30% were senior nursing specialists, and 1.30% were associate nursing specialists or higher. 79.80% of the participants wanted career advancement.
③ Positions and types of employment: 96.70% of the participants were nurses, 3.10% were nurse managers, 63.80% were contractors, 8.00% earned less than $3,000 while 38.90% earned more than $10,000.
④ Professional Achievements:91.50% of participants held patents, 17.20% published papers, and 3.00% were involved in research projects, while 97.00% were not. Regarding work experience, 44.90% had less than 5 years, 19.80% had 6–10 years, 16.90% had 11–15 years, 6.30% had 15–20 years, and 12.10% had more than 20 years. Additionally, 17.50% of participants held a nurse specialist qualification, 5.10% had research training, and 4.50% held academic appointments.
⑤ Work Environment and Feelings:13.30% of participants reported rarely feeling stressed, 9.50% reported very stressed.27.40% of the participants reported never feeling burned out, 30.10% reported feeling burned out sometimes, and 5.80% reported feeling burned out all the time. Detailed demographic information is presented in Table 1.
Table 1
General information
Characteristics
Value
N
%
Creative self-efficacy Mean ± SD
t/F
p
Information competency Mean ± SD
t/F
p
Innovation behaviour Mean ± SD
t/F
p
Gender
Male
69
5.90
29.58
7.91
0.11
0.74
94.10
26.30
0.05
0.82
36.81
9.70
0.03
0.86
Female
1097
94.10
29.28
7.21
93.51
20.71
36.99
8.07
Ethnicity
Han
1092
93.70
29.29
7.24
0.03
0.87
93.36
21.10
1.21
0.27
36.95
8.14
0.23
0.63
Minority
74
6.30
29.43
7.44
96.15
20.49
37.42
8.70
Marital Status
Single
593
50.90
30.17
6.91
5.88
0.00
95.88
20.27
5.81
0.00
38.04
7.96
7.12
0.00
Married
551
47.30
28.41
7.51
91.08
21.74
35.90
8.29
Divorced
21
1.80
28.05
7.25
90.48
17.82
35.05
7.72
Separated
1
0.10
30.00
123.00
42.00
Health Status
Good
1001
85.80
29.89
6.99
24.53
0.00
94.78
20.82
12.63
0.00
37.56
8.08
21.29
0.00
Average
158
13.60
25.77
7.75
85.87
21.17
33.73
7.82
Poor
7
0.60
24.57
8.79
88.00
19.15
26.71
6.75
Personality
Extroverted
566
48.50
30.21
6.93
17.79
0.00
96.08
20.26
16.22
0.00
38.13
7.93
22.11
0.00
Introverted
600
51.50
28.44
7.44
91.14
21.55
35.90
8.26
Children Number
None
665
57.00
30.28
6.98
17.98
0.00
96.02
20.53
12.36
0.00
38.02
8.01
14.76
0.00
One
347
29.80
27.44
7.41
89.20
21.55
35.13
8.12
Two or more
154
13.20
29.27
7.24
92.63
20.72
36.66
8.29
Family Support
Low
27
2.30
27.67
8.39
36.64
0.00
89.89
25.22
30.05
0.00
35.96
8.54
38.67
0.00
Medium
385
33.00
26.86
6.85
87.05
19.14
34.12
7.47
High
754
64.70
30.60
7.08
96.97
21.07
38.47
8.12
Education Level
Junior High or below
7
0.60
29.86
9.84
3.55
0.01
96.86
32.53
3.28
0.02
38.29
10.66
2.90
0.03
Associate Degree
287
24.60
30.20
7.47
96.22
21.18
38.02
8.59
Bachelor’s Degree
858
73.60
28.93
7.11
92.47
20.83
36.57
8.00
Master’s Degree or above
14
1.20
33.14
7.75
102.86
22.05
39.79
7.01
Desire for Further Education
Yes
701
60.10
30.55
7.00
54.88
0.00
97.17
20.33
54.39
0.00
38.41
8.08
56.42
0.00
No
465
39.90
27.41
7.21
88.08
21.00
34.82
7.85
Teaching Mentor
Yes
239
20.50
27.71
6.99
14.66
0.00
90.61
19.86
5.80
0.02
35.13
7.73
15.64
0.00
No
927
79.50
29.71
7.26
94.29
21.31
37.46
8.22
Professional Title
Nurse
472
40.50
30.92
6.71
16.02
0.00
97.22
20.41
10.69
0.00
38.89
7.88
16.77
0.00
Nursing Specialist
372
31.90
28.55
7.46
91.95
20.71
35.82
7.93
Senior Nursing Specialist
307
26.30
27.60
7.25
89.36
21.53
35.29
8.36
Deputy Chief Nursing Specialist and above
15
1.30
31.87
7.69
102.53
20.72
40.00
7.25
Desire for Professional Advancement
Yes
930
79.80
29.75
7.18
18.40
0.00
94.89
20.83
19.05
0.00
37.37
8.15
10.38
0.00
No
236
20.20
27.50
7.27
88.24
21.19
35.45
8.12
Job Position
None
1128
96.70
29.27
7.23
1.88
0.15
93.25
20.98
3.61
0.03
36.89
8.18
3.92
0.02
Nurse Manager
36
3.10
29.75
7.88
101.78
22.17
39.17
7.40
Head Nurse or above
2
0.20
39.00
1.41
111.50
26.16
50.00
0.00
Employment Type
Temporary
91
7.80
29.32
7.59
4.98
0.00
94.57
21.58
4.14
0.01
37.21
8.30
3.41
0.02
Contract
744
63.80
29.48
7.35
94.13
21.25
37.09
8.21
Personnel Agency
140
12.00
30.58
6.00
96.11
19.06
38.28
7.65
Permanent
191
16.40
27.64
7.31
88.86
21.00
35.48
8.18
Income
Less than 3000
93
8.00
29.84
7.11
2.23
0.06
96.03
19.88
3.42
0.01
38.43
7.79
3.18
0.01
Less than 5000
87
7.50
27.57
7.18
87.80
20.64
34.55
7.05
Less than 8000
273
23.40
29.14
7.15
92.11
21.79
37.18
8.33
Less than 10,000
260
22.30
30.10
7.29
96.33
20.86
37.56
8.14
More than 10,000
453
38.90
29.16
7.29
93.40
20.83
36.69
8.30
Patents
Yes
1067
91.50
29.17
7.30
3.69
0.06
93.07
21.18
6.39
0.01
36.83
8.25
4.09
0.04
No
99
8.50
30.64
6.51
98.65
19.22
38.57
7.10
Publications
Yes
201
17.20
28.47
6.97
3.16
0.08
92.09
22.42
1.15
0.28
36.11
8.30
2.72
0.10
No
965
82.80
29.47
7.30
93.84
20.77
37.16
8.14
Research Projects
Yes
35
3.00
31.29
7.43
2.72
0.10
103.46
19.72
8.04
0.01
40.66
7.47
7.35
0.01
No
1131
97.00
29.24
7.24
93.23
21.04
36.86
8.17
Years Of Work Experience
Less than 5 years
523
44.90
31.00
6.53
15.96
0.00
97.78
19.91
11.34
0.00
38.96
7.77
16.06
0.00
6–10 years
231
19.80
28.84
7.87
92.17
21.64
35.97
8.59
11–15 years
197
16.90
26.82
6.95
87.50
20.84
34.29
7.43
15–20 years
74
6.30
28.35
7.37
91.18
18.81
36.09
7.72
More than 20 years
141
12.10
27.71
7.62
89.76
22.69
35.49
8.49
Specialist Nurse Qualification
Yes
204
17.50
28.79
7.09
1.20
0.27
93.47
21.03
0.00
0.96
36.88
7.92
0.04
0.85
No
962
82.50
29.41
7.28
93.56
21.09
37.00
8.23
Research Training
Yes
60
5.10
29.58
7.42
0.10
0.76
99.40
21.40
4.91
0.03
38.07
7.70
1.12
0.29
No
1106
94.90
29.28
7.24
93.22
21.01
36.92
8.20
Academic Appointmen
Yes
52
4.50
31.06
7.45
3.21
0.07
103.15
22.09
11.44
0.00
40.35
7.43
9.30
0.00
No
1114
95.50
29.22
7.23
93.09
20.92
36.82
8.18
Work Pressure
None
155
13.30
32.81
6.77
35.90
0.00
104.17
21.61
27.59
0.00
40.90
8.13
36.12
0.00
Some
538
46.10
30.23
6.82
94.86
19.72
38.02
7.87
A lot
362
31.00
27.67
6.69
90.21
19.94
35.22
7.19
Very much
111
9.50
25.20
8.45
83.19
23.06
32.19
9.10
Job Burnout
Never
319
27.40
32.31
6.86
36.91
0.00
101.16
21.10
26.42
0.00
40.13
8.23
34.41
0.00
Rarely
343
29.40
30.10
6.51
95.41
19.56
38.07
7.42
Unsure
85
7.30
28.27
6.84
90.41
20.07
34.84
7.79
Sometimes
351
30.10
27.06
6.94
88.16
19.55
34.75
7.40
Always
68
5.80
23.94
7.80
80.01
22.42
30.87
8.59
Correlation analysis
Table 2 indicates a significant positive correlation between creative self-efficacy and innovative behavior (r = 0.848, p < 0.001), and between creative self-efficacy and information competence (r = 0.766, p < 0.001). Additionally, a significant positive relationship was found between information competence and innovative behavior (r = 0.787, p < 0.001).
Table 2
Correlation analysis
Mean
SD
Creative Self-Efficacy
Innovation behaviour
Information competency
Creative Self-Efficacy
29.30
7.25
1
.85**
.79**
Innovation behaviour
36.98
8.17
.85**
1
.77**
Information competency
93.54
21.07
.79**
.77**
1
**p < 0.01
Mediating effect analysis
Preliminary tests indicated no residual autocorrelation (Dubin-Watson statistic close to 2), no multicollinearity (variance inflation factor < 10), and no common method bias (Harmon’s one-way test indicated the first factor explained 25.7% of the variance, below the 40% threshold). The mediating role of nursing information competence between creative self-efficacy and nurse innovation behavior is illustrated in Fig. 1 and Table 3. Creative self-efficacy indirectly influences nurse innovation behavior via information competence (indirect effect = 0.208, p < 0.01) and directly (direct effect = 0.640, p < 0.001). The mediating effect of information competence accounts for 24.5% of the total effect.
Fig. 1
Mediation and moderation effects
Table 3
Analysis of intermediation effects
Mediation model
β
LLCI
ULCI
p
Total effect
0.85
0.81
0.88
0.00
Direct effect
0.64
0.59
0.68
0.00
Indirect effect
0.21
0.17
0.25
0.00
Modulation model
Creative Self-Efficacy
0.66
0.61
0.70
0.00
Information competency
0.24
0.19
0.29
0.00
Modulation(Creative Self-Efficacy × Information competency)
0.07
0.04
0.09
0.00
×
Moderating effect analysis
For the moderating effect analysis, all variables were standardized. The interaction term (creative self-efficacy × information competence) was introduced into the model to assess the moderating effect. Results, presented in Table 3 and Fig. 1, show that the interaction term significantly and positively influenced the relationship between creative self-efficacy and nurses’ innovative behavior (moderating effect size = 0.066, p < 0.001).
Further visualization of the moderating effect was achieved through stratified regression. Information competence was categorized into three levels: below mean-standard deviation, between mean ± standard deviation, and above mean + standard deviation. Regression curves for creative self-efficacy and nurses’ innovative behavior within each group are depicted in Fig. 2. The analysis reveals that with increasing information competence, both creative self-efficacy and nurses’ innovative behavior increase. Additionally, the slope of the regression line becomes steeper with higher levels of information competence, indicating an enhancing effect on the influence of creative self-efficacy on nurses’ innovative behavior. This suggests a positive moderating role of information competence.
Fig. 2
Scatter plot grouped by information competence
×
Discussion
In this study, Table 2 illustrates that the nurses’ creative self-efficacy score is (29.30 ± 7.25), which is higher than the score of clinical nurses in tertiary general hospitals from previous studies [39]. This could be attributed to the fact that patients in oncology hospitals often require long-term treatment and care, and their conditions are typically complex and dynamic. As a result, nurses in these settings need to possess a higher level of resilience and innovative thinking, in their daily work, nurses are frequently confronted with new challenges, which in turn stimulates their creative potential and boosts their sense of creative self-efficacy. For example, in the management of chemotherapy complications and pain care for tumor patients nurses continually explore new methods and nursing measures to reduce patients’ pain and improve their quality of life in order to improve therapeutic effects [42]. When caring for oncology patients with depression, nurses with an innovative sense of self-efficacy may try to employ unconventional nursing methods such as music therapy, aromatherapy, and cognitive-behavioral therapy to improve mood and treatment outcomes [43]. This process of exploration and innovation continuously exercises and enhances nurses’ creative self-efficacy. Therefore, we believe that in oncology nursing practice, creative self-efficacy plays an important role that cannot be ignored. It not only helps nurses better cope with various challenges and improve their work effects but also promotes their personal growth and career development.
This study found differences in creative self-efficacy among nurses based on their personal characteristics and family factors. These factors include personality, education level, marital status, health status, children number, and family support. These differences not only reflect nurses’ varied psychological states and coping abilities when they face challenges at work but also provide important insights for nursing management. For example, extroverted nurses may be more adept at social interactions and more open to acquiring new information and inspiration, which can promote innovative thinking [44]. Nurses with higher education levels tend to have a richer knowledge base and stronger learning ability, enabling them to adapt to new nursing techniques and methods more quickly [45]. Unmarried nurses also show higher levels of creative self-efficacy, possibly due to having fewer family responsibilities and more time and energy to focus on personal career development and learning new things. The group of nurses with good health shows higher creative self-efficacy. A healthy body is the foundation of continuous learning and innovation, reducing work interference due to health problems. This allows them to be more focused and energized in creative activities. Childless nurses may have more free time for self-improvement and innovation attempts. Moreover, a high level of family support will make nurses more relieved to be engaged in their work, reducing life stress and enabling them to pursue creativity at work with greater peace of mind [46]. In the future, strategic guidance could be provided to care managers and educators to address these differences. This could involve developing individualized training programs, optimizing work schedules to balance family and work, and creating supportive work environments to fully stimulate the creative potential of the care team. The study revealed that various job-related factors such as the desire for further education, teaching mentor, professional title, desire for professional advancement, employment type, years of work experience, work pressure, job burnout, and research projects have an impact on nurses’ creative self-efficacy. These findings offer a comprehensive understanding of the factors that influence nurses’ innovative behavior. The influence of job-related factors on creative self-efficacy is multifaceted and intricate, with each factor interacting to shape nurses’ innovative behaviors. Recognizing these differences can help healthcare organizations develop targeted policies such as facilitating professional development opportunities, refining contract systems, rationalizing workloads, implementing effective stress management and burnout intervention strategies, and fostering research involvement with increased financial support. These measures can enhance creative self-efficacy among all nurses [47].
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In this study, the total score for the innovative behavior of nurses was (36.98 ± 8.17), which indicates a high level of innovation. This finding is consistent with previous studies [48], and it may be attributed to the characteristics of the study population. Among the 523 (44.90%) nurses who participated, a significant portion had less than 5 years of experience. Younger nurses tend to receive more recent nursing education and prioritize innovative and critical thinking [49]. Unlike experienced older nurses, they are less bound by traditional nursing perspectives and more open to trying new approaches, which contributes to the development of innovative behaviors. Moreover, among the surveyed nurses, 858 (73.60%) held undergraduate degrees. Nurses with higher education were more likely to take part in scientific research activities such as research projects, writing papers, and attending academic conferences. This in turn stimulated innovative thinking and promoted the integration of theory and practice. A total of 694 (59.5%) nurses with intermediate and higher technical titles, who are typically the backbone of departmental operations, demonstrated strong clinical thinking skills. They were proficient at identifying problems and had the authority to voice concerns regarding financial support and the implementation of new policies, empowering them to lead innovative activities within the department. Additionally, 1067 (91.50%) nurses had applied for patents. The application process involved several trials, corrections, and validations, leading to the accumulation of valuable problem-solving experience and the enhancement of resilience and innovative strategies in addressing challenges.
In this study, the total score for nurses’ information competence was (93.54 ± 21.07), which was higher than the results of Amer et al. [50], and lower than that of Somayeh et al. [51]. This score indicates a medium level, suggesting that nurses in China’s oncology hospitals have a solid foundation in information competence, but there is still room for improvement. This result may be attributed to the advancement of China’s healthcare system’s informatization construction and the increased prevalence of nurses’ information education, it may also be linked to the lack of post-employment training on information systems and highlights the deficiency in nurses’ ability to apply information in their actual work [52]. The information competence of nursing staff significantly improved after participating in nursing information training, including lectures, slide presentations, group discussions, and online exercises [51]. Additionally, we suggest that future training should cover new technologies such as cloud computing, artificial intelligence, and remote monitoring through workshops and online courses. These efforts aim to enhance nursing practice and prepare staff for the new era of nursing paradigm. The study revealed differences in information competence among nurses based on their academic qualifications, titles, and years of experience. This indicates the need for personalized training programs tailored to the specific characteristics and needs of different groups. For instance, young nurses could benefit from enhanced training in basic information knowledge and skills, whereas experienced nurses may require a focus on innovative application of information. This highlights the importance of expanding and deepening information education for nurses with varying backgrounds, ultimately improving their knowledge and application of information technology.
This study corroborates the significant positive correlation between creative self-efficacy and innovation behavior among nurses. Consistent with previous research [17], we found that higher levels of creative self-efficacy are associated with increased innovation behavior. This relationship underscores the importance of self-confidence and a positive mindset in the face of challenges and setbacks. High creative self-efficacy fosters mental resilience, enabling individuals to persist and achieve creative goals despite obstacles [53]. Oncology care often encounters unpredictable problems, such as the diversity of patient responses to treatment and the management of complications. creative self-efficacy gives caregivers the confidence to try new solutions and deal with these problems creatively, improving quality of care and patient safety. The study’s results revealed a significant positive correlation between nurses’ creative self-efficacy and information competence (r = 0.766, p < 0.001). This means that as nurses’ creative self-efficacy increases, so does their information competence. This finding aligns with a previous study’s results [54]. When nurses have high confidence in their creative abilities, they are more likely to proactively explore new technologies and methods, and actively engage in information technology training and learning. This, in turn, enhances their ability to retrieve, process, analyze, and utilize information. Therefore, creative self-efficacy plays a crucial role in nursing by empowering nurses to master and apply information technology, ultimately improving their information competency. Additionally, the results indicated a significant and positive correlation between information competence and innovative behavior (r = 0.787, p < 0.001). This means that higher information competence is associated with better innovative behavior, aligning with findings from previous studies [55]. Nurses with strong information competence are capable of effectively accessing and evaluating information, integrating it into the innovation process to create new knowledge and technology, which form the foundation of innovative behavior. As a result, it is recommended that educational institutions for nursing prioritize the development of students’ innovative thinking and information technology application skills through their curriculum and practical teaching. Furthermore, in clinical settings, healthcare organizations should cultivate a culture that fosters innovation and learning, and provide continuous training in information technology and resource support to harness nurses’ potential and enhance their overall information competence.
Furthermore, our findings reveal that information competence not only positively correlates with creative self-efficacy and innovation behavior but also mediates their relationship. This supports our hypothesis that creative self-efficacy influences the emergence of innovative behaviors through the enhancement of nursing information competence. Prior studies suggest that individuals with high creative self-efficacy are more motivated to innovate [56], and this motivation drives the pursuit of innovative information. Nurses with a strong inclination towards innovation are adept at using information technology to develop new nursing service models, thereby providing efficient and patient-centric care [57]. High creative self-efficacy leads to innovative thinking and effective information resource utilization, fostering innovative behaviors.
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When nurses’ creative self-efficacy and information competence align, they create a powerful virtuous circle: high self-efficacy motivates nurses to explore new areas, while enhanced information competence equips them with the tools needed for these explorations, turning innovative ideas into actionable behaviors. This positive feedback loop accelerates nursing innovation, allowing services to adapt swiftly to changes in the healthcare environment and effectively address the diverse needs of patients. Our research shows a strong link between creative self-efficacy, nursing information competence, and innovative behavior. We found that nursing information competence plays a crucial role as a mediator, connecting creative self-efficacy and innovative behavior. By enhancing the ability to acquire, process, analyze, and apply information, nursing information competence forms a strong foundation for innovative activities in nursing practice. This finding has significant implications for nursing education and clinical practice. It suggests that administrators should take a two-pronged approach to foster innovation in nursing. They can enhance nurses’ information competence by providing training in literature searching, subscribing to relevant journals, accessing databases, and other practical measures. This will strengthen nurses’ information skills so they can proficiently use information technology tools. Additionally, administrators should focus on nurturing nurses’ creative self-efficacy, creating an environment conducive to innovation, and encouraging them to challenge the status quo. This will empower nurses to propose and implement new nursing concepts and overcome nursing problems in oncology nursing. Ultimately, this approach will promote a more scientific, efficient, and humane direction for the nursing service model.
In addition to our study, we discovered the moderating role of informational competence in the relationship between creative self-efficacy and innovative behavior. Specifically, when nurses have a strong grasp of information and knowledge, they can effectively utilize resources and confidently explore new areas, thus leading to more frequent and higher-quality innovative behaviors. Conversely, nurses with weak informational competence may struggle to translate innovative ideas into action due to a lack of necessary tools or skills, even if they possess high creative self-efficacy [58]. Which provides new perspectives for the field of nursing education and clinical practice. This study highlights the importance of information competence in encouraging innovative behaviors, especially among a group of nurses with a relatively weak sense of their own creative abilities. Improving information competence is a crucial step in helping these nurses enhance their skills in acquiring, analyzing, integrating, and applying information. This, in turn, can boost their intrinsic creativity, leading to innovation in nursing practices and continuously improving service quality. Further research can explore specific factors affecting the relationship between nurses’ Creative self-efficacy and information competence, such as organizational culture, leadership style, and career development planning. Understanding these factors can help in developing more precise and effective interventions. Additionally, future studies can focus on the differences and commonalities of this relationship in different nursing fields or positions, contributing to the overall development of the nursing discipline.
Limitations and future prospects
This study has some limitations. The use of convenience sampling from only two oncology specialty hospitals in Beijing limits the generalizability of our findings. Additionally, the cross-sectional nature of this study restricts our ability to infer causality. Future research should employ longitudinal designs to better understand and improve innovative behaviors among oncology specialty nurses. We have acknowledged the limitations of focusing primarily on a Chinese population, we encourage future international scholars to conduct similar studies in different cultural and institutional contexts in order to promote cross-border knowledge exchange and cooperation.
Conclusion
Previous research has established the influence of creative self-efficacy on innovative behavior, but the role of information competence in this dynamic has been less explored. This study, focusing on nurses in oncology hospitals, aimed to unravel this relationship. Cultivating creative self-efficacy and enhancing innovative behaviors among nurses in oncology hospitals is crucial for improving patient care quality. Our analysis provides insights into how nursing information competence affects the interplay between creative self-efficacy and innovative behaviors. These findings offer a basis for managers to develop targeted strategies for enhancing the innovative behaviors of nurses in oncology specialty hospitals and constructing interventions to bolster these behaviors.
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Relevance for clinical practice
First, there is a certain correlation between nursing information competence and innovative behavior. Nurses need to continuously acquire, integrate, and apply a large amount of medical information in their work, and a high level of information competence can help nurses better cope with complex information environments, thus promoting their more innovative awareness and innovative behavior.
Secondly, nursing information competency has a positive impact on enhancing nurses’ innovation ability. By cultivating nurses’ information management skills, information retrieval skills, and information transfer skills, nurses’ ability to identify and solve problems in the patient care process can be improved, thus further stimulating nurses’ innovative behavior.
In addition, studying the impact of nursing information competence on innovative behavior can also help to further improve the nursing education and training system. For different levels of nursing personnel, information competency training can be targeted to improve the level of nurses’ information competency, thus promoting the innovative development of the entire nursing profession.
Therefore, an in-depth study of the impact of nursing information competence on innovative behavior is conducive to the continuous improvement of the overall quality of nurses and the level of medical services and further promotes the innovation and development of the nursing field.
Acknowledgements
The authors thank all participants and researchers involved in this study.
Declarations
Ethics approval and consent to participate
This study was approved by the Ethics Committee of the National Cancer Center/National Clinical Research Center for Cancer (NCRCC)/ Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Approval No. (23/313–4055).All methods were carried out in accordance with relevant guidelines and regulation. We explained the research methods and objectives to the participants, assured them of the voluntary and confidential nature of the study, and obtained their informed consent.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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The mediating and moderating role of nursing information competence between nurses’ creative self-efficacy and innovation behavior in a specialized oncology hospital
verfasst von
Lu Liu Man Liu Zhuoheng Lv Feng yan Ma Yousheng Mao Yan Liu
