The association between care-resistant behavior in dementia patients and nurses' occupational burnout: a cross-sectional serial mediation analysis of psychological detachment and professional calling.

Background: Care-resistant behavior in dementia patients is a common and highly challenging stressor in clinical nursing practice. It not only increases the difficulty of nursing care but may also have a negative impact on nurses' occupational health. Occupational burnout, a prevalent state of psychological exhaustion among nurses, poses a serious threat to both the mental health of nursing staff and the quality of nursing services. Psychological detachment, as an important experience of recovery from the work context, and professional calling, as an individual's intrinsic identification with and sense of meaning in their profession, may play key mediating roles in the relationship between care-resistant behavior and occupational burnout. However, existing research has yet to systematically explore the serial indirect associations among these variables. Therefore, this study used a chain mediation model grounded in the Job Demands-Resources (JD-R) theory to examine the associations among care-resistant behavior in dementia patients, psychological detachment, professional calling, and occupational burnout, including the hypothesized serial indirect pathway, aiming to provide empirical evidence for nursing managers to develop targeted intervention strategies. Methods: A questionnaire survey was conducted among 421 nurses recruited from five tertiary hospitals located in Shaanxi Province, China. The survey utilized a general information questionnaire, the Chinese version of the Resistiveness to Care Scale for patients with dementia, the Psychological Detachment Questionnaire, Professional Calling Scale (PCS), and the Burnout Inventory. Since all continuous variables did not satisfy the assumption of normal distribution (assessed by the Shapiro-Wilk test), Spearman correlation analysis was used to examine the relationships among variables, and structural equation modeling (SEM) using AMOS with the Bootstrap method (2,000 resamples) was employed to estimate the direct and indirect associations specified in the hypothesized serial mediation model, with the significance of indirect effects evaluated using 95% confidence intervals. Results: In this study, the mean scores for care-resistant behavior, psychological detachment, professional calling, and occupational burnout among the 421 nurses were (43.89 ± 21.75), (9.61 ± 3.72), (31.03 ± 10.96), and (63.00 ± 27.79), respectively. Care-resistant behavior was positively correlated with occupational burnout ( Conclusion: This study identified a statistically significant serial indirect association involving psychological detachment and professional calling in the relationship between care-resistant behavior in dementia patients and occupational burnout among clinical nurses. The observed pattern was consistent with the hypothesized serial mediation model but did not establish the temporal or causal ordering of these variables. Accordingly, the findings should be interpreted as associations rather than causal relationships. The results provide a theoretical basis for future longitudinal and intervention studies examining whether improving psychological detachment and professional calling may be associated with lower occupational burnout.