INTRODUCTION
1. Background
The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020, and managed the disease as a pandemic-level threat for more than three years until May 5, 2023, when it was declared as having ended, with approximately 7 million deaths [1,2]. Korea also officially declared the end of the COVID-19 pandemic on May 11, 2023, and on August 31, 2023, it was down-graded to a Level 4 infectious disease, and managed accordingly [3].
During infectious disease outbreaks, the workloads of infection control nurses (ICNs) increase to prevent the introduction and spread of the disease [4]. In particular, since ICNs are on the front line of infection control, changes in the trends of infectious diseases can directly affect their mental health [4]. During the pandemic, ICNs experienced considerable confusion due to the rapidly evolving infection control guidelines. Nevertheless, driv-en by a strong sense of responsibility for infection control, they endeavored to respond proactively. However, the overwhelming surge in workload ultimately led to severe burnout [5]. Consequently, it is imperative to comprehensively assess their mental health in the post-pandemic era to ensure an effective response to future epidemics.
Mental well-being can be defined as the subjective feeling of maintaining optimal mental functioning [6]. There has been a recent surge of interest in the concept of mental well-being, which emphasizes the positive aspects of mental health, and the development of competencies to cope with mental health problems [7,8]. While the prevailing focus on deficiencies in the mental well-being of health-care workers is understandable, it is important to recognize that mental well-being is inherently linked to happiness rather than deficiencies, and that it also enables individuals to find real meaning in their work [9]. In essence, mental well-being serves as a crucial metric for assessing the quality of mental health in relation to job-related factors [10]. Despite the paucity of research on ICNs, there has been growing interest in mental well-being among firefighters [11], maritime police [12], and hospital nurses [9] and workers [10]. In the preceding studies, mental well-being has been associated with job stress [10-12] and burnout [9]. However, given the nature of the work, a direct comparison is not possible. The work of ICNs has been shown to be a significant source of stress and burnout, which can be attributed to the specialized expertise and pursuit of high-quality patient safety care that is inherent to their profession. Therefore, it is intended to expand the knowledge of ICNs’ mental well-being based on the findings of previous studies, which reported that: the socially prescribed perfectionism of professional nurses [13] and time pressure of nurses in charge of patient safety nursing [14] are risk factors for their mental health; the mental well-being of frontline nurses minimized burnout during the COVID-19 pandemic and increased with the promotion of adaptive flexibility and psychological flexibility [15]; and intensive care unit (ICU) staff in stressful situations can be engaged in their work through psychological flexibility [16].
Socially prescribed perfectionism is defined as the belief that significant others have expectations of an individual that are unrealistic and challenging to meet [17]. Individuals may believe that high achievement is required to be accepted by others, they are incapable of meeting expectations, or they must attain perfection to be accepted by others [18]. The high-pressure environment of dealing with patients’ lives, where even minor errors are not tolerated, has been shown to contribute to the development of socially prescribed perfectionism, particularly among individuals with perfectionist tendencies [13]. The on-going global health crisis has had a profound impact on nurses, including infection control nurses, by introducing a range of challenges, including lack of expertise and increase in responsibilities. However, amidst these difficulties, nurses have also experienced a sense of empowerment, often manifested in proactive coping mechanisms [19]. However, over time, socially prescribed perfectionism can lead to burnout and compromise mental health [13]. Thus, for ICNs, socially prescribed perfectionism has the potential to influence level of their mental well-being, depending not only on how much it is perceived but also on the timing of when it is demanded. Time pressure is a state of stress caused by a perceived lack of time and sense of urgency, and not having enough time to complete a task [20]. The existence of time pressure has been demonstrated to be a contributing factor to nurses’ burnout [14]. ICNs are likely to have different roles and tasks depending on the severity and timing of the pandemic, thereby being exposed to different time pressures and experiencing different levels of mental well-being.
Conversely, psychological flexibility is defined as the capacity to perceive thoughts, emotions, and bodily responses objectively, and adjust or modify behaviors in accordance with individual circumstances to achieve personal goals or values [21]. Overall, individuals who exhibit high levels of psychological flexibility are more likely to maintain positive mental health, have lower turnover intentions, and not be easily influenced by organizational culture pressures, even in the face of an unsatisfactory job situation [22]. In the context of research trends on psychological flexibility in South Korea, this construct has primarily been examined across diverse populations as an independent or mediating variable, rather than as a dependent one. Previous studies have predominantly investigated its associations with factors such as adaptation, subjective well-being, anxiety, depression, and quality of life [23]. A previous study demonstrated that psychological flexibility can serve as a mitigating factor in the development of burnout among nurses, thereby promoting mental well-being [15]. Moreover, flexibility in hospital workers has been identified as a mediator in the relationship between job stress and mental well-being [10]. Similarly, a study on ICU staff revealed that psychological flexibility plays a mediating role in the association between job engagement and distress [16]. It is also considered to function as a mediating factor in the relationship between factors that pose a threat to the mental health of ICNs and their mental well-being.
WHO [2] stressed the potential for the reemergence of novel infectious diseases subsequent to the conclusion of the pandemic, underscoring the necessity for infrastructure maintenance and cultivation of a responsive capacity to address evolving epidemic scenarios. This study aims to ascertain the relationship between socially prescribed perfectionism, time pressure, psychological flexibility, and mental well-being among ICNs, who are a crucial component in the management of infectious diseases. This study seeks to furnish fundamental data necessary for the formulation of policies and systems, that can mitigate the adverse impact of these factors on mental well-being, and promote mental well-being in the post-pandemic era.
2. Purpose
This study aimed to examine the mediating effects of psychological flexibility on the relationships among socially prescribed perfectionism, time pressure, and mental well-being in ICNs in the post COVID-19 era. Its specific objectives are:
• To identify the respondents’ general characteristics: socially prescribed perfectionism, time pressure, and degree of psychological flexibility and mental well-being
• To identify differences in the level of mental well-being according to the respondents’ general characteristics
• To determine the correlation between respondents’ socially prescribed perfectionism, time pressure, psychological flexibility, and mental well-being
• To determine the mediating effects of psychological flexibility on the relationships between respondents’ socially prescribed perfectionism, time pressure, and mental well-being.
METHODS
1. Study Design
This descriptive survey study examined the mediating effects of psychological flexibility on the relationships between socially prescribed perfectionism, time pressure, and mental well-being in ICNs in the post-pandemic era.
2. Respondents
The respondents were ICNs, who after the declaration of the end of the COVID-19 pandemic by WHO (May 2023), had been working for at least a year (as of March 2024), and understood the study's purpose, and gave their consent to participate.
Using the G*Power 3.1.9.4 program, the adequate sample size for this study was calculated to be 162 for a regression analysis, assuming a significance level of .05, a power of .95, and 13 predictors (10 general traits, socially prescribed perfectionism, time pressure, and psychological flexibility). Accordingly, a total of 180 responses were collected, with a dropout rate of approximately 10%. After excluding two insufficient responses, 178 responses (98.9% recovery rate) were used in the final analysis.
3. Measures and Scales
The general characteristics were measured with 10 items on age, gender, education level, religion, overall clinical experience, infection control experience, type of qualification, hospital size, perceived staffing adequacy, and job satisfaction. There was a total of 52 items, including 15 on socially prescribed perfectionism, 5 on time pressure, 8 on psychological flexibility, and 14 on mental well-being.
1) Mental well-being
Mental well-being was measured using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), which was developed by Stewart-Brown and Janmohamed [8], and validated in Korean by Kim et al.[24]. The 14-item scale is scored on a 5-point Likert scale, with 1 point for “ never,” 2 for “ rarely,” 3 for “ sometimes,” 4 for “ often,” and 5 for “ always,” with a higher score indicating a higher level of mental well-being. The Cronbach's ⍺ for the scale was .89 and .94 in the study by Stewart-Brown and Janmohamed [8] and Kim et al.[24], respectively, and .96 in this study.
2) Socially prescribed perfectionism
The Multidimensional Perfectionism Scale developed by Hewitt and Flett [18], and validated by Han [17] in Korean, was used to measure socially prescribed perfectionism. The scale consisted of three subscales: self-oriented, other-oriented, and socially prescribed perfectionism, with 15 items in each subscale for a total of 45 items. This study used the 15 items on socially prescribed perfectionism that aligned with the research's theme. The items were scored on a 5-point Likert scale, ranging from 1 point for “ strongly disagree” to 7 for “ strongly agree,” with items 2, 6, 8, 12, and 15 being reverse scored, with a higher score indicating a higher level of socially prescribed perfectionism. The Cronbach's ⍺ for the socially prescribed perfectionism scale was .87 and .76 in the studies by Hewitt and Flett [18] and Han, respectively [17], and .91 in this study.
3) Time pressure
The Time Pressure Scale developed by Putrevu and Ratchford [20], modified and supplemented by Teng et al. [14] for use with nurses, and translated into Korean by Lee [25], was used. The scale consisted of a total of five items scored on a 7-point Likert scale. Each item was scored from 1 point for “ strongly disagree” to 7 for “ strongly agree,” with a higher score indicating a higher level of time pressure. The Cronbach's ⍺ of the scale was .95 in the studies by Teng et al.[14] and Lee [25], and .93 in this study.
4) Psychological flexibility
Psychological flexibility was measured using the Korean version of the Acceptance and Action Questionnaire II (KAQ-II), which was developed by Bond et al. [21], and adapted by Heo et al. [22]. The scale consisted of a total of eight items scored on a 7-point Likert scale, from 1 point for “ strongly disagree” to 7 for “ strongly agree.” Except for item 5, all the items were reverse scored, with a higher score indicating a higher level of psychological flexibility. The Cronbach's ⍺ for the scale was .86 and .85 in the studies by Bond et al. [21] and Heo et al. [22], respectively, and .93 in this study.
4. Data Collection
The data were collected from March 9 to 18, 2024. After receiving approval from the Institutional Review Board (KYU-2023-11-011-001) of the investigator's university, the study was promoted through online communities (nurse and hospital nursing departments) to ensure the reliability of the data and respondents from various regions. To ensure autonomy, a link to the materials was disseminated to the mobile phone numbers provided by the respondents who had consented to participate. The survey took less than 10 minutes to complete, and a reward was provided in return.
5. Data Analysis
The collected data were analyzed using the SPSS/WIN 29.0/windows program (IBM Corp., USA). The general characteristics-socially prescribed perfectionism, time pressure, psychological flexibility, and mental well-being of the respondents-were subjected to descriptive analysis. Differences in mental well-being according to the respondents’ general characteristics were analyzed by an independent t-test, Mann-Whitney test, and one-way ANOVA, and post hoc tests were performed using the Scheffé test. Pearson's Correlation Coefficient was employed to analyze the relationship between the primary variables. The mediating effect of psychological flexibility on the relationship of the independent variables-socially prescribed perfectionism and time pressure-with mental well-being was examined by hierarchical regression as proposed by Baron and Kenny [26]. The validity of the mediation effect was verified by the bootstrapping test of the SPSS process macro.
RESULTS
1. Differences in Mental Well-being according to the Respondents’ General Characteristics
Table 1 shows the respondents’ general characteristics and differences in mental well-being by general characteristics. An analysis of the respondents’ general characteristics revealed that out of the 178 respondents, the majority were women (176, 98.9%), in their 30s (108, 60.7%), had no religion (111, 62.4%), had 5 to 10 years of total work experience (93, 52.3%), had less than 3 years of experience in infection control (93, 52.3%), and had a bachelor's degree (112, 62.9%). In terms of type of job-related qualification, most respondents answered that they were not qualified (90, 50.6%) Hospital size ranged from 301 beds or more to 600 beds or less (117, 65.7%); staffing adequacy was perceived as moderate (102, 57.3%); and in terms of job satisfaction, they were generally satisfied with their job (148, 83.1%).
Table 1.
Mental Well-being according to General Characteristics (N=178)
| Variables | Categories | n (%) | Mental well-being | |
|---|---|---|---|---|
| M± SD | t or F (p) Scheffé | |||
| Gender | Men | 2 (1.1) | 4.21±1.11 | 115.00 |
| Women | 176 (98.9) | 3.57±0.81 | (.434†) | |
| Age (year) | ≤20a | 55 (30.9) | 3.98±0.89 | 11.02 |
| 30∼39b | 108 (60.7) | 3.38±0.71 | (＜.001) | |
| ≥40c | 15 (8.4) | 3.52±0.64 | a＞ b | |
| Religion | No | 111 (62.4) | 3.51±0.81 | -1.51 |
| Yes | 67 (37.6) | 3.70±0.79 | (.133) | |
| Education level | Associate's degreea | 31 (17.4) | 3.30±0.31 | 4.81 |
| Bachelor's degreeb | 112 (62.9) | 3.66±0.92 | (.009) | |
| ≥ Graduate schoolc | 35 (19.7) | 3.55±0.67 | a＜ b | |
| Total clinical experience (year) | ＜5a | 49 (44.3) | 3.86±0.60 | 8.51 |
| 5∼10b | 93 (52.3) | 3.43±0.91 | (＜.001) | |
| ≥11c | 36 (20.2) | 3.58±0.67 | a＞ b | |
| Infection control work experience (year) | ＜3 | 93 (52.3) | 3.78±0.74 | 2.51 |
| 3∼6 | 65 (36.5) | 3.26±0.85 | (.084) | |
| ≥7 | 20 (11.2) | 3.66±0.70 | ||
| Qualification type | Nonea | 90 (11.8) | 3.90±0.81 | 30.90 |
| Practical expertb | 48 (26.9) | 3.59±0.56 | (＜.001) | |
| Advanced practice nursesc | 40 (22.5) | 2.85±0.98 | a, b＞ c | |
| Hospital size (beds) | ≤300 | 21 (11.8) | 3.45±0.43 | 0.53 |
| 301∼800 | 117 (65.7) | 3.62±0.82 | (.592) | |
| ≥801 | 40 (22.5) | 3.52±0.93 | ||
| Perception of adequacy of manpower | Insufficiencya | 39 (21.9) | 3.62±0.78 | 3.12 |
| Averageb | 102 (57.3) | 3.67±0.70 | (.047) | |
| Appropriatec | 37 (20.8) | 3.29±1.04 | b＞ c | |
| Satisfaction with work | Dissatisfied | 30 (16.9) | 3.36±0.58 | -1.65 |
| Satisfied | 148 (83.1) | 3.62±0.84 | (.101) | |
The differences in mental well-being according to the respondents’ general characteristics were statistically significant for age (F=11.02, p<.001), total clinical experience (F=4.81, p=.009), infection control experience (F=8.51, p< .001), type of qualification (F=30.90, p<.001), and perceived staffing adequacy (F=3.12, p<.047) (Table 1). Post hoc analyses indicated that those in their 20s exhibited higher levels of mental well-being than those in their 30s. Additionally, individuals with less than 5 years of total clinical experience demonstrated higher levels of well-being, compared to those with 5 to 10 years of experience. Individuals with less than 3 years of experience in infection control exhibited a higher level of mental well-being compared to those with 3 to 6 years of experience. Additionally, those who perceived staffing adequacy as moderate exhibited a higher level of mental well-being compared to those who perceived it as adequate. Furthermore, those with no relevant qualifications or practical experts had a higher level of mental well-being than the advanced practice nurse group.
2. Levels of Socially Prescribed Perfectionism, Time Pressure, Psychological Flexibility, and Mental Well-being
The levels of socially prescribed perfectionism, time pressure, psychological flexibility, and mental well-being of the respondents were as follows (Table 2).
Table 2.
Levels of Mental Well-being, Socially Prescribed Perfectionism, Time Pressure, and Psychological Flexibility (N=178)
The mean scores were 4.16±1.10, 4.53±1.37, and 4.50± 1.35 (out of 7 points) for socially prescribed perfectionism, time pressure, and psychological flexibility, respectively; and 3.58±0.81 out of 5 points for mental well-being.
3. Correlations between Socially Prescribed Perfectionism, Time Pressure, Psychological Flexibility, and Mental Well-being
The results of the correlation analysis (Table 3) revealed that social perfectionism (r=-.48, p<.001) and time pressure (r=-.20, p=.008), each had a statistically significant negative correlation with the respondents’ mental well-being, while psychological flexibility had a positive correlation (r=.69, p<.001). Furthermore, socially prescribed perfectionism had a positive correlation with time pressure (r=.59, p <.001) and negative correlation with psychological flexibility (r=-.61, p<.001), while time pressure and psychological flexibility had a negative correlation (r=-.32, p<.001).
Table 3.
Correlations of Mental Well-being, Socially Prescribed Perfectionism, Time Pressure, and Psychological Flexibility (N=178)
4. Mediating Effects of Psychological Flexibility on the Relationships between Socially Prescribed Perfectionism, Time Pressure, and Mental Well-being
After reviewing the appropriateness of the regression model, it was assumed that the multicollinearity problem did not exist as the variance inflation factor between the input variables ranged from 1.12 to 2.94, which was less than 10, and the tolerance limit ranged from 0.34 to 0.89, which was greater than 0.1. The Durbin-Watson index was 2.05, which was close to 2, indicating that autocorrelation was unlikely to occur, making the regression analysis appropriate. To ascertain the normality of the primary variables, the absolute value of skewness ranged from 0.41 to 0.77 and did not exceed the criterion of 3, while the absolute value of kurtosis ranged from 0.23 to 0.57 and did not exceed 8 or 10, thereby indicating a normal distribution [27].
The results of the analysis, applying the three steps of Baron and Kenny's [25] mediation effect analysis, are as follows (Table 4, Figure 1). First, the independent variables-socially prescribed perfectionism (β=-.61, p<.001) and time pressure (β=-.32, p<.001)-exhibited a negative and significant impact on the mediator, psychological flexibility. Second, the independent variables-socially prescribed perfectionism (β=-.48, p<.001) and time pressure (β=-.20, p=.008)-had a negatively significant effect on the dependent variable-mental well-being. Finally, the independent variable-socially prescribed perfectionism-was not statistically significant for mental well-being (β=-.11, p=.123), while only the mediator-psychological flexibility-was statistically significant (β=.62, p<.001). Time pressure was also not statistically significant (β=.03, p=.670), while psychological flexibility was found to be statistically significant (β=.69, p<.001).
Figure 1.
Mediating effect of psychological flexibility on the relationship between socially prescribed perfectionism, time pressure, and mental well-being.
Table 4.
Mediating Effects of Psychological Flexibility and the Bootstrapping Test (N=178)
The findings of the significance test demonstrated the indirect effect of the mediator-psychological flexibility- between the independent variables-socially prescribed perfectionism (Boot LLCI=-.36, Boot ULCI=-.19) and time pressure (Boot LLCI=-.21, Boot ULCI=-.06), and that mental well-being did not contain “0” at the 95% confidence interval, thereby validating the mediation effect. In the direct effects, the 95% confidence intervals for socially prescribed perfectionism (Boot LLCI=-.18, Boot ULCI=.02) and time pressure (Boot LLCI=-.05, Boot ULCI=.08) both contained “0,” confirming the full mediating effect of psychological flexibility on the relationship of the independent variables-socially prescribed perfectionism and time pressure-with mental well-being.
DISCUSSION
The discussion of this study, which attempted to examine the mediating effect of psychological flexibility on the relationship between socially prescribed perfectionism, time pressure, and mental well-being among ICNs, is as follows.
The mean score of ICNs’ mental well-being was 3.58 ±0.81 out of 5 points. This was generally lower than the mental well-being among U.S. hospital nurses [9], measured using the same scale, but at an unknown time; firefighters [11], whose data were collected in 2018 (i.e., before the COVID-19 outbreak); and maritime police [12], whose data were collected at an unknown time. Conversely, ICNs’ mental well-being was similar to that of psychiatric hospital workers [10] collected in March 2022, during the COVID-19 pandemic using the same scale. It is imperative to exercise caution when conducting direct comparisons, as the studies differ in terms of population, timing of data collection, and measurement scales. However, the implication is that the mental well-being of ICNs will not be resolved by the conclusion of the pandemic. Therefore, in light of the growing importance of infection prevention, longitudinal studies are needed to develop targeted resources and provide sustained support for the psychological well-being of ICNs.
In terms of general characteristics, the mental well-being of ICNs was higher among those in their 20s than 30s; those with less than 5 years of total clinical experience compared to those with 5 to 10 years of experience; those with less than 3 years of experience in infection control compared to those with 3 to 6 years of experience; those with no relevant qualifications compared to advanced practice nurses; and those who perceived the staffing adequacy to be moderate compared to those who perceived it to be adequate. This differs from findings that showed no difference in mental well-being among psychiatric hospital workers [10], but it was a factor in positive affect, a subdomain of subjective well-being, among nurses [28]. Furthermore, age was also a factor, with no difference in positive effect on subjective well-being, but a statistically significant difference in negative effect among those in their 30s compared to those in their 20s, and 40s and older [28]. However, a direct comparison of these previous studies is challenging owing to the study participants’ varying job characteristics. This study's findings indicated that a younger age and lower work experience groups exhibited higher levels of mental well-being. This phenomenon may be attributed to the relatively more organized and stabilized pandemic response system during that period. Mean-while, the mental well-being of advanced practice nurses was significantly lower than that of those with no relevant qualifications, or practical experts. As advanced practice nurses perform demanding advanced nursing care, they may experience mental health issues, such as burnout owing to overwhelming workloads and performance expectations [13]. Pandemics are emerging more frequently with shorter intervals. Delivering quality infection control requires more specialized and advanced practices. Achieving this goal necessitates the establishment of appropriate compensation systems for highly trained professionals, along with strategies to promote their psychological well-being.
The correlation analysis demonstrated a negative correlation between mental well-being and socially prescribed perfectionism and time pressure, and a positive correlation with psychological flexibility. A comparative analysis, which was somewhat extensive due to the paucity of studies that had matched participants and factors, found that perfectionism in nurse practitioners [13] and workers [29,30] were negatively correlated with well-being and burnout. Perfectionism can be reinforced in situations where nurses working in clinical settings have a sense of responsibility and mission to their patients, and do not tolerate mistakes in their work [13]. However, there is a need for repeated studies that examine ICNs’ mental well-being to allow for direct comparisons across participants and factors.
The negative correlation of time pressure with mental well-being was consistent with a previous study [31] which demonstrated that time pressure had a positive correlation with nurses’ burnout. Research on time pressure has been largely limited to studies on patient safety nursing activities [31,32] and its relevance to the work environment [32]. The issue of time pressure has been the focus of research in the context of organizational outcomes, with particular attention being paid to patient safety, nursing activities, and the work environment. However, given the established associations between job-related psychological states, such as burnout [31], and mental well-being, future research should endeavor to provide an integrated view of these relationships.
A positive correlation was identified between psychological flexibility and mental well-being. This finding aligns with prior studies that have examined the relationship between psychological flexibility and well-being [22], as well as studies that have demonstrated a strong correlation between flexibility and mental well-being among hospital workers [10]. In essence, flexibility is a universal phenomenon in the psychological and cognitive domains, thereby supporting the notion that high flexibility contributes to psychological well-being by enabling individuals to adapt to environmental stresses by modifying their reactions or behaviors according to the situation, while maintaining their self-esteem. However, there is a paucity of research on ICNs, indicating a need for further investigation into the role of psychological flexibility in their mental health.
The mediation effect test demonstrated that socially prescribed perfectionism and time pressure among ICNs did not directly impact mental well-being, but rather, this impact was only observed through psychological flexibility. This finding aligns with the findings of previous studies that have demonstrated the mediating role of flexibility in the relationship between job stress and mental well-being in hospital workers and nurses [10,33]. Taken together with the correlation analysis results, socially prescribed perfectionism, like job stress and burnout, was negatively correlated with mental well-being, while psychological flexibility was positively related. It can be interpreted that socially prescribed perfectionism is a negative factor for psychological flexibility and mental well-being, and that socially prescribed perfectionism alone does not contribute to mental well-being, which is only possible through psychological flexibility. The mechanisms of time pressure reduction can be interpreted as analogous, but this should be interpreted with caution owing to the difficulty of comparison with prior studies. However, the post-pandemic period is a time to assess the deficiencies that surfaced during the pandemic, and implement requisite stimulus measures. This study identified that the strategy to enhance psychological flexibility among ICNs could promote personal mental well-being in the short term. Psychological flexibility has been demonstrated to reduce stress in ICU staff [16] and mitigate burnout in nurses during the course of the pandemic [34]. Furthermore, it has been identified as a factor contributing to the enhancement of job engagement [16] and mitigation of turnover intentions [34] over an extended timeframe. In other words, psychological flexibility not only enhances the mental well-being of organizational members but also mediates factors that hinder organizational performance and sustainability. To ascertain the mediating role of psychological flexibility in organizational contexts, longitudinal or intervention studies are necessary.
The study's limitations are as follows. Firstly, it should be noted that it was a cross-sectional study conducted at the end of the pandemic, which limited its ability to identify and describe overall changes in the participants. Second, the independent variables of socially prescribed perfectionism and time pressure prove inadequate in elucidating participants’ mental well-being. Third, convenience sampling was executed using institutional communities and online forums to encourage voluntary participation from a diverse array of organizations and audiences. Therefore, caution should be exercised in generalizing its findings. Lastly, this study did not employ a structural equation modeling (SEM) approach, which might have been more effective in analyzing pathways involving variables that remain underexplored in prior research. Consequently, the study has limitations in identifying the detailed mechanisms of these pathways.
CONCLUSION
This study found that ICNs’ level of mental well-being at the conclusion of the pandemic was not higher than that of other participants. It also found that there were significant differences in general characteristics by age, total clinical experience, and years of experience in infection control, as well as by subdomains of qualification type. Specifically, the independent variables of socially prescribed perfectionism and time pressure exert an influence on mental well-being through psychological flexibility, that exhibits a full mediating effect. This study's primary significance lies in its focus on ICNs’ mental well-being, a subject that has received scant attention in extant literature. It identifies the mediating role of psychological flexibility in its relationship with factors that threaten mental well-being.
Based on these findings, this study provides the following recommendations. First, longitudinal or intervention studies on ICNs’ mental well-being, that take into account the time of the epidemic are needed. Second, further research is necessary to identify multidimensional factors that can explain and predict ICNs’ mental well-being. Third, the development and consistent implementation of programs aimed at cultivating psychological flexibility can serve as a valuable resource for ICNs’ mental well-being during periods of uncertainty surrounding emerging infectious disease outbreaks.
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