Stress/Resource Complex, Sense of Coherence and Professional Identity Among Nursing Students: A Latent Profile and Mediation Analysis

Figures & data

Figure 1 The hypothetical framework of stress/resource complex, sense of coherence and professional identity among nursing students.

Table 1 Demographic and Relevant Variables Differences in Scores of Professional Identity

Variables	Overall Sample (N=595)	p value
Gender, n (%)		0.616
Male	215 (36.1)
Female	380 (63.9)
Educational level, n (%)		<0.001
Junior college education	236 (39.7)
Bachelor education	359 (60.3)
Only children, n (%)		0.868
No	488 (82.0)
Yes	107 (18.0)
Place of residence, n (%)		0.031
Countryside	376 (63.2)
Cities and towns	219 (36.8)
Any medical staffs as relatives, n (%)		0.612
No	425 (71.4)
Yes	170 (28.6)
Nursing role model, n (%)		<0.001
No	352 (59.3)
Yes	242 (40.7)
Willingness to leave the profession, n (%)		<0.001
No	508 (85.4)
Yes	87 (14.6)
Psychological resilience, M±SD	26.04±7.06
Self-efficacy, M±SD	25.00±6.02
Perceived stress, M±SD	15.81±5.71
Sense of coherence, M±SD	59.00±12.32

Note: Bold figures highlight statistically significant in the univariate analysis.

Figure 2 Pearson correlation heatmap among stress/resource complex, sense of coherence and professional identity.

Table 2 Fitting Index and Group Size of Latent Profile Analysis Models

Indicators	LPA Model
	1-Class	2-Class	3-Class	4-Class	5-Class
Fit statistics
LL	−21699.12	−18978.13	−18190.55	−17746.64	−17446.71
AIC	43518.24	38138.26	36625.1	35799.29	35261.41
BIC	43781.55	38537.61	37160.51	36470.74	36068.91
aBIC	43591.07	38248.72	36773.19	35985.01	35484.77
Entropy	1.000	0.965	0.945	0.935	0.951
LMR (P)	—	<0.001	0.003	0.179	0.496
Group size (%)
C1	595 (100.0)	359 (60.3)	244 (41.0)	110 (18.5)	52 (8.74)
C2	—	236 (39.7)	263 (44.2)	184 (30.9)	265 (44.5)
C3	—	—	88 (14.8)	250 (42.0)	34 (5.7)
C4	—	—	—	51 (8.6)	186 (31.3)
C5	—	—	—	—	58 (9.7)

Note: Bold figures highlight the selected class solution.

Abbreviations: LL, Log-likelihood; AIC, Akaike Information Criterion; BIC, Bayesian Information Criterion; aBIC, Adjusted BIC; LMR, Lo, Mendell, and Rubin likelihood ratio test.

Table 3 Univariate and Multivariate Logistic Regression results for Predicting External Features on the 3-Class Pattern

Variables	LPA-Based Stress/Resource Complex Types
	Univariate Analysis				Multivariate Analysis
	Ordinary vs Maladjustment		Flexibility vs Maladjustment		Ordinary vs Maladjustment		Flexibility vs Maladjustment
	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
Gender (female as ref)	1.35 (0.94–1.94)	0.109	1.41 (0.85–2.33)	0.186	1.34 (0.93–1.93)	0.123	1.38 (0.83–2.29)	0.217
Educational level (junior college as ref)	1.10 (0.77–1.57)	1.096	1.10 (0.67–1.82)	0.700
Only children (no as ref)	1.05 (0.66–1.67)	0.838	1.46 (0.80–2.66)	0.220
Place of residence (countryside as ref)	0.83 (0.58–1.19)	0.310	0.84 (0.51–1.39)	0.496
Any medical staffs as relatives (no as ref)	1.21 (0.82–1.78)	0.341	1.25 (0.73–2.13)	0.423
Nursing role model (no as ref)	1.48 (1.04–2.13)	0.032	2.03 (1.24–3.33)	0.005	1.48 (1.03–2.13)	0.035	1.92 (1.17–3.16)	0.011
Willingness to leave the profession (no as ref)	0.97 (0.60–1.57)	0.903	0.45 (0.20–1.06)	0.067	1.04 (0.64–1.69)	0.866	0.51 (0.22–1.20)	0.124

Note: Bold figures highlight statistically multivariate logistic regression.

Abbreviations: OR, Odds ratio; CI, confidence interval.

Table 4 ANOVA Comparisons of Scale Scores Across Three Latent Classes

Subgroups	Psychological Resilience	Self-Efficacy	Perceived Stress	Sense of Coherence	Professional Identity
Maladjustment (a)	19.89±3.93	20.17±3.29	19.73±3.99	53.68±10.07	80.04±16.78
Ordinary (b)	28.17±4.11	26.49±3.79	14.84±3.58	59.79±10.72	89.67±13.49
Flexibility (c)	36.72±3.38	33.90±4.68	7.90±5.51	71.38±13.08	102.14±14.67
F	660.04	472.65	284.74	87.31	73.93
P	<0.001	<0.001	<0.001	<0.001	<0.001
η^2	0.690	0.615	0.490	0.228	0.200
Post-hoc	c > b > a	c > b > a	a > b > c	c > b > a	c > b > a

Notes: Post-hoc comparisons were conducted using the Bonferroni multiple comparison test; η²= eta squared represents variance of a dependent variable by three LPA-based subgroups.

Figure 3 Parameters for the final three-class patterns.

Notes: C1 = Maladjustment, C2 = Ordinary; C3 = Flexibility.

Table 5 The Mediating Effect of Sense of Coherence on Professional Identity

Variables	β	SE	t	P	LLCI	ULCI	R^2
	Mediating variable model (Outcome variable: Sense of coherence)						0.251
Ordinary type	0.25	0.04	6.89	<0.001	0.18	0.32
Flexibility type	0.50	0.04	12.20	<0.001	0.42	0.58
	Dependent variable model (Outcome variable: Professional identity)						0.344
Ordinary type	0.21	0.04	5.33	<0.001	0.14	0.28
Flexibility type	0.30	0.05	6.61	<0.001	0.21	0.39
Sense of coherence	0.26	0.04	6.70	<0.001	0.18	0.34
	Direct and indirect effect of general resistance resources on professional identity
	Variables		Effect	SE	t	LLCI	ULCI
Indirect effect	Ordinary type		0.07	0.01	4.53	0.04	0.10
	Flexibility type		0.13	0.02	5.65	0.09	0.18
Direct effect	Ordinary type		0.21	0.04	5.33	0.14	0.28
	Flexibility type		0.30	0.05	6.61	0.21	0.39
Total effect	Ordinary type		0.27	0.04	7.07	0.20	0.35
	Flexibility type		0.43	0.04	11.53	0.36	0.50

Notes: Educational level, place of residence, nursing role model, and willingness to leave the profession are controlled statistically. Maladjustment type is used as the reference.

Abbreviations: SE, standard error; LLCI, lower level of confidence interval; ULCI, upper level of a confidence interval.

Figure 4 A hypothesized mediator model with three stress/resource complex types as independent variable (X), sense of coherence as a mediator (M), and professional identity as dependent variable (Y).

Notes: ***P < 0.001; Educational level, place of residence, nursing role model, and willingness to leave the profession are controlled statistically, and the control variables are not presented in the figure for brevity. Maladjustment type is used as the reference.