Effect of stress on study skills self-efficacy in Nursing students: the chain mediating role of general self-efficacy and self-directed learning

Study skills self-efficacy, which is concerned with a person's view of their skills, is a personal belief in one's capacity to organize and carry out the actions required to obtain particular types of results [1]. According to Bandura's self-efficacy theory, one's behavior may be impacted by their perception of their ability to achieve a goal [2]. Students who have a high level of self-efficacy in a variety of academic areas are more likely to select activities that will help them advance their knowledge, expertise, and abilities in those areas [3]. Especially for nursing students, who must take control of their learning in a changing and challenging learning environment [4]. Previous studies demonstrated that self-efficacy has a positive impact on increasing nursing students' ability to solve problems [5], improving academic achievement [2, 6, 7], and enhancing learning motivation [8].

Many studies have been conducted to study what aspects would influence study skills self-efficacy, and stress are the important aspects. Stress is caused by a person's interactions with their surroundings and results from a person's assessment of their capacity to handle a demanding circumstance that exceeds the resources at their disposal [9, 10]. Moderate pressure can improve learning effectiveness and memory capacity. Nevertheless, excessive stress may affect nursing students' physical and mental health, impair their memory, and problem-solving skills, and decrease academic performance [11‐13]. Studies reveal that stress is relatively frequent among nursing students in various parts of the world [14, 15]. This pressure mainly stems from multiple factors, among which the most significant are academic pressure and clinical pressure [16‐18]. In terms of academic pressure, students need to master a vast knowledge system of medicine and nursing, facing challenges such as complex courses, exams, and assignments [17]. As the grade level increases, the difficulty and depth of courses significantly increase, requiring students to cope with stricter and more frequent assessments [19]. After entering higher grades, clinical internships become an important component of academic performance. Faced with real patients and complex medical environments, many students may worry that their nursing knowledge and practical experience are insufficient to meet the challenges [20]. High workload, adaptation to new environments, and communication difficulties further increase the pressure [21]. In addition, senior students also face employment pressure, increasing uncertainty about career prospects, and anxiety about self-evaluation [22]. These sources of stress have had a profound impact on the physical and mental health, learning outcomes, and future career development of nursing students. Therefore, I deeply feel the need to explore these issues in depth to better understand the pressure that nursing students are under and find effective mitigation strategies.

To better investigate the effect of stress on the study skills self-efficacy of college students, general self-efficacy was introduced as a mediator based on a literature review. One source of self-efficacy is physiological, emotional, and emotional states. A positive emotional state enhances self-efficacy, enabling students to assess the challenges that need to be achieved cognitively [8]. Previous research demonstrated that self-efficacy is positively correlated with positive psychology and negatively correlated with negative psychology [23]. Under positive emotions, students can transition from mechanical passive learning to meaningful active learning, improve learning efficiency, and achieve academic goals. Whereas negative emotions are exactly the opposite [24, 25].

Self-directed learning ability plays a crucial role in improving college students' study skills self-efficacy [26]. Self-directed learning, as defined by Knowles, is a process in which individuals, with or without the assistance of others, take the initiative in diagnosing their learning requirements, formulating learning goals, identifying human and material resources for learning, selecting and implementing suitable learning strategies, and evaluating learning outcomes [27]. In recent years, self-directed learning has become increasingly important in nursing education, with universities placing particular emphasis on cultivating students' lifelong self-directed learning skills [28, 29]. For nursing students, self-learning ability is the cornerstone for them to cope with clinical challenges and continue to learn and improve [30]. This ability enables them to quickly adapt to changing environments, actively explore, and thus improve their professional level and service quality. Study skills self-efficacy is an internal factor that influences a student's ability to self-directed learning readiness, and students with high self-efficacy often exhibit more positive learning attitudes and behaviors, are brave enough to face challenges, and persist in pursuing goals [31]. Therefore, by enhancing self-efficacy, nursing students can be more confident in their studies, brave in exploring the unknown, and lay a solid foundation for their professional growth.

In sum, we built a structural equation model to explore the relationship between positive stress, negative stress, general self-efficacy, self-directed learning ability, and study skills self-efficacy. This study makes the following hypotheses: (1) Positive stress or negative stress is significantly correlated with study skills self-efficacy; (2) Positive stress or negative stress will influence study skills self-efficacy through the mediating effect of general self-efficacy; (3) Positive stress or negative stress will influence study skills self-efficacy through the mediating effect of self-directed learning ability; (4) General self-efficacy and self-directed learning ability play a chain mediating role in the influence of positive stress and negative stress on study skills self-efficacy. The hypothesis model is shown in Fig. 1.

Table 1 shows the differences in study skills self-efficacy level according to participants’ general characteristics. The average age of the participants was 22.25 ± 2.05 years, with 1174 females (91.1%) and 115 males (8.9%). There were 405 first-year students (31.4%), 497 second-year students (38.6%), and 387 third-year students (30.0%). Regarding the family economy, 140 (73.3%), 881 (15.9%), and 268 (10.8%) participants indicated it to be high, middle, and low, respectively. The analysis of differences in study skills self-efficacy level, according to students’ general characteristics, showed significant variations based on the degree of the academic year (F = 5.489, P = 0.004), family economy (F = 3.992, P = 0.019), and with honor titles (t = 4.735, P < 0.001).

Table 2 shows the student’s levels of positive stress, negative stress, general self-efficacy, self-directed learning ability, and study skills self-efficacy level. The mean positive stress was 2.34 ± 0.65 out of 5, the mean negative stress was 1.98 ± 0.58 out of 5, the mean general self-efficacy was 2.32 ± 0.50 out of 4, the mean of self-directed learning ability was 3.59 ± 0.50 out of 5, and mean of study skills self-efficacy level was 3.62 ± 0.81 out of 6. The scores of the subscales for SDLI were the highest for interpersonal communication (IC) appraisal at 3.67 ± 0.58. The mean score of the subscales for the study skills self-efficacy scale was the highest for self-correction at 3.93 ± 0.87, respectively.

Table 3 shows the results of the correlation analysis of participants’ positive stress, negative stress, general self-efficacy, self-directed learning ability, and study skills self-efficacy level. The four dimensions of the study skills self-efficacy scale positively correlated with positive stress (r range from 0.090 to 0.279, P < 0.01), and general self-efficacy (r range from 0.283 to 0.387, P < 0.01). In addition, there are negative correlations with negative stress (r range from -0.112 to -0.060, P < 0.05), and the four dimensions of self-directed learning ability (r range from -0.411 to -0.267, P < 0.01).

Table 4 shows the results of regression analysis among positive stress, general self-efficacy, self-directed learning ability, and study skills self-efficacy. Three models might be built. The first is that SSSES is the outcome variable, positive stress (β = 0.201, p < 0.001) is the prediction variable, and the fitting degree R² is 0.040. In the second, SSSES was used as the outcome variable, positive stress (β = -0.122, p < 0.001) and GSES (β = -0.397, p < 0.001) were utilized as predictors, and the fitting degree R² was 0.192. The third model, which has an R² of 0.279, is created when positive stress (β = 0.123, p < 0.001), GSES (β = 0.209, p < 0.001) and SDLI (β = -0.358, p < 0.001) predict SSSES.

Table 5 shows the results of regression analysis among negative stress, general self-efficacy, self-directed learning ability, and study skills self-efficacy. Three models might be built. The first is that SSSES is the outcome variable, negative stress (β = -0.230, p < 0.001) is the prediction variable, and the fitting degree R² is 0.053. In the second, SSSES was used as the outcome variable, negative stress (β = 0.100, p < 0.001) and GSES (β = -0.399, p < 0.001) were utilized as predictors, and the fitting degree R² was 0.187. When negative stress (β = 0.037, p < 0.001), GSES (β = 0.234, p < 0.001), and SDLI (β = -0.380, p < 0.001) predict SSSES and the third model with R² of 0.266 is constructed.

Study skills self-efficacy ability as variable Y, positive stress as variable X₁, negative stress as variable X₂, general self-efficacy, and study skills self-efficacy as multiple mediating variables, general self-efficacy as M1 and study skills self-efficacy as M2, and mediation analysis was performed. A total of 5000 Bootstrap samples were chosen in order to estimate the 95% confidence interval of various mediating effects. Bootstrap test results show no 0 between BootLLCI and BootULCI, indicating a significant mediating effect.

Table 6 of the test findings suggests that general self-efficacy and self-directed learning ability have partial mediation effects between positive stress and study skills self-efficacy, with a mediating effect of 0.639. Three mediating chains work together to provide the mediating effect. First, indirect effect: X₁ → M₁ → Y, and general self-efficacy plays a significant mediating role; Second, indirect effect: X₁ → M₂ → Y, self-directed learning ability plays a significant mediating role; Third, chain mediating effect: X₁ → M₁ → M₂ → Y, demonstrating the importance of both these traits in the chain multiple mediation between positive stress and study skills self-efficacy. The three routes' impact values were 0.235, 0.245, and 0.159. Figure 2 depicts the precise path of the chain mediation effect of positive stress and self-efficacy of study skills in college students.

Table 7 of the test results show that general self-efficacy and self-directed learning ability have partial mediating effects between negative stress and study skills self-efficacy, and the mediating effect is -0.792. First, indirect effect: X₂ → M₁ → Y, and general self-efficacy plays a significant mediating role; Second, indirect effect: X₂ → M₂ → Y, self-directed learning ability plays a significant mediating role; Third, chain mediating effect: X₂ → M₁ → M₂ → Y, which shows that general self-efficacy and self-directed learning ability play a significant role in chain mediating effect between positive stress and study skills self-efficacy. The effect values of the three pathways were -0.337, -0.238, and -0.218. The specific path of the chain mediation effect of college students’ negative stress and study skills self-efficacy is shown in Fig. 3.

This study identified the mediating pathways by which stress influences the study skills self-efficacy of college students. The findings showed that general self-efficacy and self-directed learning ability play partially mediating roles in the relationship between positive stress and study skills self-efficacy. However, general self-efficacy and self-directed learning ability play completely mediating roles in the relationship between negative stress and study skills self-efficacy.

The results of regression analysis showed that positive stress significantly positively predicted study skills self-efficacy, which is obviously consistent with the previous result [49]. Córdova A. et al. demonstrated that Stress is not a mere negative aspect; it is necessary for learning, becoming a positive aspect when it is under control [49]. Due to the different ways students experience stress, good stress management can generate positive emotions, while poor stress management can lead to negative emotions [50, 51]. Under positive emotions, students can transition from mechanical passive learning to meaningful active learning, improve learning efficiency, and achieve academic goals. Whereas negative emotions are exactly the opposite [24]. Our study also found that negative stress can negatively predict study skills self-efficacy on the basis of general self-efficacy and self-directed learning ability, but the direct effect is not statistically significant. Therefore, we should attach great importance to the different effects of positive and negative stress on the emotions of college students, in order to utilize the role of positive emotions to improve students' study skills self-efficacy.

This study shows that general self-efficacy and self-directed learning ability play a chain intermediary role in the relationship between positive and negative stress and study skills self-efficacy, indicating that the mediating effect of general self-efficacy and self-directed learning ability was established. In addition to the direct effect of positive stress, it can also affect study skills self-efficacy through the indirect role of general self-efficacy and self-directed learning ability. However, we did not find a direct effect of negative stress on study skills self-efficacy. Students with high general self-efficacy tend to have high study skills self-efficacy during the learning and internship process [7]. Moreover, self-directed learning ability also plays a partial mediating role between positive stress and study skills self-efficacy. Interestingly, our study found self-directed learning had a negative predictive effect on study skills self-efficacy, meaning that the higher a students’ self-directed learning ability, the lower their study skills self-efficacy. This may be because self-directed learning ability requires students to have more control over their learning and a higher sense of self-determination. Whereas improving students' study skills self-efficacy should be attributed more to their level of effort rather than their ability [52]. Additionally, self-directed learning has some drawbacks, including difficulties with finding teaching and learning resources, a lack of teacher supervision, inefficient time management, and challenges in evaluating learning processes and outcomes [53]. These issues may impede the development of students' study skills self-efficacy.

Although a chain mediating effect of general self-efficacy and self-directed learning ability on the relationship between positive and negative stress and study skills self-efficacy was demonstrated, this study had some limitations. Firstly, cross-sectional design means that we cannot directly derive causal relationships. Secondly, we only investigated nursing students from two medical universities in Liaoning Province, so this result may be geographically limited. Thirdly, 91.1% of the students in this study are female, so there may be gender biases in the survey results, which are not reflected in the research results. Lastly, The sample collected in this study did not cover all grades, and the study only included nursing students from freshman to junior year, which may limit the generalizability of the research results. In addition, differences in environmental exposure can also affect the results. Due to the fact that the research sample covered multiple grades, but did not analyze in detail the specific impact of different environments on student stress, it is difficult to accurately determine the role of environmental differences in stress formation. Future research should strive to expand the sample size to include nursing students from different regions and all grades of universities, especially senior and graduate students. A more comprehensive understanding of the stress situations faced by students in different grades, as well as the changing trends of stress with learning stages. In addition, a more detailed analysis should be conducted on the different environments that students are exposed to, such as classrooms, laboratories, clinical settings, etc., to explore the specific impact of different environments on student stress. In addition to general self-efficacy and self-directed learning ability, further research is needed to investigate whether there are other mediating factors on the impact mechanism of stress on college students' self-efficacy in learning skills.

This study shows that positive stress has a positive effect on study skills self-efficacy in nursing students, but negative stress has a negative effect on study skills self-efficacy in nursing students. General self-efficacy and self-directed learning ability played a chain mediating role between positive and negative stress and study skills self-efficacy. The chain mediating effect indicates that general self-efficacy and self-directed learning ability have important practical significance in improving college students’ study skills self-efficacy. This study will provide a reference for educators to improve the stress management ability and study skills self-efficacy of college students in the future.