Chain-mediating effects of psychological capital and pain management self-efficacy on the relationship between perceived organizational support and cancer pain management competency among oncology nurses: A cross-sectional study

Abstract

Background

Cancer pain management competency among oncology nurses remains suboptimal, although it is essential for improving patient outcomes and quality of care. Existing evidence has primarily focused on individual-level determinants, such as knowledge, clinical experience, and training, whereas less is known about how organizational resources influence this competency. In particular, the psychological mechanisms through which perceived organizational support affects cancer pain management competency remain insufficiently understood.

Aim

This study aimed to examine the association between perceived organizational support and oncology nurses' cancer pain management competency and to test the chain-mediating roles of psychological capital and pain management self-efficacy.

Methods

A multicenter cross-sectional survey was conducted among oncology nurses from 48 hospitals in Anhui Province, China, between July and September 2025. Eligible participants were registered nurses with at least one year of oncology nursing experience who provided informed consent. Nurses on leave or visiting nurses were excluded. Data were collected through an online survey comprising measures of demographic and professional characteristics, perceived organizational support, psychological capital, pain management self-efficacy, and cancer pain management competency. Spearman correlation analysis, group comparisons, and structural equation modeling were performed. Bias-corrected bootstrapping with 5000 resamples was used to test mediation effects.

Results

A total of 391 oncology nurses were included. Most participants were female (98.47%), held a bachelor's degree (91.05%), and worked in tertiary hospitals (86.70%). Perceived organizational support, psychological capital, pain management self-efficacy, and cancer pain management competency were significantly and positively correlated with each other (all P < 0.01). Structural equation modeling showed that perceived organizational support did not directly predict cancer pain management competency (β = 0.027; Boot SE = 0.050; 95% CI [−0.068, 0.127]). However, the total indirect effect was significant (β = 0.399; Boot SE = 0.046; 95% CI [0.313, 0.492]), accounting for 93.7% of the total effect. Two significant indirect pathways were identified: mediation through psychological capital alone (β = 0.149; Boot SE = 0.042; 95% CI [0.072, 0.239]) and chain mediation through psychological capital and pain management self-efficacy (β = 0.188; Boot SE = 0.030; 95% CI [0.137, 0.256]). The indirect pathway through pain management self-efficacy alone was not statistically significant (β = 0.062; Boot SE = 0.035; 95% CI [−0.005, 0.135]).

Conclusions

Perceived organizational support was associated with oncology nurses' cancer pain management competency primarily through indirect psychological pathways, particularly the chain-mediating pathway involving psychological capital and pain management self-efficacy. Nursing managers, educators, and clinical leaders should combine supportive organizational environments with strategies that strengthen psychological capital and task-specific self-efficacy to improve cancer pain management competency and the quality of nursing care.