{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:57:23Z","timestamp":1790575043921,"version":"4.1.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"\n Background<\/jats:title>\n 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\u2019 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\u2019s 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u2013Wilk 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In this study, the mean scores for care-resistant behavior, psychological detachment, professional calling, and occupational burnout among the 421 nurses were (43.89\u202f\u00b1\u202f21.75), (9.61\u202f\u00b1\u202f3.72), (31.03\u202f\u00b1\u202f10.96), and (63.00\u202f\u00b1\u202f27.79), respectively. Care-resistant behavior was positively correlated with occupational burnout (\n r<\/jats:italic>\n \u202f=\u202f0.702,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), and negatively correlated with psychological detachment (\n r<\/jats:italic>\n \u202f=\u202f\u22120.519,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) and professional calling (\n r<\/jats:italic>\n \u202f=\u202f\u22120.626,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Psychological detachment was positively correlated with professional calling (\n r<\/jats:italic>\n \u202f=\u202f0.600,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) and negatively correlated with occupational burnout (\n r<\/jats:italic>\n \u202f=\u202f\u22120.641,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Professional calling was negatively correlated with occupational burnout (\n r<\/jats:italic>\n \u202f=\u202f\u22120.862,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Serial mediation analysis indicated that both the direct association (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.303,\n p<\/jats:italic>\n \u202f=\u202f0.001) and the total indirect effect (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.510,\n p<\/jats:italic>\n \u202f=\u202f0.001) between care-resistant behavior in dementia patients and nurses\u2019 occupational burnout were significant. A significant serial indirect association involving psychological detachment and professional calling was observed in the relationship between care-resistant behavior and occupational burnout (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.126). This serial indirect association accounted for 15.5% of the total association, with a 95% confidence interval of (0.075\u20130.201).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1860688","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:45:38Z","timestamp":1790574338000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The association between care-resistant behavior in dementia patients and nurses\u2019 occupational burnout: a cross-sectional serial mediation analysis of psychological detachment and professional calling"],"prefix":"10.3389","volume":"17","author":[{"given":"Yao","family":"Ding","sequence":"first","affiliation":[{"name":"Department of Rehabilitation, Tangdu Hospital, the Fourth Military Medical University","place":["Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Tangdu Hospital, the Fourth Military Medical University","place":["Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aini","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Tangdu Hospital, the Fourth Military Medical University","place":["Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Tangdu Hospital, the Fourth Military Medical University","place":["Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Tangdu Hospital, the Fourth Military Medical University","place":["Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Tangdu Hospital, the Fourth Military Medical University","place":["Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1016\/j.ijnurstu.2014.11.004","article-title":"Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research","volume":"52","author":"Adriaenssens","year":"2015","journal-title":"Int. J. Nurs. Stud."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1002\/alz.13016","article-title":"Alzheimer\u2019s disease facts and figures","volume":"19","year":"2023","journal-title":"Alzheimers Dement."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1037\/ocp0000056","article-title":"Job demands-resources theory: taking stock and looking forward","volume":"22","author":"Bakker","year":"2017","journal-title":"J. Occup. Health Psychol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e14451","DOI":"10.1002\/alz.14451","article-title":"Factors associated with care-resistant behavior in the National Alzheimer\u2019s coordinating center\u2019s uniform data set","volume":"21","author":"Bratches","year":"2025","journal-title":"Alzheimers Dement."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e13079","DOI":"10.1111\/inr.13079","article-title":"Teamwork, psychological detachment from work during nonwork time, and burnout experienced by hospital-based nurses","volume":"72","author":"Cho","year":"2025","journal-title":"Int. Nurs. Rev."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/j.sleh.2024.05.005","article-title":"Psychological detachment from work during nonwork time as a moderator and mediator of the relationship of workload with fatigue and sleep in hospital nurses","volume":"10","author":"Cho","year":"2024","journal-title":"Sleep Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1037\/a0019364","article-title":"Linking job demands and resources to employee engagement and burnout: a theoretical extension and meta-analytic test","volume":"95","author":"Crawford","year":"2010","journal-title":"J. Appl. Psychol."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12960-020-00469-9","article-title":"Burnout in nursing: a theoretical review","volume":"18","author":"Dall\u2019Ora","year":"2020","journal-title":"Hum. Resour. Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1037\/0021-9010.86.3.499","article-title":"The job demands-resources model of burnout","volume":"86","author":"Demerouti","year":"2001","journal-title":"J. Appl. Psychol."},{"key":"ref10","first-page":"1394","article-title":"The relationship between professional calling and job burnout among grassroots police officers: the moderating role of psychological detachment","volume":"27","author":"Deng","year":"2019","journal-title":"China J. Health Psychol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e5971","DOI":"10.1002\/gps.5971","article-title":"The role of maladaptive personality in behavioural and psychological symptoms in dementia","volume":"38","author":"Dero","year":"2023","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1111\/scd.13057","article-title":"Oral health, treatment burden and demographics of elders with care-resistant behavior: a cross-sectional study","volume":"44","author":"El Gedaily","year":"2024","journal-title":"Spec. Care Dentist."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1111\/insr.12011_25","article-title":"Principles and practice of structural equation modeling, third edition by rex B. Kline","volume":"81","author":"Fonseca","year":"2013","journal-title":"Int. Stat. Rev."},{"key":"ref14","first-page":"21","article-title":"Stress and burnout syndrome and their associations with coping and job satisfaction in critical care nurses: a literature review","volume":"31","author":"Friganovi\u0107","year":"2019","journal-title":"Psychiatr. Danub."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e105","DOI":"10.1016\/S2468-2667(21)00249-8","article-title":"Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the global burden of disease study 2019","volume":"7","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e12158","DOI":"10.1111\/opn.12158","article-title":"Formal caregivers\u2019 experiences of aggressive behaviour in older people living with dementia in nursing homes: a systematic review","volume":"12","author":"Holst","year":"2017","journal-title":"Int. J. Older People Nursing"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1037\/ocp0000280","article-title":"Interventions for improving psychological detachment from work: a meta-analysis","volume":"26","author":"Karabinski","year":"2021","journal-title":"J. Occup. Health Psychol."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1016\/j.gerinurse.2024.06.007","article-title":"The relationship between caregivers\u2019 behaviors and resistant behaviors of persons living with dementia during personal care in long-term care facilities: a lag sequential analysis","volume":"58","author":"Lee","year":"2024","journal-title":"Geriatr. Nurs."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"6380","DOI":"10.1111\/jan.16761","article-title":"The effect of nurses\u2019 perceived social support on job burnout: the mediating role of psychological detachment","volume":"81","author":"Li","year":"2025","journal-title":"J. Adv. Nurs."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"170","DOI":"10.16128\/j.cnki.1005-3611.2003.03.004","article-title":"Investigation on job burnout among medical staff","volume":"11","author":"Li","year":"2003","journal-title":"Chin. J. Clin. Psychol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"104046","DOI":"10.1016\/j.ijnurstu.2021.104046","article-title":"Optimizing mealtime care for people with dementia from the perspective of formal caregivers: a systematic review of qualitative research","volume":"123","author":"Li","year":"2021","journal-title":"Int. J. Nurs. Stud."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1309901","DOI":"10.3389\/fpsyg.2024.1309901","article-title":"Analysis of the chain-mediated effects of nurses\u2019 sense of professional gain and sense of professional mission between psychological resilience and work engagement in 10 general hospitals in Sichuan Province","volume":"15","author":"Liu","year":"2024","journal-title":"Front. Psychol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1633956","DOI":"10.3389\/fpubh.2025.1633956","article-title":"The impact of horizontal violence among nurses on their job burnout: a moderated mediation model","volume":"13","author":"Liu","year":"2025","journal-title":"Front. Public Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1186\/s40359-025-02606-2","article-title":"The impact of professional mission on turnover intention among operating room nurses: a chain mediation model analysis of professional identity and job burnout","volume":"13","author":"Liu","year":"2025","journal-title":"BMC Psychol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"182","DOI":"10.5694\/mja2.51849","article-title":"Young-onset dementia diagnosis, management and care: a narrative review","volume":"218","author":"Loi","year":"2023","journal-title":"Med. J. Aust."},{"key":"ref26","volume-title":"A Study on the Correlation between Nurses\u2019 Medical Narrative Ability and Occupational Burnout: the Mediating role of Compassion Fatigue","author":"Luo","year":"2025"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.12740\/PP\/OnlineFirst\/91686","article-title":"Psychiatrists and occupational burnout syndrome\u2014a phenomenon, a problem, a threat?","volume":"53","author":"Makara-Studzi\u0144ska","year":"2019","journal-title":"Psychiatr. Pol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1111\/sjop.12622","article-title":"The role of psychological detachment in burnout and depression: a longitudinal study of Malaysian workers","volume":"61","author":"Muhamad Nasharudin","year":"2020","journal-title":"Scand. J. Psychol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2713","DOI":"10.1111\/jan.13807","article-title":"Caregivers\u2019 perceptions of aggressive behaviour in nursing home residents living with dementia: a meta-ethnography","volume":"74","author":"Nybakken","year":"2018","journal-title":"J. Adv. Nurs."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1007\/s11357-024-01400-z","article-title":"The efficacy of cognitive stimulation, cognitive training, and cognitive rehabilitation for people living with dementia: a systematic review and meta-analysis","volume":"47","author":"Paggetti","year":"2025","journal-title":"GeroScience."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1146\/annurev-psych-120710-100452","article-title":"Sources of method bias in social science research and recommendations on how to control it","volume":"63","author":"Podsakoff","year":"2012","journal-title":"Annu. Rev. Psychol."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"103660","DOI":"10.1016\/j.iccn.2024.103660","article-title":"Job satisfaction and burnout syndrome among intensive-care unit nurses: a systematic review and meta-analysis","volume":"82","author":"Quesada-Puga","year":"2024","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e0185781","DOI":"10.1371\/journal.pone.0185781","article-title":"Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies","volume":"12","author":"Salvagioni","year":"2017","journal-title":"PLoS One"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"937","DOI":"10.3233\/WOR-210283","article-title":"Prevalence of job burnout in Iranian nurses: a systematic review and meta-analysis","volume":"73","author":"Sohrabi","year":"2022","journal-title":"Work"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1037\/1076-8998.12.3.204","article-title":"The recovery experience questionnaire: development and validation of a measure for assessing recuperation and unwinding from work","volume":"12","author":"Sonnentag","year":"2007","journal-title":"J. Occup. Health Psychol."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"16617","DOI":"10.3390\/ijerph192416617","article-title":"The mediation chain effect of cognitive crafting and personal resources on the relationship between role ambiguity and dentists\u2019 emotional exhaustion","volume":"19","author":"Stan","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref37","volume-title":"Revision of the Chinese Version of the Care-Resistant Behavior in Dementia Patients Scale and Analysis of its Influencing Factors","author":"Wang","year":"2024"},{"key":"ref38","first-page":"54","article-title":"A study on the influence of primary and secondary school teachers\u2019 professional calling on occupational burnout","volume":"30","author":"Wang","year":"2025","journal-title":"Teaching and Administration."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1186\/s40359-023-01384-z","article-title":"Relationship between psychological detachment from work and depressive symptoms: indirect role of emotional exhaustion and moderating role of self-compassion","volume":"11","author":"Wu","year":"2023","journal-title":"BMC Psychol."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"gnae084","DOI":"10.1093\/geront\/gnae084","article-title":"Care-resistant behavior trajectories during mouth care among nursing home residents with dementia","volume":"64","author":"Xiao","year":"2024","journal-title":"Gerontologist"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1177\/2165079920986159","article-title":"Certified nursing assistants\u2019 perceived workplace violence in long-term care facilities: a qualitative analysis","volume":"69","author":"Xiao","year":"2021","journal-title":"Workplace Health Saf."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1111\/inr.12957","article-title":"The impact of career calling on nurse burnout: a moderated mediation model","volume":"71","author":"Xie","year":"2024","journal-title":"Int. Nurs. Rev."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1186\/s12912-024-01935-8","article-title":"How does psychosocial safety climate cross-level influence work engagement and job burnout: the roles of organization-based self-esteem and psychological detachment","volume":"23","author":"Yuan","year":"2024","journal-title":"BMC Nurs."},{"key":"ref44","volume-title":"Professional Calling: Structure, Measurement, and its Relationship with well-Being [Doctoral Dissertation]","author":"Zhang","year":"2015"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1007\/s10943-022-01642-1","article-title":"\u201cThere for the right reasons\u201d: New Zealand early childhood professionals\u2019 sense of calling, life goals, personal and spiritual values","volume":"63","author":"Zhang","year":"2024","journal-title":"J. Relig. Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1605966","DOI":"10.3389\/ijph.2023.1605966","article-title":"Association of job characteristics and burnout of healthcare workers in different positions in rural China: a cross-sectional study","volume":"68","author":"Zhang","year":"2023","journal-title":"Int. J. Public Health"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1186\/s12912-024-02271-7","article-title":"Psychological resilience mediates sense of professional mission and career success in Chinese intensive care unit nurses: a cross-sectional study","volume":"23","author":"Zhang","year":"2024","journal-title":"BMC Nurs."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1216810","DOI":"10.3389\/fpubh.2023.1216810","article-title":"The relationships between burnout, general wellbeing, and psychological detachment with turnover intention in Chinese nurses: a cross-sectional study","volume":"11","author":"Zhang","year":"2023","journal-title":"Front. Public Health"},{"key":"ref49","first-page":"776","article-title":"The chain-mediating role of psychological resilience and insomnia between occupational burnout and depression among psychiatric nurses","volume":"47","author":"Zhao","year":"2025","journal-title":"Guangxi Med. J."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1860688\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:45:40Z","timestamp":1790574340000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1860688\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":49,"alternative-id":["10.3389\/fpsyg.2026.1860688"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1860688","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"article-number":"1860688"}}