Impact of Covid‐19 Pandemic on Knowledge and Attitude of Nursing Students Regarding Vaccination and Vaccine Hesitancy in China: A Cross‐Sectional Study

ABSTRACT

Background and Aims

To analyze the impact of the COVID‐19 pandemic on vaccine acceptance among nursing students by assessing their knowledge, attitudes towards vaccination, and levels of vaccine hesitancy, thereby addressing the research gap in this area to inform public health strategies.

Methods

A total of 1013 nursing students (544 freshmen and 469 seniors) from Binzhou Medical University, Shandong Second Medical University, and Shandong First Medical University were enrolled during the 2024 academic year. This cross‐sectional study used a self‐reported questionnaire, and descriptive statistics were applied to illustrate trends in the data. A Chi‐square test was conducted to assess the impact of the COVID‐19 pandemic on knowledge acquisition, attitudes, and vaccine hesitancy among nursing students.

Results

Senior nursing students demonstrated a stronger knowledge of vaccines and maintained overall positive attitudes compared to freshman. The medical immunology course was the primary source of their vaccine knowledge (p < 0.001). Most nursing students were aware of the significant debate and misinformation surrounding vaccination during the COVID‐19 pandemic. In fact, the pandemic heightened their interest in immunology while also contributing to increased vaccine hesitancy (p < 0.001). Key factors in overcoming this hesitancy included the safety and necessity of vaccination, as well as confidence in government policies and recommendations from medical experts. Medical education played a vital role in enhancing their ability to identify misinformation about vaccines.

Conclusion

Overall, this study indicates that senior nursing students have a strong understanding of vaccines and maintain positive attitudes toward them, underscoring the importance of medical education. The COVID‐19 pandemic has positively influenced learning motivation while negatively affecting vaccine hesitancy. Comprehensive medical education could further boost vaccine confidence and acceptance among nursing students.

Abbreviation

COVID‐19

coronavirus disease 2019

1. Introduction

Vaccines have proven effective in eliminating life ‐ threatening infectious diseases. Unlike innate immunity, which provides a nonspecific, immediate defense against pathogens, vaccines induce a form of passive immunity. By introducing weakened or inactivated components of pathogens, vaccines stimulate the body to produce specific antibodies or activate T cells. This process primes the immune system to recognize and combat foreign invaders such as bacteria and viruses more effectively. Notable examples include vaccines for the flu, smallpox, hepatitis B, and measles [1]. In 1980, the World Health Organization (WHO) declared smallpox eradicated globally [2], the first infectious disease to achieve this, thanks to mass vaccination and international cooperation [3]. Vaccines benefit individuals by reducing infection, morbidity, and mortality, and also contribute to herd immunity, protecting vulnerable groups like newborns, the elderly, and those with weakened immune systems [4].

Despite the remarkable efficacy of vaccines in disease prevention and public health protection, public confidence and trust in vaccines currently face formidable challenges. Vaccine hesitancy, which is defined as an attitude of uncertainty towards accepting or rejecting vaccines, was highlighted by the WHO in 2019 as one of the top 10 global health threats [5]. The potential side effects of vaccines, including fever and chills, headache, fatigue, myalgia, and arthralgia, as well as the possible association with autism, although research suggests there is no connection between the two, are among the key factors contributing to the increase in vaccine hesitancy [6, 7, 8, 9]. It is noteworthy that the phenomenon of vaccine hesitancy has been further highlighted after the outbreak of COVID‐19. This disease is caused by the Severe Acute Respiratory Distress Syndrome Coronavirus‐2 (SARS‐CoV‐2). According to the latest update from the WHO dated April 11, 2024, the pandemic continues to claim thousands of lives each week [10]. Vaccination targeting SARS‐CoV‐2 is among the most effective and cost‐efficient measures to prevent the disease from becoming severe, thereby reducing morbidity and mortality [11]. However, During the COVID‐19 pandemic, there has been multifarious misinformation regarding vaccines, thereby augmenting vaccine distrust in the population [12]. Although the Chinese government has carried out universal free vaccination, vaccine hesitancy still existed among both healthcare workers and nurses [13, 14]. This kind of hesitation also existed among undergraduate students majoring in nursing [15].

Previous studies have revealed a multitude of individual, social, and organizational factors contributing to the hesitancy of nurses and nursing students towards COVID‐19 vaccines [16, 17, 18]. The identified barriers to vaccination among nurses and nursing students included misinformation on social media and suspicion about the insufficient safety and effectiveness of the vaccines [16, 19, 20]. Conversely, continuing education on COVID‐19 vaccines for nursing majors provided a direction for addressing vaccine hesitancy [21]. Notably, younger nurses were three times more likely to be vaccine hesitant compared to other nurses [22]. In addition, nursing students were more hesitant than practising nurses, with students being overrepresented in the more hesitant profiles [19]. Although most undergraduate nursing students intended to get vaccinated, over 30% still exhibited vaccine hesitancy [23]. During the COVID‐19 pandemic, nursing students' receipt of remote and online education, along with the lack of opportunities for clinical practice, may be potential reasons hindering vaccination [24, 25]. Nursing students are the core of future frontline nurses. Therefore, it is crucial to understand the barriers and facilitators of vaccine acceptance or hesitancy among undergraduate nursing students, especially those in freshman and senior years, so as to increase the vaccination rate and promote the development of public health.

This study included various survey selection questions, such as collecting data on vaccine knowledge and attitudes of undergraduate nursing students in freshman and senior years, as well as data related to the barriers and facilitators of vaccination among these students affected by the COVID‐19 pandemic. The aim was to explore the factors influencing vaccination among students in freshman and senior years.

2. Methods

2.1. Study Design and Participants

This cross‐sectional online survey (Wenjuanxing platform, March 1 to May 31, 2024) utilized convenience sampling to recruit freshman and senior nursing students from three medical universities (Binzhou Medical University, Shandong Second Medical University, and Shandong First Medical University) in China. Stratified by academic year, 1058 questionnaires were collected, with 1013 retained after excluding incomplete/contradictory responses (95.75% validity). The final sample included 544 freshmen and 469 seniors. All potential participants were thoroughly informed about the study's aims and the confidentiality of their data. Students who agreed to participate were asked to complete the anonymous questionnaire, with no incentives or penalties.

2.2. Questionnaire

Based on the Guidelines for COVID‐19 Vaccination (first edition) issued by National Health Commission of the People's Republic of China, the WHO's “Vaccine Explained” series featuring illustrated articles on vaccine development and distribution (2021) and the guiding principles for immunization activities during the COVID‐19 pandemic from the Chinese Center for Disease Control and Prevention (2021), The New York State Department of Health (2021), United States Food and Drug Administration (2021) and the related literature [26], we developed this questionnaire (Tables 1, 2, 3, 4). Four experts were invited to review the questionnaire, comprising two professors in public health, a community‐based nursing specialist overseeing vaccination programs, and a nursing education specialist. Before the survey, a convenience sampling method was employed to select 100 nursing students who met the specified criteria for a presurvey. This preliminary step aimed to assess the acceptability of the questionnaire. The respondents reported that the questionnaire items were clear and easy to understand, confirming its suitability for the main study. The questionnaire consists of the following Five parts [26, 27]:

• 1.Demographic characteristics: Age, gender, grade, university.
• 2.Knowledge of vaccines (9 items): This section aimed to assess the knowledge level and acquisition channels of nursing students regarding vaccines. Non‐scale data were collected.
• 3.Attitudes toward vaccines (6 items): This section aimed to assess the attitudes of nursing students regarding vaccines. Non‐scale data were collected.
• 4.Influencing factors of vaccine hesitancy (11 items): This section aimed to assess the associated factors of nursing students regarding vaccine hesitancy or acceptance. Non‐scale data were collected.
• 5.Influence of COVID‐19 pandemic (7 items): This section aimed to assess the influence of COVID‐19 pandemic on vaccine hesitancy and learning motivate of nursing students. Non‐scale data were collected.

Table 1.

Knowledge regarding vaccines in first‐year students and final‐year students.

Item	Category	First‐year students (544)		Final‐year students (469)
		Number	Ratio (%)	Number	Ratio (%)	χ2	p value
Vaccines play crucial roles to reduce the chances of acquiring life‐threatening diseases	Yes	544	100	469	100	—	—
	No	0	0	0	0
Vaccines induce antibodies to provide protection against infectious diseases	Yes	540	99.26	465	99.15	0.044	0.833
	No	4	0.74	4	0.85
Smallpox is the first infectious disease eradicated by a collaborative global vaccination program led by WHO	Yes	537	98.71	468	99.79	3.705	0.054
	No	7	1.29	1	0.21
The types of vaccines include inactivated vaccines, live attenuated vaccines, recombinant vaccines, adenoviral vector vaccines, and nucleic acid vaccines	Yes	433	79.60	450	95.95	60.21	< 0.001
	No	111	20.40	19	4.05
Vaccines contain weakened or inactivated parts (antigens) of specific organisms that can trigger an immune response in the body	Yes	403	74.08	460	98.08	115.0	< 0.001
	No	141	25.92	9	1.92
Vaccination may result in side effects including fever, fatigue, headache, muscle pain, and joint pain	Yes	423	77.76	457	97.44	85.56	< 0.001
	No	121	22.24	12	2.56
mRNA vaccines hold great hope in the immunotherapy of infectious diseases and cancers	Yes	356	65.44	453	96.59	151.9	< 0.001
	No	188	34.56	16	3.41
Vaccines can achieve herd immunity and protect vulnerable populations from infection by blocking transmission routes	Yes	389	71.51	458	97.65	125.7	< 0.001
	No	155	28.49	11	2.35
Vaccine knowledge sources	Internet and social media	323	59.38	104	22.17	—	—
	Medical immunology course	78	14.33	289	61.62	—	—
	Others	143	26.29	76	16.21	—	—

Table 2.

Attitudes regarding vaccines in first‐year students and final‐year students.

Item	Category	First‐year students (544)		Final‐year students (469)
		Number	Ratio (%)	Number	Ratio (%)	χ2	p value
It is the nurse's responsibility to educate the public about vaccines and the great contribution in eliminate infectious diseases	Agree	338	62.13	392	83.58	57.56	< 0.001
	Disagree	206	37.87	77	16.42
I am willing to advocate for the public, relatives, and friends to take vaccines under the condition of global pandemic	Agree	352	64.71	382	81.45	35.38	< 0.001
	Disagree	192	35.29	87	18.55
I hold enough self‐confidence to reassure the public's fear and overcome the public's vaccine hesitancy	Agree	212	38.97	307	65.46	70.73	< 0.001
	Disagree	332	61.03	162	34.54
I have concerns about the vaccine safety and side reactions	Agree	498	91.54	418	89.13	1.701	0.192
	Disagree	46	8.46	51	10.87
I have concerns about the vaccine effectiveness	Agree	303	55.70	189	40.30	23.91	< 0.001
	Disagree	241	44.30	280	59.70
I hold optimistic attitude and perceived that the benefits of vaccines outweigh the risks	Agree	464	85.29	401	85.50	0.009	0.926
	Disagree	80	14.71	68	14.50

Table 3.

Attitude of vaccine hesitancy among first‐year students and final‐year students.

Item	Category	First‐year students (544)		Final‐year students (469)
		Number	Ratio (%)	Number	Ratio (%)	χ2	p value
I have vaccine hesitancy under the hypothetical condition of global pandemic	Agree	189	34.74	147	31.34	1.313	0.252
	Disagree	355	65.26	322	68.66
I am willing to get vaccinated because I'm worried about the severity of the infection	Agree	505	92.83	451	96.16	5.263	0.022
	Disagree	39	7.17	18	3.84
I am willing to get vaccinated because I follow the advice of the government and medical experts	Agree	477	87.68	438	93.39	9.385	0.002
	Disagree	67	12.32	31	6.61
I am willing to get vaccinated because I believe it is my responsibility to protect myself and others from the spread of the virus	Agree	416	76.47	364	77.61	0.185	0.667
	Disagree	128	23.53	105	22.39
I am willing to get vaccinated because I understand that it helps to control the pandemic and contributes to the well‐being of society as a whole	Agree	361	66.36	327	69.72	1.307	0.253
	Disagree	183	33.64	142	30.28
I am hesitant about getting vaccinated because I am concerned about vaccine's adverse reactions	Agree	168	30.88	123	26.23	2.667	0.102
	Disagree	376	69.12	346	73.77
I am hesitant about getting vaccinated because I am concerned about vaccine's effectiveness	Agree	178	32.72	139	29.64	1.113	0.291
	Disagree	366	67.28	330	70.36
I am hesitant about getting vaccinated because I am concerned about vaccination needle pricking pain	Agree	142	26.10	126	26.87	0.075	0.784
	Disagree	402	73.90	343	73.13
I am hesitant about getting vaccinated because I am concerned about economic factors (Cost of Vaccination, Economic Stability, and Healthcare Accessibility)	Agree	25	4.60	30	6.40	1.591	0.207
	Disagree	519	95.40	439	93.60
I am hesitant about getting vaccinated because I am concerned about the negative influence of friends or relatives	Agree	44	8.09	35	7.46	0.137	0.711
	Disagree	500	91.91	434	92.54
I am hesitant about getting vaccinated because I distrust government decisions and forced measure	Agree	9	1.65	7	1.49	0.042	0.837
	Disagree	535	98.35	462	98.51

Table 4.

The concern of first‐year students and final‐year students on vaccine safety and effectiveness with the outbreak of COVID‐19 pandemic.

Item	Category	First‐year students (544)		Final‐year students (469)
		Number	Ratio (%)	Number	Ratio (%)	χ2	p value
The COVID‐19 pandemic enhanced my vaccine hesitancy	Yes	323	59.38	187	39.87	38.32	< 0.001
	No	221	40.63	282	60.13
I underwent an exposure to disordered information about COVID‐19 vaccines	Yes	544	100	469	100	—	—
	No	0	0	0	0
I have seen news on social media about vaccines causing serious side effects	Yes	487	89.52	435	92.75	3.211	0.073
	No	57	10.48	34	7.25
I have seen news on social media that vaccines are ineffective	Yes	501	92.10	424	90.41	0.907	0.341
	No	43	7.90	45	9.59
I was capable of discriminating misinformation and false news about COVID‐19 vaccines during the outbreak of COVID‐19 pandemic	Yes	235	43.20	323	68.87	67.09	< 0.001
	No	309	56.80	146	31.13
Medical education enhanced my ability to distinguish misinformation regarding vaccines	Yes	405	74.45	428	91.26	48.70	< 0.001
	No	139	25.55	41	8.74
The COVID‐19 pandemic enhanced my learning motive about immunology and vaccines	Yes	516	94.85	457	97.44	4.449	0.035
	No	28	5.15	12	2.56

2.3. Statistical Methods

The standard calculation formula used in statistics to estimate the population proportion: n = (Z ²⋅p⋅(1−p))/E ². In this regard, the minimum required sample size was 384 (95% confidence level, 5% margin of error). The final sample size was 1013. Frequency and percentage were used to analyze demographic characteristics. Pearson chi‐square test was used to compare the two groups. A p value of < 0.05 was considered significant (Two‐sided). All analyses were performed using SPSS 26.0 (IBM Corporation, New York, NY, United States).

2.4. Ethical Statements

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Medical Ethics Committee of Binzhou Medical University. All participants gave their consent to take part in this study. This includes participants under 18 years of age, whom the Ethics Committee also approved.

3. Results

3.1. Participant Demographic Characteristics

In the conducted survey, a total of 1058 questionnaires were collected; however, 45 were excluded due to missing essential information or incomplete responses. Consequently, 1013 valid questionnaires were retained, resulting in an effective response rate of 95.75% (1013/1058). The final analysis comprised 544 freshman students and 469 senior students, ensuring a robust representation of the target population.

3.2. Knowledge Regarding Vaccines

The study conducted a comprehensive assessment of nursing students' general knowledge and sources of information regarding vaccines, employing the Chi‐square test for comparative analysis between freshman and senior students. Both cohorts demonstrated a commendable understanding of the functional benefits of vaccines, with the statement “vaccines play crucial roles to reduce the chances of acquiring life‐threatening diseases” achieving a perfect accuracy rate of 100%. Furthermore, both groups exhibited satisfactory accuracy regarding the concepts that “vaccines induce antibodies to provide protection against infectious diseases” and that “smallpox is the first infectious disease eradicated by a collaborative global vaccination program led by WHO.” Notably, senior nursing students outperformed their freshman counterparts in awareness of various aspects of vaccines, including their category, composition, side effects, and advancements in vaccine science (p < 0.001). Conversely, the lowest accuracy rate (65.44%, 356/544) for freshman students pertained to the statement on mRNA vaccines' potential in treating infectious diseases and cancers (p < 0.001). Additionally, an overwhelming majority of senior participants (97.65%, 458/469) recognized the importance of vaccines in achieving herd immunity and protecting vulnerable populations, compared to only 71.51% (389/544) of freshman students (p < 0.001). In terms of knowledge sources, freshman students predominantly relied on the Internet and social media, whereas 61.62% (289/469) of senior students identified their medical immunology course as the most significant avenue for acquiring vaccine knowledge. This survey underscores the vital role that structured medical education, particularly in immunology, plays as a credible information source for nursing students.

3.3. Attitudes Regarding Vaccines

In the attitude dimension, 83.58% (392/469) of senior participants and 62.13% (338/544) of freshman nursing students perceived that it was the nurse's responsibility to educate the public about vaccines and their significant role in eliminating infectious diseases (p < 0.001). Given the global pandemic, 81.45% (382/469) of senior nursing students and 64.71% (352/544) of freshman nursing students were willing to advocate for the public, relatives, and friends to get vaccinated (p < 0.001). Additionally, 65.46% (307/469) of senior participants and 38.97% (212/544) of freshman nursing students felt confident enough to reassure the public's fears and address vaccine hesitancy (p < 0.001). Concerns about vaccine safety and side effects were reported by 89.13% (418/469) of senior participants and 91.54% (498/544) of freshman nursing students (p = 0.192), while concerns about vaccine effectiveness were expressed by 40.30% (189/469) of senior participants and 55.70% (303/544) of freshman nursing students (p < 0.001). An optimistic attitude was held by 85.50% (401/469) of senior participants and 85.29% (464/544) of freshman nursing students, who believed that the benefits of vaccines outweigh the risks (p = 0.926). Details are shown in Table 2. Taken together, these data suggest that senior nursing students exhibit a more positive attitude towards vaccines, proving that effective medical education can foster an optimistic view on vaccination.

3.4. Influencing Factors of Vaccine Hesitancy

This study revealed significant insights into vaccine hesitancy among nursing students, highlighting that 34.74% (189/544) of freshman students and 31.34% (147/469) of senior nursing students expressed reluctance to receive vaccines under hypothetical conditions of a global pandemic (p = 0.252). The primary motivators for vaccine acceptance included concerns regarding the severity of potential infections, as well as endorsements from recognized health authorities and medical professionals. Conversely, the predominant factors contributing to vaccine hesitancy were apprehensions surrounding possible adverse reactions, doubts about vaccine effectiveness, and anxiety related to the pain associated with needle injections. Additional contributors included economic considerations, negative influence from peers or family members, and a general distrust in governmental policies. Notably, confidence in public health measures emerged as a crucial determinant of vaccine hesitancy, with the data indicating that a substantial majority of nursing students exhibited high levels of trust in both government policies and recommendations from medical experts regarding vaccinations, as detailed in Table 3.

3.5. Influence of COVID‐19 Pandemic

According to the previous study, the outbreak of COVID‐19 pandemic aggravated the fear and distrust of the public towards vaccines. This study presented compelling evidence that the COVID‐19 pandemic significantly intensified nursing students' concerns regarding vaccine safety and efficacy. Notably, 59.38% of freshman students (323/544) and 39.87% of senior students (187/469) indicated that the pandemic heightened their vaccine hesitancy (p < 0.001). A substantial portion of participants reported exposure to disordered information characterized by controversy and conflicting opinions about COVID‐19 vaccines. Specifically, 43.20% (235/544) of freshman students and 68.87% (323/469) of senior students demonstrated the ability to discern misinformation and false narratives related to these vaccines during the pandemic (p < 0.001). Importantly, a striking 91.26% (428/469) of senior nursing students acknowledged that their medical education significantly improved their capacity to differentiate between credible information and misinformation regarding vaccines (p < 0.001). Furthermore, nearly all students expressed that the pandemic enhanced their motivation to learn about immunology and vaccines. These findings, detailed in Table 4, strongly indicate that while the COVID‐19 pandemic negatively impacted vaccine hesitancy, it simultaneously fostered an increased interest in learning among nursing students.

4. Discussion

This study examined the knowledge and attitudes of freshman and senior nursing students regarding general vaccines at three universities in China. Additionally, the research assessed the impact of the COVID‐19 pandemic on the learning motivation and vaccine hesitancy of nursing students. The findings aim to enhance understanding of educational needs and inform strategies to improve vaccine‐related knowledge and attitudes among nursing professionals.

Our study showed that senior students demonstrated broader vaccine knowledge (such as herd immunity and vaccine science) and relied more on medical immunology courses (61.62%) for information, while freshman students heavily depended on social media. Although our study did not directly collect relevant data, past research indicated that online learning models during the pandemic were more likely to reduce the academic performance of freshman students [28], and the use of social media by first‐year students increased significantly during pandemic lockdowns [29]. Additionally, prior studies showed that willingness to receive vaccines was positively correlated with academic year [30]. Taken together, the pandemic has indeed significantly altered the learning methods, information acquisition channels, and vaccine hesitancy levels of both freshman and senior students. Freshman students may face more challenges in knowledge construction in digital learning environments, and their reliance on social media may further influence vaccine‐related cognition and attitudes. In contrast, the knowledge base formed by senior students through structured courses may enhance their confidence in vaccines and reduce hesitancy.

Both groups recognized vaccination's importance, but seniors showed more positive attitudes toward educating the public about vaccines, though only 65.46% of seniors and 38.97% of freshmen felt confident addressing hesitancy. Notably, 59.38% of freshmen and 39.87% of seniors linked their increased vaccine hesitancy to the pandemic. This aligns with global trends showing a 23.8% decline in vaccine confidence from 2019 to 2022 [12], where pandemic‐related uncertainty exacerbated distrust. For nursing education, this underscores the need to integrate real‐time pandemic data and debunking exercises into curricula to strengthen students' ability to address public misconceptions. Moreover, this study revealed that academic level significantly influenced nursing students' attitudes toward vaccines, with seniors exhibiting more positive outlooks and a stronger sense of duty to address public vaccine hesitancy, though only 65.46% of seniors and 38.97% of freshmen felt sufficiently confident in doing so. Vaccine hesitancy was associated with vaccine‐related factors (such as efficacy and safety), social factors (such as collective responsibility), misinformation, and other factors [31, 32]. The COVID‐19 pandemic exacerbated hesitancy (59.38% of freshmen and 39.87% of seniors cited pandemic‐driven doubts), largely due to misinformation, though senior students‐91.26% of whom credited their medical education with enhancing misinformation detection‐showed greater resilience. These findings highlight the critical role of structured nursing education in fostering vaccine confidence and combating hesitancy.

Previous study has indicated that the blended learning format during the pandemic was more conducive to enhancing freshmen's learning motivation [33]. Another study showed that online learning cases incorporating rich clinical practice information can effectively compensate for the lack of practical opportunities, thereby improving medical students' learning motivation [34]. Against this backdrop, the intrinsic motivation for self‐learning demonstrated by nursing students in online learning during the pandemic is particularly critical [35]. Data from this study show that 94.85% of freshmen and 97.44% of senior students believed the pandemic significantly increased their motivation to learn immunology and vaccine‐related knowledge. This suggests that the blended learning format and clinical practice‐oriented online teaching may serve as effective pathways to enhance nursing students' professional learning motivation, particularly in public health emergencies, where such educational designs need to be further strengthened to consolidate learning outcomes.

The study has several limitations. First, as a cross‐sectional study, it cannot infer causal relationships, and any observed associations reflect correlations rather than direct cause‐and‐effect mechanisms. Second, the sample comprised nursing students from only three universities in China, introducing sampling bias and limiting the generalizability of the findings to nursing students in other regions or cultural contexts. Third, the reliance on self‐reported data may have introduced social desirability bias, as participants‐particularly future healthcare providers‐might underreport vaccine hesitancy. Fourth, while the study focused on the COVID‐19 pandemic's impact, it did not assess pandemic‐related curriculum disruptions (e.g., online vs. in‐person learning) or mental health effects on learning motivation, both of which could indirectly influence vaccine attitudes. Finally, the results may not be generalizable to non‐nursing students or practicing nurses, as their experiences and knowledge levels differ from those of pre‐professional nursing learners. These limitations highlight the need for future longitudinal research with more diverse samples to explore causal pathways and validate the findings.

5. Conclusions

In conclusion, this study demonstrated that senior nursing students exhibited a robust understanding of vaccines and maintained positive attitudes toward them, highlighting the critical role of medical education. The COVID‐19 pandemic was found to have a dual impact: it enhanced learning motivation while concurrently reducing vaccine hesitancy. Implementing comprehensive medical education strategies could further strengthen vaccine confidence and acceptance among nursing students. However, the study acknowledged limitations in terms of generalizability and causal inference due to its cross‐sectional design and sample characteristics. Future longitudinal research involving diverse populations was essential to validate these findings and explore how pandemic‐era curricula influenced learning motivation and vaccine hesitancy over time.

Author Contributions

Li Li: writing – original draft, methodology, data curation, funding acquisition. Chengyun Zhang: data curation. Bao Han: data curation. Hui Wang: methodology. Xinyang Li: methodology. Changxiu Qiao: supervision, writing – review and editing, funding acquisition.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The lead author Changxiu Qiao affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.