Perceived Pressure, Job Stress, and Self-Efficacy Among Full-Time Hospital Caregivers in Shandong, China: A Cross-Sectional Study with Qualitative Triangulation

This study examined perceived pressure, job stress, and self-efficacy among full-time hospital caregivers in a Class III ‎Grade A tertiary hospital in Shandong Province, China. Using a cross-sectional descriptive design with qualitative ‎triangulation, 130 caregivers (family and employed) completed validated measures of perceived pressure, job stress, and ‎general self-efficacy; an eight-member focus group of supervising nurses provided contextual insights. Overall, caregivers ‎reported average perceived pressure and job stress, but low self-efficacy. Correlational analyses indicated that higher ‎perceived pressure and job stress were strongly associated with lower self-efficacy. One-way MANOVAs showed no ‎significant differences in perceived pressure, job stress, or self-efficacy by age, gender, education level, or ‎caregiver-patient relationship, suggesting broadly shared stress experiences across subgroups. Qualitative findings echoed ‎these patterns, highlighting system-level pressures, such as unrealistic family expectations, limited training access, and ‎suboptimal shift policies, as primary stressors, with supervising nurses noting that confidence improves when structured ‎training is available. Grounded in Roy’s Adaptation Model and Bandura’s Self-Efficacy Theory, the results underscore ‎self-efficacy as a modifiable buffer and point to the need for institutional interventions: competency-based skills training, ‎Cognitive Behavior Therapy-informed stress-management supports, and scheduling reforms (e.g., limits on consecutive ‎night shifts). The study contributes evidence to guide hospital administrators in designing targeted, scalable programs that ‎strengthen caregiver well-being and, in turn, patient care quality; future research should expand sampling and assess ‎longitudinal impacts of these interventions‎.