The Effect of Stigmatization on Working Nurses’ Willingness to Care for Patients with Psoriasis and Its Mediating Factors
DOI:
https://doi.org/10.2340/actadv.v105.43662Keywords:
psoriasis, Care, social stigma, Social Discrimination, Nurse EducationAbstract
Psoriasis-related stigmatization affects nurses’ willingness to provide care, potentially compromising patient outcomes. However, limited research has examined this issue. A cross-sectional survey of 1,873 nurses was conducted, which assessed 4 stigmatization dimensions and their correlation with the willingness to care for patients with psoriasis, and explored the roles of education, working environment, and self-reported psoriasis knowledge. Structural equation modelling and regression analyses were conducted. The results revealed that stigmatization negatively impacted nurses’ willingness to provide care (p < 0.001), with social distance exhibiting the strongest effect (r = –0.476, OR = 0.87, 95% CI: 0.85–0.88, p < 0.001). A significant dose–response relationship was observed, where higher stigmatization levels corresponded to lower care willingness (overall trend test: p < 0.001; nonlinear trend test: p < 0.001). Nurses with higher education levels (p < 0.001) or those working in tertiary hospitals (p < 0.001) demonstrated lower willingness to provide care. Interestingly, greater self-reported psoriasis knowledge was associated with increased stigmatization, which in turn reduced care willingness (direct effect: –0.618; 95% CI: –0.814, –0.422; proportion mediated: 29.0%, 95% CI: 0.094, 0.486). These findings underscore the need for targeted training programmes, improved work environments, and stigma-reduction initiatives to enhance nurses’ willingness to care for patients with psoriasis.
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References
Kaufman BP, Alexis AF. psoriasis in skin of color: insights into the epidemiology, clinical presentation, genetics, quality-of-life impact, and treatment of psoriasis in non-white racial/ethnic groups. Am J Clin Dermatol 2018; 19: 405–423. DOI: https://doi.org/10.1007/s40257-017-0332-7
Sewerin P, Brinks R, Schneider M, Haase I, Vordenbäumen S. Prevalence and incidence of psoriasis and psoriatic arthritis. Ann Rheum Dis 2019; 78: 286–287. DOI: https://doi.org/10.1136/annrheumdis-2018-214065
Hawro M, Maurer M, Weller K, Maleszka R, Zalewska-Janowska A, Kaszuba A, et al. Lesions on the back of hands and female gender predispose to stigmatization in patients with psoriasis. J Am Acad Dermatol 2017; 76: 648–654.e2. DOI: https://doi.org/10.1016/j.jaad.2016.10.040
Pearl RL, Wan MT, Takeshita J, Gelfand JM. Stigmatizing attitudes toward persons with psoriasis among laypersons and medical students. J Am Acad Dermatol 2019; 80: 1556–1563. DOI: https://doi.org/10.1016/j.jaad.2018.08.014
Singh S, Taylor C, Kornmehl H, Armstrong AW. Psoriasis and suicidality: a systematic review and meta-analysis. J Am Acad Dermatol 2017; 77: 425–440.e2. DOI: https://doi.org/10.1016/j.jaad.2017.05.019
Major B, O’Brien LT. The social psychology of stigma. Annu Rev Psychol 2005; 56: 393–421. DOI: https://doi.org/10.1146/annurev.psych.56.091103.070137
Aranda AM, Helms WS, Patterson KDW, Roulet TJ, Hudson BA. Standing on the shoulders of Goffman: advancing a relational research agenda on stigma. Business & Society 2023; 62: 1339–1377. DOI: https://doi.org/10.1177/00076503221148441
Armstrong A, Jarvis S, Boehncke WH, Rajagopalan M, Fernández-Peñas P, Romiti R, et al. Patient perceptions of clear/almost clear skin in moderate-to-severe plaque psoriasis: results of the Clear About Psoriasis worldwide survey. J Eur Acad Dermatol Venereol 2018; 32: 2200–2207. DOI: https://doi.org/10.1111/jdv.15065
Fino E, Mazzetti M, Russo PM. Psoriasis-related stigma and its intersection with intergroup bias in medical students. J Am Acad Dermatol 2021; 84: 1432–1434. DOI: https://doi.org/10.1016/j.jaad.2020.06.060
Zhang H, Yang Z, Tang K, Sun Q, Jin H. Stigmatization in patients with psoriasis: a mini review. Front Immunol 2021; 12: 715839. DOI: https://doi.org/10.3389/fimmu.2021.715839
Kong SZ, Niu HR, Xu XY, Wang RX, Cui SM, Xie JR, et al. The effect of stigmatization on working nurses’ willingness to care for patients with psoriasis. Mendeley Data V1; 2025, February 7, Version 1.
Snejina Vassileva M. Commentary on “Stigmatizing Attitudes toward Persons with Psoriasis among Laypersons and Medical Students”. Skinmed 2019; 17: 415.
Simona M, Christopher E, Selina M, Alexander Z, Pablo S, Maximilian S, et al. The potential of Instagram to reduce stigmatization of people with psoriasis: a randomized controlled pilot study. Acta Derm Venereol 2023; 103: adv3513. DOI: https://doi.org/10.2340/actadv.v103.3513
Weinberger N-A, Mrowietz S, Luck-Sikorski C, von Spreckelsen R, John SM, Sommer R, et al. Effectiveness of a structured short intervention against stigmatisation in chronic visible skin diseases: results of a controlled trial in future educators. Health Expect 2021; 24: 1790–1800. DOI: https://doi.org/10.1111/hex.13319
Huang Y. Towards understanding current clinical nurses’ knowledge, attitude, and willingness to care for HIV/AIDS patients among hospitals in Zhejiang province. Master’s thesis, Zhejiang University; 2016.
M PR, Joerg L, A HC. The stigmatizing effect of visual media portrayals of obese persons on public attitudes: does race or gender matter? J Health Commun 2013; 18: 805–826. DOI: https://doi.org/10.1080/10810730.2012.757393
Pan Y, Qi Q, Qiu H, Yang C, Su W, Zhang S, et al. Factors influencing the willingness of clinical nurses to participate in narrative nursing: a cross-sectional study. J Adv Nurs 2024; 81: 1924–1936. DOI: https://doi.org/10.1111/jan.16434
Perrott SB, Murray AH, Lowe J, Mathieson CM. The psychosocial impact of psoriasis: physical severity, quality of life, and stigmatization. Physiol Behav 2000; 70: 567–571. DOI: https://doi.org/10.1016/S0031-9384(00)00290-0
Vardy D, Besser A, Amir M, Gesthalter B, Biton A, Buskila D. Experiences of stigmatization play a role in mediating the impact of disease severity on quality of life in psoriasis patients. Br J Dermatol 2002; 147: 736–742. DOI: https://doi.org/10.1046/j.1365-2133.2002.04899.x
Jankowiak B, Kowalewska B, Krajewska-Kułak E, Khvorik DF. Stigmatization and quality of life in patients with psoriasis. Dermatol Ther (Heidelb) 2020; 10: 285–296. DOI: https://doi.org/10.1007/s13555-020-00363-1
Sommer R, Mrowietz U, Radtke MA, Schäfer I, von Kiedrowski R, Strömer K, et al. What is psoriasis? Perception and assessment of psoriasis among the German population. J Dtsch Dermatol Ges 2018; 16: 703–710. DOI: https://doi.org/10.1111/ddg.13539
Feldman SR, Malakouti M, Koo JY. Social impact of the burden of psoriasis: effects on patients and practice. Dermatol Online J 2014; 20: 13030/qt48r4w8h2. DOI: https://doi.org/10.5070/D3208023523
Green-Armytage M, Simonds LM, John M, Woodger N. Depictions of acne and psoriasis influence interpersonal aversion. Psychol Health Med 2019; 24: 94–100. DOI: https://doi.org/10.1080/13548506.2018.1497188
Zhou L, Lv H, Yu Y, Shao J, Wu Y, Li X, et al. An inverted U-shaped relationship between work–family conflict and job burnout among village clinic doctors: the moderating effect of information and communication technology use. BMC Psychiatry 2024; 24: 761. DOI: https://doi.org/10.1186/s12888-024-06221-0
Arndt C, Lischetzke T, Crayen C, Eid M. The assessment of emotional clarity via response times to emotion items: shedding light on the response process and its relation to emotion regulation strategies. Cogn Emot 2018; 32: 530–548. DOI: https://doi.org/10.1080/02699931.2017.1322039
Shimazu A, Schaufeli WB, Kubota K, Watanabe K, Kawakami N. Is too much work engagement detrimental? Linear or curvilinear effects on mental health and job performance. PLoS One 2018; 13: e0208684. DOI: https://doi.org/10.1371/journal.pone.0208684
Lawrence LA. Work engagement, moral distress, education level, and critical reflective practice in intensive care nurses. Nurs Forum 2011; 46: 256–268. DOI: https://doi.org/10.1111/j.1744-6198.2011.00237.x
Porfyri GN, Athanasiadou M, Siokas V, Giannoglou S, Skarpari S, Kikis M, et al. Mental health-related stigma discrimination and prejudices among Greek healthcare professionals. Front Psychiatry 2022; 13: 1027304. DOI: https://doi.org/10.3389/fpsyt.2022.1027304
Geese F, Bryant-Lukosius D, Zwakhalen S, Hahn S. Advanced practice nurses and their roles in Swiss cancer care: a cross-sectional study. Semin Oncol Nurs 2024; 40: 151626. DOI: https://doi.org/10.1016/j.soncn.2024.151626
Fajarini M, Setiawan A, Sung CM, Chen R, Liu D, Lee CK, et al. Effects of advanced practice nurses on health-care costs, quality of care, and patient well-being: a meta-analysis of randomized controlled trials. Int J Nurs Stud 2024; 162: 104953. DOI: https://doi.org/10.1016/j.ijnurstu.2024.104953
Høegh-Larsen AM, Gonzalez MT, Rierson IA, Husebø SIE, Hofoss D, Ravik M. Nursing students’ clinical judgment skills in simulation and clinical placement: a comparison of student self-assessment and evaluator assessment. BMC Nurs 2023; 22: 64. DOI: https://doi.org/10.1186/s12912-023-01220-0
Li LZ, Yang P, Singer SJ, Pfeffer J, Mathur MB, Shanafelt T. Nurse burnout and patient safety, satisfaction, and quality of care: a systematic review and meta-analysis. JAMA Netw Open 2024; 7: e2443059. DOI: https://doi.org/10.1001/jamanetworkopen.2024.43059
Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. Nurses’ burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis. J Adv Nurs 2021; 77: 3286–3302. DOI: https://doi.org/10.1111/jan.14839
Hu Z, Wang H, Xie J, Zhang J, Li H, Liu S, et al. Burnout in ICU doctors and nurses in mainland China: a national cross-sectional study. J Crit Care 2021; 62: 265–270. DOI: https://doi.org/10.1016/j.jcrc.2020.12.029
Membrive-Jiménez MJ, Velando-Soriano A, Pradas-Hernandez L, Gomez-Urquiza JL, Romero-Béjar JL, Cañadas-De la Fuente GA, et al. Prevalence, levels and related factors of burnout in nurse managers: a multi-centre cross-sectional study. J Nurs Manag 2022; 30: 954–961. DOI: https://doi.org/10.1111/jonm.13575
Bruyneel A, Bouckaert N, Maertens de Noordhout C, Detollenaere J, Kohn L, Pirson M, et al. Association of burnout and intention-to-leave the profession with work environment: a nationwide cross-sectional study among Belgian intensive care nurses after two years of pandemic. Int J Nurs Stud 2023; 137: 104385. DOI: https://doi.org/10.1016/j.ijnurstu.2022.104385
Cohen C, Pignata S, Bezak E, Tie M, Childs J. Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review. BMJ Open 2023; 13: e071203. DOI: https://doi.org/10.1136/bmjopen-2022-071203
Mantzorou M, Economou M, Kalokerinou A, Sourtzi P, Zyga S, Politis A, et al. Exploration of the relationship between stigma and burnout among Greek nurses in dementia care. J Nurs Manag 2020; 28: 615–624. DOI: https://doi.org/10.1111/jonm.12964
Gu L, Xu D, Yu M. Mediating effects of stigma on the relationship between contact and willingness to care for people with mental illness among nursing students. Nurse Educ Today 2021; 103: 104973. DOI: https://doi.org/10.1016/j.nedt.2021.104973
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Copyright (c) 2025 Shuzhen Kong, Haoru Niu, Xinyu Xu, Ruixue Wang, Simeng Cui, Jiarui Xie, Weihua Zou, Jianqiao Ye, Deling Kong, Cong Yao, Huiyun Yang, Baibing Mi, Songmei Geng
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