The impact of clinical learning environment factors on caring behaviors: the mediating role of psychological resilience among nursing intern students.

Background: Clinical learning environments significantly influence nursing students' caring behaviors; however, most studies have examined clinical learning environments in a general sense but have not identified the specific components or mechanisms that influence nursing students' caring behaviors. In this study, the relationships between specific factors in clinical learning environments and caring behaviors among nursing interns were examined, and whether psychological resilience mediates the influence of clinical learning environmental factors on caring behaviors was investigated.

Methods: This study adopted a cross-sectional, descriptive correlational design involving 565 nursing interns in China. Three validated instruments-the Clinical Learning Environment Scale (CLES), the Caring Behaviors Inventory-24 (CBI-24), and the Connor-Davidson Resilience Scale (CD-RISC10)-were used to collect data. Descriptive statistics, Pearson correlation, and multiple linear regression analyses were conducted with SPSS 26.0 to identify relationships between variables. Mediation analysis was performed using the PROCESS macro (Model 4) with 5,000 bootstrap samples to examine the mediating role of psychological resilience.

Results: Correlation analysis revealed six clinical learning environment factors were associated with nursing students' caring behaviors. In the multiple regression analysis, student involvement (β = 0.200), task orientation (β = 0.147), and psychological resilience (β = 0.668) were positive predictors of caring behaviors, whereas personalization (β=-0.098) was a negative predictor. The results of the mediation analysis further revealed that student involvement and task orientation had direct effects on caring behaviors (β = 0.232 and 0.201, respectively) and indirect effects via psychological resilience (β = 0.650 and 0.589, respectively). In contrast, personalization had no significant direct effect but exerted a significant indirect effect through psychological resilience (β = 0.652), suggesting a fully mediated relationship.

Conclusions: Clinical learning environment factors were related to caring behaviors among nursing interns, and psychological resilience mediated the influence of clinical learning environment factors on caring behaviors. To improve caring behaviors, nursing educators should create a good clinical learning environment for nursing interns, provide structured task orientation, involve students more in clinical practice, and develop their resilience.

Clinical trial number: Not applicable.