Faculty lived experiences in recognizing nursing students’ psychological support needs in Saudi Arabia

Faculty lived experiences in recognizing nursing students’ psychological support needs in Saudi Arabia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Faculty lived experiences in recognizing nursing students’ psychological support needs in Saudi Arabia Samirh Said Alqhtani, Seham Alselami, Hend Alnajjar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6373129/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted 10 You are reading this latest preprint version Abstract Background/Objectives : Nursing students often experience high levels of stress, anxiety, and depression throughout their academic and clinical education. Academic and social pressures can intensify mental health challenges during university studies. Faculty members play a vital role in fostering a supportive and inclusive learning environment that prioritizes the mental well-being of nursing students. This study aimed to gain a deeper understanding of faculty members' experience in recognizing nursing students’ psychological support needs. Methods : This qualitative study involved purposive sampling of faculty members in two nursing colleges in Saudi Arabia. In-depth, face-to-face, semi-structured interviews of eight faculty members using open-ended questions were conducted. The interviews were recorded, transcribed verbatim, and thematically analyzed using the NVivo program. Results : Data analysis revealed four major themes: students’ emotional support, challenges of supporting students, recognition of distress and utilizing resources, and faculty training needs. Conclusions : This study identified a multidimensional role of faculty members in supporting students' emotional well-being and academic success. However, they faced challenges that need to be addressed through educational organizations. There is a need to examine the effectiveness of training programs in educating faculty on identifying mental health issues and providing adequate support. faculty members nursing students psychological support mental health recognition of distress mental health r resources nursing education Saudi Arabia Background The mental well-being of nursing students is essential for their academic success, professional development, and overall quality of life. Previous research demonstrated that nursing students frequently encounter elevated levels of stress, anxiety, and depression throughout their academic, clinical training, and social factors [ 1 , 2 ]. In Saudi Arabia, nursing students face academic stress due to heavy coursework, exams, and clinical training hours [ 3 , 4 ]. Mental health issues can affect students’ cognitive ability and academic success [ 5 ]. Many studies reported a high prevalence of nursing students; 65.1% had depression, and 83.19% had anxiety [ 6 , 7 ]. Researchers reported the importance of assessing nursing students' stress and early detection of depression before students experience academic failure[ 8 , 9 ]. Thus, faculty members play a crucial role in creating a supportive learning environment that promotes the mental health of nursing students. They can offer emotional assistance, direction, and connections to relevant support services[ 10 ]. Positive faculty-student relationships help to reduce emotional distress and increase a sense of belonging within the academic environment[ 11 ]. However, faculty members face uncertainty and experiences in providing timely support to students with mental health issues because of tensions between their academic and professional and the lack of explicit policies between faculty and student support services [ 12 ]. Various studies indicate a gap between faculty members' readiness to discuss students' mental health and the decision to refer students to mental health services [ 13 ]. Therefore, nursing faculty must know and be able to identify when student stress before it manifests in symptoms. However, research reported that faculty members had a lack of knowledge, training, or confidence to deal with a student facing mental health challenges, which can hinder their ability to recognize and support students [ 13 ]. Faculty members are on the frontline to identify at-risk students, provide information about mental health services, and refer them for help. Studies reported different strategies improved faculty’s knowledge and awareness, such as an education program [ 14 ], therapeutic communication techniques [ 15 ], and a trauma-informed training program [ 16 ] to identify and support students experiencing emotional distress. Understanding the faculty members’ experiences in identifying psychological support for the students has not been explored in Saudi Arabia. Therefore, this study aimed to deeply understand the meaning of faculty members’ lived experiences in recognizing nursing students’ psychological support needs. This study is significant in identifying faculty members' experiences in supporting nursing students, providing practical strategies, and tailoring interventions to inform faculty members and optimize students' well-being and academic success. Aim of the Study This study aimed to understand the meaning of faculty members’ lived experiences in recognizing nursing students’ psychological support needs. Research Question What is the lived experience of faculty members in recognizing nursing students’ psychological support needs? Methodology Design and participants A qualitative phenomenological approach was used to explore the meaning of, gain a deeper understanding of human experiences, and influence all research processes [ 17 ]. The COREQ checklist was used to report this study’s findings [ 18 ]. A purposive sampling strategy was used to recruit participating faculty members from two nursing colleges located in the Central and Western regions of Saudi Arabia. This sampling method is useful for recruiting participants who experienced the interest and providing rich data about the phenomenon [ 19 ]. Researchers recruited faculty members who work at the College of Nursing and enrolled in advising roles. The exclusion criteria are staff who do not have a teaching role or advising role. The number of participants recruited based on data saturation was eight participants. Rigor Lincoln & Guba criteria were employed to ensure this study's trustworthiness [ 20 ]. The credibility of the findings was established through prolonged engagement with the data and by providing rich, detailed of participants' experiences. Additionally, peer debriefing allowed researchers to review and offer constructive feedback, enhancing the validity of the findings. Collaborative analyses involving multiple perspectives enriched the depth and accuracy of the results. Dependability was addressed by creating a clear audit trail. Confirmability was achieved using a reflexive journal, where the researchers consistently recorded their thoughts, reactions, and decisions throughout the study. Transferability was enhanced by including direct quotes from participants to provide authentic, detailed insights into their experiences. The accuracy of the data was further supported by transcribing audio recordings immediately after interviews and cross-checking these transcripts against the original recordings. Data collection Data was collected through face-to-face interviews. After participants signed the written consent form, the interviews were conducted. The researchers collected demographic data via questionnaire in the first 5 minutes of the interview. Interviews were semi-structured and used open-ended questions, which lasted 45 to 60 minutes. All interviews were conducted in English language and tap recorded. Data analysis The transcripts of interviews were imported to the NVivo program version 15 software for data management and organizing the codes and themes. Thematic analysis was used for data analysis following Braun & Clarke process [ 21 ]: 1- Familiarizing with data: the researchers immersed in the data by reading and re-reading the data (interview transcripts and observational notes) to gain a deep understanding of its content. 2- Generating initial codes: the researchers systematically coded the data by identifying and labeling interesting features or patterns. 3- Searching for themes: the researchers organized codes into meaningful groups to identify patterns and relationships 4-Reviewing themes: the researchers generated a thematic map by checking the themes in relation to the coded extracts and the entire data set. 5- Defining and naming themes: the researchers refined the specifics of each theme and generated clear definitions and names for each theme. 6- Producing the report: the researchers then finalized and reflected on the identified themes and related the analysis to the research question and literature. Results Demographic Data Eight faculty members participated in this study. The demographic characteristics are presented in Table 1 . Table 1 Demographic characteristics of faculty members ( N = 8) Participants Academic service Number of Supervising students Academic rank Specialty in Nursing P1 > 5 years 20 Lecturer Critical Care P2 > 5 years 10 Lecturer Maternity P3 > 5 years 10 Lecturer Medical and Surgical P4 > 5 years 10 Associate professor Maternity P5 5 years 15 Assistant professor Psychiatrics P7 > 5 years 10 Assistant professor Community P8 < 5 years 10 Assistant professor Management and leadership Themes: The data analysis revealed three major themes: “student’s emotional support,” “challenges of supporting students,” “recognition of distress and utilizing resources,” and “faculty training needs.” Student Emotional Support Faculty members created an empathetic, non-judgmental environment where students feel comfortable sharing their emotional struggles. Active listening was central to the faculty’s experiences in supporting students. Most faculty expressed that all students need to be heard and be present with them. This theme also reflects that faculty members provide academic advice and provide space to express their emotions that support students’ emotional well-being. A participant illustrated, “Sometimes, my way of communication is treating advisees differently than the students I lecture. I do not lecture them. I let them vent. This is the way that I think best communicates with them. Sometimes, they do not need to go to the wellness center; they do not have depression, anxiety, or any of those psychological issues; they need emotional support, someone who listens to them.” (Participant 6) Further, the participants were mindful that maintaining confidentiality is crucial to fostering trust when students are vulnerable. Most participants expressed the importance of creating a safe environment of acceptance and trust. Another participant added, “I try to be very open and very patient and never judge students when they talk about something, such as being anxious or depressed or when they say I lost my interest in completing my degree. One day, a student with personal issues came to me, cried, and said: I want to talk to you; I want someone to listen to me. I closed the door and made sure that we had a private environment. I told her that she could speak and I would listen. I tried not to interrupt her” (Participant 4). This positions faculty members as compassionate guidance rather than fixing the students’ problems. This theme also describes faculty members’ proactive efforts to reach out to students with signs of distress through direct interactions either during class or clinical sessions. A participant said, “I approach the students during their class, which is the only way I can contact them. Sometimes, I use the Team’s program because the students like to write emails and text messages and feel more comfortable than face-to-face conversations.” (Participant 1) Several faculty members expressed the importance of face-to-face communication for building trust and being flexible in using online communication channels to support students who might feel hesitant about face-to-face conversations. A participant stated, "… certain students say, I want to talk to you privately. Then, in those circumstances, I give them an appointment through WhatsApp or the call. They can call me, and then they come and meet me personally” (Participant 7). This flexibility helps students feel empowered and fosters an environment where they can contact faculty to seek help. Faculty members extended their availability time outside regular working hours to support students. This extended care indicates recognizing students’ emotional distress and having deep empathy. Further, easy accessibility goes beyond academic advising, showing a genuine commitment to students' mental health and stability. A participant reported, “I follow up with students if it is a serious situation because I want to see how the student gets better. I will contact the student, and if I do not see her after a while, I will contact her and ask her how she is doing. Alternatively, I will tell her; please let me know what happened. So sometimes students come back, and they tell me about their issues, sometimes they do not, and then I will call them and ask them, and if they say they are fine, then it is fine. However, I always reassure them that I am always available. Because they are my advice, I would see them, so I made an appointment to see them. Ask them to come and see me.” (Participant 2) Faulty members expressed their role as academic guidance, supported students’ personal development, and assisted them with work-life balance. A participant explained, “I get some of the students who have low GPAs or low achievements or no grades in the course, and I will contact them to come to my office and discuss what I can do for them. If they want me to repeat some part of the lectures, or they want me to help them by giving a tutorial or by giving examples.” (Participant 4) Many participants shared strategies to help students with academic struggles, such as group study sessions, personalized follow-ups, and time management. Other participants shared their academic experiences that helped alleviate helplessness and isolation. “Sharing experience with them is really helpful. I shared my experiences with students, like my experience with public speaking, my experience with academic struggles, how to deal with low grades, and how all of these experiences helped me overcome many of my stresses. I believe the only faculty members have a big role in supporting students as they have been through all these things.” (Participant 1) Recognition of Distress and Utilizing Resources This theme focuses on how faculty members identified the early signs of emotional and social distress and their collaborative role in leveraging institutional resources to address students’ needs. Faculty members emphasized their ability to recognize visible signs of students with emotional or psychological issues through observable behavior or academic performance. Faculty noted that academic performance is an indicator that directly impacts students' mental and emotional well-being, such as low grades or exam difficulty. A participant illustrated, “...I see them; I can read their body. So early detection is a huge, huge piece. It is a huge responsibility for the faculty. Only those who have issues, but if the student has an academic issue like absenteeism or something that is purely academic, not with underlying psychological issues, I handle it online. However, if I suspect, I dive deeper.” (Participant 6). Another participant stated, “Some students will not show any sign or warning signs of psychological issues, but it reflects on their grades, and we can see some issues because their assignment marks are good, but they are unable to do well in the exams.” (Participant 3) Faculty members reported that isolation or withdrawal from group activities is the first sign of students’ distress. A participant stated, “I have noticed that when lecturing, it's often apparent who is struggling, as some students may seem disengaged or isolated. These students tend to sit at the back of the class, away from others.” (Participant 4). Another said, "Sometimes, students display antisocial behaviors, such as isolating themselves. You will often see them sitting alone, not interacting with the group, or avoiding social engagement.” (Participant 2) Faculty members also worked with course coordinators and academic affairs to coordinate efforts to address the student's situation. A participant said, “I would create a session under the academic advisor unit. I will sit with the student, talk about her issues, and address her concerns, whether the problem is psychological or social; if it is psychological, we will do multiple sessions to address it. If unresolved, I will ask the student’s permission to communicate with the social worker. If she approves, I will refer her to the social worker designated by the College.” (Participant 6) The faculty members highlight the use of a structured approach within the college system for students in need of support and close monitoring, including advising and counseling systems and referrals to social workers or psychologists. A participant reported, “We have something called... Shawnee System or Wellness Center. Those who are specially approaching the social workers will be maintained as separate records and monitored frequently from the social worker’s side. Because apart from all the 10–15 students, if I am forwarding only one or two to the social worker, then it is her duty to concentrate only on those specific students. Those students will be specially maintained with records, like how they are every month or every weekly report.” (Participant 8) Faculty members reported that they connect students to various network resources through the advising and counseling system, such as referring to social workers or psychologists. A participant stated, “Our college offers various resources, including a wellness center with medical professionals and psychologists.” (Participant 4) Challenges Of Supporting Students Faculty members encountered challenges in addressing students' mental health concerns and providing adequate support. Faculty members expressed uncertainty and discomfort about using proper communication strategies to handle students’ difficulties. Many faculty members reported feeling unprepared to address or assess mental health concerns and uncomfortable asking students direct questions about their mental health. A participant said, "I am not comfortable at all... if the student agrees she has psychological issues, I am kind of getting stressed because I do not know how to deal with it." (Participant 8). A common strategy mentioned is referring students to Wellness Centers or professionals for its safest and most effective approach. A participant explained, “I prefer just to refer the student to the Wellness Center and to make sure that she is visiting the Wellness Center; this is all I can do in the situation, but it makes me feel really bad also because I could not communicate once I know that this student had psychiatric disorders I really cannot communicate with her because I believe every word would affect her in a way or the other. So, I am very cautious about that.” (Participant 1) This discomfort was pronounced when students did not openly disclose their struggles. Several faculty members also faced challenges with students reluctant to seek help, making it difficult for faculty to identify those needing support. These communication barriers were either due to stigma or unawareness. A participant reported, “I know about a student from her friends. They come to me and say, (She is not fine. She is going through something). I know that she has been dealing with psychosis, but she does not like to talk about it. We want to identify students like her so we can help and support them, but I am not sure how to do that.” Faculty Traning Needs This theme emphasizes the need for increased awareness of mental health resources and training for faculty members and staff on dealing with students with emotional distress. Most faculty members discussed the need for training on handling students with psychological issues. A participant stated, “We need more workshops or education on how to detect students with mental distress and suicidal ideation. Because we did not know when another thing would happen, people must also work on the stigmatization and not judge them because it is still happening.” (Participant 5). Another participant stated, “We should increase awareness among faculty. So, it is our responsibility to identify students or students who have anxiety or are isolated because.” (Participant 6) Further, the faculty highlights the need for clear guidelines when handling mental health crises. A participant said, “We need a clear guideline or policy that I can read or know about a high case that should be reported and interact with, such as suicidal ideation.” (Participant 2). Several faculty members shared their need for workshops and educational sessions focusing on practical skills such as communication techniques and strategies for supporting distressed students. A participant illustrated, “We need workshops about communication techniques and support techniques. I attended a workshop about giving feedback. I learned much from this session. We should have all the skills to talk with the students and give them feedback.” (Participant 3) Faculty members suggested a clear orientation for students and staff about the availability of mental health resources, particularly the wellness center and advising units. Several participants noted that students receive guidance during orientation, but there is a lack of detailed and easily accessible information on mental health resources to seek help. A participant explained, “I think it started with the orientation part where they orientated about the university; they should give students clear pictures about the resources that we have in universities and like assurance that everyone here in the wellness center is to help and support differently, and they can approach maybe also give them a better orientation about advising units. What support can they get? Why is the advising unit here?” (Participant 4) Discussion The findings of this study underscore the critical role that faculty members play in supporting both the emotional well-being and academic success of students. Faculty are in a unique position to offer both direct and indirect support to students experiencing emotional distress due to their frequent interactions, which enables them to identify and address early signs of distress. The study's results align with previous research, particularly a study that found that faculty who actively promote mental health resources and work to reduce stigma significantly contribute to students’ well-being [ 22 ]. The study also emphasizes how faculty actively engage with students who show signs of distress. Their willingness to extend their availability outside of working hours and adapt various communication methods (such as online platforms) reflects a deep sense of responsibility and empathy. Such proactive engagement is essential in creating an environment where students feel accessible to faculty and can trust them enough to seek help. This dynamic contributes to a sense of belonging and community, crucial factors for fostering student motivation and engagement, particularly in high-stress academic environments [ 23 ]. However, it’s also worth noting that a study found that many students prefer the online personal counseling model due to its anonymity and reduced stigma [ 24 ]. Thus, integrating online counseling into existing support structures can offer comprehensive support to students in distress. Further research is needed to explore the student’s perspective on the effectiveness and preferences of online counseling versus face-to-face interaction. Despite these positive findings, the study also revealed significant challenges that faculty face in supporting students, particularly in identifying and addressing mental health concerns. Faculty members often expressed discomfort and uncertainty about how to approach psychological issues, citing a lack of training and clear guidelines. This gap in faculty preparedness is reflected in existing research. For example, a previous study reported that faculty members lack sufficient knowledge of mental health [ 25 ] and have not received comprehensive training in crisis intervention and mental health first aid [ 26 ]. These challenges emphasize the need for institutional support to equip faculty with the necessary skills and knowledge to effectively handle such situations. Further supporting this point, research by [ 12 ] suggests that the lack of institutional support systems and clear guidelines can contribute to faculty stress and burnout. The study underscores the necessity for clear institutional policies that not only encourage open discussions of mental health with students but also help faculty develop the skills to manage cases involving severe distress or suicidal ideation. This is especially critical in addressing the broader mental health crisis in educational settings. Additionally, the study found that faculty members were often unaware of available institutional resources, which hindered their ability to respond to student needs effectively. This finding aligns with previous studies that highlight the importance of training faculty to better understand their roles in supporting students and reducing the stigma surrounding mental health issues [ 27 , 12 , 28 ]. In conclusion, this study reinforces the need for comprehensive institutional support, training, and policies to empower faculty in addressing mental health challenges effectively. By fostering an informed and empathetic faculty, institutions can better support students in their academic and emotional journeys. Implications The study findings highlight the need for nursing curricula to incorporate mental health awareness and emotional resilience as essential components. Nursing faculty should have clear guidelines for available institutional resources, such as wellness centers, counseling services, and social workers. Strong collaboration between nursing faculty and these resources can ensure that students receive comprehensive support. In addition to increasing awareness about mental health, it is important to ensure that students understand that seeking help is a sign of strength, not weakness, by normalizing discussions of emotional well-being. The findings of this research have several implications for nursing research. Nursing research could focus on developing, implementing, and evaluating training programs for nursing faculty that address mental health awareness, crisis intervention, and communication strategies for engaging students in distress. This research could help assess their impact on faculty confidence and student outcomes. Furthermore, a qualitative study on understanding how faculty communication styles influence students’ emotional health could lead to the development of best practices for supporting nursing students in distress. Limitations This study provides a deep understanding of the experience of faculty members recognizing nursing students’ psychological support needs. The findings of this study are limited in generalizability due to the small sample size that is not representative of all educational contexts. This study does not capture the experiences of students and their preferences for counseling methods. Thus, more research is needed on how students perceived and utilized the counseling services. A potential bias of this study is the presence of social bias that may arise due to personal beliefs to provide socially accepted responses. Conclusion This study provides insight into faculty members’ lived experiences in recognizing nursing students’ psychological support needs. The findings emphasize the multidimensional role of faculty members in providing students with emotional and academic support. Faculty consistently demonstrate empathetic engagement by fostering a non-judgmental and confidential environment for students to share their struggles. Their efforts in connecting students to institutional resources, like wellness centers and social workers, reveal a collaborative approach to addressing mental health concerns. However, faculty encounter significant challenges, including discomfort in addressing mental health issues, communication barriers with students, and limited training in handling psychological concerns. Thus, institutional support through training, resources, and clear protocols is essential for equipping them to navigate the complexities of mental health concerns effectively. Declarations List of abbreviations Not applicable Supplementary Information The online version of supplementary materials is available at Ethics approval and consent to participate This study is conducted in accordance with the Declaration of Helsinki and approved by the Ethical Committee of King Abdullah International Medical Research Center (KAIMRC) (IRB/NRJ24/018/5). Written informed consent was obtained to participate in this study. The consent form includes the study's aim and informs participants that they can withdraw from the study at any time. Confidentiality and privacy were maintained in all research processes. Consent for publication Not applicable Availability of data and materials The full transcripts of the interviews are not available to the public due to privacy concerns. However, data from this study can be obtained from the corresponding author upon reasonable request. Competing Interest The authors declared no competing interests. Funding The authors received no financial support for the authorship and/or publication of this research. Clinical trial number Not applicable Authors' contributions SSA designed the study and supervised its progress. SSA and SA collected and analyzed the data. SSA, SA, and HA participate in manuscript writing. SSA, SA, and HA participated in the discussion and implication and revised the manuscript. All authors have read the published version of the manuscript. Acknowledgements We would like to express our sincere gratitude to all the participants who took part in this study. 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Supplementary Files SupplementaryInformation.docx Cite Share Download PDF Status: Published Journal Publication published 15 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 17 Jun, 2025 Reviews received at journal 10 Jun, 2025 Reviewers agreed at journal 10 Jun, 2025 Reviews received at journal 13 May, 2025 Reviewers agreed at journal 09 May, 2025 Reviewers agreed at journal 07 May, 2025 Reviewers invited by journal 07 May, 2025 Editor assigned by journal 10 Apr, 2025 Submission checks completed at journal 10 Apr, 2025 First submitted to journal 04 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6373129","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":454371281,"identity":"e76bae4c-3883-4dc1-9604-878d937971dc","order_by":0,"name":"Samirh Said Alqhtani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABHUlEQVRIiWNgGAWjYDACdgYGZhDNxsB8GCxgACJ48GlhBqEEkBa2ZBK1AJUZE6eFv5l54+fCH3Z5fPxnPhv+qDnMYM5/gPHB2zYGe/4G7FokDrMVS89ISC5mk8jdnMxz7DCD5YwEZsO5bQyJMw7gsOYwj4E0TwJzYpsE7+bDDGyH6zfcYGCT5m0DOhaHFvnDPMa/eRLqE9v4zzw++OPfYQaD8wfYfwO12Mvj0GJwmMcMaMvhxDaGHOYE3jaglgMJbMxALYwbcGgxPMxWZs2TdhzosDRjY96+dAaDG4nNknPOSSRuxKFF7njz5ts8NtWJ8/sPP5b88c0a6LDDBz+8KbOxl8PlfWhEIAPGBiAhgVM9Ni2jYBSMglEwClABADhdVQPaIo9YAAAAAElFTkSuQmCC","orcid":"","institution":"King Saud bin Abdulaziz University for Health Sciences, Riyadh","correspondingAuthor":true,"prefix":"","firstName":"Samirh","middleName":"Said","lastName":"Alqhtani","suffix":""},{"id":454371282,"identity":"310562aa-6fb9-4b3a-ac7e-5972848fd5f9","order_by":1,"name":"Seham Alselami","email":"","orcid":"","institution":"King Saud bin Abdulaziz University for Health Sciences, Jeddah","correspondingAuthor":false,"prefix":"","firstName":"Seham","middleName":"","lastName":"Alselami","suffix":""},{"id":454371283,"identity":"23f0362c-a6a8-4ced-96a2-e727e758e033","order_by":2,"name":"Hend Alnajjar","email":"","orcid":"","institution":"King Saud bin Abdulaziz University for Health Sciences, Jeddah","correspondingAuthor":false,"prefix":"","firstName":"Hend","middleName":"","lastName":"Alnajjar","suffix":""}],"badges":[],"createdAt":"2025-04-04 04:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6373129/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6373129/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-07652-3","type":"published","date":"2025-07-15T15:57:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87219347,"identity":"993aec71-bf0e-4b58-ba9c-10604cf54563","added_by":"auto","created_at":"2025-07-21 16:04:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":681582,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6373129/v1/a445ed56-d1b4-4adc-9ab7-a28140d6cb09.pdf"},{"id":82486914,"identity":"a25674a0-1758-4f6d-846d-3cd2d3616fb3","added_by":"auto","created_at":"2025-05-12 05:44:22","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15427,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-6373129/v1/329102d797ed947a708230ee.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Faculty lived experiences in recognizing nursing students’ psychological support needs in Saudi Arabia","fulltext":[{"header":"Background","content":"\u003cp\u003eThe mental well-being of nursing students is essential for their academic success, professional development, and overall quality of life. Previous research demonstrated that nursing students frequently encounter elevated levels of stress, anxiety, and depression throughout their academic, clinical training, and social factors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In Saudi Arabia, nursing students face academic stress due to heavy coursework, exams, and clinical training hours [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Mental health issues can affect students\u0026rsquo; cognitive ability and academic success [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Many studies reported a high prevalence of nursing students; 65.1% had depression, and 83.19% had anxiety [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearchers reported the importance of assessing nursing students' stress and early detection of depression before students experience academic failure[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Thus, faculty members play a crucial role in creating a supportive learning environment that promotes the mental health of nursing students. They can offer emotional assistance, direction, and connections to relevant support services[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Positive faculty-student relationships help to reduce emotional distress and increase a sense of belonging within the academic environment[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, faculty members face uncertainty and experiences in providing timely support to students with mental health issues because of tensions between their academic and professional and the lack of explicit policies between faculty and student support services [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Various studies indicate a gap between faculty members' readiness to discuss students' mental health and the decision to refer students to mental health services [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, nursing faculty must know and be able to identify when student stress before it manifests in symptoms. However, research reported that faculty members had a lack of knowledge, training, or confidence to deal with a student facing mental health challenges, which can hinder their ability to recognize and support students [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFaculty members are on the frontline to identify at-risk students, provide information about mental health services, and refer them for help. Studies reported different strategies improved faculty\u0026rsquo;s knowledge and awareness, such as an education program [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], therapeutic communication techniques [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and a trauma-informed training program [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] to identify and support students experiencing emotional distress.\u003c/p\u003e \u003cp\u003eUnderstanding the faculty members\u0026rsquo; experiences in identifying psychological support for the students has not been explored in Saudi Arabia. Therefore, this study aimed to deeply understand the meaning of faculty members\u0026rsquo; lived experiences in recognizing nursing students\u0026rsquo; psychological support needs. This study is significant in identifying faculty members' experiences in supporting nursing students, providing practical strategies, and tailoring interventions to inform faculty members and optimize students' well-being and academic success.\u003c/p\u003e\n\u003ch3\u003eAim of the Study\u003c/h3\u003e\n\u003cp\u003eThis study aimed to understand the meaning of faculty members\u0026rsquo; lived experiences in recognizing nursing students\u0026rsquo; psychological support needs.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch Question\u003c/h2\u003e \u003cp\u003eWhat is the lived experience of faculty members in recognizing nursing students\u0026rsquo; psychological support needs?\u003c/p\u003e \u003c/div\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDesign and participants\u003c/h2\u003e \u003cp\u003eA qualitative phenomenological approach was used to explore the meaning of, gain a deeper understanding of human experiences, and influence all research processes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The COREQ checklist was used to report this study\u0026rsquo;s findings [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A purposive sampling strategy was used to recruit participating faculty members from two nursing colleges located in the Central and Western regions of Saudi Arabia. This sampling method is useful for recruiting participants who experienced the interest and providing rich data about the phenomenon [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Researchers recruited faculty members who work at the College of Nursing and enrolled in advising roles. The exclusion criteria are staff who do not have a teaching role or advising role. The number of participants recruited based on data saturation was eight participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRigor\u003c/h3\u003e\n\u003cp\u003eLincoln \u0026amp; Guba criteria were employed to ensure this study's trustworthiness [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The credibility of the findings was established through prolonged engagement with the data and by providing rich, detailed of participants' experiences. Additionally, peer debriefing allowed researchers to review and offer constructive feedback, enhancing the validity of the findings. Collaborative analyses involving multiple perspectives enriched the depth and accuracy of the results. Dependability was addressed by creating a clear audit trail. Confirmability was achieved using a reflexive journal, where the researchers consistently recorded their thoughts, reactions, and decisions throughout the study. Transferability was enhanced by including direct quotes from participants to provide authentic, detailed insights into their experiences. The accuracy of the data was further supported by transcribing audio recordings immediately after interviews and cross-checking these transcripts against the original recordings.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData was collected through face-to-face interviews. After participants signed the written consent form, the interviews were conducted. The researchers collected demographic data via questionnaire in the first 5 minutes of the interview. Interviews were semi-structured and used open-ended questions, which lasted 45 to 60 minutes. All interviews were conducted in English language and tap recorded.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe transcripts of interviews were imported to the NVivo program version 15 software for data management and organizing the codes and themes. Thematic analysis was used for data analysis following Braun \u0026amp; Clarke process [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]:\u003c/p\u003e \u003cp\u003e1- Familiarizing with data: the researchers immersed in the data by reading and re-reading the data (interview transcripts and observational notes) to gain a deep understanding of its content.\u003c/p\u003e \u003cp\u003e2- Generating initial codes: the researchers systematically coded the data by identifying and labeling interesting features or patterns.\u003c/p\u003e \u003cp\u003e3- Searching for themes: the researchers organized codes into meaningful groups to identify patterns and relationships\u003c/p\u003e \u003cp\u003e4-Reviewing themes: the researchers generated a thematic map by checking the themes in relation to the coded extracts and the entire data set.\u003c/p\u003e \u003cp\u003e5- Defining and naming themes: the researchers refined the specifics of each theme and generated clear definitions and names for each theme.\u003c/p\u003e \u003cp\u003e6- Producing the report: the researchers then finalized and reflected on the identified themes and related the analysis to the research question and literature.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Data\u003c/h2\u003e \u003cp\u003eEight faculty members participated in this study. The demographic characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of faculty members (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcademic service\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of Supervising students\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAcademic rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSpecialty in Nursing\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLecturer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCritical Care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLecturer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMaternity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLecturer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedical and Surgical\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssociate professor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMaternity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssistant professor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssistant professor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePsychiatrics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssistant professor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssistant professor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eManagement and leadership\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eThemes:\u003c/h2\u003e \u003cp\u003eThe data analysis revealed three major themes: \u0026ldquo;student\u0026rsquo;s emotional support,\u0026rdquo; \u0026ldquo;challenges of supporting students,\u0026rdquo; \u0026ldquo;recognition of distress and utilizing resources,\u0026rdquo; and \u0026ldquo;faculty training needs.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudent Emotional Support\u003c/h2\u003e \u003cp\u003eFaculty members created an empathetic, non-judgmental environment where students feel comfortable sharing their emotional struggles. Active listening was central to the faculty\u0026rsquo;s experiences in supporting students. Most faculty expressed that all students need to be heard and be present with them. This theme also reflects that faculty members provide academic advice and provide space to express their emotions that support students\u0026rsquo; emotional well-being.\u003c/p\u003e \u003cp\u003e A participant illustrated, \u0026ldquo;Sometimes, my way of communication is treating advisees differently than the students I lecture. I do not lecture them. I let them vent. This is the way that I think best communicates with them. Sometimes, they do not need to go to the wellness center; they do not have depression, anxiety, or any of those psychological issues; they need emotional support, someone who listens to them.\u0026rdquo; (Participant 6)\u003c/p\u003e \u003cp\u003eFurther, the participants were mindful that maintaining confidentiality is crucial to fostering trust when students are vulnerable. Most participants expressed the importance of creating a safe environment of acceptance and trust. Another participant added, \u0026ldquo;I try to be very open and very patient and never judge students when they talk about something, such as being anxious or depressed or when they say I lost my interest in completing my degree. One day, a student with personal issues came to me, cried, and said: I want to talk to you; I want someone to listen to me. I closed the door and made sure that we had a private environment. I told her that she could speak and I would listen. I tried not to interrupt her\u0026rdquo; (Participant 4). This positions faculty members as compassionate guidance rather than fixing the students\u0026rsquo; problems.\u003c/p\u003e \u003cp\u003eThis theme also describes faculty members\u0026rsquo; proactive efforts to reach out to students with signs of distress through direct interactions either during class or clinical sessions. A participant said, \u0026ldquo;I approach the students during their class, which is the only way I can contact them. Sometimes, I use the Team\u0026rsquo;s program because the students like to write emails and text messages and feel more comfortable than face-to-face conversations.\u0026rdquo; (Participant 1)\u003c/p\u003e \u003cp\u003eSeveral faculty members expressed the importance of face-to-face communication for building trust and being flexible in using online communication channels to support students who might feel hesitant about face-to-face conversations. A participant stated, \"\u0026hellip; certain students say, I want to talk to you privately. Then, in those circumstances, I give them an appointment through WhatsApp or the call. They can call me, and then they come and meet me personally\u0026rdquo; (Participant 7). This flexibility helps students feel empowered and fosters an environment where they can contact faculty to seek help.\u003c/p\u003e \u003cp\u003eFaculty members extended their availability time outside regular working hours to support students. This extended care indicates recognizing students\u0026rsquo; emotional distress and having deep empathy. Further, easy accessibility goes beyond academic advising, showing a genuine commitment to students' mental health and stability. A participant reported, \u0026ldquo;I follow up with students if it is a serious situation because I want to see how the student gets better. I will contact the student, and if I do not see her after a while, I will contact her and ask her how she is doing. Alternatively, I will tell her; please let me know what happened. So sometimes students come back, and they tell me about their issues, sometimes they do not, and then I will call them and ask them, and if they say they are fine, then it is fine. However, I always reassure them that I am always available. Because they are my advice, I would see them, so I made an appointment to see them. Ask them to come and see me.\u0026rdquo; (Participant 2)\u003c/p\u003e \u003cp\u003eFaulty members expressed their role as academic guidance, supported students\u0026rsquo; personal development, and assisted them with work-life balance. A participant explained, \u0026ldquo;I get some of the students who have low GPAs or low achievements or no grades in the course, and I will contact them to come to my office and discuss what I can do for them. If they want me to repeat some part of the lectures, or they want me to help them by giving a tutorial or by giving examples.\u0026rdquo; (Participant 4)\u003c/p\u003e \u003cp\u003eMany participants shared strategies to help students with academic struggles, such as group study sessions, personalized follow-ups, and time management. Other participants shared their academic experiences that helped alleviate helplessness and isolation. \u0026ldquo;Sharing experience with them is really helpful. I shared my experiences with students, like my experience with public speaking, my experience with academic struggles, how to deal with low grades, and how all of these experiences helped me overcome many of my stresses. I believe the only faculty members have a big role in supporting students as they have been through all these things.\u0026rdquo; (Participant 1)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRecognition of Distress and Utilizing Resources\u003c/h2\u003e \u003cp\u003eThis theme focuses on how faculty members identified the early signs of emotional and social distress and their collaborative role in leveraging institutional resources to address students\u0026rsquo; needs. Faculty members emphasized their ability to recognize visible signs of students with emotional or psychological issues through observable behavior or academic performance.\u003c/p\u003e \u003cp\u003eFaculty noted that academic performance is an indicator that directly impacts students' mental and emotional well-being, such as low grades or exam difficulty. A participant illustrated, \u0026ldquo;...I see them; I can read their body. So early detection is a huge, huge piece. It is a huge responsibility for the faculty. Only those who have issues, but if the student has an academic issue like absenteeism or something that is purely academic, not with underlying psychological issues, I handle it online. However, if I suspect, I dive deeper.\u0026rdquo; (Participant 6). Another participant stated, \u0026ldquo;Some students will not show any sign or warning signs of psychological issues, but it reflects on their grades, and we can see some issues because their assignment marks are good, but they are unable to do well in the exams.\u0026rdquo; (Participant 3)\u003c/p\u003e \u003cp\u003eFaculty members reported that isolation or withdrawal from group activities is the first sign of students\u0026rsquo; distress. A participant stated, \u0026ldquo;I have noticed that when lecturing, it's often apparent who is struggling, as some students may seem disengaged or isolated. These students tend to sit at the back of the class, away from others.\u0026rdquo; (Participant 4). Another said, \"Sometimes, students display antisocial behaviors, such as isolating themselves. You will often see them sitting alone, not interacting with the group, or avoiding social engagement.\u0026rdquo; (Participant 2)\u003c/p\u003e \u003cp\u003eFaculty members also worked with course coordinators and academic affairs to coordinate efforts to address the student's situation. A participant said, \u0026ldquo;I would create a session under the academic advisor unit. I will sit with the student, talk about her issues, and address her concerns, whether the problem is psychological or social; if it is psychological, we will do multiple sessions to address it. If unresolved, I will ask the student\u0026rsquo;s permission to communicate with the social worker. If she approves, I will refer her to the social worker designated by the College.\u0026rdquo; (Participant 6)\u003c/p\u003e \u003cp\u003eThe faculty members highlight the use of a structured approach within the college system for students in need of support and close monitoring, including advising and counseling systems and referrals to social workers or psychologists. A participant reported, \u0026ldquo;We have something called... Shawnee System or Wellness Center. Those who are specially approaching the social workers will be maintained as separate records and monitored frequently from the social worker\u0026rsquo;s side. Because apart from all the 10\u0026ndash;15 students, if I am forwarding only one or two to the social worker, then it is her duty to concentrate only on those specific students. Those students will be specially maintained with records, like how they are every month or every weekly report.\u0026rdquo; (Participant 8)\u003c/p\u003e \u003cp\u003eFaculty members reported that they connect students to various network resources through the advising and counseling system, such as referring to social workers or psychologists. A participant stated, \u0026ldquo;Our college offers various resources, including a wellness center with medical professionals and psychologists.\u0026rdquo; (Participant 4)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eChallenges Of Supporting Students\u003c/h2\u003e \u003cp\u003eFaculty members encountered challenges in addressing students' mental health concerns and providing adequate support. Faculty members expressed uncertainty and discomfort about using proper communication strategies to handle students\u0026rsquo; difficulties. Many faculty members reported feeling unprepared to address or assess mental health concerns and uncomfortable asking students direct questions about their mental health. A participant said, \"I am not comfortable at all... if the student agrees she has psychological issues, I am kind of getting stressed because I do not know how to deal with it.\" (Participant 8). A common strategy mentioned is referring students to Wellness Centers or professionals for its safest and most effective approach. A participant explained, \u0026ldquo;I prefer just to refer the student to the Wellness Center and to make sure that she is visiting the Wellness Center; this is all I can do in the situation, but it makes me feel really bad also because I could not communicate once I know that this student had psychiatric disorders I really cannot communicate with her because I believe every word would affect her in a way or the other. So, I am very cautious about that.\u0026rdquo; (Participant 1)\u003c/p\u003e \u003cp\u003eThis discomfort was pronounced when students did not openly disclose their struggles. Several faculty members also faced challenges with students reluctant to seek help, making it difficult for faculty to identify those needing support. These communication barriers were either due to stigma or unawareness. A participant reported, \u0026ldquo;I know about a student from her friends. They come to me and say, (She is not fine. She is going through something). I know that she has been dealing with psychosis, but she does not like to talk about it. We want to identify students like her so we can help and support them, but I am not sure how to do that.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFaculty Traning Needs\u003c/h2\u003e \u003cp\u003eThis theme emphasizes the need for increased awareness of mental health resources and training for faculty members and staff on dealing with students with emotional distress. Most faculty members discussed the need for training on handling students with psychological issues.\u003c/p\u003e \u003cp\u003eA participant stated, \u0026ldquo;We need more workshops or education on how to detect students with mental distress and suicidal ideation. Because we did not know when another thing would happen, people must also work on the stigmatization and not judge them because it is still happening.\u0026rdquo; (Participant 5). Another participant stated, \u0026ldquo;We should increase awareness among faculty. So, it is our responsibility to identify students or students who have anxiety or are isolated because.\u0026rdquo; (Participant 6)\u003c/p\u003e \u003cp\u003e Further, the faculty highlights the need for clear guidelines when handling mental health crises. A participant said, \u0026ldquo;We need a clear guideline or policy that I can read or know about a high case that should be reported and interact with, such as suicidal ideation.\u0026rdquo; (Participant 2). Several faculty members shared their need for workshops and educational sessions focusing on practical skills such as communication techniques and strategies for supporting distressed students. A participant illustrated, \u0026ldquo;We need workshops about communication techniques and support techniques. I attended a workshop about giving feedback. I learned much from this session. We should have all the skills to talk with the students and give them feedback.\u0026rdquo; (Participant 3)\u003c/p\u003e \u003cp\u003eFaculty members suggested a clear orientation for students and staff about the availability of mental health resources, particularly the wellness center and advising units. Several participants noted that students receive guidance during orientation, but there is a lack of detailed and easily accessible information on mental health resources to seek help.\u003c/p\u003e \u003cp\u003eA participant explained, \u0026ldquo;I think it started with the orientation part where they orientated about the university; they should give students clear pictures about the resources that we have in universities and like assurance that everyone here in the wellness center is to help and support differently, and they can approach maybe also give them a better orientation about advising units. What support can they get? Why is the advising unit here?\u0026rdquo; (Participant 4)\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study underscore the critical role that faculty members play in supporting both the emotional well-being and academic success of students. Faculty are in a unique position to offer both direct and indirect support to students experiencing emotional distress due to their frequent interactions, which enables them to identify and address early signs of distress. The study's results align with previous research, particularly a study that found that faculty who actively promote mental health resources and work to reduce stigma significantly contribute to students\u0026rsquo; well-being [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study also emphasizes how faculty actively engage with students who show signs of distress. Their willingness to extend their availability outside of working hours and adapt various communication methods (such as online platforms) reflects a deep sense of responsibility and empathy. Such proactive engagement is essential in creating an environment where students feel accessible to faculty and can trust them enough to seek help. This dynamic contributes to a sense of belonging and community, crucial factors for fostering student motivation and engagement, particularly in high-stress academic environments [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, it\u0026rsquo;s also worth noting that a study found that many students prefer the online personal counseling model due to its anonymity and reduced stigma [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Thus, integrating online counseling into existing support structures can offer comprehensive support to students in distress. Further research is needed to explore the student\u0026rsquo;s perspective on the effectiveness and preferences of online counseling versus face-to-face interaction.\u003c/p\u003e \u003cp\u003eDespite these positive findings, the study also revealed significant challenges that faculty face in supporting students, particularly in identifying and addressing mental health concerns. Faculty members often expressed discomfort and uncertainty about how to approach psychological issues, citing a lack of training and clear guidelines. This gap in faculty preparedness is reflected in existing research. For example, a previous study reported that faculty members lack sufficient knowledge of mental health [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and have not received comprehensive training in crisis intervention and mental health first aid [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These challenges emphasize the need for institutional support to equip faculty with the necessary skills and knowledge to effectively handle such situations. Further supporting this point, research by [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] suggests that the lack of institutional support systems and clear guidelines can contribute to faculty stress and burnout. The study underscores the necessity for clear institutional policies that not only encourage open discussions of mental health with students but also help faculty develop the skills to manage cases involving severe distress or suicidal ideation. This is especially critical in addressing the broader mental health crisis in educational settings.\u003c/p\u003e \u003cp\u003eAdditionally, the study found that faculty members were often unaware of available institutional resources, which hindered their ability to respond to student needs effectively. This finding aligns with previous studies that highlight the importance of training faculty to better understand their roles in supporting students and reducing the stigma surrounding mental health issues [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn conclusion, this study reinforces the need for comprehensive institutional support, training, and policies to empower faculty in addressing mental health challenges effectively. By fostering an informed and empathetic faculty, institutions can better support students in their academic and emotional journeys.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eImplications\u003c/h2\u003e \u003cp\u003eThe study findings highlight the need for nursing curricula to incorporate mental health awareness and emotional resilience as essential components. Nursing faculty should have clear guidelines for available institutional resources, such as wellness centers, counseling services, and social workers. Strong collaboration between nursing faculty and these resources can ensure that students receive comprehensive support. In addition to increasing awareness about mental health, it is important to ensure that students understand that seeking help is a sign of strength, not weakness, by normalizing discussions of emotional well-being. The findings of this research have several implications for nursing research.\u003c/p\u003e \u003cp\u003eNursing research could focus on developing, implementing, and evaluating training programs for nursing faculty that address mental health awareness, crisis intervention, and communication strategies for engaging students in distress. This research could help assess their impact on faculty confidence and student outcomes. Furthermore, a qualitative study on understanding how faculty communication styles influence students\u0026rsquo; emotional health could lead to the development of best practices for supporting nursing students in distress.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study provides a deep understanding of the experience of faculty members recognizing nursing students\u0026rsquo; psychological support needs. The findings of this study are limited in generalizability due to the small sample size that is not representative of all educational contexts. This study does not capture the experiences of students and their preferences for counseling methods. Thus, more research is needed on how students perceived and utilized the counseling services. A potential bias of this study is the presence of social bias that may arise due to personal beliefs to provide socially accepted responses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides insight into faculty members\u0026rsquo; lived experiences in recognizing nursing students\u0026rsquo; psychological support needs. The findings emphasize the multidimensional role of faculty members in providing students with emotional and academic support. Faculty consistently demonstrate empathetic engagement by fostering a non-judgmental and confidential environment for students to share their struggles. Their efforts in connecting students to institutional resources, like wellness centers and social workers, reveal a collaborative approach to addressing mental health concerns. However, faculty encounter significant challenges, including discomfort in addressing mental health issues, communication barriers with students, and limited training in handling psychological concerns. Thus, institutional support through training, resources, and clear protocols is essential for equipping them to navigate the complexities of mental health concerns effectively.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eList of abbreviations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe online version of supplementary materials is available at\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is conducted in accordance with the Declaration of Helsinki and approved by the Ethical Committee of King Abdullah International Medical Research Center (KAIMRC) (IRB/NRJ24/018/5). Written informed consent was obtained to participate in this study. The consent form includes the study\u0026apos;s aim and informs participants that they can withdraw from the study at any time. Confidentiality and privacy were maintained in all research processes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe full transcripts of the interviews are not available to the public due to privacy concerns. However, data from this study can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared\u0026nbsp;no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the authorship and/or publication of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSSA designed the study and supervised its progress. SSA and SA collected and analyzed the data. SSA, SA, and HA participate in manuscript writing. SSA, SA, and HA participated in the discussion and implication and revised the manuscript. All authors have read the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to all the participants who took part in this study. We also appreciate the Office of Research at King Saud bin Abdulaziz University for Health Sciences for providing language editing services and the King Abdullah International Medical Research Center in Riyadh, Saudi Arabia.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePhu TG, Thao NH, Long PT. Stress Levels among undergraduate nursing students in relation to demographic factors at Tra Vinh university, Vietnam, 2023. \u003cem\u003eEAS J Psychol Behav Sci\u003c/em\u003e 2024, \u003cem\u003e6\u003c/em\u003e; https://doi.org/10.36349/easjpbs.2024.v06i03.001\u003c/li\u003e\n\u003cli\u003eChoudhury K. 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S, . Z, Alam S, Rangkuti R. WEB-Based e-Personal Counseling (e-PC) model reduces anxiety in the face of national examination. KSS [Internet]. 2023Mar.3;\u003cem\u003e8\u003c/em\u003e(4):244\u0026ndash;253. https://knepublishing.com/index.php/KnE-Social/article/view/12905\u003c/li\u003e\n\u003cli\u003eSatparam J. Examining the mental health literacy and challenges to supporting students among regional Philippine teacher education faculty. \u003cem\u003eJEMDS. \u003c/em\u003e2023 Sept 30;\u003cem\u003e3\u003c/em\u003e(3):41\u0026ndash;53. doi:10.52631/jemds.v3i3.169\u003c/li\u003e\n\u003cli\u003eGunawardena, H., Leontini, R., Nair, S. et al. Teachers as first responders: classroom experiences and mental health training needs of Australian schoolteachers. \u003cem\u003eBMC Public Health 24\u003c/em\u003e, 268 (2024). https://doi.org/10.1186/s12889-023-17599-z\u003c/li\u003e\n\u003cli\u003eSabrifha E, Darmawati D. The importance of teacher interpersonal communication as an effort to maintain students\u0026rsquo; mental health: A study of lerature review. \u003cem\u003eJurnal Educatio\u003c/em\u003e: \u003cem\u003eJurnal Pendidikan Indonesia\u003c/em\u003e. 2022 Dec 30;\u003cem\u003e8\u003c/em\u003e(2):236. doi:10.29210/1202222931\u003c/li\u003e\n\u003cli\u003eZheng F. Fostering Students\u0026apos; Well-Being: the mediating role of teacher interpersonal behavior and student-teacher relationships. \u003cem\u003eFront Psychol\u003c/em\u003e. 2022 Jan 4;\u003cem\u003e12\u003c/em\u003e:796728. doi: 10.3389/fpsyg.2021.796728.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"faculty members, nursing students, psychological support, mental health, recognition of distress, mental health r resources, nursing education, Saudi Arabia","lastPublishedDoi":"10.21203/rs.3.rs-6373129/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6373129/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Objectives\u003c/strong\u003e: Nursing students often experience high levels of stress, anxiety, and depression throughout their academic and clinical education. Academic and social pressures can intensify mental health challenges during university studies. Faculty members play a vital role in fostering a supportive and inclusive learning environment that prioritizes the mental well-being of nursing students. This study aimed to gain a deeper understanding of faculty members' experience in recognizing nursing students’ psychological support needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This qualitative study involved purposive sampling of faculty members in two nursing colleges in Saudi Arabia. In-depth, face-to-face, semi-structured interviews of eight faculty members using open-ended questions were conducted. The interviews were recorded, transcribed verbatim, and thematically analyzed using the NVivo program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Data analysis revealed four major themes: students’ emotional support, challenges of supporting students, recognition of distress and utilizing resources, and faculty training needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: This study identified a multidimensional role of faculty members in supporting students' emotional well-being and academic success. However, they faced challenges that need to be addressed through educational organizations. There is a need to examine the effectiveness of training programs in educating faculty on identifying mental health issues and providing adequate support.\u003c/p\u003e","manuscriptTitle":"Faculty lived experiences in recognizing nursing students’ psychological support needs in Saudi Arabia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-12 05:28:01","doi":"10.21203/rs.3.rs-6373129/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-17T07:22:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-10T14:11:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227399558565273488796646286994965152293","date":"2025-06-10T14:08:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-13T18:58:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330683892346266120926417960562744559032","date":"2025-05-09T09:43:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"98832322758391364935437016002981208466","date":"2025-05-07T12:43:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-07T09:04:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-10T14:17:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-10T14:13:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-04-04T04:21:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f9d56be4-2211-4ae1-a0d1-11ee4090ac11","owner":[],"postedDate":"May 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T16:01:59+00:00","versionOfRecord":{"articleIdentity":"rs-6373129","link":"https://doi.org/10.1186/s12909-025-07652-3","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-07-15 15:57:10","publishedOnDateReadable":"July 15th, 2025"},"versionCreatedAt":"2025-05-12 05:28:01","video":"","vorDoi":"10.1186/s12909-025-07652-3","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07652-3","workflowStages":[]},"version":"v1","identity":"rs-6373129","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6373129","identity":"rs-6373129","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}