ArticleBMJ open2025
Mediating role of self-efficacy and cognitive flexibility in the relationship between critical thinking and positive mental health in Turkish nursing students: a cross-sectional study.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- The Mediating Role of Cognitive Flexibility in the Relationship Between Self-Transcendence and Depression Symptom Level: A Sample of Health Department Students.Nursing open · 2026Article
- Exposure to Conflict-Related News and Psychological Distress Among Nursing Students: The Mediating Role of Sleep Difficulties and Study Disruption.Healthcare (Basel, Switzerland) · 2026Article
- Self-Efficacy, Mental Health and Support Services Use Among Baccalaureate Nursing Students: A Cross-Sectional Pilot Study.Nursing open · 2026Article
- From Simulation to Sustainability: The Mediating Role of Clinical Self-Efficacy Among Undergraduate Healthcare Students.European journal of investigation in health, psychology and education · 2026Article
- Early Development of Clinical Reasoning Through Virtual Patient Simulation: Nursing Students' Perceptions of Collaborative Decision-Making.Nursing reports (Pavia, Italy) · 2026Article
- The relationship between cognitive flexibility and decision-making styles of midwifery and nursing students.BMC medical education · 2026Article
- Enhancing academic success in higher education: the predictive role of critical thinking through sequential mediation of academic control, self-efficacy, and intrinsic motivation.Frontiers in psychology · 2026Article
- Digital health literacy and sports participation among college students: the role of cognitive flexibility and physical activity self-efficacy.Frontiers in psychology · 2026Article
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2 authors.
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Abstract
objectivesPositive mental health is crucial for nursing students, impacting their well-being and professional performance. It facilitates stress management throughout nursing education and career development. Limited research has examined the relationship between critical thinking and perceived positive mental health. This study examines the relationship between critical thinking and positive mental health, exploring the mediating effects of self-efficacy and cognitive flexibility.
designA cross-sectional survey was used.
settingThe study was conducted in different public universities in Türkiye. The survey was administered via Google Forms, which included information about the purpose of the study and a consent form where participants declared their voluntary involvement.
participantsA random sampling method was used to recruit 464 students from various health sciences faculties at different universities, consisting of 44.4% males and 55.6% females. The participants, aged 18-25, had a mean age of 19.52 (SD=1.24). PRIMARY AND SECONDARY OUTCOME MEASURES: The questionnaire included the following scales: Critical Thinking Disposition Scale, Positive Mental Health Scale, Cognitive Flexibility Scale and General Self-efficacy Scale. Descriptive analysis, correlation analysis and multiple mediation analysis were used to analyse the data.
resultsThe findings indicate that critical thinking is positively associated with self-efficacy (β=0.58, p<0.001), cognitive flexibility (β=0.25, p<0.001) and positive mental health (β=0.26, p<0.001). Self-efficacy also shows a positive relationship with cognitive flexibility (β=0.51, p<0.001) and positive mental health (β=0.27, p<0.001), while cognitive flexibility is positively associated with positive mental health (β=0.21, p<0.001). Multiple mediation analyses revealed that self-efficacy and cognitive flexibility accounted for 51.85% of the total effects, with self-efficacy alone explaining 29.63%. Both self-efficacy and cognitive flexibility served as sequential and parallel mediators between critical thinking and positive mental health.
conclusionThe study highlights the importance of integrating interventions that enhance self-efficacy and cognitive flexibility in nursing education programmes to promote positive mental health outcomes. These psychological resources can strengthen both critical thinking abilities and overall well-being among nursing students. The findings recommend implementing targeted training programmes in nursing education curricula and perceived positive mental health support services through problem-based learning and simulation-based education.
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