Emotional intelligence and education-related stress among baccalaureate nursing students in Indonesia: A cross-sectional study

Abstract

Background

Nursing students frequently encounter education-related stress (ES) arising from demanding academic workloads, clinical responsibilities, and personal adjustments during their training. Persistent stress can negatively impact learning outcomes, clinical performance, and psychological well-being. Emotional intelligence (EI), which involves the ability to perceive, understand, and manage emotions in oneself and others, is recognized as a protective factor that helps individuals regulate stress and adapt to challenges. However, research exploring the relationship between EI and ES among nursing students in Indonesia remains limited.

Objective

This study examined the association between EI and ES among baccalaureate nursing students at a public university in Indonesia.

Methods

A cross-sectional correlational design was conducted from September to November 2024 with 225 participants selected through stratified random sampling. Data were collected using the Indonesian version of the Trait Emotional Intelligence Questionnaire–Short Form and the Indonesian-translated Arabic Higher Education Stress Inventory. Descriptive statistics summarized the levels of EI and ES, while Spearman’s correlation, Mann–Whitney U, and Kruskal–Wallis tests were used to assess associations between variables.

Results

Most students demonstrated moderate levels of EI (73.8%) and ES (64%). The median (IQR) scores were 138.00 (29) for EI and 37.00 (8) for ES. A significant negative correlation was found between EI and ES (rₛ = -0.445, p <0.01), indicating that students with higher EI experienced lower stress levels. Among demographic variables, only gender was significantly associated with ES (p = 0.05), with men reporting higher mean ranks than women.

Conclusion

The findings highlight the importance of emotional intelligence in mitigating education-related stress among nursing students. Incorporating EI development into nursing curricula through emotional regulation training, reflective practices, and social–emotional learning strategies can build resilience, improve coping skills, and boost students’ academic and clinical performance. Further long-term studies are recommended to investigate the causal relationships and effectiveness of EI-based interventions.

Background

Nursing education endeavors to furnish graduates with the essential knowledge and capabilities required to work as professional nurses. Throughout the theoretical and clinical practicum phases of their curriculum, nursing students frequently encounter considerable stress (Ahmed & Mohammed, 2019). Sources of this stress encompass substantial academic workloads, interpersonal anxieties, demanding clinical requirements, and various personal difficulties (Alghamdi et al., 2019). Contributing factors also include the student's academic year, significant time pressures, and the direct responsibilities associated with patient care (Lavoie-Tremblay et al., 2022). When such elevated stress remains unmitigated over time, students may exhibit impaired learning outcomes, suboptimal clinical performance, and diminished overall well-being. Elevated stress levels may ultimately lead to depression and suicidal tendencies (Gomathi et al., 2017).

Given these challenges, identifying factors that can mitigate stress among nursing students has become increasingly important. One such factor is Emotional Intelligence (EI), which has been recognized as a key determinant of how individuals perceive and manage stress (Ranasinghe et al., 2017). EI refers to the ability to perceive, understand, and regulate his or her emotions and others, using this awareness to guide thoughts and behaviors (Salovey & Mayer, 1990). In the nursing profession, EI plays a vital role by making nurses to build trusting relationships with patients, deliver high-quality care, and serve effectively as counsellors (White & Grason, 2019). Conversely, insufficient EI can impede effective communication and contribute to unprofessional conduct, whereas higher EI promotes social support, enhances workplace collaboration, stimulates creativity, improves productivity, and increases job satisfaction (Toyama & Mauno, 2017). Numerous studies examining the association between EI and student stress have indicated that greater EI is associated with lower perceived stress levels (Foster et al., 2018). Thus, students with higher EI show a stronger ability to manage their stress (Larijani et al., 2017).

Building on this understanding, EI theory posits that EI plays a vital role in regulating emotions, nurturing interpersonal relationships, shaping future careers and psychological well-being, as well as fostering personal growth and achievement (Akerjordet & Severinsson, 2007). In this context, EI is significantly associated with ES. Nursing students with higher EI generally exhibit better mental health and academic performance, as they are more capable of managing stress, overcoming challenges, and developing effective problem-solving strategies in academic settings (Yildirim Hamurcu & Terzioglu, 2022). Likewise, grounded in social learning theory, students with higher EI are more adept at forming supportive social networks under stressful conditions to mitigate the adverse effects of stress during their academic journey. Nonetheless, the association between EI and ES remains complex and evolving (Mukhalalati et al., 2022).

To better understand this relationship, it is important to consider the core components of EI—self-awareness, self-management, motivation, empathy, and social skills. Individuals with high EI tend to be better able to recognize sources of stress, regulate emotional responses, and choose adaptive coping strategies, making them more resilient to stress (Cejudo et al., 2018; Fteiha & Awwad, 2020; Lea et al., 2023). From the perspective of social learning theory, coping behavior against stress is also learned through observation and social interaction. Social support and positive role models can enhance the ability to manage stress, particularly when individuals imitate effective coping strategies observed in their environment (Jones et al., 2025; Ullah et al., 2023).

In higher education settings, stress, often referred to as educational stress (ES), is defined as stress related to academic activities, career paths, and life experiences while studying in higher education (Pacheco et al., 2023). ES is a global issue that continues to affect students across disciplines (Andargeery, 2024). During their higher education, students generally face various stresses (including academic, professional, social, and psychological) that are higher than lower levels of education (Hyseni Duraku et al., 2023). A more significant course load usually causes stress, uncertainty about getting a job in the future, social demands, and specific personal goals (Toqan et al., 2023). There are two main domains of higher education-related stress: challenging stress (e.g. difficulties in achieving academic and clinical goals) and unsatisfactory stress (e.g. academic evaluations, faculty environment, classmates, patients, and the overall experience of academic activities) (Goff, 2023; Zhu et al., 2020). Prolonged exposure to such stress can impact students’ academic performance and mental health, potentially leading to emotional disorders (Alhamed, 2023; Pi-Ming et al., 2023).

Considering this, previous studies have shown a significant correlation between EI and ES among nursing students (Yildirim Hamurcu & Terzioglu, 2022). Therefore, examining the association between EI and stress within higher education is crucial, as such insight can inform strategies for providing appropriate support and guidance to assist nursing students in managing various forms of stress. This understanding can further enhance their academic success and contribute to improved outcomes in their future professional careers (Xu et al., 2023).

However, research investigating the relationship between EI and ES within the Indonesian context remains limited. A review of the literature revealed only two comparable studies. The first, conducted among nursing students at Hasanuddin University, reported a significant association between EI and ES among first-year students, indicating that higher EI corresponded with lower stress levels, although the sample size was limited to 74 respondents (Muhnia et al., 2018). The second study, conducted at the Faculty of Nursing, University of Indonesia, involved 101 respondents and similarly found a significant association between EI and ES (Sukmawati, 2015).

Building upon these findings, the present study hypothesized that higher EI would correspond to lower ES among nursing students. Consequently, this research aimed to investigate the association between EI and ES among baccalaureate nursing students at the Faculty of Nursing, Universitas Sumatera Utara, Indonesia.

Methods

Study Design

This research was a cross-sectional correlational design that sought to examine the relationship between EI and ES among nursing students at the Universitas Sumatera Utara, Indonesia. The cross-sectional approach enabled the collection of data at a single point in time, allowing for the assessment of existing relationships between the two variables without manipulation or intervention. This design was appropriate for identifying potential associations that could inform future longitudinal or interventional research focused on enhancing EI and managing stress among nursing students.

Sample/Participants

The study population comprised 515 nursing students from the Universitas Sumatera Utara from the 2021, 2022, and 2023 academic years. The number of samples was computed following the formula of Yamane (1967) as cited in Israel (2003): n = N / [1 + N(e)²]. Based on the formula, the sample size was derived as follows: n = 515 / [1 + 515(0.05)²] = 225 respondents. A post hoc analysis (G*Power version 3.1) was employed to strengthen the justification of the sample size. With a two-tailed correlation, an effect size (correlation coefficient) of -0.445, an alpha error probability of 0.05, and a power of 0.95, the required sample size was 59 respondents. Therefore, the number of samples of 225 nursing students in the study was sufficient. It is noted that the post hoc power analysis was based on the observed effect size, which limits its predictive validity. Future studies should perform an a priori power calculation using estimated effect sizes from prior literature.

This study used a stratified random sampling method. The method was selected because the number of students varied between academic years. Although stratified random sampling was used, proportional allocation across academic-year groups was not explicitly confirmed, which could have impacted how well the sample represented the population. The number of nursing students in the 2021, 2022, and 2023 academic years was 92, 206, and 217, respectively.

The inclusion criteria were participants who were willing to respond and complete the questionnaire. The exclusion criteria included respondents who had entered the clinical practice stage in a health service setting, such as hospitals or primary healthcare facilities, and those who did not complete the questionnaire.

Instruments

This study used three instruments: a demographic data questionnaire, an EI questionnaire, and an ES questionnaire. The demographic data questionnaire asked about gender, age, academic year, and place of residence during college.

The Indonesian version of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) version 1.50 was used to measure EI. This instrument was translated into Indonesian and subsequently evaluated for validity and reliability within the Indonesian population. It comprises 15 facets and 30 items rated on a 7-point Likert scale ranging from ‘strongly disagree’ (score 1) to ‘strongly agree’ (score 7). The possible total scores range from 30 to 210, with higher scores indicating a greater level of EI (Febriana & Fajrianthi, 2021). Authorization to employ the instrument was obtained from the translator. In the present study, the reliability assessment of the TEIQue-SF administered to 30 respondents produced a Cronbach’s alpha coefficient of 0.843.

The TEIQue-SF version 1.50 was originally developed by Andrew Cooper and K. V. Petrides. Psychometric evaluations employing Item Response Theory have been conducted to assess the quality and precision of the TEIQue-SF across diverse populations and contexts. Most items in the TEIQue-SF demonstrate strong discrimination indices and threshold values, providing substantial information at the global level of the EI trait. The instrument exhibits high measurement accuracy within the low to moderate EI range and is therefore recommended for rapid assessment (Cooper & Petrides, 2010). Authorization to utilize the instrument was obtained from the original developers.

The Arabic Higher Education Stress Inventory (Arabic-HESI) measures ES. The original HESI was developed for medical students. Furthermore, the instrument was adopted for nursing students and was declared valid (CVI = 0.92) and reliable (Cronbach’s α = 0.75). The instrument consists of two factors and 16 statements. Each statement was rated on a four-point Likert scale: ‘strongly disagree’ (score 1), ‘disagree’ (score 2), ‘agree’ (score 3), and ‘strongly agree’ (score 4). The lowest and highest scores were 16 and 64, respectively. The higher the total score, the higher the ES and vice versa (Mashaal et al., 2021). The Arabic-HESI was selected due to its excellent content validity and strong reliability. Furthermore, the shortened version allows for efficient completion with and minimal response time. The instrument was translated into Indonesian at the Australia Centre in Medan, Indonesia, following permission from the original developer. In this study, reliability testing of the HESI administered to 30 respondents produced a Cronbach’s alpha coefficient of 0.787.

Data Collection

Data were collected from September to November 2024 using Google Forms. Data collection was not assisted by research assistants. One of the research members (HYLS) was responsible for data collection. Prior to data collection, all participants were informed of the research objectives and procedures. They have also been informed that they can withdraw from the research process at any time without needing to notify the researcher, and they will not face any consequences.

Data Analysis

This study utilized IBM SPSS version 23 for data analysis. The results of the normality test, using the Kolmogorov-Smirnov test, showed that although the data for the EI variable were normally distributed, the data set for the ES variable did not follow a normal distribution. Therefore, descriptive statistics were used to summarize the frequencies, percentages, medians, interquartile ranges, and mean ranks. For inferential statistics, the Spearman correlation test was used to assess the correlation between EI and ES, while the Mann–Whitney U and Kruskal–Wallis tests were employed to determine differences in these variables across respondents’ demographic characteristics. Statistical significance was established at p < 0.05. Because multiple nonparametric tests were conducted, p-values should be interpreted cautiously to avoid inflated type I error.

Ethical Considerations

Before starting data collection, the Research Ethics Committee of Universitas Sumatera Utara approved the research protocol (approval number 1056/KEPK/USU/2024). This ethical approval confirmed that the study followed the principles in the Declaration of Helsinki, which highlights respect for human dignity, privacy, and the rights and welfare of participants. All participants received detailed information about the study’s goals, procedures, potential risks, and benefits.

Participation was completely voluntary, and informed consent was obtained from all respondents before their involvement in the research. Participants were assured that their responses would stay confidential and that no identifying information would be included in any reports or publications. The collected data was used solely for academic and research purposes and was stored securely to prevent unauthorized access. Additionally, participants were informed of their right to withdraw from the study at any time without facing any academic or personal consequences. The researchers also made sure there was no coercion or undue influence during recruitment. These measures were implemented to uphold ethical standards, ensure transparency, and protect the autonomy and well-being of all participants. By adhering to these ethical procedures, the study ensured the integrity of the research process and fostered trust between the researchers and participants.

Results

Table 1 presents the demographic characteristics of the 225 nursing students who participated in the study. The majority of participants were women (90.7%), aged 17–20 years (81.8%), and enrolled in the 2023 academic year (48.4%). In terms of residence, most students lived in rented or boarding houses (62.2%), while 37.8% lived with their parents.

Table 1.

Respondents’ characteristics (N = 225)

Variables	f	%
Gender
Men	21	9.3
Women	204	90.7
Age (year)
17–20	184	81.8
21–23	41	18.2
Academic Year
2021	38	16.9
2022	78	34.7
2023	109	48.4
Residence
With Parents	85	37.8
Rented or boarding house	140	62.2

As shown in Table 2, the majority of nursing students demonstrated a moderate level of Emotional Intelligence (73.8%), followed by high (25.3%) and low (0.9%) levels. For Education-related Stress, most students reported moderate (64%) or low (36%) levels, with no participants indicating high levels of stress. The median and interquartile range (IQR) scores further support these findings, with EI showing a median of 138.00 (IQR = 29) within an actual range of 84–200, and ES showing a median of 37.00 (IQR = 8) within an actual range of 19–50.

Table 2.

Levels and summary statistics of EI and ES among nursing students (N = 225)

Variable	Level	f (%)	Possible Score Range	Actual Range	Median	IQR
Emotional Intelligence	High	57 (25.3)	30–210	84–200	138.00	29
	Moderate	166 (73.8)
	Low	2 (0.9)
Education-related Stress	High	–	16–64	19–50	37.00	8
	Moderate	144 (64.0)
	Low	81 (36.0)

Note. EI = Emotional Intelligence; ES = Education-related Stress; IQR = Interquartile Range.

The results of the bivariate Spearman’s rank correlation between EI and ES revealed a significant negative correlation between the two variables (rₛ = -0.445, p <0.01, two-tailed), indicating that nursing students with higher EI tended to experience lower levels of ES.

In addition, a borderline significant difference in ES was observed between male and female students. The mean rank for men (139.40) was higher than that for women (110.28), with p = 0.050. The calculated effect size (r = 0.130) indicated a small effect. However, given the unequal group sizes (male = 21; female = 204), the robustness of the Mann–Whitney U test may be limited; thus, this result should be interpreted with caution. No other demographic variables showed significant differences in either EI or ES (Table 3). The effect size for EI between men and women was r = 0.103. For age, the effect sizes for EI and ES were r = 0.103 and r = 0.001, respectively. Based on academic year, the effect sizes for EI and ES were η² = 0.000 and η² = 0.000, respectively. Regarding place of residence, the corresponding effect sizes were r = 0.089 for EI and r = 0.027 for ES.

Table 3.

The correlations between EI, ES, and demographic variables (N = 225)

Variables			Mean rank	p-value
Gender	Emotional intelligence	Men	127.95	0.269
		Women	111.46
	Education-related stress	Men	139.40	0.050
		Women	110.28
Age (year)	Emotional intelligence	17–20	109.84	0.123
		21–23	127.18
	Education-related stress	17–20	113.04	0.983
		21–23	112.80
Academic year	Emotional intelligence	2021	130.91	0.107
		2022	115.01
		2023	105.32
	Education-related stress	2021	107.88	0.745
		2022	117.14
		2023	111.82
Residence	Emotional intelligence	With Parents	120.44	0.181
		Rented or boarding house	108.48
	Education-related stress	With Parents	115.28	0.681
		Rented or boarding house	111.61

Note. Mann–Whitney U test was used for variables with two groups (gender, age, residence), and Kruskal–Wallis test for variables with three or more groups (academic year).

Discussion

Principal Findings

This study found that the majority were in the moderate category of 166 (73.8%). A study in Saudi Arabia reported that nursing students had a moderate to high (96.6%) (Almansour, 2023) and high (Baghdadi et al., 2024) level of EI. A study in Turkey detected moderate levels of EI in nursing students (Batmaz et al., 2022), whereas studies in Morocco (Ksiksou et al., 2023) and Palestine (Bsharat, 2024) found high levels of ES in this population.

Most participants reported experiencing a moderate level of stress (64%). A study conducted in Iraq revealed that 30% of nursing students reported severe stress, while the remaining participants experienced moderate stress (Al-Zeyadi & Mohammed, 2019). Findings from a study at one of Saudi Arabia’s largest universities indicated that nursing students experienced moderate stress across all subscales and high stress in the time management subscale (Andargeery, 2024), whereas another study identified academic and clinical stress as high in 25.7%, moderate in 57.5%, and low in 16.8% of students (Mohamed et al., 2024). Comparable moderate stress levels have been documented among nursing students in Morocco (Ksiksou et al., 2023) and Egypt (56.3%) (Dogham et al., 2024). In Thailand, stress levels varied, with 49.70% reporting mild stress, 36.80% moderate stress, and 13.40% severe stress (Tantalanukul & Wongsawat, 2022). In Spain, 47.92% of nursing students reported moderate stress, and 25% experienced severe stress (Onieva-Zafra et al., 2020). The results of an overview of systematic reviews reported that the levels of low stress were 0.8–65%, moderate stress 5.9–84.5%, and severe stress 6.7–99.2% in Sudan, Saudi Arabia, Palestine, Pakistan, Oman, Jordan, Iraq, Egypt, and Bahrain (Chaabane et al., 2021).

This research identified a significant negative correlation between EI and ES among nursing students. Theoretically, EI, as an ontological-level ability, influences self-perception, interpersonal relationships, emotional regulation, and professional conduct. It encompasses emotional awareness that fosters a positive mindset in addressing environmental demands and underscores the importance of understanding the connection between stress and mental health. Although EI enhances the capacity to manage stress effectively, individuals with higher emotional sensitivity may also be more vulnerable to the detrimental impacts of stress (Akerjordet & Severinsson, 2007).

Social learning theory posits that EI can be cultivated through social processes such as observation, interaction, and imitation of others’ behaviors within educational settings. The application of social-emotional learning grounded in social learning theory enables students to enhance emotional regulation, develop empathy, and strengthen social competence through engagement with teachers, peers, and the broader learning environment (Hsu et al., 2024). In Indonesia, the incorporation of social-emotional learning into curricula and teacher education programs has been initiated, although its implementation continues to encounter cultural and resource-related challenges (Rahmawati, 2019; Seda & Marquez, 2025).

Strengthening EI through social emotional learning in elementary school to college can help students cope with ES and increase learning motivation (Elmi, 2020; Rahmawati, 2019). Social learning theory supports the importance of social learning in shaping EI, so that observation, simulation, and role-play based training programs are very relevant for the Indonesian educational context (Hsu et al., 2024; Setiawan & Ardian, 2025).

The Spearman’s rank correlation coefficient of −0.445 indicates a moderate association (Schober et al., 2018), suggesting that higher EI is associated with lower ES. This finding holds significance for the design of EI enhancement programs, as it demonstrates that strengthening EI may help mitigate ES. Such programs should therefore prioritize the cultivation of EI as a preventive or stress-reducing measure. Therefore, as stated by Teskereci et al. (2020), assessing nursing students’ EI levels and integrating targeted interventions within the nursing curriculum are essential to foster their EI development.

A study conducted in Iran revealed that students with higher EI were more adept at managing emotional challenges encountered while delivering nursing care to patients, thereby perceiving lower levels of stress (Alinejad et al., 2023). Similarly, research involving nursing students from four universities in Spain demonstrated that those with greater EI exhibited emotional stability when engaged in complex and demanding clinical environments. Therefore, they were able to regulate their emotions constructively through adaptive strategies such as seeking support and identifying solutions during decision-making or stressful clinical situations (Rodríguez-Leal et al., 2023). However, excessively ambitious goals may induce emotional strain when students fail to achieve the outcomes they anticipate, leading to increased stress levels (Zakirulla et al., 2021).

This study obtained only one demographic variable related to ES, namely gender; the mean rank for men was higher than that for women. For comparison, a study in Iraq reported that several demographic variables were significantly associated with ES (Al-Zeyadi & Mohammed, 2019). In Saudi Arabia, a study found that demographic variables related to EI included age, gender, and academic year (Almansour, 2023). A study in Turkey by Yildirim Hamurcu and Terzioglu (2022) noticed a significant and negative association between EI and ES among first-year nursing students.

However, the distribution of women (90.7%) was much larger than that of men; therefore, the results cannot be applied to a broader population. Indeed, many studies in nursing journals show that an average of 71–75% of participants are women, and about one-third of studies involve women alone, which can result in a gender distribution bias. The bias is consistent across countries, areas of specialization, and research methods. This imbalance causes nursing research results to be less generalizable for men, so there is a potential for knowledge gaps and inappropriate interventions for male groups (Polit & Beck, 2013). Likewise with demographic variables such as age, academic year, and residence. The highest number of respondents were 17-20 years old (81.8%), the majority in the 2023 academic year, and were dominated by nursing students living in rented or boarding houses (62.2%). The imbalance of the number of samples may affect the result of statistical analysis among demographic variables in this study.

Cultural factors have a significant influence on EI in Indonesia, which is a multiethnic and multicultural country. A study shows that EI competencies in Indonesia vary between ethnic groups. Studies of Batak, Minangkabau, and Javanese ethnicities found significant differences in interpersonal aspects, assertiveness, empathy, social responsibility, flexibility, and problem-solving. However, there are also common characteristics of EI among the three ethnicities, indicating the existence of shared cultural values that influence EI nationally (Dewi et al., 2018). In addition, Indonesian culture emphasizes communal values, mutual cooperation, and spirituality that shape the way individuals manage emotions and build social relationships. Students in Indonesia tend to rely on community support and religious values in managing stress and emotions, in contrast to other cultures that are more individualistic (Effendi et al., 2025).

Implications for Nursing Education

The incorporation of EI into nursing education is crucial to equip students with emotional competencies that foster academic achievement, psychological well-being, and interpersonal effectiveness. Consequently, nursing curricula should integrate EI development through formal strategies (e.g., communication and empathy training) and informal approaches (e.g., reflective practice and role modeling), particularly for students exhibiting very low EI levels. Moreover, a systemic framework and curricular coherence should be established within nursing education programs to ensure the comprehensive enhancement of EI throughout the learning process.

Limitations

This study has limitations, including using a cross-sectional design, where the design does not support establishing causal relationships. Second, the research was conducted in a single setting which may not adequately represent other nursing institutions across the country. Consequently, the generalizability of the findings to other regions may be limited. Finally, data collection was based on a self-report instrument, which can result in social desirability bias.

Conclusion

The findings of this study highlight the association between EI and ES in nursing students. This can be used as a theoretical basis for improving EI so that students can cope with stress during college. Nursing educators should help students cultivate EI, which can produce nurses who have the clinical skills and competencies to transform emotions into humanistic competencies and skills while providing nursing care. Educators are recommended to design and integrate EI training systematically and periodically into the nursing curriculum, either through special courses, workshops, or integrated learning modules. In addition, evaluate its effectiveness through a pre-post assessment to ensure an increase in EI and a reduction in ES. Although this study found a difference in ES between men and women, there is a tendency for gender distribution bias. After all, the effect size calculation results indicate a small effect size.

Funding Statement

Funding None.

Declaration of Conflicting Interest

No conflict of interest to declare.

Authors’ Contributions

MT contributed to the study’s conception and design, data analysis, wrote the first draft of the manuscript, revised the final draft, and gave final approval of the version to be published. HYLS contributed to the study’s conception and design, data collection, data analysis, and wrote the first draft of the manuscript. JMP, REN, and KN contributed to the interpretation and intellectual content of the manuscript.

Authors’ Biographies

Mula Tarigan, S.Kp., M.Kes., Ph.D, is an Assistant Professor at the Faculty of Nursing, Universitas Sumatera Utara, Indonesia.

Hanna Yudit Lamro Silitonga, S.Kep, is a student at the Nursing Study Program, Faculty of Nursing, Universitas Sumatera Utara, Indonesia.

Jenny Marlindawani Purba, S.Kp., MNS., Ph.D, is an Associate Professor at the Faculty of Nursing, Universitas Sumatera Utara, Indonesia.

Dr. Rika Endah Nurhidayah, S.Kp., M.Pd, is an Associate Professor at the Faculty of Nursing, Universitas Sumatera Utara, Indonesia.

Kessarawan Nilvarangkul, Ph.D., RN, is a Professor at the Faculty of Nursing, Chiang Rai Rajabhat University, Thailand.

Data Availability

The dataset generated during and analyzed during the current study is available from the corresponding author upon reasonable request.

Declaration of Use of AI in Scientific Writing

Nothing to declare.