Online Positive Feedback Linked to Positive Coping Styles in Emergency Nurses

Emergency nurses in China who receive more positive feedback on social media tend to report more adaptive ways of coping with stress, according to a large cross-sectional survey that mapped the pathways linking digital habits to coping styles. The study, conducted across 12 hospitals in five provinces, found that both the intensity of social media use and proactive engagement—actively posting, sharing and interacting—were associated with more frequent online positive feedback, which in turn was associated with positive coping styles such as problem solving and seeking social support. The findings, published as a path analysis grounded in self-determination theory, suggest that online social experiences may relate to coping in a high-stress occupational group that has received comparatively little attention in social media research.

The emergency department is widely regarded as one of the most demanding environments in healthcare. Nurses there manage the largest volumes of critically ill patients and the most complex emergency conditions, working under sustained pressure that can erode both physical and mental health. Harsh publicity, overcrowding and inadequate staffing are common stressors, and prolonged exposure to such conditions can push nurses toward ineffective coping, including avoidance and emotional numbness. During the COVID-19 outbreak, when the emergency department became a major frontline setting for epidemic prevention and control, 66 of 263 frontline nurses—25.1 percent—reported a negative coping style, underscoring the scale of the challenge.

Positive coping styles, by contrast, comprise effective and healthy strategies for solving problems, alleviating stress and adapting to difficult circumstances. They are associated with psychological well-being, resilience and quality of life. Identifying factors that support them is therefore a priority for nursing research, yet most studies of social media and mental health have focused on the general population or on students rather than on high-stress professionals. The new study set out to examine the pathways through which social media use and online positive feedback are associated with positive coping among emergency nurses, by testing a structural equation model in which social media use intensity and proactive use predict online positive feedback, and online positive feedback in turn predicts positive coping.

The theoretical framework came from self-determination theory, which holds that motivation, behaviour and well-being depend on the satisfaction of three basic psychological needs: autonomy, competence and relatedness. The researchers reasoned that proactive social media engagement, such as sharing experiences and initiating interactions, may support autonomy by letting nurses choose how and when they communicate. Positive online feedback—the positive attention and acceptance individuals receive in response to their social-network activities, taking the form of timely, affirming comments—may affirm nurses’ efforts and capabilities, supporting competence, while also signalling acceptance and belonging, strengthening relatedness. Satisfaction of these needs may then support positive coping when stress strikes.

To test these ideas, the team recruited emergency nurses through convenience sampling between September and December 2023, distributing an online questionnaire via hospital nursing managers and professional WeChat and Tencent QQ groups. Eligible participants held a nursing licence, were directly involved in patient diagnosis, treatment and nursing care, and used social media; nurses on extended leave of more than three months and interns were excluded. The sample size was planned using a standard structural equation modelling rule of roughly 10 participants per observed variable, yielding a minimum of 470 for the 47-item questionnaire, later raised to 564 to allow for 20 percent incomplete or invalid responses. A supplementary power analysis using G*Power 3.1 set a much lower floor of 77 participants. In the end, 856 questionnaires were collected and 850 were deemed valid after six were excluded for failing predefined data-quality criteria such as response times under 200 seconds, a validity rate of 99.3 percent.

The questionnaire combined a demographic section with four validated instruments: the Social Media Use Intensity Scale, originally developed by Ellison and colleagues and adapted into Chinese, which covers the number of social media contacts, average daily time online and the extent to which individuals like and rely on social media; the Proactive Social Media Use Scale, measuring how often nurses actively share photos, post updates and interact with friends on a seven-point frequency scale; the Online Positive Feedback Scale, capturing the frequency of likes, comments, shares and supportive responses to personal content; and the Simplified Coping Style Questionnaire, a 20-item measure with positive and negative coping dimensions rated on a four-point scale. Internal consistency was strong throughout, with Cronbach’s alpha values of 0.915, 0.893, 0.964 and 0.933 for the positive coping subscale respectively.

The 850 analysed nurses were predominantly female (82.7 percent) and married (58.5 percent), with a mean age of 31.20 years and mean work experience of 9.46 years. They spent an average of 2.92 hours per day on social media, and most (60.9 percent) had between 100 and 300 contacts on the platforms they used most frequently. Perhaps the most striking descriptive result concerned coping tendencies: after standardizing the positive and negative coping scores and subtracting one from the other, 393 nurses (46.2 percent) showed a positive coping tendency, characterized by problem solving, seeking social support and emotional adjustment, while 457 nurses (53.8 percent) showed a negative coping tendency, marked by avoidance, denial or self-blame. In other words, a slight majority of these emergency nurses leaned toward less adaptive coping.

The correlational and path-analytic results told a consistent story. Online positive feedback correlated positively with social media use intensity (r = 0.484, 95% CI 0.431–0.534), proactive use (r = 0.647, 95% CI 0.606–0.684) and positive coping style (r = 0.186, 95% CI 0.120–0.250), all statistically significant. In the structural model, which achieved good fit indices (chi-square/df = 4.538, GFI = 0.937, CFI = 0.972, TLI = 0.965, RMSEA = 0.065), social media use intensity was positively associated with online positive feedback (β = 0.264, 95% CI 0.183–0.343) and proactive use even more strongly (β = 0.473, 95% CI 0.403–0.543). Bootstrapping with 2000 resamples confirmed a significant indirect effect of use intensity on feedback through proactive engagement (β = 0.238, 95% CI 0.190–0.285), and online positive feedback was positively associated with positive coping styles (β = 0.188, 95% CI 0.120–0.256). All three hypotheses were supported.

The authors caution that the design imposes real limits. Convenience sampling may have introduced selection bias, and the findings from Chinese emergency nurses may not generalize to other cultural contexts. All variables were self-reported by the same respondents, leaving room for social desirability and recall bias; Harman’s single-factor test suggested no substantial common method bias, with the first factor explaining 32.75 percent of variance, below the conventional 40 percent threshold, but residual bias cannot be excluded. Most importantly, the cross-sectional design cannot establish causality or temporal precedence—whether positive feedback fosters positive coping, or whether nurses who cope more positively simply engage more positively online, remains an open question for longitudinal and multi-source studies. The researchers also note that five correlated residuals were added sequentially to improve model fit, a data-driven modification that involved correlations between residuals rather than new directional structural pathways.

Even with those caveats, the study carries practical implications. Online peer support platforms have been recognized as promising tools for supporting mental health and facilitating peer communication, and the authors suggest that healthcare organizations could consider cultivating supportive online environments where emergency nurses share clinical experiences, exchange insights, participate in learning and engage constructively with colleagues. Nursing managers, they propose, could consider incorporating constructive online positive feedback into routine team communication to foster a supportive and encouraging working environment. Such measures are framed as potential components of broader strategies to support coping and well-being—not as standalone solutions—for a workforce in which, by this study’s own count, more than half of emergency nurses leaned on negative coping tendencies to get through the demands of the emergency department.

Subject of Research: Associations between social media use, online positive feedback and coping styles among emergency nurses in China

Article Title: Path Analysis of the Role of Social Media Use and Online Positive Feedback on Positive Coping Styles in Emergency Nurses

Article References: Jiang, Q., Wang, R., He, Y., Wen, N., Peng, J., Zhang, J., & Feng, L. (2026). Path Analysis of the Role of Social Media Use and Online Positive Feedback on Positive Coping Styles in Emergency Nurses. Nursing Open, 13(10), Article e70977. https://doi.org/10.1002/nop2.70977

Image Credits: AI Generated

DOI: 10.1002/nop2.70977

Keywords: emergency nursing, social media, online positive feedback, coping styles, self-determination theory, structural equation modelling, cross-sectional study, occupational stress, China, nursing management, peer support, Path