The mediating effects of attitudes toward people with dementia on the relationship between caregiving burden and sense of competence among dementia care staff in Southern Chinese nursing homes: A cross-sectional study

Background With the aging population, the number of individuals with dementia is increasing rapidly, placing a significant burden on long-term care systems. In nursing homes, professional dementia caregivers play a crucial role, and their psychological well-being directly impacts the quality of care provided. This study, integrating the Self-Efficacy Theory, the Conservation of Resources Theory and the Transactional Model of Stress and Coping, aimed to investigate the structural relationships between caregiving burden, attitudes towards dementia, and the caregiving sense of competence among dementia care staff in Chinese nursing homes. Methods In this cross-sectional study, a total of 355 individuals were recruited between March and June 2025, from six elderly care institutions in Shanghai, China. We collected data using a structured questionnaire that assessed professional caregivers' general information, sense of competence, burden, and attitudes toward people with dementia. Pearson’s correlations were used to explore the relationships between caregiver burden, attitudes towards dementia, and the caregiving sense of competence among dementia care staff. The path relationships were analyzed by constructing a structural equation model using AMOS software. Results Our results showed that caregiving burden was negatively associated with the sense of ability.. However, there was a significant positive correlation between the sense of ability and attitudes toward people with dementia. Furthermore, caregiving burden had a direct effect on caregiving sense of competence (-0.187); and on attitudes toward people with dementia (-0.407); Attitudes toward people with dementia had a direct effect on caregiving sense of competence (0.338). In other words, attitudes toward people with dementia mediated the relationship between caregiving burden and caregiving sense of competence among nursing staffs caring dementia (-0.138), and this indirect effect accounted for approximately 42.5% of the total effect. Conclusions To enhance the professional competence of dementia care staff in nursing homes, nursing managers should develop targeted strategies aimed at alleviating caregiving burden and fostering positive attitudes toward dementia care.