Relationships between problem-solving, resilience, self-efficacy, and perceived social support in nursing students: a serial mediation model

Abstract

Background

Despite existing evidence highlighting individual connections between resilience and perceived social support, social problem-solving, and self-efficacy, the precise nature of interrelations of all four variables among nursing students remains insufficiently understood.

Aim

This research focused on investigating the mediator effects of self-efficacy and perceived social support in the relationship between social problem-solving and resilience levels of student nurses.

Design

A serial mediation model.

Methods

The study took place in the nursing faculty of a public university based in Türkiye. Data were collected using validated instruments measuring resilience, self-efficacy, social problem-solving ability, and perceived social support. The sample comprised four hundred and forty-five nursing students.

Results

Among the students, 69.9% were female (n = 311) and 30.1% were male (n = 134). Problem-solving was correlated positively with social support (r = .19, p ≤ .01), self-efficacy (r = .58, p ≤ .01), and resilience (r = .63, p ≤ .01). Also, social support was correlated positively with self-efficacy (r = .22, p ≤ .01), and resilience (r = .32, p ≤ .01). Finally, self-efficacy was correlated positively with resilience (r = .68, p ≤ .01). Self-efficacy significantly mediated the relationship between problem-solving and resilience, B = 0.251, BCa 95% CI = 0.195; 0.307. Also, social support significantly mediated the relationship between problem-solving and resilience, B = 0.028, BCa 95% CI = 0.011; 0.052. Additionally, it was observed that problem-solving facilitated resilience through social support and self-efficacy (B = 0.010, BCa 95% CI = 0.002; 0.020).

Discussion

The fact that resilience encompasses many characteristics makes it a complex concept to understand. This study has facilitated a better understanding of resilience.

Conclusions

The study indicated a predictive relationship between problem-solving and resilience in nursing students. Nursing faculties should establish support structures that facilitate students’ ability to overcome frequent challenges and obstacles they face during their studies.

Trial registration

Not applicable.

Introduction

Nursing education—particularly the clinical training component—can often be perceived by students as a significant source of stress. Exposure to demanding situations—such as dealing with emergency cases, observing patients in life-threatening conditions, fear of error in clinical interventions, or a perceived lack of clinical competence—can be particularly overwhelming [1, 2]. Such stressors may lead to harmful consequences for students’ physical and psychological well-being, academic performance, and clinical competence [3–5]. Therefore, it is crucial to support nursing students in developing adaptive coping strategies and fostering resilience throughout their professional formation.

Stress encountered in clinical environments is not confined to nursing students alone. Exposure to patient distress, strained interactions with team members, and the continuous need to suppress or manage negative emotions represent significant emotional demands, which may impair nurses’ well-being and job performance, and may ultimately result in burnout [6–8]. Nurses represent an important part of the health care team. However, stress and burnout have contributed to a decline in the number of nurses [9]. Therefore, the underlying causes of workforce attrition should be thoroughly investigated by the relevant authorities. While some nurses experience burnout due to the difficulties brought about by working conditions [9], some nurses can successfully overcome these difficulties [10–12]. This phenomenon is explained through the concept of resilience. The term psychological resilience is generally used to denote a class of phenomena characterised by positive patterns of adaptation in the face of significant adversity or risk [13]. Masten (2015) posits that psychological resilience may be understood as the capacity to adapt positively and effectively to challenging circumstances or hardships, and that it may be observed in individuals, families, or other dynamic systems [14]. Several protective factors have been associated with resilience. These include well-developed cognitive abilities such as problem-solving skills; positive self-perceptions (including self-efficacy, self-esteem, confidence, and optimism); a sense of meaning in life; effective emotional and behavioural regulation; attributes valued by oneself and society (e.g., an engaging personality or specific talents); a good sense of humour; supportive peer relationships; a stable and nurturing family environment; close relationships with parents; positive sibling interactions; higher levels of parental education; socioeconomic advantages; and access to quality education [13–15].

The notion of resilience is frequently cited in existing studies as a protective mechanism against stress. Defined as the ability to adapt constructively to hardship, navigate emotional strain, and rebound from difficult experiences, resilience is a key psychological resource [8, 11]. Within the nursing discipline, resilience is regarded as a crucial attribute that supports nurses in coping with the demands of clinical environments, regulating their emotional responses, maintaining professional standards, enhancing personal well-being, and implementing constructive coping mechanisms—all of which contribute to optimal patient care [16]. Increased resilience among nurses is associated with improved mental health, more fulfilling professional relationships, higher job satisfaction, and enhanced overall occupational functioning [17].

To foster resilience and manage stressful life events effectively, individuals are expected to develop the ability to resolve the problems they encounter [16, 18]. One theoretical framework that addresses this capacity is the Social Problem-Solving Model, which conceptualises problem-solving as a skill that is acquired through learning, a generalised coping mechanism, and a form of self-regulation [19]. Through a combination of cognitive, emotional, and behavioural strategies, social problem-solving skills enable individuals to identify challenges and generate adaptive responses to everyday stressors [20]. Social problem-solving is a conscious, rational, goal-oriented action that aims to improve the problematic situation, reduce or change the negative emotions arising from this situation, or both [21]. Social problem-solving consists of two broad components: ‘problem orientation’ and ‘problem-solving style’. Problem orientation (positive or negative) is a metacognitive process that primarily serves a motivational function in social problem-solving. It requires the application of a set of cognitive and emotional schemas that reflect not only an individual’s appraisal of their own problem-solving abilities but also their general awareness and evaluations of problems in life (such as self-efficacy beliefs and outcome expectancies). Problem-solving skills, on the other hand, refer to the activities undertaken by individuals as they attempt to understand problems encountered in daily life and to identify effective solutions or coping strategies. Over time, this concept has come to be referred to as ‘problem-solving styles’ [21]. Dysfunctional patterns include the ‘impulsivity/carelessness style’ and the ‘avoidance style’. By contrast, ‘rational problem solving’ represents a constructive style, encompassing four sequential skills: (1) defining and formulating the problem, (2) generating alternative solutions, (3) making decisions, and (4) implementing and evaluating the solution [20, 21].

As a scientific problem-solving approach, the nursing process enables nurses to systematically provide care while solving patients’ problems [22]. Problem-solving competencies are essential in nursing, as they may influence professional efficiency, the provision of excellent care, and favourable clinical outcomes [23]. However, nurses rely on social problem-solving not solely within the context of clinical decision-making or patient care, but also in handling the complexities of daily life [4]. In addition to identifying and solving their patients’ problems, nurses also use social problem-solving skills in applying their professional competencies, working within a team, and managing their daily social lives. As nursing education and the professional practice itself are widely recognised as highly stressful processes [11], social problem-solving is regarded as a critical skill that student nurses should acquire throughout their training.

Self-efficacy, described as the confidence in one’s ability to organise and perform actions to meet specific goals, is a significant factor in how individuals manage stress [24]. According to Bandura, self-efficacy influences motivation, the selection of activities, and the effort expended in the face of challenges [25]. For instance, an individual with high self-efficacy may perceive a demanding task not as something to be avoided, but as a challenge to be overcome. Such an individual is likely to persist longer and remain resilient despite setbacks. By contrast, a person with low self-efficacy may avoid a task altogether or discontinue engagement with it. Within Bandura’s self-efficacy theory, performance accomplishments, vicarious experiences, verbal persuasion, and physiological states (such as emotional arousal) are identified as key sources that shape one’s level of self-efficacy [25]. Within nursing education, cultivating high levels of self-efficacy is crucial for students to succeed in clinical placements. Those with stronger self-efficacy tend to display higher levels of confidence, enabling them to manage unforeseen challenges and fulfil their responsibilities, even when faced with crises or unexpected situations in patient care [26, 27].

Another factor affecting resilience is perceived social support. Social support includes spending time with people who are important to the individual, maintaining interdependent and co-operative relationships, and receiving material or moral support from them [28]. Individuals who experience strong social support are generally better equipped to manage stress and overcome psychological difficulties more effectively [29]. Social support is the mutual interaction between individuals and their surrounding social networks, including family members, peers, and close companions [30]. Social support is typically categorised into ‘received social support’ and ‘perceived social support’. Perceived social support refers to the belief that such supportive behaviours will be available when needed. While perceived support represents the cognitive aspects of social support, received or provided support reflects its behavioural dimensions. Perceived social support can be understood as an individual’s cognitive appraisal of their relationships with others, since support—although present—holds little value if it is not perceived as accessible or sufficient to meet one’s needs. Individuals who have a negative perception of the support offered may reject it. For example, parental support is considered beneficial for adolescent resilience, whereas an overly protective parenting approach may negatively impact it. Social support affects mental health in two different ways: As outlined in the main effect framework, the presence of social support is linked to enhanced mental well-being through its direct and consistent impact. The main effect approach posits that social support exerts a positive influence on physical health and well-being regardless of circumstances, and that insufficient support has detrimental consequences for individuals. In contrast to the main effect model, the buffering model emphasises the role of social support in protecting mental health by mitigating or offsetting the adverse effects of stressful life events. When stressors are absent, however, the lack of social support does not exert a negative impact on health and well-being [31]. The perceived social support of nursing students, who experience significant changes in their social networks and sources of support upon transitioning to university education, is particularly important. It provides emotional security and a sense of belonging, thereby enhancing their stress-coping abilities and resilience, and ultimately contributing to higher levels of well-being [17, 32]. Receiving support from mentors during clinical practice holds a vital role in shaping the professional growth of student nurses [33].

Nursing students frequently face numerous stressors during their training. To navigate this demanding period successfully, they must be capable of applying effective social problem-solving strategies and hold confidence in their own capacity to deal with obstacles, which is fundamentally linked to self-efficacy. It is expected that only in this way can students maintain their resilience.

Although a considerable number of studies in the literature have explored the problem-solving abilities of nursing students, few have specifically examined these skills within the framework of the Social Problem-Solving Model [4, 34]. The capacity of nursing students to engage in social problem-solving is central to understanding both their resilience and the approaches they utilise to cope with stress. Social problem-solving serves as a mechanism for managing stress [35] and is recognised as a buffering element contributing to resilience [16]. Resilience, as a broader psychological construct, encompasses both coping mechanisms and social problem-solving strategies [35]. Self-efficacy, which refers to one’s confidence in their capability to act effectively, influences social problem-solving behaviour and represents its motivational dimension [35]. Furthermore, it is also conceptualised as a behavioural element of resilience [16]. Within the context of the Social Problem-Solving Model, individuals often seek social support while addressing problems [35], and such support not only enhances self-efficacy through verbal reinforcement but also acts as a resilience-enhancing protective factor [36]. In light of the information presented above, it can be inferred that resilience represents a more comprehensive construct within the field of psychology. This perspective facilitates a clearer understanding of the interrelations among various positive psychology concepts previously discussed. Although resilience is often regarded as an overarching or umbrella term encompassing numerous other positive psychological constructs [12], certain studies in the literature highlight other concepts more prominently, which may lead to conceptual ambiguity. For instance, some studies suggest that students’ levels of self-efficacy are shaped by their access to social support and their capacity for resilience [27]. Others report that both resilience and self-efficacy contribute to enhanced problem-solving abilities [37], while additional research has incorporated resilience as a predictor variable in regression models aiming to explain variance in students’ academic self-efficacy [26]. However, causal interpretations of relationships between variables should be avoided in analyses relying on cross-sectional data. Although numerous studies have examined the individual links between resilience and social problem-solving, perceived social support, and self-efficacy, the precise nature of interrelations of all four variables among nursing students remains insufficiently understood.

In this study, to better understand the relationships among resilience, social problem-solving, perceived social support and self-efficacy, the theoretical frameworks of Hobfoll’s Conservation of Resources (COR) Theory and Bandura’s Social Cognitive Theory have been adopted [24, 38, 39]. The COR theory offers a conceptual framework for comprehending the mechanisms through which individuals experience, cope, manage, and develop resilience in response to chronic or traumatic stress [38, 40]. Within this framework, coping processes constitute a central component, as they determine how individuals protect, conserve, and replenish their personal and social resources when faced with stressors [6]. Personal resources represent internal attributes that are closely associated with resilience and reflect an individual’s perception of their capacity to effectively influence and manage their environment [41]. When individuals possess sufficient resources, situational demands tend to be appraised as less overwhelming, thereby facilitating more effective coping responses [6]. According to the COR theory, much of human behaviour revolves around the acquisition, maintenance, and protection of valued resources. These resources are often interrelated and embedded within individuals, families, communities, and broader cultural systems [38, 40]. Resources are conceptualised as objects, personal characteristics, conditions, or energies that individuals value and that fundamentally determine their capacity to cope with stress. From this perspective, individuals’ social problem-solving abilities can be viewed as a cognitive-behavioural competence that enables them both to utilise their existing resources effectively and to generate new ones when confronted with challenging or stressful circumstances. The COR theory posits that four categories of resources—objects, conditions, personal characteristics, and energies—serve as predictors of both psychological strain and optimal functioning. For instance, social support received from friends represents a condition resource [6]. The theory rests upon two central assumptions. First, individuals invest their resources to confront threatening circumstances and to mitigate potential negative outcomes. Second, beyond merely protecting their existing resources, individuals are also motivated to acquire and accumulate them over time [41]. Observed correlations among different types of resources are described as resource caravans, reflecting the tendency for resources to accumulate within individuals and groups and to be maintained across the lifespan [40]. Resources often give rise to additional resources, thereby forming these caravans that contribute to adaptive outcomes such as enhanced coping abilities and greater well-being [41]. The positive linkage between external resources, such as social support, and internal resources, such as self-efficacy, exemplifies a resource caravan. Potential resource caravan passageways that may account for this relationship include the modelling and reinforcement of social problem-solving behaviours within family, educational, and peer contexts [40]. Although individuals’ perceptions of and adaptations to their environments vary according to the level of personal resources they possess, these personal resources are themselves shaped and strengthened by environmental factors. The availability of environmental resources can activate and enhance personal resources, which in turn may foster favourable psychological and organisational outcomes [41]. Both self-efficacy and social support theories are regarded as key resource theories, as they address the development and utilisation of essential personal and social resources. In contrast, Lazarus and Folkman’s (1984) coping theory is considered an integrated resource theory, as it encompasses the dynamic interplay between environmental demands, personal resources, and coping processes [39, 42]. An integrated resource theory conceptualises resources as elements within a broader, dynamic system that underpins well-being through their ongoing utilisation. Such models typically: (a) adopt a comprehensive view of resources rather than concentrating on a single type; (b) emphasise changes in resources under stressful conditions as the central mechanism influencing health and well-being; and (c) highlight the importance of possessing dependable reservoirs of resources to foster and sustain psychological and physical well-being. Although Lazarus and Folkman (1984) primarily emphasised cognitive appraisal and coping processes, they also recognised that individuals’ personal and social resources form the foundational context within which these processes occur [39, 42]. Social problem-solving is recognised as a form of coping strategy [35]. According to Hobfoll (2002), a common mechanism underlying resource-based theories is that individuals who possess greater resources are better equipped to address and resolve the problems that arise in stressful situations [39]. Within the resilience literature, there appears to be a growing shift from key resource theories toward integrated resource theories. This transition does not imply that integrated theories hold greater validity, but rather reflects a logical research sequence in theoretical development. Given the robustness and consistency of findings regarding several key resources—such as self-efficacy and social support—it is a natural advancement to integrate these elements within comprehensive causal frameworks. Consequently, integrated resource models have generally focused on exploring causal processes regarding the interactive and dynamic mechanisms through which key resources jointly contribute to adaptive functioning and resilience [39, 40].

Drawing on Social Cognitive Theory [24], social support is conceptualised as an environmental resource that fosters positive self-beliefs, thereby enhancing self-efficacy. Elevated self-efficacy, in turn, strengthens individuals’ capacity to engage in effective problem-solving and to cultivate resilience when confronted with academic and clinical stressors. Empirical evidence among nursing and health sciences students supports this sequence, demonstrating that self-efficacy mediates the relationship between social support and adaptive outcomes such as stress management, professional identity, and learning motivation [43–45].

The rationale for this study is grounded in the unique academic and clinical challenges encountered by nursing students during their education. Nursing students are expected not only to acquire theoretical knowledge but also to develop complex clinical skills and engage early in emotionally demanding patient care activities. When combined with a heavy workload, high levels of stress, and responsibilities for patient safety, resilience becomes a critical capacity for maintaining well-being, as well as for supporting academic success and professional commitment [46]. Drawing upon existing literature, the present study hypothesises that social support and self-efficacy function as mediators in the relationship between social problem-solving and resilience among nursing students.

The proposed model posits a serial mediation pathway in which social support precedes self-efficacy. Bandura’s Social Cognitive Theory posits that perceived social support functions as an environmental or contextual resource influencing individuals’ beliefs in their capabilities, namely self-efficacy. According to this theory, social support is conceptualised as an environmental resource that provides emotional encouragement, modelling, and verbal persuasion, thereby strengthening individuals’ self-efficacy beliefs [24]. Enhanced self-beliefs in turn facilitate more effective coping, problem-solving, resilience, and related skills. Empirical studies in nursing education support this assumption, demonstrating that social support predicts higher levels of academic self-efficacy and professional identity among nursing students [26, 43]. Furthermore, recent evidence indicates that social support exerts indirect effects on stress management, health literacy, and resilience via self-efficacy [44, 47].

Based on this theoretical and empirical foundation, the present study proposes a serial mediation pathway in which social support precedes self-efficacy in predicting the relationship between social problem-solving and resilience. Building upon this hypothesis, the present study sought to examine the relationships among the variables using a serial mediation model, thereby contributing to a deeper understanding of resilience. To the best of our knowledge, this research constitutes the first attempt to incorporate all four positive psychology constructs into a single serial mediation model involving a sample of nursing students.

This study aims to address a gap in the literature by comprehensively examining the interactions among these four variables, thereby enhancing the understanding of nursing students’ psychosocial adaptation processes. Within this context, the primary research question focuses on how the relationship between social problem-solving and resilience is shaped through the mediating roles of perceived social support and self-efficacy.

Methods

Study design, setting and participants

This research followed a cross-sectional methodology and utilised a serial mediation model to examine whether social support and self-efficacy mediate the relationship between nursing students’ problem-solving abilities and their resilience.

The study took place in the nursing faculty of a public university based in western Türkiye. Nursing education in Türkiye typically lasts four academic years (eight semesters), and includes theoretical, laboratory, and practical courses. In the study centre, nursing students commence their clinical training in the second semester of their initial academic year. One of the measurement tools used in this study (‘the Resilience Scale for Nurses’) contains items specific to clinical-related situations. Therefore, participants in their first year of undergraduate nursing education were deliberately excluded from the study, considering that their exposure to the clinical environment was insufficient. Students in their second through fourth years of the nursing curriculum were approached to participate in the study. Data collection was carried out between February and March 2022 using a convenience sampling approach. Out of 850 registered nursing students—264 from the second year, 270 from the third, and 316 from the fourth—all were invited to join the study. Among them, 459 consented to participate, but only 445 submitted fully completed questionnaires.

Instruments

Data were obtained through a self-report questionnaire comprising a personal information section and four standardised instruments: the Social Problem Solving Inventory-Short Form [48], the General Self-Efficacy Scale [49], the Resilience Scale for Nurses [11], and the Multidimensional Scale of Perceived Social Support [50]. The personal information section included items related to participants’ year of study, age, gender, satisfaction with faculty life, voluntary choice of the nursing profession, perceived level of academic achievement, and subjective assessment of economic status.

Social problem solving-inventory-short form

The 25-item Social Problem Solving Inventory-Short Form developed by D’Zurilla et al. (2002) was subsequently adapted for Turkish populations by Çekici and Güçray [48]. The scale is theoretically grounded in the Social Problem-Solving Model and comprises five subscales: positive problem orientation, negative problem orientation, rational problem-solving, impulsive/careless style, and avoidance style. Responses are measured using a five-point Likert scale ranging from 0 (‘not at all true of me’) to 4 (‘extremely true of me’), yielding a total score between 0 and 100. Higher total scores reflect stronger social problem-solving. In the Turkish adaptation study, Cronbach’s alpha coefficients for the individual subscales varied from 0.61 to 0.81. The overall reliability coefficient in the current research was found to be 0.89.

Resilience scale for nurses

Polk (1997) suggested a resilience model for nurses based on Rogers’ theory and described four resilience patterns (dispositional, relational, situational, and philosophical patterns). Based on this model, Park et al. (2019) developed a 19-item scale to assess resilience among nurses, which was later validated and tested for reliability in Turkish nursing students by Şenocak et al. [11]. This scale consists of a four-factor structure measuring the dispositional, relational, situational, and philosophical patterns of resilience. Responses are scored using a five-point Likert scale from 1 (‘Almost never’) to 5 (‘Almost always’), with higher scores reflecting stronger resilience. The Turkish adaptation reported a Cronbach’s alpha of 0.93, while the reliability coefficient in the current research was found to be 0.90.

General self-efficacy scale

The scale created by Schwarzer and Jerusalem (1995), was validated and tested for reliability in Turkish populations by Aypay [49]. The scale comprises a two-factor structure. Items loading on the first factor emphasise effort and persistence in coping with challenges, and thus this factor is labelled ‘effort and persistence’. Items loading on the second factor highlight capability and self-confidence in managing difficulties, and accordingly, this factor is named ‘skill and confidence’. It has ten items and responses are scored using a four-point Likert scale ranging from 1 (‘Strongly disagree’) to 4 (‘Strongly agree’), with higher scores reflecting stronger perceptions of self-efficacy. The internal consistency coefficient reported in the Turkish validation study was 0.83, while the present study found a Cronbach’s alpha of 0.91.

Multidimensional scale of perceived social support

Zimet et al. (1988) created a scale to assess perceived social support from family, friends, and a significant other, which was later validated and tested for reliability in Turkish populations by Eker et al. [50]. The scale contains 12 items rated on a seven-point Likert scale, with responses ranging from 1 (‘Strongly No’) to 7 (‘Strongly Yes’). Higher scores reflect a stronger perception of social support. Cronbach’s alpha coefficients reported in previous reliability analyses varied from 0.83 to 0.91. The overall reliability coefficient in the current research yielded an alpha value of 0.89.

Data collection

Data were collected during class sessions and required approximately 15 min to complete. The questionnaires were distributed in person by the researchers to students who voluntarily agreed to participate, and the forms were completed under direct supervision.

Statistical analysis

Statistical procedures were performed utilizing IBM SPSS Statistics version 23 in conjunction with the PROCESS macro (version 4.2). Serial mediation analyses were performed using the Bootstrap method with a sample size of 5000. In this study, Model 6 of Hayes’ PROCESS macro was selected, as our research question necessitated examining how multiple mediators sequentially influence the relationship between the independent and dependent variables [51]. Our theoretical framework posits that social support enhances individuals’ psychological resources (e.g., feedback, modelling, validation), which in turn bolster self-efficacy, and that these internal evaluations (agentic beliefs) subsequently influence adaptation or outcome variables. This sequential process aligns with the pathways described in Social Cognitive Theory (mastery experiences, vicarious learning, verbal persuasion) and the Conservation of Resources framework (external resources → cognitive/evaluative resources → adaptation), reflecting the ‘external support → self-efficacy → outcome’ trajectory.

The choice to utilise a serial mediation model via PROCESS was informed by both theoretical and empirical considerations. Consequently, PROCESS Model 6 was employed to examine this hypothesised chain, as it permits the assessment of multiple mediators operating in a theoretically specified order [51]. This approach aligns with the study’s objective of elucidating not only whether social support and self-efficacy serve as mediators, but also how these mechanisms interact to shape the relationship between social problem-solving and resilience among nursing students.

Prior to analysis, the dataset was examined for assumptions of linearity, normality, homoscedasticity, and homogeneity of variance. Outliers were detected using Mahalanobis distance. Multicollinearity was assessed using VIF. The data satisfied the normality assumption, with skewness and kurtosis remaining within the ± 2 threshold [52]. Sample size adequacy and power analysis for models featuring indirect relationships were conducted using Monte Carlo simulation methods based on Schoemann, Boulton, and Short’s (2017) algorithm [53]. The findings revealed that, with 445 participants, 1000 replications, 2000 Monte Carlo iterations, and a 95% confidence interval, path power values ranged between 0.81 and 1.00. The study evaluated multicollinearity through VIF and tolerance values. Findings showed that VIF values were below 10 and tolerance values were greater than 0.10, ruling out multicollinearity concerns [54, 55]. The Durbin-Watson statistic was measured as 1.74, further supporting the absence of issues with residual correlations.

Ethical considerations

Ethical clearance for the research was granted by the Non-interventional Clinical Research Ethics Committee of the Faculty of Nursing, Aydın Adnan Menderes University (Protocol No: 2019/120). Request to conduct data collection was also approved by the faculty administration. Prior to participation, students were informed of the study’s aim and scope. Data were gathered through face-to-face interactions. Participation was entirely voluntary; informed consent was secured, and participants were informed of their withdrawal rights throughout the study.

Results

Demographic characteristics

After confirming that the statistical assumptions were met, the study proceeded with descriptive statistics and correlations. One hundred and sixty-three students were in 4th year (36.6%), 150 in 3rd year (33.7%) and 132 were in 2nd year (29.7%). Among the respondents, 69.9% were female (n = 311) and 30.1% were male (n = 134), with a mean age of 21.42 years (SD = 1.46; range = 19–30). Of the participants, 51.7% (n = 230) described themselves as academically successful, 61.6% reported having chosen the nursing programme willingly, 47% assessed their financial condition as balanced, and 41.1% expressed satisfaction with their university life.

Descriptive statistics and correlation matrix of study variables

Table 1 outlines the descriptive statistics for each study variables. Additionally, bivariate Pearson correlation coefficients between the variables are presented, allowing for a clearer understanding of the relationships between them. This thorough analysis highlights the statistical characteristics of the data and their associations.

Table 1.

Mean scores, standard deviations, and correlations

	1	2	3	4
1. Problem-solving		0.19*	0.58*	0.63*
2. Social support			0.22*	0.32*
3. Self-efficacy				0.68*
4. Resilience
M	65.21	64.29	30.40	71.26
s.d.	13.58	15.27	5.94	11.11
Skewness	− 0.32	− 0.73	− 0.07	− 0.29
Kurtosis	0.24	0.12	− 0.64	0.19

Note: All correlations are two-tailed, N = 445; *p ≤ .01; M = Mean, s.d. = Standard deviation

Descriptive statistics, along with the intercorrelations among research variables, are provided in Table 1. Problem-solving was correlated positively with social support (r = .19, p ≤ .01), self-efficacy (r = .58, p ≤ .01), and resilience (r = .63, p ≤ .01). A positive significant correlation was detected between perceived social support and self-efficacy (r = .22, p ≤ .01), as well as between resilience and social support (r = .32, p ≤ .01). In addition, self-efficacy showed a strong positive correlation with resilience (r = .68, p ≤ .01). These findings provide initial empirical support for the proposed hypotheses.

Hypothesized model

After completing the descriptive statistics and correlation assessments, the research proceeded with a serial mediation analysis. This was conducted utilizing Model 6 within the SPSS PROCESS macro, enabling a detailed investigation of the serial mediation effects between variables. The results from this regression-based analysis, which highlight the mediating pathways and their statistical significance, are comprehensively presented in Table 2, offering valuable insights into the relationships that exist between the predictor, mediators, and outcome variables.

Table 2.

Regression model coefficients, standard error values, and summary statistics for the model

Antecedent	Consequent
	SS(M1)			SE(M2)			RE(Y)
	Coefficient	SE	p	Coefficient	SE	p	Coefficient	SE	p
PS(X)	0.21	0.05	0.000**	0.24	0.02	0.000**	0.28	0.03	0.000**
SS(M1)	-	-	-	0.05	0.02	0.003*	0.11	0.02	0.000**
SE(M2)	-	-	-	-	-	-	0.84	0.07	0.000**
Constant	50.36	3.50	0.000**	11.56	1.35	0.000**	20.55	2.23	0.000**
R 2	0.04			0.35			0.57
F	16.56(1−443)			119.17(2−442)			191.61(3−441)

Note: *p ≤ .05, **p ≤ .001; PS = Problem-solving, SS = Social support, SE = Self-efficacy, RE = Resilience

According to results presented in Table 2, problem-solving significantly predicted social support (B = 0.21, BCa 95% CI = 0.110; 0.317) and self-efficacy (B = 0.24, BCa 95% CI = 0.211; 0.278). It was found that social support, as a predictor, had a positive effect on self-efficacy (B = 0.05, BCa 95% CI = 0.015; 0.075). The analysis indicates that both social support (B = 0.11, BCa 95% CI = 0.064; 0.157) and self-efficacy (B = 0.84, BCa 95% CI = 0.700; 0.985) significantly contribute to predicting resilience. Additionally, the total effect of problem-solving on resilience demonstrated statistically significant (B = 0.51, BCa 95% CI = 0.574; 0.628). The direct effect of problem-solving on resilience remains significant even after controlling for social support and self-efficacy (B = 0.28, BCa 95% CI = 0.214; 0.339).

According to Fig. 1, problem-solving ability has a positive effect on social support (a₁ = .21), indicating that individuals with stronger problem-solving skills appear to benefit from higher levels of perceived social support. Furthermore, problem-solving ability significantly predicts self-efficacy (a₂ = 0.24), implying that the capacity to manage challenges contributes positively to individuals’ belief in their own competence. Moreover, the effect of social support on self-efficacy is notable (d₁ = 0.5), emphasising the reinforcing role of a supportive environment in fostering self-confidence. Self-efficacy, in turn, strongly influences resilience (b₁ = 0.84), indicating that those with greater self-efficacy are more inclined to demonstrate resilience under stress. Finally, problem-solving also influences resilience (c’ = 0.28), highlighting its contribution to coping ability. Subsequent sections of the study further explore the indirect effects presented in Table 3.

Fig. 1.

A visual representation of social support and self-efficacy working in serial within the model

Table 3.

Indirect effects of problem-solving, social support, self-efficacy on resilience

Effect	B	SE	Bootstrapping 95% Confidence interval
			LL	UL
Total effects	0.514	0.030	0.454	0.574
Direct effects	0.277	0.032	0.214	0.339
Total indirect effect	0.290	0.028	0.234	0.347
Indirect effect (X→M1→Y)	0.028	0.011	0.011	0.052
Indirect effect (X→M2→Y)	0.251	0.028	0.195	0.307
Indirect effect (X→M1→ M2→Y)	0.010	0.005	0.002	0.020

Evidence from the mediation analysis confirmed that self-efficacy and social support significantly mediated the link between problem-solving and resilience for social support (B = 0.028, BCa 95% CI = 0.011; 0.052), and self-efficacy (B = 0.251, BCa 95% CI = 0.195; 0.307). Additionally, it was observed that problem-solving facilitated resilience through social support and self-efficacy (B = 0.010, BCa 95% CI = 0.002; 0.020).

Discussion

This cross-sectional study employed a serial mediation modelling approach to explore whether perceived social support and self-efficacy mediate the relationship between nursing students’ social problem-solving abilities and their resilience. To the best of our knowledge, it represents the initial attempt to integrate all four positive psychology constructs within a single serial mediation model conducted with nursing students.

The findings confirmed that problem-solving skills were correlated positively with resilience, self-efficacy, and perceived social support. Furthermore, problem-solving predicted significantly each of these variables. In addition, both self-efficacy and social support were found to act as mediators between problem-solving and resilience. These findings correspond with previous research [26, 27, 37, 56]. Another finding of this study indicates that self-efficacy plays a stronger mediating role than perceived social support in the relationship between social problem-solving and resilience. While the theoretical rationale for the ordering of the mediators was informed by Conservation of Resources Theory and supporting empirical evidence, it is important to emphasise that the present cross-sectional design does not permit temporal or causal inferences. These results suggest that the psychological processes shaping resilience in nursing students operate primarily through individual beliefs and self-regulatory mechanisms. According to Bandura’s Social Cognitive Theory, although social support constitutes an important environmental resource that fosters self-efficacy (e.g., through modelling, verbal persuasion, and emotional encouragement), its behavioural impact is primarily manifested via self-efficacy [24]. Similar patterns have been reported in the literature: among Chinese nursing students, the effect of perceived social support on e-health literacy was found to be significant through self-efficacy [44]. In another study, both self-efficacy and psychological resilience mediated the relationship between perfectionism and learning motivation, with self-efficacy exhibiting a stronger mediating effect [45]. Additionally, research examining the link between clinical learning environments and nursing competence identified self-efficacy as a significant mediator, accounting for 45.9% of the relationship [57]. Collectively, these findings underscore that, while social support remains important, self-efficacy represents a central mechanism in fostering resilience. Therefore, nursing education should provide supportive environments and strengthen students’ self-efficacy through strategies such as mastery experiences, constructive feedback, role modelling, and self-reflective performance improvement to enhance their ability to cope with academic and clinical challenges [5, 16].

Problem-solving skills are crucial for nurses when planning and implementing appropriate interventions. As such, fostering this competence among student nurses during their academic and clinical studies is of great importance. However, students in various countries have expressed challenges in mastering problem-solving [4, 18, 22, 34]. This is particularly evident in clinical contexts where students must accurately identify patients’ health issues through systematic reasoning and sound decision-making processes. Providing problem-solving training to nursing students positively influences their resilience and self-efficacy levels [4].

Resilience enhances nursing students’ coping abilities, psychological well-being, and personal development [12]. Resilient students are generally more capable of withstanding environmental challenges or adversity. Therefore, students who exhibit less resilient behaviours are more likely to face greater difficulties when confronted with stressors and, as a result, regard their studies as more demanding [26]. Resilience—characterised as the ability to maintain psychological stability while recovering from adversity—serves as a vital protective resource for nurses working under challenging conditions [56]. Social support and resilience contribute to nurses’ competence levels.

Resilience and social support may explain self-efficacy in nursing students [26]. According to Labrague (2024), resilience plays a pivotal role in predicting self-efficacy [27]. Resilient individuals show increased intrinsic drive, perseverance, and a strong inclination towards personal development. Their capacity to remain committed and exert sustained effort when confronted with academic challenges contributes to better academic outcomes, a reinforced belief in their capabilities, and elevated self-efficacy [27]. Self-efficacy in nursing students plays a mediating role between professional identity and students’ engagement with learning tasks [58]. Students demonstrating strong self-efficacy are generally more confident in approaching complex tasks, unlike their peers with lower self-efficacy, who often exhibit self-doubt and find it difficult to complete assigned tasks [26]. Perceptions of self-efficacy can vary daily depending on environmental, cognitive, or behavioural factors. Wang et al. (2018) examined how self-efficacy mediated the relationship between resilience and social support from various sources—namely from family, friends, and colleagues— in early-career registered nurses [59]. The study concluded that self-efficacy mediated only the relationship between co-worker support and resilience.

The formation of self-efficacy in students is largely shaped by the presence of social support and the degree of resilience they exhibit [27]. Social support is a crucial component of human life, as it fosters resilience and enhances stress-coping mechanisms. Previous research emphasises the pivotal function of social support in alleviating stress, either by directly mediating its effects or by acting as a moderating factor [28]. Social support has been recognised as a key notion in fostering resilience among nursing students [26]. As nursing students perceive educational support as part of social support, academics should create and maintain an environment that fosters both academic and clinical training.

Labrague (2024) highlights that support and encouragement from key individuals—such as family, friends, educators, or other significant individuals— are essential for maintaining students’ well-being and achieving educational accomplishment [27]. Li et al. (2018) demonstrated that the effect of stress on one’s capability to solve problems is mediated by resilience, self-efficacy, and proactive social support-seeking [37]. In educational contexts, social support serves as a vital resource that empowers students to manage difficulties, strengthens their self-belief, and nurtures a feeling of connectedness. An increase in social support and resilience among university students may also lead to a rise in their academic self-efficacy. Nursing students who possess strong self-efficacy beliefs are generally more capable of addressing academic demands and solving problems during their education. By identifying and nurturing these self-perceptions, nurse educators and academic institutions can implement targeted strategies and support mechanisms that promote students’ confidence, resilience, and overall academic achievement throughout their professional development.

Park and Choi (2025), in their concept analysis study to gain a deeper understanding of nursing students’ resilience levels, identified that resilience comprises 28 sub-features across three key characteristics [12]. The researchers highlighted that individuals who demonstrate resilience commonly exhibit strong problem-solving skills, a high sense of self-efficacy, and access to reliable social support networks. The fact that resilience encompasses so many characteristics makes it a complex concept to understand. This study has facilitated a better understanding of resilience, which plays a crucial role for nursing students.

Limitations

This study has several limitations. Data were collected using self-report measures, which may be susceptible to biases such as social desirability and recall errors. Relying on self-report measures carries a risk of bias, as participants’ responses may not fully correspond to externally observed behaviours or observations by instructors. The study did not account for potential contextual variables such as students’ mental health status, academic workload, or intensity of clinical experience. These factors are considered important as they may influence the relationships among social problem-solving, social support, self-efficacy, and resilience. Convenience sampling was employed for participant selection, which, while facilitating data collection from accessible and willing students, may limit the representativeness of the sample for the broader population of nursing students. Moreover, the sample consisted solely of students from a single nursing faculty, further restricting the generalisability of the findings. Since a cross-sectional methodology was utilised, the outcomes are restricted to the particular timeframe during which the data were collected, and potential changes over time cannot be accounted for.

While the theoretical rationale for the ordering of the mediators is grounded in Social Cognitive Theory and supporting empirical evidence, the cross-sectional design of the present study does not permit temporal or causal inferences. Although the proposed model posits a serial mediation pathway in which social support precedes self-efficacy, the ordering of these mediators should be interpreted with caution. The theoretical justification for this sequence is grounded in Conservation of Resources Theory and supporting empirical evidence, which highlight the role of supportive social environments in fostering self-beliefs [38]. However, the cross-sectional design of the present study precludes establishing temporal precedence, and thus causal inferences regarding the directionality of the observed relationships cannot be made. Resilience and its associated psychosocial variables may interact in complex and potentially synergistic ways that are not fully captured by linear frameworks. Future research employing longitudinal or experimental designs is warranted to more rigorously test the proposed mediator sequence and to explore causal, reciprocal, or alternative pathways. Another limitation of this study is the absence of basic subgroup comparisons, such as those based on gender or academic year.

Implications for nursing education

Several intervention approaches have been shown to be effective in enhancing self-efficacy and resilience among nursing students. For instance, a randomized controlled trial conducted in Türkiye demonstrated that social problem-solving skills training, based on the Social Problem-Solving Model, not only significantly improved students’ social problem-solving abilities but also enhanced their resilience and self-efficacy, while reducing perceived stress levels [4]. A systematic review and meta-analysis examining the effectiveness of resilience-focused educational programs found no significant effect on pre- and post-intervention resilience scores in quasi-experimental studies, and no immediate post-intervention effect in randomized controlled trials; however, a significant effect favouring the intervention group was observed at one-month follow-up [5]. In a study implementing a brief Stress Management and Resiliency Training (SMART) program as part of nurse orientation, participants in the intervention group exhibited increased mindfulness and resilience scores alongside reductions in anxiety and stress levels [60]. Additionally, resilience enhancement programs delivered via online platforms offer greater accessibility for both nurses and nursing students, while providing opportunities to improve resilience and self-confidence [61].

This study highlights the mediating roles of self-efficacy and social support in explaining how individuals’ problem-solving abilities contribute to their resilience. Promoting resilience should be a strategic focus within nursing education, with faculties taking deliberate steps to establish structured support frameworks that enable students to cope with the typical stressors of their academic experience. The cultivation of a constructive and affirming learning environment is fundamental to strengthening learners’ resilience and their sense of self-efficacy. Providing constructive feedback is essential to support students’ academic development. Nursing education providers ought to give precedence to embedding robust social support systems within their curricula. Initiatives like mentorship schemes, resilience-focused workshops, and a positive academic climate have been shown to foster resilience among nursing students [5, 16, 27]. Incorporating dedicated modules that address resilience-building strategies and enhance problem-solving capabilities, along with the establishment of peer support groups, can provide nursing students with tangible methods for managing both academic and clinical demands. As problem-solving skills, belief in one’s abilities, and social support are key characteristics of resilience, teaching problem-solving should be an essential component of the nursing curriculum [12]. A strong sense of self-efficacy is a key determinant in students’ perception of their readiness to undertake clinical responsibilities [62]. Therefore, educators should teach students how to solve problems independently and seek solutions. Using competency-based training through simulations can enhance self-efficacy. Support from academic staff plays a pivotal role in enhancing students’ resilience, thereby enabling them to cope with stress more efficiently, build self-assurance, and perform successfully in clinical contexts [33]. Therefore, it is necessary to invest in programmes that develop educators’ competencies in clinical instruction, effective communication, and mentoring. At the policy level, institutional measures are recommended to facilitate nursing students’ access to psychosocial resources within academic and clinical settings.

Conclusion

The findings of this study indicate that problem-solving ability is a significant predictor of resilience among nursing students, with self-efficacy and social support acting as mediating factors in this relationship. This underscores the need for nursing education to prepare students not only for academic achievement but also for the psychological demands of the profession. Nursing education must take an active role in equipping students to navigate academic and clinical demands, cultivate self-belief, improve resilience, and ultimately enhance their overall academic and professional competence. To achieve this, nursing faculties should prioritise resilience enhancing strategies by dedicating appropriate resources, offering structured training, and establishing robust support mechanisms aimed at strengthening students’ capacity to cope with stress and adversity. The study offers several implications for both nursing education and healthcare policy, advocating for the incorporation of resilience education, the systematic development of problem-solving skills, and the promotion of self-efficacy through ongoing educational and institutional support. Healthcare institutions are likewise urged to cultivate supportive workplace environments and to invest in the lifelong learning and growth of their nursing workforce.

Author contributions

All of the authors are in agreement with the content of the manuscript and meet the authorship criteria. SÜŞ, TT: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Writing - original draft, Writing - review & editing, Supervision, Project administration. FD: Conceptualization, Methodology, Validation, Investigation, Resources, Writing - review & editing, Supervision, Project administration.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

All the data are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This research has been carried out in line with the principles of the Declaration of Helsinki. Ethical clearance for the research was granted by the Non-interventional Clinical Research Ethics Committee of the Faculty of Nursing, Aydın Adnan Menderes University (Protocol No: 2019/120). Request to conduct data collection was also approved by the faculty administration. Prior to participation, students were informed of the study’s aim and scope. Data were gathered through face-to-face interactions. Participation was entirely voluntary; informed consent was secured, and participants were informed of their withdrawal rights throughout the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.