The relationship between received and perceived social support with ways of coping in nurses

Abstract

BACKGROUND:

Stress is inevitable in the nursing profession, and ways of coping are one of the solutions to reduce stress. Social support is one of the influencing factors on coping strategies, but there is probably a difference between the effects of received or perceived social support on coping strategies.

OBJECTIVE:

The aim was to investigate the relationship between received and perceived social support with ways of coping in nurses.

METHODS:

This is a cross-sectional descriptive-correlational study. The sample consisted of 292 nurses by simple random sampling. The data collection tool included Zimmet’s multidimensional perceived social support scale, McCain and Marklin’s perceived social support questionnaire, and Lazarus’ ways of coping questionnaire. Data were analyzed using Pearson correlation and multiple regression tests in SPSS v.22.

RESULTS:

The results showed that received social support (β= 0.20, p < 0.001) and perceived social support (β= 0.35, p < 0.001) are able to explain changes in the dimension of seeking social support. Received social support (β= 0.16, p = 0.005) and perceived social support (β= 0.22, p < 0.001) are able to explain changes after positive reappraisal, but only received social support could explain changes in accepting responsibility (β= 0.15, p = 0.01).

CONCLUSION:

This study showed that received and perceived social support have a significant correlation with ways of coping, but only able to explain the changes in social support seeking dimensions, positive reappraisal, accepting responsibility. Both types of social support are necessary, but that received social support covered more adaptive coping strategies.

Keywords

Received social support perceived social support coping strategies nurse job satisfaction mental health

1 Introduction

Ways of coping are thoughts and actions that people use to deal with stressful events [1]. The ways of coping are to manage problems, emotions, and physical and psychological consequences [2]. These strategies are generally thought of as mediating variables that are called upon when experiencing a stressor [3]. The successful and correct use of ways of coping will help people to manage stressful events and reduce negative emotions [4]. Nurses are always faced with many stressful factors in the work environment, which causes various problems for them [5].

Long-term and continuous stress is harmful and leads to organizational inefficiency, high staff turnover, and reduced job satisfaction [6]. The stressful nature of the nursing profession and hospitals requires more studies to control it [7]. The negative consequences of stress have different dimensions [8], among which we can mention cognitive symptoms [9], physical symptoms [10], psychological symptoms [11], and behavioral symptoms [12]. The techniques nurses use to cope with stressful situations help them adapt and respond to different conditions [7]. The choice of these strategies is influenced by background factors, experience, and level of anxiety [13]. Meanwhile, nurses mostly use problem-solving and planning strategies, self-control, re-evaluation, and seeking social support as ways of coping in their workplace (such as a hospital) [12]. Social support, as one of the factors affecting coping strategies, plays an important role in the successful use of ways of coping when a person faces stress and endures stress [14].

Social support is the support that a person receives and feels from other people and organizations [15]. Social support improves a person’s ability to interact with a stressful event [2] and leads to greater understanding, encouragement, courage, and a sense of success and self-efficacy in people [16]. Healthcare givers have a wide social communication network, so social support can correct the perception of stressors and inappropriate physiological responses [17]. Social support often comes from two sources: colleagues and managers as occupational and family as non-occupational [18]. The results of a study show that increasing social support of occupational sources has caused more job enthusiasm among nurses [19]. Social support from non-occupational sources (such as family) also increases the resilience capacity of nurses [20]. Received social support and perceived social support are two distinct concepts and it cannot be said that nurses perceive social support when they have received social support [21]. Received social support is defined as using the knowledge, experience, skills, and abilities of others to help solve a problem [22]. Having received social support can have a positive effect on nurses’ job satisfaction [23]. Received social support is mostly received from occupational sources [24]. Perceived social support is a person’s assessment of the availability of support in necessary situations [14]. Sources of perceived social support are generally from non-occupational sources [25]. Received social support is more common when faced with stressful factors and perceived social support often occurs when needed [26].

There is still a debate about the relationship between social support (received and perceived) and coping strategies, and more studies are needed [27]. Also, the difference between received social support and perceived social support has not been considered in most research [28]. Therefore, the aim was to investigate the relationship between received and perceived social support with ways of coping in nurses.

2 Methods

This research is a cross-sectional descriptive-correlation study. Data were collected at one time.

2.1 Sample method

A sample consisting of 292 nurses working in selected Hospitals of Tehran University of Medical Sciences (Three centers: Shariati hospital, Imam Khomeini Hospital Complex, Sina hospital). First, we prepared a list of nurses. Then we selected the participants using a random number table. The inclusion criteria for the study included: all working nurses who had at least an associate degree in nursing, and a work experience of at least 6 months, and the exclusion criteria were the non-response or incomplete responses to the research tools.

2.2 Measurements

Demographic characteristics included information such as age, sex, marital status, education degree, service history, type of employment, type of shift (fixed or rotating), department, working in one or more places.

–Multidimensional Scale of Perceived Social Support (MSPSS): MSPSS is used to evaluate the level of perceived social support [29]. MSPSS has 12 items. This scale measures the perceived social support in three subscales (family: 3, 4, 8, 11, friends: 6, 7, 9, 12, and a significant other: 1, 2, 5, 10) on a seven-point Likert scale from strongly disagree to completely agree. The minimum and maximum score of the individual on the whole scale is 12 and 84, respectively. The validity of the Persian version was confirmed by factor analysis. Also, the reliability of the scale was tested for the three subscales (family: 0.82, friends: 0.86, and a significant other: 0.86) [30]. Cronbach’s alpha was 0.83 in the study of Sadouqi and Hosampour [31]. Cronbach’s alpha was calculated and 0.88 in this study.

–The McCain and Marklin Social Integration Scale (MMSI): MMSI scale was used to evaluate received social support [32]. MMSI has 14 questions, eight of which measure the social support from colleagues, and six items are about support from supervisors and head nurses. This tool was scored as not at all (1 point) to I totally agree (5 points). The minimum score is 14 and the maximum 70; the classification method is low support (32–14), medium support (33–51), and high support (52–70) [33]. The test-retest method was used and Cronbach’s alpha was 0.76 [24]. Cronbach’s alpha value was calculated and 0.77 in the present study.

–Ways of Coping Questionnaire (WCQ): The WCQ measures coping styles, specifically the problem-focused and the emotion-focused types of coping. It has 66 questions in 8 areas: confronting coping (questions 6, 7, 17, 28, 34, 46), distancing (questions 12, 13), self-controlling (10, 14, 35, 43, 54, 62, 63), seeking social support (8, 18, 22, 31, 45, 42), accepting responsibility (9, 25, 29, 51), escape-avoidance (11, 16, 33, 40, 50, 58, 59, 47), planful problem solving (1, 16, 39, 48, 49, 52), and positive reappraisal (20, 23, 30, 36, 38, 56, 60). The scoring of the questionnaire is according to the Likert scale and is as follows: I have not used it at all, score zero, I have used it sometimes, score one, I often use it, score three, I use it a lot, score four. A score between 0 and 66 indicates a low level of using coping strategies, a score between 66 and 110 indicates a normal level of using coping strategies, and a score of 110 and above indicates a high level of using coping strategies. The Persian version of the WCQ has been standardized in Iran; the reliability has been reported as 0.84 [2]. Cronbach’s alpha was from 0.61 to 0.79. In this study, Cronbach’s alpha was 0.89.

2.3 Statistical analysis

Data were analyzed by SPSS v.22. The normality of the data was checked by the Kolmogorov-Smirnov test, which met the conditions for using parametric tests. Descriptive statistics were reported using frequency distribution tables, mean and standard deviation, and analytic statistics through Pearson correlation, chi-score, and multiple regression statistical tests. Significance was considered a level of less than 0.05.

2.4 Ethics approval and consent to participate

We confirm that all methods were carried out following relevant guidelines and regulations in our manuscript or Declaration of Helsinki. This study has been approved by the ethical committee of the School of Nursing and Midwifery of Tehran University of Medical Sciences (Ref: IR.TUMS.FNM.REC.1400.186). We explained the objectives of the study to the participants and written informed consent was obtained from them.

3 Results

The aim was to investigate the relationship between received and perceived social support with ways of coping in nurses. The normality of the data was checked using the Kolmogorov-Smirnov test (p > 0.08). Skewness is between –2 to +2 and kurtosis is between –7 to +7. The sample included 292 nurses working in Shariati Hospital.

The mean age of the participants was 34.26±8.15 (range 23 to 60 years). 75.3% of participants were female and 61.6% were married. Other demographic characteristics are shown in Table 1.

Table 1
Demographic characteristics of participating nurses

Variables F %

Sex

Female 220 75.3

Male 72 24.7

Marital status

Single 112 38.4

Married 180 61.6

Shift

Fixed 65 22.3

Rotating 227 77.7

Working in several departments

No 246 84.2

Yes 46 15.8

Employment agreement

Permanent working contract 220 75.3

Temporary working contract 72 24.6

Departments

Emergency 38 13

Critical care units 97 33.2

Other 157 53.8

Education

Bachelor 260 89

Master 30 10.3

Ph.D. 2 0.7

Variables	F	%
Sex
Female	220	75.3
Male	72	24.7
Marital status
Single	112	38.4
Married	180	61.6
Shift
Fixed	65	22.3
Rotating	227	77.7
Working in several departments
No	246	84.2
Yes	46	15.8
Employment agreement
Permanent working contract	220	75.3
Temporary working contract	72	24.6
Departments
Emergency	38	13
Critical care units	97	33.2
Other	157	53.8
Education
Bachelor	260	89
Master	30	10.3
Ph.D.	2	0.7

Table 2 shows the mean and standard deviation of perceived social support and received social support and ways of coping in the participants. None of the demographic variables were correlated with ways of coping (p = n.s). There was no difference between the mean and standard deviation of perceived and received social support, and ways of coping with demographic variables (p = n.s).

Table 2

Mean and Standard deviation of perceived and received social support, and ways of coping in nurses

Min.	Max.	$\bar{x} \pm$ SD
Perceived social support	Family	4	28	22.31±4.92
	Friends	4	28	19.09±5.74
	Significant other	4	28	21.63±5.11
	Total	21	84	63.03±12.46
Received social support	Colleagues	11	40	24.83±3.47
	Supervisors and head nurses	6	29	18.47±3.88
	Total	18	64	43.30±5.84
Ways of coping	Confrontive coping	3	16	8.14±2.44
	Distancing coping	1	16	7.65±2.52
	Self-controlling coping	3	18	10.45±2.77
	Seeking social support coping	1	18	9.05±3.11
	Accepting responsibility coping	0	12	6.17±1.99
	Escape-avoidance coping	1	19	8.99±3.46
	Planful problem-solving coping	1	17	9.35±2.64
	Positive reappraisal coping	1	17	10.69±3.04
	Total	31	164	94.74±19.75

Table 3 shows the distribution of the frequency of the ways of coping that most of the participants had an average level of ways of coping (75.4%).

Table 3

Frequency distribution of nurses’ coping strategies

Coping strategies	F (%)
Low	15 (5.1)
Normal	220 (75.4)
High	57 (19.5)

RSS (r = 0.12, p = 0.04) and PSS (r = 0.18, p = 0.002) had a significant correlation with confronting coping. RSS (r = 0.12, p = 0.03) was correlated with self-controlling coping, but PSS was not correlated with self-controlling coping (r = 0.09, p = 0.12). RSS (r = 0.26, p < 0.001) and PSS (r = 0.40, p = 0.001) had a significant correlation with seeking social support coping. RSS had a significant correlation with accepting responsibility coping (r = 0.16, p = 0.008), but the PSS did not correlate with accepting responsibility coping (r = 0.07, p = 0.22). RSS (r = 0.13, p = 0.02) and PSS (r = 0.17, p = 0.003) had a significant correlation with planful problem-solving coping. RSS (r = 0.20, p < 0.001) and PSS (r = 0.25, p = 0.001) had a significant correlation with positive reappraisal coping. But RSS and PSS did not have a significant correlation with distancing coping and escape-avoidance coping (p = n.s) (other details in Table 4).

Table 4

Correlation of received social support and perceived social support with ways of coping

Ways of coping	Received social support			Perceived social support
Colleagues	Supervisors and head nurses	Total	Family	Friends	Significant other	Total
Confrontive coping	r = 0.16^*	r = 0.04	r = 0.12^*	r = 0.12^*	r = 0.13^*	r = 0.16^*	r = 0.18^*
	p = 0.008	p = 0.51	p = 0.04	p = 0.03	p = 0.02	p = 0.005	p = 0.002
Distancing coping	r = 0.11	r = 0.05	r = 0.11	r =-0.04	r = 0.05	r = 0.03	r = 0.01
	p = 0.06	p = 0.34	p = 0.07	p = 0.46	p = 0.41	p = 0.56	p = 0.74
Self-controlling coping	r = 0.07	r = 0.12^*	r = 0.12^*	r = 0.12^*	r = 0.04	r = 0.07	r = 0.09
	p = 0.22	p = 0.03	p = 0.03	p = 0.04	p = 0.49	p = 0.26	p = 0.12
Seeking social support coping	r = 0.18^*	r = 0.23^*	r = 0.26^*	r = 0.35^*	r = 0.29^*	r = 0.30^*	r = 0.40^*
	p = 0.003	p < 0.001	p < 0.001	p = 0.001	p = 0.001	p = 0.001	p = 0.001
Accepting responsibility coping	r = 0.06	r = 0.18^*	r = 0.16^*	r = 0.10	r = 0.004	r = 0.08	r = 0.07
	p = 0.28	p = 0.002	p = 0.008	p = 0.11	p = 0.95	p = 0.18	p = 0.22
Escape-avoidance coping	r = 0.03	r = 0.06	r = 0.06	r = 0.01	r = -0.11	r = 0.03	r = -0.04
	p = 0.03	p = 0.13	p = 0.02	p = 0.008	p = 0.81	p = 0.007	p = 0.003
Planful problem-solving coping	r = 0.13^*	r = 0.09	r = 0.13^*	r = 0.15^*	r = 0.10	r = 0.16^*	r = 0.17^*
	p = 0.03	p = 0.13	p = 0.02	p = 0.008	p = 0.81	p = 0.007	p = 0.003
Positive reappraisal coping	r = 0.14^*	r = 0.18^*	r = 0.20^*	r = 0.24^*	r = 0.12^*	r = 0.24^*	r = 0.25^*
	p = 0.02	p = 0.002	p < 0.001	p = 0.04	p = 0.001	p = 0.001	p = 0.001
^*Significant

The relationship between perceived and received social support and ways of coping of nurses was investigated using a multiple linear regression model through Enter method. The results of Table 5 show that received social support (β= 0.20, p < 0.001) and perceived social support (β= 0.35, p < 0.001) are able to explain changes in seeking social support coping. Also, RSS (β= 0.16, p = 0.005) and PSS (β= 0.22, p < 0.001) are able to explain changes in positive reappraisal coping. The RSS could explain the changes in accepting responsibility coping (β= 0.15, p = 0.01) (other details are shown in Table 5).

Table 5

Regression between perceived social support and received social support with ways of coping in nurses

Ways of coping	Constant	Received social support			Perceived social support			F	R²	AR²
		B	β	p	B	β	p
Confrontive coping	10.58	0.04	0.09	0.13	0.03	0.16	0.007	5.82^*	0.04	0.03
Distancing coping	11.71	0.04	0.11	0.08	0.00	0.00	0.98	1.59^*	0.01	0.004
Self-controlling coping	14.22	0.05	0.11	0.70	0.02	0.07	0.23	2.93^*	0.02	0.01
Seeking social support coping	4.87	0.11	0.20	<0.001	0.09	0.35	<0.001	33.68^*	0.19	0.18
Accepting responsibility coping	7.57	0.05	0.15	0.01	0.007	0.04	0.46	3.84^*	0.02	0.02
Escape-avoidance coping	16.01	0.42	0.07	0.23	–0.02	–0.04	0.41	0.89	0.006	–0.001
Planful problem solving coping	12.63	0.02	0.05	0.39	0.02	0.11	0.07	2.49	0.02	0.01
Positive reappraisal coping	10.70	0.08	0.16	0.005	0.05	0.22	<0.001	13.83^*	0.09	0.08

^*Significant, R2: Coefficient of determination, AR2: Adjusted R².

4 Discussion

The aim was to investigate the relationship between received and perceived social support with ways of coping in nurses. The results showed that received social support and perceived social support had a statistically significant relationship with the ways of coping including confronting coping, self-controlling coping, Seeking social support coping, accepting responsibility coping, planful problem-solving coping, and positive reappraisal coping, but they did not correlate with distancing coping and escape-avoidance coping.

A study found that there is a positive and significant relationship between received social support and coping strategies and failure tolerance in students [9]. Higher social support from colleagues and relatives leads to nurses experiencing less stress, it was also found that the received social support is a mediating factor in job stress and job satisfaction [32]. A review study stated that healthcare workers use social support from family, friends, and colleagues to manage adverse mental health outcomes [34]. Social support can help people through direct assistance, giving feedback, information, and emotional support [35]. Social support creates a sense of belonging and dependence on others, in addition, the feeling of support prevents the feeling of loneliness [36]. Social support, especially from nursing managers, increases the individual’s ability to deal with stress and increases the individual’s efficiency, and increases the job satisfaction of nurses in the workplace [37].

In this study, it was found that both types of social support (received and perceived) are related to adaptive coping strategies, and probably in this way, it can lead to the reduction of stress, anxiety, and violence. The study showed that the social support of colleagues leads to the control of violence in the workplace by influencing effective ways of coping [13]. However, the use of maladaptive coping strategies such as avoidance style is directly related to anxiety and violence [38]. This study shows that social support is not correlated with maladaptive coping strategies. Therefore, social support with its effect on the ways of coping leads to the use of adaptive ways in people. Nurses can perform their activities with more focus and accuracy by using adaptive ways of coping [39]. The results of Hamama et al.’s study showed that social support has an inverse relationship with nurses’ burnout [40]. Nurses’ motivation and positive attitude toward the nursing profession are improved with social support and their compassion and commitment increase toward patients [41].

Received social support and perceived social support are able to explain changes in seeking social support coping and positive reappraisal coping. Received social support can explain changes in accepting responsibility coping in addition to seeking social support coping and positive reappraisal coping. The coefficient of determination was very weak for received social support and perceived social support in all dimensions of coping based on the R square; but they were able to explain the coping changes. Roohafza et al.’s study determined that among active coping, seeking social support and positive reappraisal, and acceptance are the most protective factors for depression and anxiety; Like our study, Roohafza also found that perceived social support is correlated with seeking social support and positive reappraisal, and acceptance [42].

Positive reappraisal reduces distress by finding positive meaning in a negative situation [43]. Seeking social support may increase self-esteem during stressful periods [44]. Accepting responsibility refers to acknowledging your role in the problem along with trying to make things right. Social support significantly predicts mental health [45]. It seems that social support has a direct effect on distress and can indirectly reduce stress by strengthening ways of coping.

Received social support is defined as the quantity of supportive behaviors received by an individual, while perceived support is also defined as satisfaction with available support [46]. Eagle’s study showed that there is a weak relationship between perceived and received social support [47]. Some studies have shown that perceived social support has a greater impact on psychological strain than received social support [46 , 49]; But this study showed that the received social support affects more dimensions of coping strategies. These results can depend on the culture and type of support. Perhaps one of the factors that led to these results is that social support has not been received enough, and the standards of nurses have not been paid attention to in Iranian hospitals (other variables: organizational culture, socio-economic status, etc.). It is necessary to compare the impact of different levels of received social support and perceived social support on the coping strategies in future studies. This requires further studies with more variables. The strategies that managers can implement to improve the working conditions of nurses include needs assessment and periodic assessment of needs and improving the working conditions of nurses, which is the responsibility of the organization.

4.1 Limitations

We selected participants only from Tehran University of Medical Sciences hospitals. The culture and organizational structure of teaching hospitals are different in universities. Therefore, this study limitation may impact the generalizability of the findings.

5 Conclusion

The findings of this study showed that the received social support and the perceived social support had a significant correlation with the ways of coping including confronting coping, self-controlling coping, Seeking social support coping, accepting responsibility coping, planful problem-solving coping, and positive reappraisal coping, but they did not correlate with distancing coping and escape-avoidance coping. Perceived social support is able to explain changes in seeking social support coping and positive reappraisal coping. Received social support can explain changes in accepting responsibility coping in addition to seeking social support coping and positive reappraisal coping. These results suggest that both types of support are necessary, but that received social support covered more adaptive coping strategies.

Ethics approval and consent to participate

Informed consent

We explained the objectives of the study to the participants and written informed consent was obtained from them.

Conflict of interest

The authors declare that they have no competing interests.

Footnotes

Acknowledgments

The authors wish to thank all nurses that participated in this study.

Funding

This study is not funded by a specific project grant.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available due to privacy and ethical concerns but are available from the corresponding author on reasonable request.

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