{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T14:41:42Z","timestamp":1786545702740,"version":"build-2736575974"},"reference-count":48,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72474062"],"award-info":[{"award-number":["72474062"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,16]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"\n Objectives<\/jats:title>\n Healthcare-acquired infection outbreaks impose significant psychological stress on healthcare workers, yet limited research has examined stress perception and protective factors during institutional-level outbreak scenarios. Grounded in the Job Demands-Resources model, this study examines the relationships among healthcare workers\u2019 perceptions of response governance, collaborative attitudes and perceived stress, and tests the moderating role of collaborative attitudes.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A cross-sectional study was conducted using an online questionnaire from May to October 2025.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Healthcare workers from hospitals in North-Eastern China.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n 1017 valid healthcare workers, including clinicians, nurses, clinical technicians, administrative personnel, support staff and others with at least 1 year of continuous employment at the hospital. Purposive and snowball sampling were used.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Perception of response governance collaborative attitude towards hospital infection outbreaks and perceived stress scores were assessed using validated self-report questionnaires.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The mean perceived stress score among study participants was 2.03 (SD=0.97, range 1\u20135), indicating low to moderate levels. However, 11.9% of individuals still experienced high stress levels. Perception of response governance showed a significant negative correlation with perceived stress (r=\u22120.224, p<0.001) and the collaborative attitude towards hospital infection outbreaks also showed a significant negative correlation with perceived stress (r=\u22120.305, p<0.001). Hierarchical multiple regression, after adjusting for demographic covariates, showed that perception of response governance (\u03b2=\u22120.400, p<0.001) and collaborative attitude (\u03b2=\u22120.210, p=0.008) negatively predicted perceived stress, thereby increasing model explanatory power by 10.2% (\u0394R\u00b2=0.102, p<0.001). Interaction analysis revealed that the interaction term between perception of response governance and collaborative attitude significantly predicted perceived stress (\u03b2=\u22120.202, p=0.022). Simple slope tests indicated that at higher levels of collaborative attitude, the negative predictive effect of perception of response governance on perceived stress intensified (low level: simple slope=\u22120.247; high level: simple slope=\u22120.402). Additionally, years of service between 11 and 15 years (\u03b2=0.381, p=0.012) and prior experience in managing healthcare-associated infection outbreaks (\u03b2=0.468, p<0.001) were identified as risk factors for perceived stress.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n While most healthcare workers reported low-to-moderate stress levels, identifiable high-risk subgroups remained. Given the cross-sectional design, causal inferences cannot be drawn; however, perceived governance and collaborative attitudes showed a synergistic moderating effect on perceived stress. Administrators should implement integrated interventions combining cognitive empowerment with collaborative support to strengthen organisational resilience.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120080","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T13:45:18Z","timestamp":1786542318000},"page":"e120080","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Perception of response governance and collaborative attitude of hospital infection outbreak and their association with perceived stress among healthcare workers: a cross-sectional study in North-Eastern China"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1020-8782","authenticated-orcid":false,"given":"Weixin","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6946-8772","authenticated-orcid":false,"given":"Cunling","family":"Yan","sequence":"additional","affiliation":[{"name":"School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man","family":"Li","sequence":"additional","affiliation":[{"name":"School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingyan","family":"Yu","sequence":"additional","affiliation":[{"name":"School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longfei","family":"Ma","sequence":"additional","affiliation":[{"name":"School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqing","family":"Xiao","sequence":"additional","affiliation":[{"name":"Institute of Disinfection and Hospital Infection Control, Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, Heilongjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Ning","sequence":"additional","affiliation":[{"name":"School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"2026081206450872000_16.8.e120080.1","first-page":"41","article-title":"Construction of an emergency management system for large public hospitals from the perspective of resilience Governance","volume":"29","author":"LI","year":"2025","journal-title":"Chinese Hospitals"},{"key":"2026081206450872000_16.8.e120080.2","unstructured":"Global report on infection prevention and control. 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