Empathy is essential in mental health nursing, as nurses serve as the first point of contact for individuals and families, playing a key role in building therapeutic relationships and providing culturally safe care. Despite its importance, empathy remains a complex and underexplored concept, particularly in culturally diverse contexts. The current study subjectively explored the cultural factors influencing nursing students' empathy toward people with mental illness. Q-methodology was used to investigate the subjective perspectives of nursing students on empathy. Nursing students were recruited to represent culturally diverse backgrounds. The sample included 23 undergraduate nursing students residing in Australia. Participants ranked 40 statements derived from a literature review on cultural tightness, relational mobility, and causal attributions of mental illness. Participants shared their subjective viewpoints by arranging the statements onto a quasi-normal distribution grid (Q-sort). The completed Q sorts were analysed using by-person factor analysis, and responses to follow-up open questions were used to enrich the interpretations of the factors. Two viewpoints explaining 49% of the variance were identified by the nursing students: "The Role of Internal Attributions and Intentional Relationships" and "The Role of External Attributions and Biological Scepticism" in empathising with people with mental illness. This study underscores the importance of understanding nursing students' socio-cultural norms, particularly as they may reflect Westernised or acculturated perspectives. The findings from this study can help inform clinical practices and interventions aimed at addressing knowledge gaps in understanding mental illness symptoms. This support is especially important as nursing students prepare for roles in mental health care settings.
The rapid integration of generative artificial intelligence (GenAI) tools, such as ChatGPT, into educational contexts has raised important questions regarding how adolescents conceptualize and make sense of these technologies. Understanding students' perceptions is essential for developing age-appropriate, ethical, and pedagogically sound approaches to AI use in secondary education. This descriptive qualitative study employed a phenomenological approach and metaphor analysis to explore secondary school students' perceptions of generative artificial intelligence. The study sample consisted of 332 students aged 14-18 years from four secondary schools in Türkiye. Data were collected using an open-ended prompt ("Generative artificial intelligence is like … because …") and analyzed through content analysis. Metaphors were categorized based on shared semantic and conceptual features, and inter-rater reliability was established using Cohen's kappa (κ = 0.92). Analysis revealed ten metaphor categories clustered under five overarching themes: generative artificial intelligence as (1) a source of knowledge, (2) a teaching and guiding entity, (3) a supportive and assisting tool, (4) a reflection of human intelligence, and (5) a dual-purpose (beneficial-risky) technology. Students most frequently conceptualized GenAI as a comprehensive knowledge source (e.g., book, encyclopedia) and as a human-like cognitive entity (e.g., brain, wise person). At the same time, metaphors reflecting ethical awareness and potential risks, such as misuse and overreliance, were also identified. The findings indicate that secondary school students hold multifaceted and nuanced perceptions of generative artificial intelligence, encompassing both educational opportunities and ethical concerns. These results highlight the importance of integrating AI literacy into secondary education in ways that promote critical thinking, responsible use, and awareness of GenAI's limitations alongside its potential benefits. It was determined that secondary school students perceive generative artificial intelligence ambivalently as both a useful tool and a source of ethical and emotional concern, highlighting the need for developmentally appropriate artificial intelligence literacy approaches. • GenAI tools such as ChatGPT are increasingly integrated into educational contexts and have the potential to support personalized learning, information access, and student engagement. • Existing research has primarily focused on educators' perspectives or higher education settings, while studies examining adolescents' perceptions of GenAI remain limited. • This study provides empirical evidence on secondary school students' metaphorical perceptions of generative artificial intelligence within a K-12 context. • Findings reveal that adolescents conceptualize GenAI in multifaceted ways, including as a knowledge source, teaching and guiding entity, supportive tool, reflection of human intelligence, and a dual-purpose (beneficial-risky) technology.
Online language is widely used among college students and reflects their communication patterns and psychosocial characteristics in digital contexts. However, existing studies mainly focus on specific aspects such as motivation or emoji use, lacking comprehensive and validated measurement tools. This study aimed to develop and validate a multidimensional scale of online language use among Chinese college students. A multi-stage scale development approach was employed. Initial items were generated through literature review, grounded theory-based interviews, and existing instruments, followed by expert evaluation. Data from 310 students were used for item analysis and exploratory factor analysis (EFA), while 1,171 students participated in confirmatory factor analysis (CFA) and reliability and validity testing. A subsample of 180 students completed a one-month retest. Analyses were conducted using SPSS 27.0, AMOS 29.0, and JASP. The final scale comprised 15 items across three dimensions: usage effectiveness, usage motivation, and usage behavior. EFA supported a three-factor structure, which was confirmed by CFA with good model fit (GFI = 0.992, AGFI = 0.988, SRMR = 0.041, NFI = 0.988). The scale demonstrated strong internal consistency (Cronbach's α = 0.891; McDonald's ω = 0.877) and excellent test-retest reliability (r = 0.957). Construct and criterion-related validity were also supported. The scale is a reliable and valid instrument for assessing online language use among Chinese college students, conceptualized as a multidimensional construct integrating effectiveness, motivation, and behavior.
The COVID-19 pandemic disrupted nursing education worldwide, limiting clinical learning opportunities and increasing psychological stress. These challenges forced nursing students to make career decisions in uncertain, risky, and changing social environments. To explore the scope, influencing factors, and strategies related to nursing students' career choices after the pandemic. A scoping review following Arksey and O'Malley's framework. Six databases were searched without restrictions on language or publication date. Seventeen studies involving 5167 nursing students from Asia, Europe, and the Middle East were included. Data were analyzed thematically to identify career intentions, influencing factors, and development strategies. Most nursing students intended to remain in the profession, although their intentions varied by country and over time. Key positive influences included strengthened professional identity, societal recognition, and supportive learning environments. Negative influences included perceived occupational risk, inadequate compensation, and reduced clinical experience. Recommended strategies included flexible teaching approaches, enhanced clinical preparation, psychological support, and policy measures to improve working conditions and enhance professional image. Despite these significant challenges, many nursing students showed resilience and a willingness to remain in nursing. Investment in education, mentorship, and workforce policy is vital to sustain the nursing workforce and strengthen healthcare resilience in the face of future crises.
With the rising incidence of psychological crisis among university students, the research focus has gradually shifted from a symptom-based to a protective-factor perspective, in which school connectedness is considered a potential protective factor. This study aimed to examine the network structure linking school connectedness and psychological crisis among university students, thereby providing empirical evidence for understanding the associations between these constructs. A total of 3,580 undergraduates from five universities in Henan Province, China, were surveyed using the School Connectedness Questionnaire and the Psychological Crisis Questionnaire. Network analysis was employed to reveal the associative patterns between the two constructs. (i) The network structure of school connectedness and psychological crisis was stable, with relatively strong internal connections within each cluster. In the cross-cluster network, a covariation was observed between "I can rely on my classmates when facing difficulties" (PS1) and "People around me hold prejudices against me" (CD4). (ii) Centrality analysis revealed that "Feeling lonely and helpless, as if on the verge of emotional collapse" (EBD8) and "Feeling incapable of doing anything well" (CD7) exhibited the highest expected influence. (iii) Bridge centrality results showed that "I can rely on my classmates when facing difficulties" (PS1) and "My classmates share happiness and sorrow with me" (PS3) had the strongest connections to the psychological crisis network, whereas "Feeling lonely and helpless, as if on the verge of emotional collapse" (EBD8) and "Having pessimistic or suicidal thoughts" (CD1) had the strongest connections to the school connectedness network. (iv) The global connectivity strength invariance test indicated that the global strength of the female network was significantly higher than that of the male network. This study employed psychological network analysis to systematically construct a school connectedness-psychological crisis network model among Chinese university students, revealing the complex associative structure between protective factors and crisis symptoms. Alleviating loneliness, correcting negative self-perceptions, and strengthening peer support may serve as three core targets for the prevention and intervention of psychological crisis among university students, potentially contributing to improved mental health and school adaptation.
Intersex surgery, formerly known as 'sex correction', is a medical procedure that aligns an individual's physical characteristics with their assigned sex at birth. Awareness and attitudes among university students in Saudi Arabia regarding intersex surgeries remain largely unexplored. A cross-sectional online survey was conducted among undergraduate students at King Faisal University. Participants were recruited using convenience sampling from various colleges. The self-administered questionnaire included four sections: (1) demographic information, (2) awareness of intersex surgery, (3) knowledge of distinguishing intersex from transgender identity, and (4) attitudes toward individuals who have undergone intersex surgery. The internal consistency reliability was assessed using Cronbach's alpha (α = 0.96). A total of 400 students participated in the study, including 270 females (67.5%) and 130 males (32.5%). Of these, 189 (47.4%) demonstrated a high level of understanding of the difference between sex correction and gender transition, and 197 participants (49.3%) showed positive attitudes. Awareness was significantly associated with gender, age group, and college type (p < 0.05). Attitudes were significantly associated with age group (χ² = 8.338, p = 0.015), with participants aged 21-24 years exhibiting the highest percentage of positive attitudes. The findings highlight the need for culturally sensitive educational initiatives to improve awareness and address misconceptions among university students in Saudi Arabia about intersex surgery.
Depressive symptoms have been on the rise among young adults, with the transition to college, particularly the first year, being a critical period of vulnerability. Despite prior research on depression trajectories in college students, limited longitudinal studies have explored unique depressive symptom trajectory groups among first-year students and their associations with academic achievement (GPA), sleep patterns, and whether sociodemographic factors are associated with certain trajectories. This study analyzed a pre-existing dataset that was collected over two waves from a private university (spring semester 2017 and 2018). The final pooled sample resulted in first-year undergraduate students (N = 271) who reported on their depressive symptoms (CES-D scale) at the start and end of the semester, signed a release record for their fall and spring term GPA, and provided continuous sleep data across the academic spring term with Fitbits. K-means + + clustering was conducted to form depressive symptom trajectory groups. ANOVAs, Watson-Williams, and Dunnett's post hoc comparison tests were employed to examine how the resulting trajectory groups were associated with GPA and sleep outcomes (bedtime, waketime, total sleep time, time in bed). Associations between sociodemographic variables and trajectory groups were investigated using chi-square tests. K-means + + clustering identified four trajectory groups: low-stable (n = 109), increasing (n = 72), decreasing (n = 51), and high-stable depressive symptoms (n = 39). The low-stable and decreasing group had a higher spring term GPA (M = 3.44 and M = 3.39, respectively) compared to the increasing and high-stable groups (M = 3.22 and M = 3.18, respectively). The low-stable group generally had an earlier wake time and bedtime, greater total sleep time and time in bed, relative to the decreasing and increasing trajectory groups. Gender, ethnicity, international student status, and first-generation student status were not associated with trajectory groups. Consistent with prior work, there are unique depression trajectory groups among first-year college students that represent stability and change of depressive symptoms over the course of a spring semester. Favorable trajectories (low-stable and decreasing symptoms) are associated with better academic performance and sleep habits.
Population ageing and the stagnation of life expectancy without loss of autonomy have prompted the development of preventive actions. Falls are a major public health issue and can result in death or severe complications. Epidemiological studies have found that nearly 50% of patients over the age of 85 fall at least once a year. Our objective was to assess the effect of a simulation-based learning tool (a serious game) on knowledge acquisition by nursing students at a French university. We conducted a multicentre, 1:1 randomized, controlled trial (PREVISS-GAME) with two parallel groups. Second-year nursing students attending one of eight nursing institutes associated with the University of Paris-Est Créteil (Créteil, France) were randomized to an intervention group (a serious game plus conventional, knowledge-based teaching) or a control group (conventional, knowledge-based teaching only). In the PREVISS-GAME simulation-based serious game, the player had to care for an older patient who had fallen over. The main outcome was the immediate post-test score (out of 20) in a 12-item knowledge questionnaire. Secondary outcomes included the 4-month post-test score. Of the 517 randomized nursing students (intervention group: n = 261; control group: n = 256), 197 (38%) completed the immediate post-test (99 and 98 in the intervention group and in the control group respectively) and were included in the main analysis. Knowledge acquisition was significantly greater (from 0.8 to nearly 1 point out of 20, representing an increase of approximately 5%) in the intervention group than in the control group among completers, regardless of whether the linear regression model took account of the pre-test score (coefficient [95% confidence interval (CI)] = 0.81 [0.04;1.58], p = 0.039), the nursing institute (coefficient [95%CI] = 0.81 [0.04;1.58], p < 0.041), or demographic and educational characteristics (coefficient [95%CI] = 0.97 [0.17;1.76], p = 0.017). The 4-month outcome could not be analyzed. When compared with conventional training, use of a serious game suggested an improvement among completers in nursing students' knowledge of fall prevention. Further research is needed to assess skills transfer in the clinical and to develop strategies for maintaining student commitment to distance learning.
Smoking, including e-cigarette use, remains a significant global public health issue, with a concerningly high prevalence among female university students in Thailand. Given the unique physiological and psychosocial barriers that female face in cessation, this study aimed to identify determinants of the intention to quit smoking among female university students in Thailand. A cross-sectional study was conducted in the Bangkok vicinity. Using snowball sampling, 423 female university students aged 18-25 years who were current users of tobacco products were recruited. Data were collected via an online questionnaire and analyzed using logistic regression. A majority of participants used e-cigarettes (67.8%), and 52.5% reported a high intention to quit. Factors significantly associated with intention to quit included decisional balance (Adjusted Odds Ratio (AOR) = 3.556; 95% Confidence Interval (CI): 1.852-6.828) and self-efficacy (AOR = 3.371; 95% CI: 1.639-6.932). Other positive correlates were type of smoking (AOR = 3.102; 95% CI: 1.350-7.129), vigorous physical activity (AOR = 2.692; 95% CI: 1.250-5.794), norms and support from peers (AOR = 2.606; 95% CI: 1.124-6.040), and previous quit attempts (AOR = 2.550; 95% CI: 1.194-5.449). Conversely, nicotine dependence (AOR = 0.058; 95% CI: 0.027-0.122), frequency of smoking (AOR = 0.394; 95% CI: 0.202-0.767), and BMI (AOR = 0.500; 95% CI: 0.252-0.992) were inversely associated with intention to quit. Interventions must focus on enhancing decisional balance, self-efficacy and providing targeted support to overcome their unique barriers.
Interprofessional education (IPE) equips healthcare students with collaborative skills essential for patient-centred care. However, fostering engagement in online IPE remains challenging, even as technological advancements enable cross-border learning. This study investigates the effects of virtual reality (VR)-enhanced education on interprofessional learning and student engagement within an online clinical environment. A randomised controlled cross-over trial was undertaken with 102 undergraduate healthcare students across universities in Hong Kong, Mainland China, South Korea, and Thailand. Participants experienced two online orthopaedic modules and were initially assigned to either the intervention group (Group A: VR-based learning) or the control group (Group B: traditional case-based learning). After a three-week washout period, groups switched modalities so every student experienced both approaches. Self-perceived interprofessional skills (SPICE-R), learner empowerment (LES), and online student engagement (OSE) were measured at baseline (T0), after module one (T1), and after module two (T2). Data were analysed using a linear mixed model that accounted for intervention group, time point, and individual differences. At T1, both groups showed significant improvements in interprofessional skills, with Group A (VR) attaining higher scores (SPICE-R: 16.44; 95% CI: 14.07, 18.82; p < 0.001) compared to Group B (13.91; 95% CI: 11.52, 16.31; p < 0.001). Notably, VR learning produced significantly greater increases in online engagement (OSE: 5.65; 95% CI: 1.43, 9.87; p = 0.009) and learner empowerment (LES: 6.97; 95% CI: 1.44, 12.50; p = 0.014) versus case-based learning. At T2, following crossover, students who experienced VR first sustained higher interprofessional skill gains (d = 4.79; 95% CI: 2.00, 7.58; p = 0.001). Correlations between SPICE-R, OSE, and LES strengthened over time. VR-empowered educational technology significantly enhances interprofessional skills, learner empowerment, and online engagement in global healthcare education. VR integration offers a promising strategy for developing collaborative competencies in diverse, international cohorts. Virtual Reality based educational technology enhances learner empowerment, student engagement, and interprofessional learning in online global healthcare education.
This pilot study examined the use of a participatory approach to co-create and prioritise menstrual health actions and interventions with university students in Ecuador. Despite growing recognition of the importance of menstrual health, university students continue to face unmet needs that can affect academic participation and daily life. Between October and November 2023, three in-person workshops engaged a total of 37 students in a structured co-creation process. The first workshop involved collaborative brainstorming, generating 31 proposed actions and interventions organised into four participant-derived categories: resources, support, infrastructure, and education. The second workshop involved thr independent ranking of the actions and interventions using a structured worksheet, with descriptive statistics used to identify a subset of highly prioritised options. The third workshop focused on refining these priorities through guided group discussion. The highest-ranked actions and interventions identified from the participatory process included institutional flexibility for chronic menstrual conditions, education-based initiatives, improved toilet/bathroom access, and student-led support. Rather than providing generalisable evidence of intervention effectiveness or population-level need, this study highlights how participatory, process-oriented methods can help generate a context-specific, student-informed response. Findings highlight the value of participatory approaches in surfacing nuanced, actionable insights in menstrual health research.
Empathy is central to humanised nursing but vulnerable to erosion in demanding academic and clinical settings. Positive mental health (PMH) encompassing emotional, psychological, and social well-being, may regulate how self-compassion is statistically linked to empathic engagement. However, evidence in nursing students remains limited. To examine the statistical association of positive mental health in the relationship between self-compassion and empathy among undergraduate nursing students within a structural equation modelling (SEM) framework. Observational, analytical, cross-sectional study. A total of 402 nursing students from a public university completed validated measures of self-compassion, empathy, and PMH. SEM with latent variables was conducted using diagonally weighted least squares (DWLS) to account for ordinal and non-normal data. Model fit was assessed using multiple indices, acknowledging the complexity of the latent structure. Self-compassion was positively associated with PMH (β = 0.772, p < 0.001), which related positively to empathy (β = 0.689, p < 0.001). The indirect effect via PMH was positive (β = 0.532, p < 0.001), while the direct effect of self-compassion on empathy was negative when controlling for PMH (β = -0.553, p < 0.001), indicating an inconsistent mediation pattern. The model explained 59.6% of the variance in positive mental health and 19.3% in empathy. PMH appears to be a key correlate in the association between self-compassion and empathy. Findings suggest that emotional well-being may be an important foundation for relational competence, although the study's cross-sectional nature precludes causal inferences and the marginal model fit warrants a cautious interpretation. Fostering empathy may require more than interpersonal skills training. Nursing curricula could benefit from integrating positive mental health promotion, including training in self-compassion and emotional regulation, to support empathic and humanised nursing practice across educational and clinical contexts.
This study aimed to examine 8th-grade students' views on the concepts of nanotechnology and nanoscience through the use of the Metaverse in science courses. The study group sample consists of five students from both the before- and after-experience groups, all of whom are in 8th grade. This study employed a qualitative research method with a case study design. Observation, interview, and document analysis were used as data collection tools. Necessary measures have been taken to ensure the validity and reliability of the research within its scope. The data were analyzed using a content analysis approach. As a result of the interviews, data were collected and analyzed. As a result of the textual examinations, code, category, and theme were determined. The findings were presented in categories through tables, and the participants' answers were included in direct quotations. Upon reviewing the literature, it becomes apparent that most studies in nanotechnology and nanoscience are conducted for informational purposes, typically presented as presentations or reports. Given the limited availability of nanotechnology and metaverse education, the study was divided into two groups: a before-experience group and an after-experience group. As a result of the survey, 8th-grade students experience the metaverse and have future expectations for nanotechnology and nanoscience. Their cognitive and affective interests have increased, as evidenced by their questioning why these applications cannot be applied to all courses and by their correct expression of the concepts. At the same time, it has been concluded that using rich materials to concretize abstract concepts, such as nanotechnology, facilitates their teaching. The study provides qualitative evidence that Metaverse-based instruction can enhance both cognitive and affective dimensions of science learning, offering design implications for integrating immersive technologies into middle school curricula to teach abstract concepts.
This perspective article explores the various advantages and disadvantages of using noise-cancelling headphones in educational settings for autistic students with auditory sensory differences. Although noise-cancelling headphones can have several advantages for autistic students in educational settings, it is important that use of such assistive technological tools should not be implemented without a plan and tailoring at an individual level.
This study examined how privacy concerns on short-form video platforms influence creativity among communication students through the mediating roles of TikTok use motives and general information technology identity. Guided by privacy calculus theory, uses and gratifications theory, and identity theory, a three-wave longitudinal design was used with 1217 students from three institutions in Chongqing, China. Privacy concerns were measured at Time 1, TikTok use motives and creativity at Time 2, and general information technology identity and creativity at Time 3. Structural equation modeling with full information maximum likelihood estimation tested mediation and sequential mediation models while controlling for demographic variables and baseline creativity. Results showed that privacy concerns negatively predicted creativity, and both TikTok use motives and general IT identity mediated this association. Sequential mediation analysis indicated that TikTok use motives promoted general IT identity, which in turn enhanced creativity. Findings highlight that motivational and identity-based processes jointly explain how privacy concerns shape creative outcomes. The study enriches theory on digital risk and creativity and offers guidance for educators and policymakers seeking to support innovation while protecting digital well-being.
The rapid integration of artificial intelligence (AI) into higher education is producing divergent learning behaviors, as student AI anxiety appears to both hinder and motivate learning. However, the psychological mechanisms that explain why these divergent responses occur remain underexplored. To address this gap, this study investigates how AI anxiety is associated with university students' motivated and avoidance learning by examining challenge and hindrance appraisals as key mediating mechanisms. The study employed a cross-sectional questionnaire design using established scales adapted to the educational AI context. An online survey was administered to students from three universities in China, yielding 591 valid responses after data screening. Results show that AI learning anxiety is primarily associated with hindrance appraisal, while AI job replacement anxiety is associated with both challenge and hindrance appraisals. Challenge appraisal is positively associated with motivated learning and negatively associated with avoidance learning, whereas hindrance appraisal shows the opposite pattern. AI learning anxiety exhibits consistent negative effects through both direct and indirect pathways, while AI job replacement anxiety exerts entirely indirect effects mediated by appraisal processes. These findings highlight cognitive appraisal as a crucial mechanism explaining the divergent behavioral associations of AI anxiety and offer valuable insights for educational intervention.
With the popularity of short video platforms, Short Video Addiction has become a growing mental health concern. From a cognitive-emotional perspective, this study examined the association between Parental Neglect and Short Video Addiction among college students, focusing on the mediating role of Thought Suppression and the moderating effect of Thought Control Ability. A cross-sectional survey was conducted among 1,337 college students using the Parental Neglect Scale, Short Video Addiction Scale, White Bear Suppression Inventory, and Thought Control Ability Questionnaire. The results showed that Parental Neglect, Thought Suppression, and Short Video Addiction were all significantly and positively correlated with one another, while Thought Control Ability was significantly and negatively correlated with these three variables. Thought Suppression partially mediated the relationship between Parental Neglect and Short Video Addiction, and Thought Control Ability moderated the path from Thought Suppression to Short Video Addiction: for individuals with lower Thought Control Ability, Thought Suppression was a stronger positive predictor of Short Video Addiction; whereas for those with higher Thought Control Ability, this positive association was significantly attenuated. These findings suggest that enhancing individual Thought Control Ability may be associated with reduced negative influence of Thought Suppression on Short Video Addiction. This provides a theoretical and practical basis for cognitive-level interventions to help prevent excessive use of short video platforms among young adults.
To develop a medical gratitude scale for medical students, and to investigate the relationship between medical gratitude and general attitude. A cross-sectional study was conducted in Guangdong, China. We used a stratified cluster sampling strategy to select 500 eligible clinical medical students in Guangdong, China. A self-administered medical gratitude scale was developed to measure the medical-specific gratitude. Fornell-Larcker criterion was used to estimate the discrimination of these two scales. A hierarchical multiple regression was used to estimate the relationships. 482 valid questionnaires were finally collected. Factor analysis showed the acceptable reliability and validity of the medical gratitude scale (Cronbach's α = 0.930). The mean scores for medical and general gratitude scales were 3.33 ± 0.42 and 3.11 ± 0.66, respectively. Fornell-Larcker criterion confirmed the discrimination between general and medical gratitude. Hierarchical multiple regression estimated the positive relationship between medical and gratitude (β = 0.46, 95%CI 0.38, 0.54, p < 0.001). Medical gratitude was also positively associated with the frequency of gratitude education received from teachers (β = 0.10, 95% CI 0.02, 0.18, p = 0.018) and from schools (β = 0.16, 95% CI 0.08, 0.25, p < 0.001). While correlated with general gratitude, medical gratitude appears to be conceptually distinct in its focus on the professional context. Integrating gratitude education into the medical school curriculum is a viable strategy to foster professionalized future physicians.
In the digital age, university students' sustained academic engagement and strong learning resilience in the face of increasing academic pressure and complex campus challenges are essential to the attainment of substantial academic achievement. At present, how to enhance students' academic engagement and foster learning resilience has become a pressing issue for educational administrators. Although previous studies have examined multiple factors influencing academic engagement and resilience, they have largely emphasized the isolated effects of psychological traits on individual learning performance while overlooking the complex possibility that perceived external contexts, such as the learning environment, learning climate, and social relationships, may jointly shape learning resilience through psychological and emotional regulatory mechanisms. Therefore, this study focuses on the interaction among external contexts, internal affective drivers (academic self-efficacy and perceived campus belonging), and learning resilience. Using questionnaire survey data and structural equation modeling, this study examines the extent to which external contexts are associated with academic self-efficacy and perceived campus belonging, explores whether these internal affective drivers are statistically associated with learning resilience through mediating pathways, and constructs an "external context-affective drivers-learning resilience" model to identify potential explanatory pathways and provide evidence-based implications for educational management.
In an increasingly technology-driven healthcare environment, digital literacy and clinical decision-making (CDM) are essential competencies for undergraduate nursing students. This study investigates the relationship between digital literacy and clinical decision-making skills among student nurses. A cross-sectional correlational design was employed, involving a convenience sample of 201 undergraduate nursing students at Taif University, Saudi Arabia. Data were collected on campus between August and September 2025 via a secure Google Forms link distributed through official university channels. Analysis included descriptive statistics, independent t-tests to examine sex differences, and Pearson's correlation and linear regression to evaluate the relationship between variables. The nursing students possessed a high level of digital literacy (M = 51.00, SD = 8.44) and a high level of clinical decision-making ability (M = 171.30, SD = 12.60). Female students (M = 51.78) scored significantly higher in digital literacy than male students (M = 44.97), with t(199) = 3.65, p < 0.001. A statistically significant positive correlation was found between the two variables (r = 0.389, p < 0.001), indicating that higher digital competency is associated with stronger clinical decision-making skills. Digital literacy was a significant predictor, accounting for approximately 15.1% (R2 = 0.151) of the variance in CDM scores. Sex differences were highly significant across both domains. Female students reported significantly higher mean digital literacy scores (51.78, SD = 7.73) compared to their male counterparts (44.97, SD = 7.89; t = -3.87, p < 0.001). Furthermore, a significant disparity was observed in clinical decision-making, where female students scored 172.50 (SD = 12.40) compared to 162.03 (SD = 14.15) for males (t = -3.82, p < 0.001). The findings underscore the critical role of digital literacy in clinical performance. The results suggest a need for targeted educational strategies to bridge sex-based competency gaps within nursing education. This ensures all students are prepared for a digitalized healthcare landscape.