Analysis of the mediating effects of psychological resilience and cognitive reappraisal between deep emotional labor and occupational burnout among emergency department nurses

Abstract

Abstract:

Objective To explore the impact of deep emotional labor on occupational burnout among emergency department nurses，and analyze the mediating effects of psychological resilience and cognitive reappraisal，so as to provide empirical evidence for emotional management and occupational burnout intervention in the field of emergency nursing. Methods From September to December 2024，convenience sampling was used to select emergency department nurses from 2 grade-A tertiary hospitals in Anhui Province and 5 grade-A tertiary hospitals in Tianjin Municipality as the research subjects. A general information questionnaire，the emotional labor scale（ELS），Connor-Davidson resilience scale（CD-RISC），emotion regulation questionnaire（ERQ），and Chinese Maslach burnout inventory（CMBI） were used for the survey. Pearson correlation analysis was applied to examine the correlations among the four variables，and AOMS 28.0 was used to construct and test the chain mediation model. Results A total of 443 emergency department nurses were surveyed，with a total score of（11.49±2.74）points for deep emotional labor，（60.77±18.98）points for psychological resilience，（29.67±6.72）points for cognitive reappraisal，and （64.68±19.83）points for occupational burnout.Statistically significant differences in deep emotional labor scores were observed among nurses with different ages，educational backgrounds，working years，employment types，monthly incomes，and night-shift nursing experiences（all P<0.05）. Statistically significant differences in psychological resilience scores were found among nurses with different ages，educational backgrounds，and job positions（all P<0.05）. Statistically significant differences in occupational burnout scores were present among nurses with different ages，employment types，and career plans（all P<0.05）. Occupational burnout was negatively correlated with deep emotional labor，psychological resilience，and cognitive reappraisal（r=-0.363，-0.494，-0.417，all P<0.05）. Mediation effect analysis showed that psychological resilience played a partial mediating role in the relationship between deep emotional labor and occupational burnout，with a mediation effect value of -0.075，accounting for 15.76% of the total effect. The partial mediating effect of cognitive reappraisal in the relationship between deep emotional labor and occupational burnout was not significant，with an effect value of -0.015，accounting for 3.15% of the total effect. Psychological resilience and cognitive reappraisal exerted a chain mediating effect in the relationship between deep emotional labor and occupational burnout，with an effect value of -0.014，accounting for 2.94% of the total effect. Conclusion Emergency department nurses show an above-average level of deep emotional labor，psychological resilience，cognitive reappraisal，and occupational burnout. The chain mediation of psychological resilience and cognitive reappraisal in the effect of deep emotional labor on occupational burnout among emergency department nurses is valid. It is suggested that nursing managers should cultivate nurses' psychological resilience and cognitive reappraisal abilities，enhance their emotional management and stress-coping skills，so as to reduce occupational burnout，improve nursing quality，and promote nurses' professional development.

Key words: Emergency department nurses, Deep emotional labor, Psychological resilience, Cognitive reappraisal, Occupational burnout

CLC Number:

R181.3+1

ZHAO Yiting, SUN Anqi, WANG Shuling, MA Yufei, ZHUANG Yinan, SUN Haiyan. Analysis of the mediating effects of psychological resilience and cognitive reappraisal between deep emotional labor and occupational burnout among emergency department nurses. [J]OCCUPATION AND HEALTH, 2026, 42(18): 2454-2459.

Figures/Tables 5

References 22

[1]	张俊冷, 陆爱红, 李国娟, 等. 情绪调节在急诊科护士自我能力否定倾向和职业倦怠间的中介作用研究[J]. 职业与健康, 2025, 41(10):1330-1334.
[2]	JUN J, OJEMENI M M, KALAMANI R, et al. Relationship between nurse burnout,patient and organizational outcomes:Systematic review[J]. Int J Nurs Stud, 2021, 119:103933. DOI URL
[3]	KO C M, LEE A Y. The mediating effect of emotional dissonance in the relationship between emotional labor and burnout among clinical nurses[J]. J Pers Soc Psychol, 2013, 19(5):647-657.
[4]	CHU L C. Effect of compassion fatigue on emotional labor in female nurses:Moderating effect of self-compassion[J]. PLoS One, 2024, 19(3):e0301101. DOI URL
[5]	CHEN S Y, YAN S R, ZHAO W W, et al. The mediating and moderating role of psychological resilience between occupational stress and mental health of psychiatric nurses:A multicenter cross-sectional study[J]. BMC Psychiatry, 2022, 22(1):823. DOI
[6]	武云婷, 郑瑞双, 郭晴. 肿瘤科护士自我同情与情绪调节对职业倦怠的影响研究[J]. 天津护理, 2024, 32(6):658-663.
[7]	王浩, 杨茗岚, 刘芳芳, 等. 全员参与质控模式在急诊抢救室护理管理中的效果评价[J]. 中国卫生标准管理, 2024, 15(22):180-185.
[8]	GRANDEY A. When “the show must go on”:Surface and deep acting as determinants of emotional exhaustion and Organizational consequences of emotional labour in peer-rated service delivery[J]. AMJ, 2003, 46(1):86-96.
[9]	骆宏, 孙庆龄, 顾利慧. 护士情绪工作能力对职业倦怠的影响研究[J]. 中华护理杂志, 2008, 43(11):969-971.
[10]	CONNOR K M, DAVIDSON J R T. Development of a new resilience scale:the Connor-Davidson Resilience Scale(CD-RISC)[J]. Depress Anxiety, 2003, 18(2):76-82. DOI URL
[11]	于肖楠, 张建新. 自我韧性量表与Connor-Davidson韧性量表的应用比较[J]. 心理科学, 2007(5):1169-1171.
[12]	GROSS J J, JOHN O P. Individual differences in two emotion regulation processes:Implications for affect,relationships,and well-being[J]. J Pers Soc Psychol, 2003, 85(2):348. DOI URL
[13]	王力, 柳恒超, 李中权, 等. 情绪调节问卷中文版的信效度研究[J]. 中国健康心理学杂志, 2007, 15(6):503-505.
[14]	李永鑫. 三种职业人群工作倦怠的比较研究:基于整合的视角[D]. 上海: 华东师范大学, 2005.
[15]	王佳, 常稳重. 妇产科护士职业倦怠的影响因素及路径分析[J]. 内蒙古医学杂志, 2025, 57(2):239-243
[16]	崔熙娟, 单涛, 乔莉娜, 等. 普外科护士心理弹性在职业压力与护患关系的中介效应[J]. 华南预防医学, 2022, 48(11):1393-1395,1399.
[17]	沈连华, 陆滢滢. 团体心理干预联合驾照式记分管理在急诊科护理带教工作中的应用体会[J]. 医学理论与实践, 2025, 38(6):1069-1072.
[18]	孙祥志, 覃露梅, 缪宴梅, 等. 手术室护士心理灵活性现状及影响因素分析[J]. 护理学杂志, 2025, 40(1):65-69.
[19]	李彦宏, 罗霞, 陈玉婷. 急诊科护士工作-家庭增益、职业韧性对职业倦怠的影响[J]. 职业与健康, 2024, 40(14):1919-1924.
[20]	PANDEY J, SINGH M. Donning the mask:effects of emotional labour strategies on burnout and job satisfaction in community healthcare[J]. Health Policy Plan, 2016, 31(5):551-562. DOI URL
[21]	翟蕾, 张韩, 张远安. 重症监护病房护士心理弹性与职业倦怠的关系[J]. 中国健康心理学杂志, 2024, 32(10):1550-1554.
[22]	谭剑, 孔雪二, 侯璇璇. 工作满意度在护士心理弹性与职业倦怠间的中介效应[J]. 护理学报, 2023, 30(8):69-73. DOI

项目	得分范围	最小值	最大值	量表得分（$\bar{x}±s$）	条目均分（$\bar{x}±s$）
深层情绪劳动	3~18	3	18	11.49±2.74	3.83±0.91
心理弹性	1~100	1	100	60.77±18.98	2.43±0.76
坚韧	0~52	0	52	32.25±9.54	2.48±0.73
自强	0~32	0	32	19.00±6.76	2.38±0.84
乐观	0~16	0	16	9.52±3.51	2.38±0.88
认知重评	6~42	6	42	29.67±6.72	4.95±1.12
职业倦怠	32~105	32	105	64.68±19.83	4.27±0.90
情感耗竭	5~35	5	35	22.19±7.16	4.44±1.43
人格解体	5~35	5	35	21.13±7.39	4.23±1.48
成就感降低	5~35	5	35	21.36±6.94	4.15±0.97

项目	得分范围	最小值	最大值	量表得分（$\bar{x}±s$）	条目均分（$\bar{x}±s$）
深层情绪劳动	3~18	3	18	11.49±2.74	3.83±0.91
心理弹性	1~100	1	100	60.77±18.98	2.43±0.76
坚韧	0~52	0	52	32.25±9.54	2.48±0.73
自强	0~32	0	32	19.00±6.76	2.38±0.84
乐观	0~16	0	16	9.52±3.51	2.38±0.88
认知重评	6~42	6	42	29.67±6.72	4.95±1.12
职业倦怠	32~105	32	105	64.68±19.83	4.27±0.90
情感耗竭	5~35	5	35	22.19±7.16	4.44±1.43
人格解体	5~35	5	35	21.13±7.39	4.23±1.48
成就感降低	5~35	5	35	21.36±6.94	4.15±0.97

项目	人数 [人（%）]	深层情绪劳动	心理弹性	认知重评	职业倦怠
性别
男	53（12.0）	11.66±2.85	64.04±21.34	28.91±7.50	74.00±19.16
女	39（88.0）	11.47±2.73	60.33±18.63	29.78±6.61	63.42±19.60
t值		0.322	0.869	0.578	2.592
P		>0.05	>0.05	>0.05	<0.05
年龄（岁）
0~<25	148（33.4）	11.32±3.31	58.00±20.96	29.28±8.00	69.73±19.18
25~<35	214（48.3）	11.29±2.42	58.03±16.67	29.72±5.69	67.90±22.15
35~<45	59（13.3）	12.41±2.31	62.63±21.64	30.31±6.50	63.07±18.28
≥45	22（5.0）	12.09±1.87	67.08±17.34	30.09±7.35	60.58±18.17
F值		3.143	4.386	0.370	3.132
P		<0.05	<0.05	>0.05	<0.05
学历
专科及以下	145（32.7）	10.86±3.45	56.39±20.53	29.66±7.40	65.09±21.21
本科	266（60.0）	11.73±2.36	62.33±17.65	29.41±6.48	65.05±19.58
研究生及以上	32（7.2）	12.41±1.01	67.72±18.92	31.88±4.87	59.81±14.53
F值		6.873	7.094	1.927	1.040
P		<0.05	<0.05	>0.05	>0.05
婚姻状况
已婚	222（50.1）	11.69±2.59	61.59±18.51	30.26±6.24	63.08±19.19
离异	17（3.8）	12.29±1.61	60.59±19.68	30.47±7.05	63.59±20.66
未婚	204（46.1）	11.21±2.94	59.89±19.48	28.96±7.14	66.52±20.38
F值		2.392	0.427	2.129	1.634
P		>0.05	>0.05	>0.05	>0.05
职务
普通护士	378（85.3）	11.40±2.72	59.70±18.07	29.51±6.57	65.20±19.84
责任组长	29（6.5）	11.89±2.29	65.56±19.92	30.28±8.51	60.93±20.56
护士长及以上职务	36（8.1）	12.14±3.38	68.83±26.21	30.89±6.62	62.22±19.15
F值		1.377	4.425	0.820	0.926
P		>0.05	<0.05	>0.05	>0.05
工作时间（年）
0~<5	198（44.7）	10.98±3.16	61.85±18.95	29.59±7.42	64.93±21.07
5~<10	145（32.7）	11.74±2.16	57.84±18.79	29.13±5.53	65.61±18.30
10~<15	52（11.7）	12.15±2.74	63.08±18.69	31.15±6.65	65.04±19.68
≥15	48（10.8）	12.15±2.04	62.67±19.56	30.04±6.95	60.83±19.30
F值		4.735	1.790	1.219	0.775
P		<0.05	>0.05	>0.05	>0.05
岗位聘用
正式在编	125（28.2）	12.14±2.18	63.10±21.34	30.14±7.41	68.36±20.47
劳务派遣	83（18.7）	11.06±3.85	60.76±23.72	28.63±8.09	64.95±24.43
合同聘用	235（53.0）	11.30±2.48	59.54±15.43	29.79±5.72	62.63±17.32
F值		5.258	1.444	1.351	3.455
P		<0.05	>0.05	>0.05	<0.05
月收入（元）
0~<5 000	127（28.7）	11.20±3.17	62.48±21.09	29.29±7.37	64.41±21.30
5 000~<7 000	91（20.5）	11.84±2.36	57.87±17.48	29.27±6.71	63.67±17.37
7 000~<9 000	124（28.0）	11.15±2.69	60.21±15.27	29.31±6.25	64.49±20.64
≥9 000	101（22.8）	11.97±2.44	61.93±21.38	30.65±6.36	66.17±19.16
F值		2.654	1.216	1.211	0.279
P		<0.05	>0.05	>0.05	>0.05
夜班次数（次）
0~<4	158（35.7）	11.71±2.66	62.66±21.12	30.20±6.72	63.61±18.90
4~<10	174（39.3）	11.84±2.05	59.92±15.74	29.28±5.63	65.48±18.78
≥10	111（25.1）	10.64±3.54	59.42±20.35	29.53±8.15	64.95±22.65
F值		7.474	1.237	0.819	0.380
P		<0.05	>0.05	>0.05	>0.05
职业规划
清晰	241（54.4）	11.46±2.47	61.93±17.29	30.04±6.40	60.73±25.72
不太清晰	157（35.4）	11.34±2.80	63.87±27.59	29.31±6.47	63.26±18.36
不清晰	45（10.2）	12.2±3.70	58.10±18.29	28.93±8.90	67.99±19.75
F值		1.758	2.621	0.862	3.746
P		>0.05	>0.05	>0.05	<0.05

项目	人数 [人（%）]	深层情绪劳动	心理弹性	认知重评	职业倦怠
性别
男	53（12.0）	11.66±2.85	64.04±21.34	28.91±7.50	74.00±19.16
女	39（88.0）	11.47±2.73	60.33±18.63	29.78±6.61	63.42±19.60
t值		0.322	0.869	0.578	2.592
P		>0.05	>0.05	>0.05	<0.05
年龄（岁）
0~<25	148（33.4）	11.32±3.31	58.00±20.96	29.28±8.00	69.73±19.18
25~<35	214（48.3）	11.29±2.42	58.03±16.67	29.72±5.69	67.90±22.15
35~<45	59（13.3）	12.41±2.31	62.63±21.64	30.31±6.50	63.07±18.28
≥45	22（5.0）	12.09±1.87	67.08±17.34	30.09±7.35	60.58±18.17
F值		3.143	4.386	0.370	3.132
P		<0.05	<0.05	>0.05	<0.05
学历
专科及以下	145（32.7）	10.86±3.45	56.39±20.53	29.66±7.40	65.09±21.21
本科	266（60.0）	11.73±2.36	62.33±17.65	29.41±6.48	65.05±19.58
研究生及以上	32（7.2）	12.41±1.01	67.72±18.92	31.88±4.87	59.81±14.53
F值		6.873	7.094	1.927	1.040
P		<0.05	<0.05	>0.05	>0.05
婚姻状况
已婚	222（50.1）	11.69±2.59	61.59±18.51	30.26±6.24	63.08±19.19
离异	17（3.8）	12.29±1.61	60.59±19.68	30.47±7.05	63.59±20.66
未婚	204（46.1）	11.21±2.94	59.89±19.48	28.96±7.14	66.52±20.38
F值		2.392	0.427	2.129	1.634
P		>0.05	>0.05	>0.05	>0.05
职务
普通护士	378（85.3）	11.40±2.72	59.70±18.07	29.51±6.57	65.20±19.84
责任组长	29（6.5）	11.89±2.29	65.56±19.92	30.28±8.51	60.93±20.56
护士长及以上职务	36（8.1）	12.14±3.38	68.83±26.21	30.89±6.62	62.22±19.15
F值		1.377	4.425	0.820	0.926
P		>0.05	<0.05	>0.05	>0.05
工作时间（年）
0~<5	198（44.7）	10.98±3.16	61.85±18.95	29.59±7.42	64.93±21.07
5~<10	145（32.7）	11.74±2.16	57.84±18.79	29.13±5.53	65.61±18.30
10~<15	52（11.7）	12.15±2.74	63.08±18.69	31.15±6.65	65.04±19.68
≥15	48（10.8）	12.15±2.04	62.67±19.56	30.04±6.95	60.83±19.30
F值		4.735	1.790	1.219	0.775
P		<0.05	>0.05	>0.05	>0.05
岗位聘用
正式在编	125（28.2）	12.14±2.18	63.10±21.34	30.14±7.41	68.36±20.47
劳务派遣	83（18.7）	11.06±3.85	60.76±23.72	28.63±8.09	64.95±24.43
合同聘用	235（53.0）	11.30±2.48	59.54±15.43	29.79±5.72	62.63±17.32
F值		5.258	1.444	1.351	3.455
P		<0.05	>0.05	>0.05	<0.05
月收入（元）
0~<5 000	127（28.7）	11.20±3.17	62.48±21.09	29.29±7.37	64.41±21.30
5 000~<7 000	91（20.5）	11.84±2.36	57.87±17.48	29.27±6.71	63.67±17.37
7 000~<9 000	124（28.0）	11.15±2.69	60.21±15.27	29.31±6.25	64.49±20.64
≥9 000	101（22.8）	11.97±2.44	61.93±21.38	30.65±6.36	66.17±19.16
F值		2.654	1.216	1.211	0.279
P		<0.05	>0.05	>0.05	>0.05
夜班次数（次）
0~<4	158（35.7）	11.71±2.66	62.66±21.12	30.20±6.72	63.61±18.90
4~<10	174（39.3）	11.84±2.05	59.92±15.74	29.28±5.63	65.48±18.78
≥10	111（25.1）	10.64±3.54	59.42±20.35	29.53±8.15	64.95±22.65
F值		7.474	1.237	0.819	0.380
P		<0.05	>0.05	>0.05	>0.05
职业规划
清晰	241（54.4）	11.46±2.47	61.93±17.29	30.04±6.40	60.73±25.72
不太清晰	157（35.4）	11.34±2.80	63.87±27.59	29.31±6.47	63.26±18.36
不清晰	45（10.2）	12.2±3.70	58.10±18.29	28.93±8.90	67.99±19.75
F值		1.758	2.621	0.862	3.746
P		>0.05	>0.05	>0.05	<0.05

项目	深层情绪劳动	心理弹性	坚韧	自强	乐观	认知重评	职业倦怠	情感耗竭	人格解体	成就感降低
深层情绪劳动	1.000
心理弹性	0.358^a	1.000
坚韧	0.358^a	0.972^a	1.000
自强	0.339^a	0.965^a	0.891^a	1.000
乐观	0.311^a	0.909^a	0.825^a	0.870^a	1.000
认知重评	0.157^a	0.345^a	0.350^a	0.304^a	0.328^a	1.000
职业倦怠	-0.363^a	-0.494^a	-0.506^a	-0.449^a	-0.435^a	-0.417^a	1.000
情感耗竭	-0.327^a	-0.507^a	-0.501^a	-0.478^a	-0.460^a	-0.427^a	0.935^a	1.000
人格解体	-0.473^a	-0.461^a	-0.478^a	-0.418^a	-0.390^a	-0.311^a	0.935^a	0.838^a	1.000
成就感降低	-0.196^a	-0.398^a	-0.418^a	-0.346^a	-0.352^a	-0.420^a	0.897^a	0.748^a	0.743^a	1.000