Abstract
Background
In the medical field, nursing students represent the future of the nursing profession.Their resilience and negative emotions are crucial to their personal growth and future job performance. During academic learning and clinical practice, nursing students encounter multiple challenges and stresses, which may potential influence on their mental health. Consequently, deeply investigating the mediating effect of coping styles employed by nursing students between resilience and negative emotions offers important theoretical and practical implications for mental health education and guidance.
Objectives
The research aims to investigate the current situation of negative emotions, resilience and coping styles among nursing students, as well as analyze the related factors influenced negative emotions, explore the relationships between negative emotions, resilience and coping styles, while further exploring how coping styles work between resilience and negative emotions.
Methods
The research conducted a cross-sectional design to survey 2,975 nursing students from two different medical colleges in Hubei Province. Data were collected using the general information questionnaire, the Depression Anxiety Stress Scales-21 (DASS-21), the Connor-Davidson Resilience Scale (CD-RISC), and the Simplified Coping Style Questionnaire (SCSQ). The questionnaire data were analyzed using SPSS 26 and AMOS 17.0.
Results
There is a correlation among negative emotions, resilience and coping styles.Significantly, coping styles exhibit a dual mediation effect between resilience and negative emotions among nursing students. Specifically, resilience influences negative emotions through an indirect pathway mediated by coping styles, with positive (β=-0.147, p < 0.01) and negative (β=-0.042, p < 0.01) coping styles significantly affecting the negative emotions of nursing students.
Conclusion
The study reveals how coping styles work between negative emotions and resilience, emphasizing the pivotal role of positive coping styles in enhancing resilience and maintaining the mental health of nursing students. Therefore, the government, school and practice unit (hospital) should cultivate positive coping styles and while diminishing negative coping approaches. This endeavor aims to improve and boost their resilience, reduce the appearance and duration of negative emotions, and ultimately maintain their mental health at a better level.
Keywords: Dual mediating, Coping style, Resilience, Negative emotions, Mental health, Nursing students
Introduction
A survey by the World Health Organization indicated that 20.3% of university students have experienced mental health problems, college students are increasingly struggling with mental health problems in 21 different countries [1]. As the country with the largest number of college students globally, China also faces the challenge of severe mental health problems among a majority of college students [2]. In the future, nursing students will be recognized as an essential part of the nursing team, shouldering the great responsibility of saving lives [3, 4]. In this challenging environment, some nursing students show remarkable resilience —a ability that enables individuals to overcome adversity and maintain mental health when facing adversities and challenges [5].As a protective factor, resilience plays a pivotal role in reducing the adverse effects of negative emotions on nursing students [6]. In the face of multiple challenges, nursing students with high psychological resilience tend to adopt effective coping styles to handle and resolve problems [7].
The American Psychological Association states that depression, anxiety and stress are emotional responses leading to various symptoms, such as insomnia, exhaustion, and irritability [8]. Globally, nursing students have been reported significantly higher levels of depression, anxiety, and stress compared to general university students and the general population [9–12]. The public health emergency has posed even greater challenges for nursing students, who have had to navigate not only academic [13] and clinical requirements [14] but also fears related to the pandemic [15]. Numerous studies have demonstrated that the public health emergency has seriously increased depression, stress, anxiety [16–18]. If long-time exposure to depression, anxiety, and stress, nursing students may suffer from cognitive disturbances [19] and suicidal tendencies [20]. Those negative emotions not only undermine the psychological health of nursing students but also adversely influence their academic grades, learning efficiency, and clinical competencies [21]. Seriously, negative emotions might lead nursing students to foresee a pessimistic future for their careers, so affecting their professional worth, career selections, and career evolution development [22]. Consequently, it is a critical task to recognize, assessment, and alleviation of negative emotions among nursing students. This is not only important for the personal mental health and development of nursing students but also holds crucial implications for the stability of the future healthcare system.
Resilience is defined by the ability to successfully cope with difficulties and challenges through mental, emotional, and behavioral adjustments, as well as adjustments to internal and external demands [23].Resilience may be considered as a personality trait—a unique quality that modulates the relationship between anxiety and depression.By efficiently using resilience, individuals can avoid further deterioration of their emotional and mental health [24]. For nursing students, resilience is not just a personal virtue but also an indispensable component of their professional competence [25]. Nursing students with high levels of resilience are less likely to feel helpless when faced with various stresses. They typically depend on their abilities to better cope with negative emotions [26]. This significantly boosts their self-efficacy and satisfaction, establishing a solid foundation for their mental health and career development. Conversely, individuals lacking sufficient resilience may be more susceptible to suffer from numerous negative emotions. Meanwhile, resilience plays a significant role in reducing negative emotions among nursing students.It shows a negative relationship with negative emotions such as depression, anxiety, pressure [27], while a positive correlations with mental health levels [28]. Therefore, enhancing the resilience levels of nursing students is important for cultivating future healthcare professionals with good psychological qualities and professional competencies.
Coping styles are some cognitive adjustments and behavioral response strategies, when individuals faced with stress or challenges, and the significance of these strategies cannot be overlooked. Coping styles are primarily classified into two types: positive coping and passive coping [29]. Current research demonstrates that coping styles are the most critical predictors of mental health, directly correlated with individuals’ psychological well-being. Positive coping styles (including problem-solving and seeking assistance) promote emotional well-being [30], whereas negative coping styles (including self-blame, fantasy, repression and so on) adversely affect emotions [31]. Meanwhile, studies have also indicated a significant correlation between coping styles and resilience [7, 32].
Folkman & Lazarus proposed the Stress-Coping Theory [33]. The theory emphasizes that stress is not solely determined by the event itself but is also significantly influenced by an individual’s subjective assessment of the event and their coping styles. When stress occurs, individuals first assess their external resources and internal capabilities. Subsequently, based on these assessments, they adopt different coping styles, which ultimately impact the occurrence of adverse outcomes. The choice of coping styles is affected by diverse situations and personal characteristics. Effective coping styles can alleviate stress and enhance mental health.In this research, academic tasks, clinical tasks and trivial matters are stressors. Resilience represents their internal capacities, negative emotions is a possible adverse outcomes. These elements together influence an individual’s selection of different coping styles when facing stress, thereby generating different outcomes.
In the background of the increasing importance of nursing education and the increasing prominence of mental health problems among nursing undergraduates, it is crucial to explore the internal relationship between resilience and negative emotions. Currently, for the mediating effects of coping strategies, the majority of research have focused on pandemic fatigue and health promotion [34], perceived parenting styles and learning motivation [35], prosocial actions and perceptions of well-being [36], stressors and depressive symptoms [37] and the like.However, there lacks sufficient evidence to substantiate that coping styles have a dual influence on the resilience and negative emotions of nursing students.
This research aims to understand the current status of negative emotions, resilience and coping styles, as well as to explore the related factors that influence negative emotions.It further examines how resilience influences negative emotions among nursing students and analyze the dual mediating role of coping style in this process. Besides, this study aims to enrich the research content of related fields and provide targeted guidance and references for the long-term development of nursing undergraduates’ mental health education and professional competence among nursing students.
Based on literature review, we construct a hypothetical framework (Fig. 1), our specific hypotheses:
Fig. 1.
The mediated model of positive coping and negative coping between resilience and negative emotions
(1)resilience is negatively correlated with negative emotions
(2)resilience is positively correlated with positive coping style
(3)resilience is negatively correlated with negative coping style
(4)positive coping style is negatively correlated with negative emotions
(5)negative coping style is positively correlated with negative emotions
(6) coping style is a dual mediator between resilience and negative emotions
Methods
Study design
The research is a cross-sectional study, which investigates and analyses the relationship among resilience, coping style and negative emotions.A total of 2,975 participants were recruited from nursing students at two medical colleges in Hubei Province by convenience sampling methods, with the data collection period spanning from May 1, 2023, to April 1, 2024.The inclusion criterion were: (1)aged 18 years or older; (2)voluntary participation and informed consent; (3)currently enrolled in a full-time nursing education program.The exclusion criterion were: (1)students with psychiatric disorders; (2)students receiving psychological therapy. The total sample size was set to be 5 to 10 times the number of research variables. The total number of variables were 74,based on 5 ~ 10 times, the intended total sample size of this study was 370 ~ 740. The additional 20% increase was included to due to account for the potential sample size losses, so a final sample size was 444 ~ 888. In our research, the sample size was deemed adequate [38].
Research tool
Research tool comprised of items on the general information questionnaire and three assessment Questionnaires, namely the Connor-Davidson Resilience Scale(CD-RISC), the Depression Anxiety Stress Scale-21(DASS-21), and the Simplified Coping Style Questionnaire (SCSQ).
The general information questionnaire
The general information questionnaire include gender (male/female), location (village/town/city), family structure (original family/single-parent family/reconstituted family), only-child (yes/no), student leader (yes/no), parents-student relationship (bad/average/good), teacher-student relationship (bad/average/good), adverse childhood experience (zero/one/two /more than two types).
Depression Anxiety Stress Scales-21 (DASS-21)
In this study, we used the Chinese version of DASS-21, which was a self-report questionnaire revised by Chinese scholars [39]. The scale comprises three dimensions: depression (items3,5,10,13,16,17,21), anxiety (items2,4,7,9,15,19,20), and stress (items1,6,8,11,12,14,18). Each dimension has 7 questions, totaling 21 items. Each item is scored using a Likert scale ranging from 0 (not true at all/never) to 3 (true nearly all of the time/almost always). A higher score indicates a higher level of disorder. According to scores obtained, participants are classified into normal (depression 0 ~ 9points; anxiety 0 ~ 7points; stress 0 ~ 14points), mild (depression 10 ~ 13; anxiety 8 ~ 9; stress 15 ~ 18), moderate (depression 14 ~ 20; anxiety 10 ~ 14; stress 19 ~ 25), severe (depression 21 ~ 27; anxiety 15 ~ 19; stress 26 ~ 33), and very severe (depression ≥ 28; anxiety ≥ 20; stress ≥ 34) based on their responses. The internal consistency was excellent (Cronbach α = 0. 73 ~ 0. 78).The Cronbach’s α of the scale in this study was 0.956.
Connor-Davidson Resilience Scale (CD-RISC)
The CD-RISC is the most commonly used instrument to evaluate resilience, specifically the ability to copy with adversity [40]. The Chinese version CD-RISC consists of 25 items instrument [41]. It has 3 dimensions: tenacity, strength and optimism, with a good internal consistency coefficients (0.91). The score ranges from 0 to 100. Tenacity includes 13 items (11–23). Strength comprises 8 items (1,5,7–10,24,25). Optimism consists of items 2,3,4,6. This is a 5-point Likert scale (ranging from 0 = not true at all to 4 = true nearly all the time), with higher scores indicating greater resilience. The Cronbach’s α of the scale in this study was 0.096.
Simplified Coping Style Questionnaire (SCSQ)
This study used the SCSQ developed by Chinese scholar Jie, which be used to evaluate the coping styles of individuals when they face challenges [42]. The questionnaire consists of 20 items for the two dimensions: positive coping (1 ~ 12items), with the score ranges from 0 to 36 and negative coping (13 ~ 20items), with the score ranges from 0 to 24. Each item was measured using 4-point Likert scale:0 (never take) to 3 (often take). In this study, the Cronbach ’ s α is 0.839, indicating good reliability and validity.
Data collection
The questionnaire was distributed to the students through Wechat. Before the formal survey, permission had been secured from school administrators, and counselors and full-time teachers were recruited. To ensure the standardization and accuracy of the questionnaire, we carried out a comprehensive training for counselors and full-time teachers by using online PPT presentations and video lectures. The training covered the study objective, significance, logical framework of the questionnaire, scoring criteria, instructions for completing and ethical requirements. Meanwhile, a simulated distribution exercise was conducted to enable teachers to directly experience the questionnaire distribution process. Subsequently, the counselors and full-time teachers introduced the research to the students. Before filling in the questionnaire, students carefully read and agreed to the informed consent. If they consent to participate, they can complete the questionnaires at their convenient time. They also had enough power to quit at any time. All questionnaires were submitted anonymously. Furthermore, all questionnaires were kept confidential and used only for the purpose of this study.
Statistical analysis
The questionnaire data were analyzed using SPSS 26 and AMOS 17.0. Descriptive statistics were used to describe social demographic information of the participants. Chi-square tests were utilized to analyse differences in negative emotions among various demographic characteristics. Pearson correlation coefficients were used to assess the correlations among different variables. Structural equation modeling (SEM) was employed to test the mediating role of coping styles between resilience and negative emotions. The Goodness-of-Fit Index (GFI > 0.90), Adjusted Goodness-of-Fit Index (AGFI > 0.90), Normed Fit Index (NFI > 0.90), Incremental Fit Index (IFI > 0.90), Tacker-Lewis index (TLI > 0.90), Comparative Fit Index (CFI > 0.90), chi-square/degrees of freedom ratio(χ²/df < 5)and Root Mean Square Error of Approximation (RMSEA) were used to evaluate the good fit of the structural equation model. An RMSEA values < 0.05 means good fit, and values of 0.08 mean reasonable error and an acceptable fit.
Results
Nursing students characteristics
In this study, a total of 3065 questionnaires were distributed, 90 unqualified questionnaires were removed. The final number of valid surveys was 2975, resulting a valid response rate of 97% response rate. The detailed social-demographic characteristics of the nursing students are presented in Table 1.
Table 1.
Social-demographic characteristics of the participants (N = 2975)
| Variables | N(%) |
|---|---|
| Gender | |
| Male | 667(22.4) |
| Female | 2308(77.6) |
| Location | |
| Village | 1490(50.1) |
| Town | 838(28.2) |
| City | 647(21.7) |
| Family Structure | |
| Original family | 2611(87.8) |
| Single-parent family | 224(7.5) |
| Reconstituted family | 140(4.7) |
| Only-Child | |
| Yes | 948(31.9) |
| No | 2027(68.1) |
| Student leader | |
| Yes | 734(24.7) |
| No | 2241(75.3) |
| Parents-Student Relationship | |
| Bad | 88(2.9) |
| Average | 743(25) |
| Good | 2144(72.1) |
| Teacher-Student Relationship | |
| Bad | 39(1.3) |
| Average | 1248(41.9) |
| Good | 1688(56.8) |
| Adverse Childhood Experience | |
| Zero | 1723(57.9) |
| One | 658(22.1) |
| Two | 306(10.3) |
| More than two types | 288(9.7) |
Comparison of negative emotions according to different nursing students characteristics data
The average scores for negative emotions was 27.96 ± 23.85.Specifically, the depression score was 8.53 ± 8.08,the anxiety score was 8.33 ± 7.55, the stress score was 10.59 ± 7.79. Chi-square tests were conducted to compare negative emotions (depression, anxiety and stress) among different nursing students characteristics (Table 2). For negative emotions, we observed statistically significant differences in terms of gender, location, family structure, parent-student relationship, teacher-student relationship, relationship with teachers and adverse childhood experience.
Table 2.
Comparison of depression, anxiety and stress in different social-demographic subgroups
| Variables | Category | N | Depression | Anxiety | Stress | |
|---|---|---|---|---|---|---|
| Gender | Male | 667 | 367(55.02) | 373(55.92) | 211(31.63) | |
| Female | 2308 | 903(39.12) | 1043(45.19) | 516(22.36) | ||
| x2 | 53.455 | 23.892 | 24.118 | |||
| P | <0.01 | <0.01 | <0.01 | |||
| Location | Village | 1490 | 660(44.30) | 750(50.34) | 364(24.43) | |
| Town | 838 | 359(42.84) | 403(48.09) | 201(23.99) | ||
| City | 647 | 251(38.79) | 263(40.65) | 162(25.04) | ||
| x2 | 5.59 | 17.084 | 0.219 | |||
| P | 0.061 | <0.01 | 0.896 | |||
| Family structure | Original family | 2611 | 1099(42.09) | 1219(46.69) | 622(23.82) | |
| Single-parent family | 224 | 111(49.55) | 129(57.59) | 74(33.03) | ||
| Reconstituted family | 140 | 60(42.86) | 68(48.57) | 31(22.14) | ||
| x2 | 4.697 | 9.887 | 9.903 | |||
| P | 0.095 | <0.01 | <0.01 | |||
| Only-Child | Yes | 948 | 398 | 437 | 241 | |
| No | 2027 | 872 | 979 | 486 | ||
| x2 | 0.283 | 1.254 | 0.731 | |||
| P | 0.594 | 0.263 | 0.393 | |||
| Student leader | Yes | 734 | 307(41.83) | 359(48.91) | 175(23.84) | |
| No | 2241 | 963(42.97) | 1057(47.17) | 552(24.63) | ||
| x2 | 0.297 | 0.674 | 0.187 | |||
| P | 0.586 | 0.412 | 0.666 | |||
| Parents-Student Relationship | Bad | 88 | 57(64.77) | 59(67.05) | 39(73.61) | |
| Average | 743 | 394(53.03) | 421(56.66) | 225(30.28) | ||
| Good | 2144 | 819(38.20) | 936(43.66) | 463(21.59) | ||
| x2 | 67.669 | 51.17 | 41.964 | |||
| P | <0.01 | <0.01 | <0.01 | |||
| Teacher-Student Relationship | Bad | 39 | 32(82.05) | 32(82.05) | 24(61.54) | |
| Average | 1248 | 651(52.16) | 693(55.53) | 354(28.36) | ||
| Good | 1688 | 587(34.77) | 691(40.94) | 349(20.26) | ||
| x2 | 113.702 | 80.068 | 52.438 | |||
| P | <0.01 | <0.01 | <0.01 | |||
| Adverse Childhood Experience | Zero | 1723 | 659(38.25) | 733(42.54) | 346(20.08) | |
| One | 658 | 274(41.64) | 314(47.72) | 166(25.23) | ||
| Two | 306 | 156(50.98) | 181(59.15) | 88(28.75) | ||
| More than two types | 288 | 181(62.85) | 188(65.28) | 127(44.09) | ||
| x2 | 70.623 | 70.127 | 81.306 | |||
| P | <0.01 | <0.01 | <0.01 |
Correlations among resilience, coping style and negative emotions
Table 3 describes the mean value, standard deviations(SD) and Pearson correlation coefficients. The results of the study showed that the resilience was positively correlated with positive coping (p < 0.01) and negatively correlated with negative coping (p < 0.01); positive coping was negatively correlated with negative emotions (p < 0.001); negative coping was positively correlated with negative emotions(p < 0.01) and the resilience was negatively correlated with negative emotions (p < 0.01).
Table 3.
The correlation relationships between the resilience, coping styles, and negative emotions
| Variables | Mean(SD) | Negative emotions | Resilience | Coping style | Positive coping style | Negative coping style |
|---|---|---|---|---|---|---|
| Negative emotions | 54.90(44.40) | - | ||||
| Resilience | 79.35(16.60) | -0.259** | - | |||
| Positive coping style | 22.85(5.84) | -0.309** | 0.421** | - | - | |
| Negative coping style | 11.05(4.03) | 0.287** | -0.080** | - | - | - |
**P < 0.01
Structural equation modeling
The model fit indices presented a preferably level, with x2/df = 4.325, GFI = 0.979, AGFI = 0.945, NFI = 0.985, IFI = 0.986, TLI = 0.972, CFI = 0.986 and RMSEA = 0.076. Table 4 shows the direct and indirect effects of each variable.In this study, hypothesis 1 was supported. Resilience had a positive direct effect on negative emotions (β=-0.112, p < 0.001); Resilience had a positive direct influence on positive coping style(β = 0.424, p < 0.001), which supported Hypothesis 2. Meanwhile, resilience had directly negative influence on negative coping style(β=-0.137, p < 0.001), which supports Hypothesis 3; Hypothesis 4 was also supported, positive coping style had directly negative influence on mental health(β=-0.347, p < 0.001); Negative coping style had directly positive influence on negative emotions(β = 0.308, p < 0.001), which supported Hypothesis 5; resilience had indirect effect on mental health through positive coping style (β=-0.147, p < 0.001) and negative coping style (β=-0.042, p < 0.001), coping style is a dual mediator between resilience and negative emotions.Hypothesis 6 was supported.The model is presented in Fig. 1.
Table 4.
The mediating effect of coping styles in the relationship resilience and negative emotions (N = 2975)
| Variables | Effect | Percentage(%) | SE | 95% CI | |
|---|---|---|---|---|---|
| Total Variables | resilience-negative emotions | -0.301 | 0.001 | (-0.328~-0.263) | |
| Direct effect | resilience-negative emotions | -0.112 | 0.372 | 0.001 | (-0.141~-0.074) |
| Indirect effect | Total Indirect effect | -0.189 | 0.631 | 0.001 | (-0.209~-0.172) |
| resilience-positive coping-negative emotions | -0.147 | 0.488 | 0.001 | (-0.163~-0.167) | |
| resilience-negative coping-negative emotions | -0.042 | 0.140 | 0.000 | (-0.054~-0.029) |
Discussion
Our research aims to investigate the dual mediation effects of coping styles between resilience and negative emotions among nursing students, when they confront with multiple pressures including academics, employment, and clinical practice pressures. The research demonstrated how resilience influences negative emotions via positive or negative coping styles. It revealed a significant negative correlation between resilience and negative emotions among nursing students, with coping styles acting as a pivotal dual mediating role in this process. Specifically, our study highlights that resilience not only directly influences the negative emotions of nursing students but also indirectly regulates their emotional states through different types of coping styles.
Consistent with numerous previous studies, our research indicates that the psychological state of nursing students is not ideal [43]. Our study further demonstrates this observation, finding that the prevalence of depression was 42.7%, anxiety was 47.6%, and perceived stress was 24.4% among the nursing students in this study. Our research indicates higher results compared to Tung’s (2018) findings [44], potentially due to the lingering impact of the public health emergency and various academic and life pressures on the mental health of nursing students.Notably, despite numerous researches have emphasized that female nursing students tend to experience more negative emotions [45, 46], our research revealed that male students also suffer from severe negative emotions, in some aspects even further deterioration.This finding is consistent with the results of studies conducted by Cao [47] and Zhang [48].We analyzed the reasons and concluded that, on the one hand, due to stereotypes in society and culture, male nursing students are easily being questioned and misunderstood by those around them, which brings them great psychological pressure. On the other hand, male nursing students may still encounter some implicit gender bias. For example, some patients may be more inclined to accept nursing services by female nurses. Meanwhile, some specific departments (such as gynecology, obstetrics, etc.) may have implicit restrictions on males. Such concerns about career development will bring them long-term pressure, leading them to have great negative emotions. From a regional perspective, Gao [47] in her 2020 study found that nursing students in urban areas have more negative emotions due to the high infection and morbidity rates.Our research findings indicate that nursing students are still affected by negative emotions in the post-pandemic period. Moreover, the current study also reveals that family factors have a significant influence on the mental health of nursing students.Those from single-parent families, reconstituted families or with strained parental relationships show more severe negative emotions. This aligns with Chu’s findings [48] that family functioning greatly influences the mental health of its members. In addition, similar to the majority of studies [49], nursing students with good teacher-student demonstrate predicted lower levels of negative emotions. Furthermore, similar to previous study [50], our findings indicate that nursing students with adverse childhood experiences exhibit more negative emotions, further highlighting the critical impact early life experiences in mental health development.
Our research indicates the resilience score is 79.35 ± 16.60, which is lower than the results of Wan’s [36] research but higher than Xu’s [51] and Devi’s [52] findings. These potential discrepancies may stem from differences in research samples, cultural backgrounds, and other factors.However, it is crucial to acknowledge that despite the majority of nursing students demonstrate resilience scores above average, still some students showed lower a level of resilience. This may be attributed to various factors, including individual differences, family environments, educational environments and so on. In our research, nursing students scored 22.85 ± 5.84 on positive coping styles, which is above average and consistent with the Li’s study [53], positive coping styles enable nursing students to understand and solve problems more objectively and comprehensively, thus reducing negative emotions to a certain extent. The score for negative coping styles was 11.05 ± 4.03,indicating a relatively lower level but still higher than the Ma’s [54] findings. We analyzed the results of our study, we deem that it is possible that these nursing students might have been in clinical practice during our study, when the high-pressure environment they were in could have led them to adopt negative coping styles. Our research suggests that the majority of nursing students adopt positive coping styles when confronted with problems; however, some students tend to adopt negative styles. Fortunately, in recent years schools, the nation and society have paid increasing attention to the mental well-being of nursing students, for example carrying out mental health education, setting up psychological counseling centers and providing comprehensive support and assistance for them. Meanwhile, the outbreak of the COVID-19 pandemic has enhanced public awareness and support for the nursing profession, significantly strengthening nursing students’ professional value recognition and identity, empowering them to maintain a positive attitude in the face of pressure.
The present study indicates a negative association between resilience and negative emotions (r = -0.259, p < 0.01), supporting our first research hypothesis 1. Higher resilience effectively buffers against negative emotions, consistent with previous many studies [55, 56]. Similar to most studies [36, 57, 58], our study revealed a negative correlation between resilience and passive coping style (r=-0.080,p < 0.01) and a positive correlation with positive coping style (r = 0.421,p < 0.01). In the face of difficulties, students with higher resilience are tend to adopt positive coping style, thereby significantly diminishing the use of passive coping style. The correlation between active coping style and negative emotions is negative (r = -0.309, p < 0.01). When encountering setbacks, students who remain positive active attitude and use positive style will be able to easily address matters and significantly reduce negative emotions, consistent with Ma [54] and Rezapour-Mirsaleh [59].
Our research indicates that resilience influences negative emotions via an indirect pathway mediated by coping styles.In particular, positive (β=-0.147, p < 0.001) and negative (β=-0.042, p < 0.001)coping styles significantly affect the negative emotions of nursing students. The result aligns with our study hypothesis. Specifically, when positive coping styles act as a mediator variable, they greatly amplify the effect of resilience on negative emotions. It means that when nursing students encounter challenges, adopting positive coping styles such as seeking social support, maintaining an optimistic outlook, creating solutions, their resilience will be translated into a resistance to negative emotions. Positive coping styles assist nursing students in directly confronting and resolving problems, therefore reducing the persistent influence of negative emotions by developing their self-efficacy and psychological resilience. On the other hand, when serving as mediating variables, passive coping styles also play a significant moderating role.Nursing students who adopt passive coping styles such as avoidance, denial and self-blame, their resilience is seriously weakened, rendering them more susceptible to the influence of negative emotions. Such situation not only fails to resolve issues but may also exacerbate their psychological burdens, generating a continuous cycle of negative emotional disturbances.
Implications
By analyzing the findings of this study, we have concluded the following conclusion: to effectively strengthen the mental health of nursing students, concerted efforts from many different groups are necessary. The nation should focus on improving policies related to mental health in nursing education, and providing special funding for mental health education in nursing higher education institutions; at the same time, the government should integrate resources to establish a mental health database on nursing students, actively promoting research in this field. Schools need to further optimize the curriculum system by adding mental health courses to the nursing curriculum as mandatory credits.They should also improve the psychological support system by setting up a 24-hour psychological counseling service hotline and conducting group counseling on a regular basis. Hospitals ought to carry out psychological resilience training before clinical practice and regularly organize psychological counselling workshops during clinical practice to strengthen their ability to copy with clinical stress.They should scientifically plan shift schedules to avoid consecutive scheduling in high-intensity sections and optimize the internship environment by setting up “stress-free days” or “mentor care time”, thereby encouraging students to express their emotions.
Study limitations
There are certain limitations in this study. The cross-sectional design only emphasized the status of various indicators among nursing students in a specific time period, failing to reveal the dynamic evolution of nursing students’ psychological resilience and coping styles over time.In terms of the research methodology, the use of convenience sampling and online data collection may have led to some errors.Meanwhile, this study focuses on specific groups and regions limited the generalizability of the findings.
Future research
Future research can be enhanced in the following ways: implementing longitudinal studies to track changes in psychological resilience and coping styles at different time points; improving research methodology by combining field investigation and online data collection to reduce research errors and enhance the representativeness of the samples data; confining the scope of the study population by integrating different levels of education and different regions. In order to compare the differences in psychological resilience and coping styles among different groups, thereby offering solid theoretical foundations and practical guidance for the development of the nursing field.
Conclusions
By adopting scientific research methodologies and rigorous data analysis, we investigated the impact of gender, location, family structure, yes/no only-child, yes/no student leader, parent-student relationships, teacher-student relationships and adverse childhood experiences on the negative emotions.The study found that resilience has a significantly negative influence on negative emotions, while concurrently revealing a significantly positive influence on positive coping style and a significant negative influence on negative coping style.Positive coping styles have significantly negative influence on negative emotions, whereas negative coping styles have significantly positive influence on negative emotions.Coping styles play a significant dual role in mediating the relationship between resilience and negative emotions of nursing students. The government, school and practice unit(hospital) should cultivate positive coping styles, diminish passive coping styles of nursing student to enhance and boost their resilience and maintain their mental health at a better level.
Acknowledgements
We thank all the participants of the survey.
Author contributions
Lvman Xiao: Data curation, Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing.Yujie Liu: Data curation, Investigation, Validation.Min Wu: Methodology, Project administration, Supervision. Jia Jia: Methodology, Project administration,Supervision. Zefeng Bao: Data curation, Investigation.Yangxue Tao: Data curation, Investigation.Xin Mei: Data curation, Investigation.Weiling He: Investigation, Resources.Jinyu Fan: Investigation, Resources.Zhixiao Li: Investigation, Resources.Yiting Tuo: Investigation, Resources.Li Ke: Conceptualization, Methodology, Project administration; Supervision, Validation, Visualization, Writing - review & editing.
Funding
This study was supported by Key Philosophy and Social Science Research Project of Department of Education of Hubei Province (Grant. 24D091);The program of the innovation and Entrepreneurship training program for students of Hubei University of Medicine(X202410929058);Teaching and Research Fund Project of Hubei University of Medicine in 2024 (2024039);The supply and demand matching employment Education Project of Ministry of Education of the People’s Republic of China (2025010532133).
Data availability
The data in this research can be obtained from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Our research is based on a survey questionnaire, does not involve clinical trials or any interventional procedures, and therefore does not meet the criteria requiring Clinical Trial registration.Clinical Trial number: not applicable.But this study was approved by the Institutional Review Board of the Hubei University of Medicine (Approval no. RW20220922). All methods were performed in accordance with the Declaration of Helsinki (as revised in 2013). Written informed consent was obtained before administering the survey. Participating students were promised that the information provided would remain anonymous.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Data Availability Statement
The data in this research can be obtained from the corresponding author on reasonable request.