From creative self-efficacy to clinical decision-making confidence: A dimensional structural equation modeling analysis through self-directed learning among nursing graduate students

IF 4.2 2区医学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES

Nurse Education Today Pub Date : 2025-09-09 DOI:10.1016/j.nedt.2025.106871

Wenyu Yue , Yihui Lin , Xiaoqin Ma

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引用次数: 0

Abstract

Background

Graduate nursing students face cognitive and emotional demands during clinical practice, often exhibiting passive cognition and struggling with the transition from academic preparation to clinical requirements. Documented gaps between theoretical knowledge and practical application highlight the need to understand how creative self-efficacy and self-directed learning contribute to clinical decision-making confidence development.

Objective

To investigate the mediating role of self-directed learning in the relationship between creative self-efficacy and clinical decision-making confidence among graduate nursing students.

Design

Cross-sectional study utilizing structural equation modeling.

Setting

Multiple Chinese medical schools and affiliated teaching hospitals.

Participants

278 graduate nursing students.

Methods

Validated questionnaires assessed creative self-efficacy, self-directed learning, and clinical decision-making confidence. Data analysis employed descriptive statistics, correlation analysis, stepwise regression, and structural equation modeling with bootstrap mediation analysis.

Results

Regression analysis revealed work experience as the strongest predictor of clinical decision-making confidence (β = 0.44, p < 0.01), followed by creative self-efficacy (β = 0.21, p < 0.01). Mediation analysis demonstrated that self-directed learning significantly mediated the relationship between creative self-efficacy and clinical decision-making confidence (β = 0.095, p = 0.04). Dimensional analysis revealed learning awareness (β = 0.067, p = 0.02) and learning strategies (β = 0.057, p < 0.01) as significant mediators.

Conclusions

Self-directed learning serves as a partial mediator (25.2 %) between creative self-efficacy and clinical decision-making confidence, with metacognitive dimensions—learning awareness and learning strategies—constituting primary pathways while behavioral and social mechanisms showed non-significant effects. Educational interventions should prioritize metacognitive skill development and strategic learning approaches to enhance clinical decision-making capabilities in graduate nursing education.

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从创新自我效能感到临床决策自信：护理研究生自主学习的维度结构方程模型分析

护理研究生在临床实践中面临认知和情感需求，往往表现出被动认知，挣扎于从学术准备到临床需求的过渡。理论知识和实际应用之间的差距突出了需要了解创造性自我效能和自我指导学习如何促进临床决策信心的发展。目的探讨自主学习在护理研究生创造性自我效能感与临床决策信心之间的中介作用。设计利用结构方程模型进行横断面研究。设有多所中医院校及附属教学医院。研究对象：278名护理专业研究生。方法采用有效问卷对创造性自我效能、自主学习和临床决策信心进行评估。数据分析采用描述性统计、相关分析、逐步回归和结构方程模型，并结合自举中介分析。结果回归分析显示，工作经验是临床决策自信的最强预测因子（β = 0.44, p < 0.01），其次是创造性自我效能感（β = 0.21, p < 0.01）。中介分析表明，自主学习在创新自我效能感与临床决策信心之间具有显著的中介作用（β = 0.095, p = 0.04）。维度分析显示，学习意识（β = 0.067, p = 0.02）和学习策略（β = 0.057, p < 0.01）是显著的中介因素。结论自主学习在创新自我效能感与临床决策自信之间起部分中介作用（25.2%），元认知维度——学习意识和学习策略是主要中介，行为机制和社会机制对创新自我效能感的影响不显著。教育干预应优先发展元认知技能和战略性学习方法，以提高研究生护理教育的临床决策能力。

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来源期刊

Nurse Education Today 医学-护理

CiteScore

6.90

自引率

12.80%

发文量

349

审稿时长

58 days

期刊介绍： Nurse Education Today is the leading international journal providing a forum for the publication of high quality original research, review and debate in the discussion of nursing, midwifery and interprofessional health care education, publishing papers which contribute to the advancement of educational theory and pedagogy that support the evidence-based practice for educationalists worldwide. The journal stimulates and values critical scholarly debate on issues that have strategic relevance for leaders of health care education. The journal publishes the highest quality scholarly contributions reflecting the diversity of people, health and education systems worldwide, by publishing research that employs rigorous methodology as well as by publishing papers that highlight the theoretical underpinnings of education and systems globally. The journal will publish papers that show depth, rigour, originality and high standards of presentation, in particular, work that is original, analytical and constructively critical of both previous work and current initiatives. Authors are invited to submit original research, systematic and scholarly reviews, and critical papers which will stimulate debate on research, policy, theory or philosophy of nursing and related health care education, and which will meet and develop the journal''s high academic and ethical standards.