The impact of clinical nurses' perception of hospital ethical climates on their organizational citizenship behavior: A cross-sectional questionnaire survey.

BACKGROUND: As the main force in the development of healthcare, nurses have the longest contact time with patients in clinical practice, their perception of the hospital ethical climates affecting nurses' attitudes and related ethical issues. hospital ethical climates have become an essential environmental factor for nurses to make and implement ethical decisions.
OBJECTIVE: This study aims to investigate the current status of nurses' perception of the hospital ethical climates and the nurses' organizational citizenship behavior, exploring the impact of the nurse's perception of the hospital ethical climates on the nurses' organizational citizenship behavior.
METHODS: A cross-sectional survey adopted, random sampling and cluster sampling were used to select 624 nurses from August 2019 to February 2020. The hospital ethical climate scale and organizational citizenship behavior scale were used as the questionnaire. The data was analyzed by SPSS 21.0 software. On-the-job clinical nurses who had been employed in the hospital for more than 1 year were eligible. Nurses who were administratively punished by the hospital or health administrative authorities were excluded.
RESULTS: The average scores of hospital ethical climates were 4.30 (standard deviation: 0.44), with organizational citizenship behavior 4.42 (standard deviation: 0.42). The correlation coefficient between nurses' perception of hospital ethical climates and organizational citizenship behavior was 0.359 (P < .01). Nurses' perception of the relationship between managers, patients and nurses could explain 23.1% of altruistic toward colleagues; Nurses' perception of the relationship between nurses, hospital, doctors could explain 21.2% of organizational identification. Nurses' perception of the relationship between hospital, nurses and doctors could explain 12.3% of conscientiousness; Nurses' perception of the relationship between managers, doctors could explain 7.6% of interpersonal harmony. Nurses' perception of the relationship between managers, nurses and doctors could explain 6.6% of protection company resources.
CONCLUSION: There is a correlation between nurses' perceptions of hospital ethical climate and organizational citizenship behavior, nurses' perceptions of hospital ethical climate influencing nurses' organizational citizenship behavior in different ways. Managers should focus on the changes of nurses' perception of hospital ethical climates, to promote the nurse to make more beneficial behavior to the organization.

Introduction

Nurses, the key sector of all the medical systems, are important for the health and wealth of all countries. With the advancement of medical technology and medicine therapy, the shortage of medical resources, as well as uncertain and complex clinical problems in medical treatment system, have led to the escalation of the ethical problems faced by nurses.[ As the mainstay of health care development, nurses have the longest contact with patients in clinical practice. They have the most frequent ethical issues with patients, as well as their surrounding colleagues, due to issues such as treatment and clinical diagnosis. For example, because the staffing of nurses is inconsistent with the needs of patients, the nurses, who should provide comprehensive services for patients, can only complete the treatment tasks prescribed by the doctor every day, thus generating ethical problems.[ At the same time, nurses are in the special position of needing to be accountable to both physicians and patients, but sometimes ethical issues arise when patients find that informed consent is not given and nurses are forced by internal and external constraints to respond to the needs of patients to the appropriate authorities.[ Organizational citizenship behavior is a social and psychological activity, which is conducive to maintaining and improving task performance.[ Lower job satisfaction and reduced organizational commitment caused by poor ethical issues are critical factors that could influence the organizational citizenship behavior of nurses.[ As the important content of organizational behavior research, organizational citizenship behavior plays a significant role in improving employee loyalty, reducing separation rate, and stabilizing the nursing team.[

According to a number of researches, the nurses’ perception of the ethical climates in hospital could affect their attitude and approach to ethical issues.[ Hospital ethical climates have been a key environmental factor for nurses to make ethical decision.[ Huang et al found that improved nurses’ perception of the hospital ethical climates could enhance their organizational citizenship behavior.[ At the same time, the nurses’ perception of the hospital ethical climates has a critical role in promoting job satisfaction and organizational commitment of nurses.[ Moreover, these indicators will have a certain impact on their organizational citizenship behavior.[ However, under the Chinese medical background, the relationship between the nurses’ perception of the ethical climates and their organizational citizenship behavior has not been verified by scientific research.[ Therefore, this study aims to investigate the current status of Chinese nurses’ ethical climates and organizational citizenship behavior, exploring the impact of nurses’ ethical climates on the organizational citizenship behavior, to provide a reference to stimulate the organizational citizenship behavior of nurses, decrease the separation rate, and stable nursing team.

Materials and methods

Sample

This cross-sectional study was from August 2019 to February 2020. Inclusion criteria: On-the-job clinical nurses who had been employed in the hospital for more than 1 year, with informed consent obtained. Exclusion criteria: Nurses who were administratively punished by the hospital or health administrative authorities for various reasons, such as being notified of criticism, demerit, or retention.

The sample size was calculated based on the formula n = Z2 × (P × [1-P])/E2, where n was the sample size, Z was the confidence interval, P was the probability value, and E was the error value. The confidence level for this study was 95% (Z = 1.96, E = 4%), with P value being .5 (taking its maximum sample variation to be 0.5), so the sample size was determined to be 600. Considering the respondents’ noncooperation and invalid questionnaires, the number of respondents was increased by 10% to a total of 660. First, a method of randomized sampling was used to select 4 third-class complex hospitals from 14 third-class complex hospitals in Zhengzhou city. Based on the department, at least 624 nurses were randomly selected from the department of medicine, surgery, gynecology, pediatrics and Intensive Care Unit in the included hospital using the cluster sampling method. We obtained a list of eligible nurses allowed for a simple random sample to maximize the representativeness of the sample. Specifically, Excel software was used to generate a random number for each eligible nurse. The nurses were then sorted according to their random numbers. The nurse with the smallest random number was included in the sample first, and so on. These nurses were required to finish the questionnaires. For the quality of the questionnaire, the premise of sampling was to ensure that all nurses in the department have informed consent.

The General Information Questionnaire: According to the aim of this study, the general information questionnaire has 8 items including age, gender, department, duration of work, status of marriage, degree of education, income, and the title of a technical post.

The Hospital Ethical Climate Survey Scale: This scale modified by Wang Lu includes 25 items and 5 dimensionalities, using the Likert 5 grades scoring method. The scores of each item are added up to the total score (1 = ’completely not,’ 5 = ’completely yes’), the higher the score meaning the better the hospital ethical climates of nurses. The Cronbach's α coefficient of the whole scale is 0.915. Cronbach's α coefficients of nurses, patients, managers, hospitals, and doctors are 0.70, 0.62, 0.84, 0.83, and 0.83, respectively, indicating that the Chinese Hospital Ethical Climate Survey Scale has good reliability and validity.

The Organizational Citizenship Behavior Scale: This scale, made by Fan JL and his team, has 20 items and 5 dimensionalities including organizational identity (4 items), sense of responsibility (5 items), altruism (4 items), interpersonal harmony (4 items) and protection of organizational resources (3 items). Using Likert's 5 grades scoring method, from “never” to “often” and “always,” 1 to 5 grades were assigned, the higher the score meaning the better the organizational citizenship behavior of nurses. However, the resource entry of the interpersonal harmony protection department is reverse scoring, with the corresponding value from 5 to 1. Cronbach's α coefficient of this scale is 0.81, suggesting good reliability and validity.

Data collection

After contacting the nursing departments of each hospital in advance and obtaining their informed consent, the data collection could be initial. After entering the scene, the investigators explained the purposes and significance of the investigation to the object, and promised to protect their privacy and ensure the confidentiality of the investigation. Once obtaining informed consent, the investigation could be started. The scale was independently completed by the respondents to ensure the authenticity of the data.

Statistic analysis

The data was inputted by the Epidata software, formed an Excel file. The data was analyzed by SPSS 21.0 software. Mean and standard deviation (SD) were used to describe the general data. Nurses’ perception of the hospital ethical climates and organizational citizenship behavior score were described by mean and SD. Pearson correlation was used to analyze the correlation between hospital ethical climates and organizational citizenship behavior. Multiple linear regression was used to analyze the impact of nurses’ perception of hospital ethics on their organizational citizenship behavior. P < .05 means that the difference is statistically significant.

Results

A total of 700 questionnaires were sent, finally 624 valid questionnaires recovered with an effective recovery rate of 89.1%. The particular situation of the survey nurses is shown in Table 1. Among them, a total of 621 nurses were female (99.5%), most of whom were under 35 years-old (91.2%), with most of education attainment being junior college or bachelor degree (98.1%). Besides, all of them had worked for more than 1 year in departments of Medicine, Surgery, Gynecology or Pediatrics, mainly as nurse or nurse practitioner (89.1%).

Table 1

General demographic information of objects (n = 624).

	Item	Amount	Rate (%)
Gender	Male	3	.5
	Female	621	99.5
Age(yr)	<26	196	31.4
	26∼	200	32.1
	30∼	173	27.7
	35∼	31	5.0
	≥40	24	3.8
Education degree	Secondary specialized student	8	1.3
	Junior college student	184	29.5
	Bachelor	428	68.6
	Postgraduate and above	4	0.6
Statue of marriage	Spinsterhood	278	44.6
	Married	346	55.4
The title of a technical post	Nurse	251	40.2
	Nurse practitioner	305	48.9
	Supervisor nurse	61	9.8
	co-chief Superintendent nurse	7	1.1
Salary/month(yuan)	<2000	79	12.7
	2000∼	72	11.5
	3000∼	137	22.0
	≥4000	336	53.8
Departments	Medicine	151	24.2
	Surgery	261	41.8
	Gynecology	99	15.9
	Pediatric	74	11.9
	ICU	39	6.3
Duration of work (yr)	1∼	313	50.1
	5∼	177	28.4
	10∼	134	21.5

ICU = intensive care unit.

Nurses’ perception level of hospital ethical climates

Among the scores of hospital ethical climate in various dimensions scale from 624 nurses, the nurses’ perception of the relationship with the doctor was the lowest (3.98 ± 0.57), while relationship with the manager was the highest (4.53 ± 0.46), with a total score 4.30 (SD: 0.44) (Table 2).

Table 2

Score of ethical atmosphere in hospital (n = 624).

Items	Scores (Mean ± SD)
Relationship with nurses	4.51 ± 0.47
Relationship with patients	4.35 ± 0.48
Relationship with doctors	3.98 ± 0.57
Relationship with mangers	4.53 ± 0.46
Relationship with hospital	4.17 ± 0.58
Hospital ethical climates	4.50 ± 0.44

SD = Standard Deviation.

Nurses’ organizational citizenship behavior level

Among the scores of nurses’ organizational citizenship behaviors scale, the scores of organizational identification dimension were the lowest (4.18 ± 0.65). In comparison, the protection department resources had the highest score (4.60 ± 0.86), with a total average score 4.42(SD: 0.42) (Table 3).

Table 3

Organizational citizenship behavior score of nurses (n = 624).

Dimension	Scores (Mean ± SD)
Altruistic behavior	4.54 ± 0.51
Organizational commitment	4.18 ± 0.65
Responsibility	4.29 ± 0.56
Interpersonal concordance	4.57 ± 0.86
Protection of department resources	4.60 ± 0.86
Organizational citizenship behavior (total scores mean)	4.42 ± 0.42

SD = standard deviation.

Correlation analysis of nurses’ perception of hospital ethical climates and organizational citizenship behavior

Using demographic indicators such as age and gender as control variables, the partial correlation coefficients of hospital ethical climates and its dimensions with organizational citizenship behavior and its dimensions were obtained. The correlation coefficient of hospital ethical climates and organizational citizenship behavior was 0.364 (P < .05), the correlation coefficient of each dimension being from 0.100 to 0.447 (P < .05) (Table 4).

Table 4

Correlation analysis of nurses’ perception of hospital ethical atmosphere and organizational citizenship behavior (r).

Variables	Altruistic behavior	Organizational commitment	Responsibility	Interpersonal concordance	Protection of department resources	Organizational citizenship behavior
Relationshi-p with nurses	0.433∗∗	0.362∗∗	0.303∗∗	0.100∗∗	0.078	0.380∗∗
Relationshi-p with patients	0.434∗∗	0.382∗∗	0.309∗∗	0.012	0.000	0.329∗∗
Relationshi-p with doctors	0.320∗∗	0.389∗∗	0.301∗∗	−0.139∗∗	-0.150∗∗	0.195∗∗
Relationshi-p with mangers	0.441∗∗	0.344∗∗	0.284∗∗	0.124∗∗	0.065	0.376∗∗
Relationshi-p with hospital	0.357∗∗	0.447∗∗	0.324∗∗	−0.032	−0.065	0.298∗∗
Hospital ethical climates	0.460∗∗	0.461∗∗	0.360∗∗	0.004	−0.030	0.364∗∗

Note:∗∗, represents P < .01.

Multiple linear regression analysis of factors influencing nurses’ organizational citizenship behavior

The predictive effect of nurses’ perception of hospital ethical atmosphere on nurses’ altruistic behavior

Using hospital ethical climates as independent variables, the regression of altruistic behavior showed that nurses’ perception of their relationship with managers, patients and nurses accounted for 23.1% of the variation in altruistic behavior (Table 5).

Table 5

Regression analysis of altruistic behavior in various dimensions of hospital ethical atmosphere.

Items	Partial regression coefficient	Standard error	Standard partial regression coefficient	T value	P value
(Constant)	1.873	0.194		9.643
Relationship with managers	0.201	0.06	0.183	3.356	.001
Relationship with patients	0.207	0.051	0.194	4.054
Relationship with nurses	0.189	0.059	0.173	3.224	.001

F = 63.388, P < .001, R2 = 0.231.

The predictive effect of nurses’ perception of hospital ethical climate on organizational commitment

Regression analysis of organizational identity was conducted using the dimensions of hospital ethical atmosphere as independent variables. The results showed that nurses’ perception of their relationship with nurses, hospitals and doctors accounted for 21.2% of the variation in organizational commitment (Table 6).

Table 6

Regression analysis of various dimensions of hospital ethical atmosphere on organizational commitment.

Items	Partial regression coefficient	Standard error	Standard partial regression coefficient	T value	P value
(Constant)	1.594	0.229		6.964
Relationship with hospital	0.308	0.064	0.276	4.801
Relationship with doctors	0.144	0.059	0.128	2.469	.014
Relationship with nurses	0.162	0.066	0.117	2.466	.014

F = 56.829, P < .001, R2 = 0.212.

The predictive effect of nurses’ perception of hospital ethical climate on responsibility

Regression analysis of responsibility with the dimensions of hospital ethical atmosphere as independent variables showed that nurses’ perception of the relationship with hospitals, nurses and doctors could explain 12.3% of the variation of responsibility (Table 7).

Table 7

Regression analysis of various dimensions of hospital ethical atmosphere on responsibility.

Items	Partial regression coefficient	Standard error	Standard partial regression coefficient	T value	P value
(Constant)	2.456	0.208		11.818
Relationship with hospital	0.12	0.058	0.125	2.054	.04
Relationship with nurses	0.183	0.06	0.153	3.068	.002
Relationship with doctors	0.129	0.053	0.133	2.428	.015

F = 30.152, P < .001, R2 = 0.123.

The predictive effect of nurses’ perception of hospital ethical climate on interpersonal concordance

Regression analysis of interpersonal harmony with the dimensions of hospital ethical atmosphere as independent variables showed that nurses’ perception of their relationship with managers and doctors could account for 7.6% of the variation of interpersonal concordance (Table 8).

Table 8

Regression analysis of various dimensions of hospital ethical atmosphere on interpersonal concordance.

Items	Partial regression coefficient	Standard error	Standard partial regression coefficient	T value	P value
(Constant)	3.965	0.332		11.932
Relationship with doctors	−0.444	0.068	−0.297	−6.545
Relationship with managers	0.525	0.084	0.283	6.24

F = 26.794, P < .001, R2 = 0.076.

The predictive effect of nurses’ perception of hospital ethical climate on protection of department resource

Taking each dimension of hospital ethical atmosphere as independent variables, regression analysis was performed on the resources of conservation department. In the separate study of the relationship between hospital ethical atmosphere and organizational citizenship behavior, the relationship between nurses and nurses, nurses and managers was not related to the protection of department resources. Nevertheless, due to the influence of other dimensions in the regression, the association between them became statistically significant and then entered the regression results. Nurses’ perception of relationships with managers, nurses, and physicians accounted for 6.6% of the variation in conservation department resources (Table 9).

Table 9

Regression analysis of various dimensions of hospital ethical atmosphere on protection of department resource.

Items	Partial regression coefficient	Standard error	Standard partial regression coefficient	T value	P value
(Constant)	4.144	0.351		11.816
Relationship with doctors	−0.462	0.071	−0.31	−6.547
Relationship with nurses	0.272	0.108	0.148	2.523	.012
Relationship with managers	0.235	0.108	0.127	2.188	.029

F = 15.649, P < .001, R2 = 0.066.

Discussion

This study explored the relationship between nurses’ perception of the hospital ethical climates and organizational citizenship behavior of nurses. The results showed that the nurse's perception of the hospital ethical climates was above the medium level. The highest score among all the dimensions was the relationship with the manager and the lowest was the relationship with the doctors, which was basically consistent with the research results of Hwang et al [ and Suhonen et al[ The highest score in relationship with managers indicates that the nurses in this study could fully trust and respect their leaders in their work, and they could get support and help from leaders in their work. Inversely, the lowest score in the relationship with doctors might be due to the long-term dominance-subordinate relationship and seniority ranking system affecting the medical care cooperation relationship. This prompts managers to use all resources, information, equipment, etc to establish better medical care cooperation, as well as use of “interdisciplinary simulation training” and other training methods to improve communication and cooperation between medical and nursing. However, the total score in our study is significantly higher than the findings of Chen et al,[ which may be related to the location of the city and the degree of education. In this study, the nurses were in provincial capitals, with the degree of education mainly undergraduate and above level, while the nurses in the study of Chen et al[ were in prefecture-level cities, with the degree of education mainly junior college or below level. Researches showed that the addition of interdisciplinary courses could strengthen the role of medical workers for each other, shorten the gap between medical workers and promote mutual respect between medical workers.[ Therefore, nurses with high education could feel better hospital ethical climates.

The total score of nurses’ organizational citizenship behavior was above the middle level, which was consistent with the research by Ji et al.[ However, in this study, the sense of responsibility score was higher than the latter, which resulted from the differences in the salary and the degree of education of the surveyed objects. The higher the education, salary and benefits, the nurses were more inclined to give back to the organization, shown more sense of ownership, as well as the higher the sense of responsibility. The lowest organizational identification score was consistent with the research results of Liu et al.[ This kind of situation may due to the hospital condition, types of the leaders, and the traditional social cognition and prejudice, which make the nurses obtain low social recognition and unwilling to take more actions actively to maintain the hospital operation. The higher personal sense of identity with the organization, the more they will hold a view that is beneficial to the organization and take actions that are beneficial to the organizations. This prompts the managers to give targeted measures based on the survey results to improve the organizational citizenship behavior of the nurses, such as giving nurses with low academic qualifications more opportunities to learn, encouraging them to upgrade their degree of education, improving salaries and benefits, as well as strengthening organizational culture construction to improve nurses’ emotional attachment and organizational recognition to the hospital.

This study showed that nurses’ perception of ethical climates was positively correlated with altruistic behavior, sense of responsibility, and organizational identity. Further regression analysis found that nurses’ perception of the relationship between managers, patients, and nurses were facilitating factors for nurses’ altruistic behavior. When nurses get more support and respect from their peers and leaders in clinical practice, and a higher degree of acceptance and understanding of the nursing knowledge from their patients, nurses could more actively help colleagues and establish a more harmonious mutual assistance relationship with them. The better relationship with hospitals, doctors, and nurses the nurses realize, the higher the organizational identification of nurses will occur, which means that the nurse's perception of the relationship between hospitals, doctors, and nurses is an important promoter of organizational identification of nurses. This prompts managers to establish a good relationship between nurses and nurses, as well as with doctors and hospitals could enhance nurses’ sense of organizational identity. For example, hospital policy formulation can help nurses solve difficult nursing problems as much as possible. Moreover, the hospital concept has a cohesive effect, enhancing the sense of ownership of employees through influence and education,[ which can take the initiative to maintain the hospital reputation and propose behaviors that are conducive to the development of the hospital. The nurses’ perception of the relationship between doctors and nurses has a positive predictive effect on nurses’ sense of responsibility (P < .05), which can explain 12.3% of nurses’ responsibility. Responsibility is the subjective consciousness of the subject about responsibility, the subjective reflection of responsibility in the human mind, and the mental state of consciously subjectively doing all beneficial things inside and outside. When nurses have a high sense of responsibility, they will consciously abide by the rules and regulations of the hospital, with error rate at work reduced, striving to improve their professional standards.[ Therefore, managers can enhance nurses’ sense of responsibility by enhancing the relationship between nurses and nurses, hospitals and doctors. From the overall analysis, the nurse's perception of the hospital ethical climates was hardly related to the nurse's interpersonal harmony and the protection of department resources. The regression analysis found that nurses’ perception of the relationship with managers is positively related to interpersonal harmony. However, nurses’ perception of the relationship with doctors is negatively related to interpersonal harmony. This prompts managers to provide nurses with more support and establish a trust relationship with nurses, so that nurses can truly feel that they are part of the department. Nurses would put the interests of hospitals and others above their personal interests, the interpersonal harmony becoming better. When the relationship between doctors and nurses is better, the nurses will be in a more relaxed environment. This prompts managers to strengthen the supervision of nurses’ behavior while strengthening the medical and nursing relationship. The better the relationship between nurses, managers and nurses, the more nurses will show the behavior of positively protecting department resources. However, the nurse's perception of the relationship with doctors has a reverse prediction effect on the protection of department resources. The better the relationship between nurses and managers and nurses is, the more work and emotional support they will get from other nurses and managers, which will enable nurses to invest more passion into their work and make more contribute and generate active actions to protect department resources. This prompts managers to give targeted measures based on the survey results and establish a benign and interactive working relationship. The better the relationship between nurses and doctors is, the lower the nurse's behavior of protecting department resources will occur, which may be due to a large population, a large number of patients, and close medical and nursing relations in China. This prompts managers to strengthen the supervision of nurses’ behaviors while strengthening medical and nursing relationships.

There is an influence of hospital ethical climate on the organizational citizenship behavior of nurses. On the other hand, the demographic characteristics of nurses also have a certain influence on hospital ethical climates. Goldman et al[ surveyed 95 nurses in Israel and found a trend of difference in the influence of male and female nurses on both self-interested and caring ethical climates, which may be related to male nurses preferring both hospital ethical climate. The education level of nurses is potentially influential on the ethical climate of the hospital.[ Registered nurses prefer a caring line and rule-based hospital ethical climate more than nurses with a bachelor's degree.[ The longer nurses work, the more they prefer a self-interested and rule-based ethical climate than nurses who have worked for a short period of time.[ Bahcecik et al reported that age and department could influence the ethical climate in hospitals, with nurses aged 18 to 22 years perceiving a more positive hospital ethical climate than nurses aged 23 years and older, and pediatric nurses perceiving a more positive hospital ethical climate than nurses in other units.[

Inevitably, some limitations existed in this study. First, the low Cronbach's alpha of individual dimensions for the hospital ethical climates reliability measure, with 3 entries entering 2 dimensions at the same time, might be due to the small sample size causing bias. Second, this study only investigated the effect of nurses’ perceptions of hospital ethical climate on nurses’ organizational citizenship behaviors, whereas other studies have shown that nurses’ perceptions of hospital ethical climate can influence more other indicators.[

Therefore, the following findings can be drawn: nurses’ perceptions of the ethical climate of the hospital and nurses’ organizational citizenship behaviors are generally moderately high; nurses’ perceptions of relationships with managers, patients, and nurses are positive predictors of altruistic behaviors; nurses’ perceptions of relationships with hospitals, doctors, and nurses are positive predictors of nurses’ organizational identity and responsibility; nurses’ perceptions of relationships with managers relationship have a positive predictive effect on nurses’ interpersonal harmony; nurses’ perception of relationship with managers and nurses have a positive predictive effect on the protection of departmental resources; and nurses’ perception of relationship with physicians had a negative predictive effect on interpersonal harmony and protection of departmental resources.

In conclusion, nurses’ perceptions of hospital ethical climate is related to organizational citizenship behavior, affecting nurses’ organizational citizenship behavior in different ways. The findings of our study are of great clinical significance. Managers should take corresponding nursing measures to build a good relationship between nurses and nurses, patients, hospital, doctors and managers to promote the nurse to make more beneficial behavior to the organization. Considering the limitations of this study, nurses’ perception of hospital ethical climates, as well as the impact of other variables, such as the impact on nurses’ organizational commitment, nursing errors, and nurses’ job satisfaction indicators, should be explored in the future.

Author contributions

Conceptualization: Lu Wang, Dan Li, Qunfeng Lu.

Data curation: Lu Wang, Dan Li, Wanhong Wei.

Formal analysis: Lu Wang, Ting Zhang, Wenjuan Tang.

Funding acquisition: Lu Wang, Qunfeng Lu.

Investigation: Lu Wang, Dan Li, Wanhong Wei, Ting Zhang, Wenjuan Tang.

Methodology: Lu Wang, Dan Li.

Project administration: Lu Wang, Dan Li, Wanhong Wei, Qunfeng Lu.

Resources: Lu Wang.

Software: Lu Wang, Dan Li, Wanhong Wei, Ting Zhang, Wenjuan Tang.

Supervision: Lu Wang, Dan Li, Qunfeng Lu.

Validation: Lu Wang, Wanhong Wei, Ting Zhang.

Visualization: Lu Wang.

Writing – original draft: Lu Wang, Dan Li, Wanhong Wei, Ting Zhang.

Writing – review & editing: Lu Wang, Wanhong Wei, Wenjuan Tang, Qunfeng Lu.