Mapping academic achievement in nursing students: Insights from a latent profile analysis

Mapping academic achievement in nursing students: Insights from a latent profile analysis | 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 Mapping academic achievement in nursing students: Insights from a latent profile analysis Xiaoyan Peng, Chao Wu, Ziyue Gai, Yonghong Yang, Shizhe He, Shujie Guo, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7290531/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Aim To identify distinct subgroups based on academic achievement (AA) among nursing students and explore factors associated with each subgroup. Design A cross-sectional survey was carried out between March and April 2025. Methods 1,011 nursing students were recruited via convenience sampling. Latent profile analysis (LPA) was applied to classify nursing students into distinct subgroups according to their AA characteristics. Additionally, multiple logistic regression was employed to investigate factors influencing subgroup membership. Results LPA revealed three distinct subgroups: Holistically proficient type (23.5%), Moderate type (62.4%), and High self-management with low learning cognition and interpersonal facilitation type (14.1%). Factors associated with AA heterogeneity included vigor, professional cognition, professional volition, professional skills, and geographic region of rural, professional affect and only - child status. Conclusions The presence of AA heterogeneity among nursing students implies a need for educators to implement individualized interventions tailored specifically to subgroup attributes. Moreover, educators are encouraged to foster higher learning engagement and bolster professional identity among students to enhance their overall AAs and contribute positively to the expansion of the nursing workforce. Impact Exploring the subgroup of nursing students’ AA, this study identified characteristics in those nursing students with high self-management but low cognitive learning and interpersonal facilitation. Our study provides insights for institutions to tailor educational interventions, enhancing understanding of academic achievement by LPA. Patient or Public Contribution No patient or public contribution. Figures Figure 1 1. Introduction Nurses constitute the largest professional cohort within a health workforce that is adequately staffed, equitably distributed, and well-supported, serving as an indispensable force. Despite global progress in addressing nursing shortages, the WHO predicts a persistent global shortfall of 4.1 million nurses by 2030, accompanied by ongoing inequities in workforce adequacy worldwide [ 1 ]. The Global Strategic Directions for Nursing and Midwifery Services (2021–2025) underscores the necessity of improving educational training for nurses and midwives to realize universal health coverage (UHC) and population health objectives. This framework advocates aligning educational outcomes with the anticipated professional roles nurses and midwives assume within health and educational institutions [ 2 ]. However, high nursing student attrition rates persist globally and are expected to worsen [ 3 ], attracting significant international attention [ 4 ]. Enhancing nursing students’ AA is therefore crucial for cultivating competent nursing professionals and effectively addressing public health challenges. AA has both broad and narrow conceptualizations. The narrow definition exclusively refers to academic performance, such as grades, while the broad definition encompasses holistic student development throughout their academic tenure [ 5 ]. Current research primarily employs a narrow conceptualization, focusing on academic performance metrics [ 6 ]. However, this approach uses oversimplified criteria that inadequately reflect students’ growth in AA. Therefore, this study adopts a competency-based framework to operationalize AA. AA represents a critical measure for evaluating educational quality and student learning outcomes [ 7 ]. It also directly influences nursing students’ completion and graduation rates. Failure to meet academic standards significantly contributes to high nursing student attrition rates [ 4 ]. Qin et al. reported that academic success has protective effects, whereas poor academic performance elevates stress and depressive symptoms among adolescents [ 8 ]. Numerous studies have further indicated that AA significantly predicts career maturity, with higher academic attainment correlating with greater career maturity [ 9 – 11 ]. Extensive research underscores AA’s pivotal role in enhancing nursing education quality, promoting students’ physical and psychological well-being, and advancing professional development. Although considerable research has explored factors influencing academic performance, the status of AA and potential heterogeneity among nursing students remain unclear. Learning engagement (LE) describes the behavioral intensity with which students initiate and sustain learning activities, combined with the quality of their emotional experiences. Engagement involves behavioral and emotional dimensions, manifesting as observable behaviors such as task initiation, active participation, sustained effort, persistence during challenges, and positive emotions including optimism, enthusiasm, and curiosity. Engagement also aligns closely with academic objectives [ 12 ]. LE is widely recognized as vital for effective learning and improving nursing education quality [ 13 ]. Mohamed et al. reported that higher engagement levels enhance knowledge acquisition and comprehension, improving academic performance and enabling nursing graduates to deliver high-quality patient care [ 14 ]. Nevertheless, existing studies on the relationship between LE and AA lack sufficient cultural adaptation to the Chinese context and neglect heterogeneity among nursing students, especially newly enrolled undergraduates. Professional identity is defined as a person's self-perception concerning their professional role, comprising fundamental occupational values, behaviors, beliefs, and attitudes. This multidimensional construct develops from individuals’ sense of professional belonging and their commitment to professional ethics and practice standards [ 15 ]. Professional identity plays a crucial role in facilitating nursing students' successful transition into clinical settings, significantly enhancing their competencies and shaping their career development [ 16 , 17 ]. A strong sense of professional identity promotes both emotional attachment and active learning participation, subsequently influencing AA through this dual-pathway process [ 18 , 19 ]. Nevertheless, current research has not clearly elucidated the interplay between professional identity and LE. Furthermore, the combined influence of professional identity and LE on AA among nursing students requires additional exploration. Despite overall improvements in AA, nursing students continue to encounter challenges such as uneven distribution of educational resources, mental health issues, professional burnout, and difficulties translating theoretical knowledge into clinical practice. Deepening our understanding of these factors and their interrelationships remains essential. Previous studies predominantly evaluated AA using aggregate measures, thereby neglecting individual variability. To overcome these shortcomings, LPA provides an appropriate methodological approach. LPA, as a person-centered analytic technique, identifies subgroups with distinct characteristics, revealing hidden heterogeneity within populations that traditional analytic methods cannot detect. By employing this method, distinct subgroups among nursing students based on AA can be effectively differentiated. Additionally, Self-Determination Theory (SDT), which highlights the intrinsic and extrinsic motivational aspects underlying individual actions, informs the conceptual framework of this research [ 20 ]. SDT postulates that fundamental psychological needs drive human behaviors [ 21 ]. Within education, SDT frequently explains student motivation and engagement behaviors [ 22 , 23 ]. In this study, LE represents the external manifestation of nursing students’ motivation, while professional identity aligns with their sense of autonomy and competence. Applying SDT facilitates understanding of how LE and professional identity fulfill these psychological needs, subsequently influencing AA. Consequently, the present study seeks to categorize nursing students into distinct AA profiles and explore influencing factors guided by SDT. This approach facilitates the formulation of precise interventions to strengthen AA, providing empirical evidence to support tailored educational practices within nursing education. The specific research questions explored include: (a)What distinct AA subgroups exist among nursing students? (b) What characteristics distinguish nursing students demonstrating higher AA levels? (c) In what ways do sociodemographic variables and personal factors (LE and professional identity) influence membership within these AA subgroups? 2. Methods 2.1 Study design This multi-site, cross-sectional, web-based study was conducted from March and April 2025 in China. 2.2 Study setting and participants Convenience sampling was employed to enroll nursing students from diverse educational institutions in Fujian, Shaanxi, Hunan, and Guangdong Provinces from March to April 2025. The minimum required sample size was set at 500 to meet the recommendations for LPA [ 24 ], the final sample consisted of 1,011 respondents. Participants were included based on the following criteria: (1) full-time enrollment in nursing education programs, and (2) voluntary consent and participation. Students on medical leave or unable to complete the questionnaire properly due to special circumstances were excluded. 2.3 Data collection instruments 2.3.1 Demographics characteristics The researchers independently developed the questionnaire based on nursing student characteristics and literature analysis findings. It consisted of six items: gender, only-child status, geographic region, educational attainment, motivations for selecting nursing as a major, relationship quality with nursing educators. 2.3.2 AA Scale for College Students AA among nursing students was measured using the College Student AA Scale, which is well-established in Chinese contexts [ 25 , 26 ]. This instrument includes 19 items across four domains: learning cognition (4 items), communication skills (5 items), self-management (5 items), and interpersonal facilitation (5 items). Responses were scored on a 5-point Likert scale, from 1 (“strongly disagree”) to 5 (“strongly agree”), with five items reverse-scored. Higher scores denote greater competency-based AA. The scale’s reliability in this study was strong (Cronbach ’s α = 0.821). 2.3.3 Chinese Version of the Utrech Work Engagement Scale-Student (UWES-S) LE among Chinese nursing students was evaluated using the UWES-S, originally formulated by Schaufeli et al. (2002) [ 27 ] and adapted to a Chinese context. This scale comprises 17 items distributed among three dimensions: motivation (6 items), vigor (6 items), and absorption (5 items). Items were rated on a 7-point Likert scale ranging from 0 (“never”) to 6 (“always”), with higher total scores indicating enhanced LE. In this study, the UWES-S demonstrated excellent internal consistency (Cronbach’s α = 0.981). 2.3.4 Professional Identity Scale for Nursing Students The Professional Identity Scale for Nursing Students , developed by Hu Zhonghua at Sichuan University in 2007[ 28 ], assessed students’ professional identity. This scale consists of 30 items across six dimensions: professional cognition (6 items), professional affect (5 items), professional volition (6 items), professional values (4 items), professional skills (5 items), and professional expectations (4 items). Items were scored on a 5-point Likert scale from 1 (strongly negative) to 5 (strongly positive), with higher cumulative scores reflecting a stronger professional identity. The scale exhibited excellent reliability in this study (Cronbach’s α = 0.902). 2.4 Data Collection We conducted an anonymous online survey using Wenjuanxing, an online data collection platform. After receiving approval from relevant institutional authorities, the researchers briefed participants on the study's aims and procedures. Questionnaires were disseminated to nursing students through department supervisors, class advisors, or student peers, with explicit emphasis on voluntary and anonymous participation. Participants were assured that collected data would only be used for academic research purposes. Technical safeguards were implemented to restrict duplicate submissions, limiting respondents to one submission per IP address, device, and account. All questionnaire items required completion prior to submission. Of the 1,011 distributed questionnaires, 100% were validly completed and returned. 2.5 Data Analysis Mplus 8.3 software was employed to conduct LPA, identifying nursing student subgroups based on AA, while SPSS 26.0 facilitated other statistical analyses. The 19 AA items served as observed indicators, and models comprising one to five latent profiles were sequentially assessed. Model fit evaluation utilized indices such as the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), adjusted BIC (aBIC), entropy, Lo-Mendell-Rubin test (LMRT), and the bootstrapped likelihood ratio test (BLRT). Optimal models were indicated by lower AIC, BIC, and aBIC values, while entropy values closer to 1 (≥ 0.8) indicated higher classification precision. LMRT and BLRT compared model fits between k-profile and (k-1)-profile solutions, with P < 0.05 signifying a superior k-profile solution. Quantitative data conforming to normal distributions were expressed as means ± standard deviations and analyzed using ANOVA. Categorical data were summarized using frequencies and percentages, with group comparisons conducted via chi-square tests. Logistic regression analyses were performed using subgroup membership from the optimal LPA model as the dependent variable, and factors significant in univariate analyses as independent predictors. A significance threshold of α = 0.05 was adopted. 2.6 Ethics Considerations Ethical approval for this study was granted by the Medical Ethics Committee of the Second Affiliated Hospital of Air Force Medical University (Approval No. K202403-02). 3. Results Nursing students from diverse educational institutions in Fujian, Shaanxi, Hunan, and Guangdong Provinces, China, were invited to participate in this study. Of the 1,011 distributed questionnaires, 1011 were validly completed and returned. The effective response rate was 1011%. 3.1. Participant Characteristics A total of 1011 nursing students participated in this study. Among them, 101 (10.0%) were male, 910 (90.0%) were female, 140 (13.8%) were only children, and 871 (86.2%) had siblings. Detailed demographic information is presented in Table 1 . Table 1 Participants’ demographic characteristics (N = 1011). Categories Number % Gender Male 101 10.0 Female 910 90.0 Only-child status Yes 140 13.8 No 871 86.2 Geographic region Rural area 765 75.7 City 246 24.3 Educational attainment Bachelor 294 29.1 Junior college degree 717 70.9 Motivations for selecting nursing as a major Voluntarily chosen 559 55.3 Program transfer 108 10.7 Other 344 34.0 Relationship quality with nursing educators Neutral 582 57.6 Positive 429 42.4 3.2. Exploratory latent profile analysis LPA of nursing students’ AA was performed using the four dimensions of the AA Scale for College Students as manifest variables. Models from one to five classes were sequentially tested until model fit could no longer improve significantly. The results are presented in Table 2 . When determining the number of latent profiles, model fit indices were comprehensively considered for rigorous selection: Information criteria (AIC, BIC, aBIC) decreased gradually with more profiles. At 3 profiles, indices dropped significantly and then slowed, indicating better fit. The entropy (0.944, close to 1) reflected high classification clarity, while it declined for 4 profiles. Likelihood ratio tests (LMRT, BLRT) showed 3 - profile model explained data better than 2 - profile; LMRT for 4 profiles neared the critical value, and 5 profiles risked “pseudo - classes” due to extreme probabilities. At 3 profiles, class probabilities (0.14/0.62/0.23) were balanced. In conclusion, 3 profiles achieved the best balance in fit goodness, classification clarity, test significance, and distribution rationality. Therefore, the 3 - profile model was considered the most reasonable and interpretable solution. Table 2 Model fit indices for LPA of AA Models AIC BIC aBIC Entropy LMRT BLRT Probabilities of classes 1 18941.822 18981.171 18955.763 - - - 1.00 2 18326.608 18390.551 18349.262 0.804 <0.001 <0.001 0.27/0.73 3 a 17304.432 17392.968 17335.799 0.944 <0.001 <0.001 0.14/0.62/0.23 4 17050.120 17163.250 17090.201 0.911 0.042 <0.001 0.12/0.12/0.54/0.23 5 16765.750 16903.474 16814.544 0.905 0.007 <0.001 0.11/0.03/0.49/0.14/0.23 a Optimal mode Based on latent profile results, Fig. 1 illustrates scores for each of the three AA categories derived from the AA Scale for College Students: C1: High self-management with low learning cognition and interpersonal facilitation type (14.1%): This subgroup characterized by the lowest scores in learning cognition, communication skills, and interpersonal facilitation, but high scores in self-management. This indicated weaker cognitive and social competencies combined with strong self-management skills. C2: Moderate type (62.4%): Students in this category demonstrated average-level scores across all dimensions. C3: Holistically proficient type (23.5%): This subgroup obtained the highest scores across all dimensions, demonstrating strong cognitive and social competencies as well as effective self-management skills. 3.3. Characteristics of latent profile membership The results of the univariate analyses indicated that the distribution of nursing students across the latent competency profiles differed significantly based on only-child status, geographic region, educational attainment, motivations for selecting nursing as a major, relationship quality with nursing educators, LE covering all dimensions: motivation, vigor and absorption, and professional identity covering all dimensions: professional cognition, professional affect, professional volition, professional values, professional skills and professional expectations (all P < 0.05). Detailed results are presented in Table 3 and Table 4 . Table 3 Differences in AA latent traits among nursing students in terms of demographics (N = 1011). Categories Class 1 Class 2 Class 3 χ 2 P Only-child status 0.013 * Yes 30 85 25 8.612 No 112 546 213 Geographic region 0.004 * Rural area 95 475 195 11.053 City 47 156 43 Educational attainment <0.001 * Bachelor 30 212 52 16.634 Junior college degree 112 419 186 Motivations for selecting nursing as a major <0.001 * Voluntarily chosen 97 360 102 28.265 Program transfer 12 70 26 Other 33 201 110 Relationship quality with nursing educators <0.001 * Neutral 43 345 194 101.305 Positive 99 286 44 Note. *Significant at the 0.05 level. Table 4 Differences in AA latent traits among nursing students in terms of LE and professional identity (N = 1011). Total scale score and dimension scores class1(131) class2(636) class3(244) F P Total scale score 1 25.32 ± 13.85 54.74 ± 13.43 66.87 ± 11.82 453.048 <0.001 * Motivation 8.91 ± 4.72 18.55 ± 4.83 22.75 ± 4.36 389.136 <0.001 * Vigor 8.9 ± 5.18 19.62 ± 4.9 24.06 ± 4.49 443.108 <0.001 * Absorption 7.51 ± 4.35 16.57 ± 4.26 20.05 ± 3.76 413.453 <0.001 * Total scale score 2 52.16 ± 16.1 70.13 ± 10.98 80.58 ± 10.46 261.417 <0.001 * Professional cognition 10.14 ± 4.12 13.66 ± 3.1 15.82 ± 2.93 137.798 <0.001 * Professional affect 9.17 ± 4.47 13.23 ± 3.17 15.36 ± 2.66 159.186 <0.001 * Professional volition 10.83 ± 4.35 15.13 ± 2.98 17.63 ± 2.48 213.287 <0.001 * Professional values 6.78 ± 2.97 9.39 ± 2.6 10.55 ± 2.52 91.932 <0.001 * Professional skills 6.82 ± 2.05 9.58 ± 2.25 11.84 ± 2.69 209.406 <0.001 * Professional expectations 8.42 ± 2.31 9.14 ± 1.9 9.39 ± 2.39 9.819 <0.001 * Note. *Significant at the 0.05 level. 3.4. Multiple Logistic Regression Analysis of Factors Influencing AA Profiles Multiple logistic regression analysis was then conducted, with the " High self-management with low learning cognition and interpersonal facilitation type " designated as the reference category. The dependent variable consisted of three latent profile groups: High self-management with low learning cognition and interpersonal facilitation type, Moderate type, and Holistically proficient type. Independent predictors included only-child status, geographic region, educational attainment, motivations for selecting nursing as a major, relationship quality with nursing educators, LE, and professional identity. Multinomial logistic regression analysis showed: Class 2 variables significantly associated with membership were vigor ( OR = 1.20, P = 0.026), professional skills ( OR = 1.38, P < 0.001), Only - child status = 1 ( OR = 0.41, P = 0.035), and geographic region = 1 ( OR = 2.06, P = 0.031). Among these, geographic region = 1 had the strongest positive impact on class 2. Class 3 variables positively predicting membership included vigor ( OR = 1.38, P = 0.001), professional cognition ( OR = 1.21, P = 0.009), professional volition (OR = 1.29, P = 0.001), professional skills ( OR = 1.81, P < 0.001), and geographic region = 1 ( OR = 2.89, P = 0.009); variables negatively associated with membership were professional affect ( OR = 0.84, P = 0.040) and only - child status = 1 ( OR = 0.34, P = 0.037). Among these, professional skills had the strongest positive impact on class 3. Additionally, geographic region = 1 also showed a prominent positive effect on membership in class 3. Detailed results are presented in Table 5 . Table 6 provides details on the coding scheme applied to these variables. Table 5 Multiple logistic regression analysis of factors influencing latent AA profiles among nursing students Variable Class 2 Class 3 B P OR (95%CI) B P OR (95%CI) Constant -7.573 -18.727 Motivation 0.039 0.555 1.04(0.91,1.18) 0.017 0.827 1.02(0.88,1.18) Vigor 0.180 0.026 * 1.20(1.02,1.40) 0.320 0.001 * 1.38(1.14,1.67) Absorption 0.084 0.314 1.09(0.92,1.28) 0.145 0.150 1.16(0.95,1.41) Professional cognition 0.067 0.258 1.07(0.95,1.20) 0.187 0.009 * 1.21(1.05,1.39) Professional affect -0.080 0.231 0.92(0.81,1.05) -0.174 0.040 * 0.84(0.71,0.99) Professional volition 0.107 0.087 1.11(0.99,1.26) 0.250 0.001 * 1.29(1.10,1.50) Professional values 0.045 0.470 1.05(0.93,1.18) 0.059 0.421 1.06(0.92,1.22) Professional skills 0.320 < 0.001 * 1.38(1.17,1.62) 0.592 < 0.001 * 1.81(1.50,2.18) Professional expectations 0.101 0.176 1.11(0.96,1.28) 0.095 0.277 1.10(0.93,1.31) Only-child status = 1 -0.902 0.035 * 0.41(0.18,0.94) -1.069 0.037 * 0.34(0.13,0.94) geographic region = 1 0.721 0.031 * 2.06(1.07,3.96) 1.060 0.009 * 2.89(1.30,6.40) Educational attainment = 1 -0.183 0.931 0.83(0.01,53.50) 0.613 0.811 1.85(0.01,276.92) Motivations for selecting nursing as a major = 1 0.130 0.707 1.14(0.58,2.24) -0.258 0.514 0.77(0.36,1.67) Motivations for selecting nursing as a major = 2 -0.683 0.309 0.51(0.14,1.88) -1.083 0.146 0.34(0.08,1.46) Relationship quality with nursing educators = 1 0.249 0.454 1.28(0.67,2.46) 0.686 0.085 1.99(0.91,4.34) Note. Refer Reference group; *Significant at the 0.05 level; High self-management with low learning cognition and interpersonal facilitation type as the reference category. Table 6 Variable Assignment Methods Variable Assignment Only-child status Yes = 1. No = 2 Geographic region Rural = 1, City = 2 Educational attainment Junior college degree = 1, Bachelor = 2 Motivations for selecting nursing as a major Voluntarily chosen = 1, Program transfer = 2, Other = 3 Relationship quality with nursing educators Neutral = 1, Positive = 2 4. Discussion 4.1. Group Heterogeneity in Nursing Students’ AA The LPA revealed three categories of AA, highlighting individual heterogeneity among nursing students: (1) High self-management with low learning cognition and interpersonal facilitation type (C1, 14.1%): Students in this subgroup displayed relatively weak skills in comprehending nursing knowledge, critical thinking, and self-directed learning. They faced difficulties in team communication and lacked strong collaborative awareness. However, they exhibited strict adherence to study schedules, precise time management, and timely task completion. They relied primarily on repetitive behaviors, such as mechanically recopying notes, to compensate for cognitive deficits, actively avoiding complex tasks requiring critical thinking or teamwork [ 29 , 30 ]. Nursing educators and administrators should therefore prioritize developing higher-order competencies among these students. Strategies include restructuring evaluation systems, emphasizing interpersonal interaction and clinical decision-making, increasing clinical practice opportunities, and employing scenario simulations and flipped classroom approaches to enhance practical adaptability [ 31 ]. (2) Moderate type (C2, 62.4%): Students in this category demonstrated moderate overall AA, cognitive ability, and self-management skills. These students could fulfill basic academic requirements and handle routine nursing scenarios but might struggle in complex, high-pressure, or rapid decision-making situations. Although they have a foundation for professional development, there remains considerable room for improvement. Incorporating simulation scenarios and reflective practices into the curriculum [ 32 ], alongside mental health support to enhance professional resilience, could effectively address these gaps [ 33 ]. (3) Holistically proficient type (C3, 23.5%): This subgroup demonstrated high overall AA, with robust cognitive abilities and self-management skills. Students in this category can serve as role models or mentors to support the development of peers in other categories. In conclusion, nursing educators can enhance AA by recognizing individual differences among nursing students and implementing targeted interventions tailored to each group’s needs. Special attention should be given to students exhibiting low cognitive and interpersonal facilitation skills. 4.2. Influences on Potential Categories of Nursing Students’ AA The vigor dimension of LE predicted heterogeneity in nursing students’ AA. Nursing students with higher vigor scores were more likely to belong to the C2 and C3 AA types. Students possessing higher energy and resilience typically dedicated sustained effort to their studies, persisted through difficulties, and subsequently attained higher academic performance and competency levels. This aligns with findings indicating that high-achieving students employ goal setting and motivational beliefs to initiate self-regulated learning [ 34 ]. Vigor amplifies achievement by enhancing proactive agency and resource utilization [ 35 , 36 ]. Nursing educators can therefore improve students’ learning efficiency and reduce error rates through curricular reform based on students’ circadian energy peaks [ 37 ]. Additionally, mindfulness-based energy management strategies—such as relaxation exercises—can reduce fatigue and extend focus duration [ 38 ]. Establishing robust social support systems, including heterogeneous small groups of three to four members, enhances students’ belongingness and self-efficacy, replenishing their energy reserves [ 39 ]. Professional identity significantly influenced the latent AA classification of nursing students. Higher scores in professional cognition, professional volition and professional skills increased the likelihood of classification into C3. Paradoxically, higher scores in professional affect reduced this likelihood, predicting classification into C1 instead. Professional cognition, professional volition, and professional skills form a stable foundation for AA, driven by goal management, resilience maintenance, and efficacy feedback, consistent with prior research [ 40 ]. Students with strong professional cognition systematically structured their nursing knowledge, facilitating efficient learning through cognitive schemas [ 41 ]. Those with robust professional volition translated their professional calling into sustained motivation, recovering effectively from setbacks [ 42 , 43 ]. Skill proficiency directly enhanced operational self-efficacy, stimulating deeper learning [ 44 ]. However, excessively strong professional affect may lead students into idealization, an aspect insufficiently explored in existing literature [ 45 , 46 ]. Consistent with the results reported by Abdullatif et al., this study indicates that nursing students with elevated expectations regarding their role perception and responsibilities may experience waning professional commitment due to unmet expectations during clinical placements, hindering the development of their academic achievement [ 47 ]. Educators should identify students’ identity dimensions clearly. For affection-dominant students, reality-oriented training is essential; cognition-dominant students require complementary training in humanistic empathy. Integrated cognitive-affective curricula, such as film-based education to discuss ethical dilemmas, or clinical preceptorships enhancing both cognitive depth and emotional rationalization, are beneficial. This study found that only-child students were less likely to belong to categories C2 and C3, contradicting existing findings. Numerous studies based on Chinese data indicated that only children generally performed better academically due to concentrated family resources [ 48 , 49 ]. Typically, only children outperform peers with siblings in standardized tests. However, some studies noted only children demonstrated weaker willpower and extroversion compared to peers from two-child families. When sibling numbers were small, the economies-of-scale effect intensified, while the resource dilution effect weakened [ 50 ]. These findings provide theoretical support for the current results. Future discussions should transcend simplistic only-child dichotomies and focus on equitable resource distribution at family and societal levels [ 51 ]. Rural students were more likely to fall into categories C2 and C3, a finding seemingly contradictory to conventional perceptions of the urban-rural educational gap [ 52 , 53 ]. Deeper analysis, however, reveals logical foundations. High-achieving rural students typically enter university through highly competitive selection processes, representing rural student elites [ 54 ]. Additionally, rural families strongly emphasize education as a means of upward mobility, demonstrating significant willingness to sacrifice resources [ 55 ]. Moreover, rural students often develop resilience and self-directed learning skills as adaptive strategies in resource-limited environments [ 56 ]. Educational policymakers should therefore recognize the achievements of outstanding rural students while addressing structural inequalities. Future research should adopt longitudinal designs, distinguish rural student subgroups (e.g., left-behind vs. non-left-behind), and assess non-cognitive abilities to comprehensively understand urban-rural educational disparities. 5. Limitations This study has several limitations that warrant consideration. First, the use of a cross-sectional methodology restricts the ability to establish causal relationships between identified factors (e.g., learning engagement, professional identity) and academic achievement profiles. Longitudinal studies are needed to explore how these profiles evolve over time. Second, the sample comprised 90.0% female nursing students, reflecting gender disparities in the nursing field globally [ 1 ]. This limits generalizability to male nursing students and underscores the need for gender-balanced sampling in future studies. Third, Reliance on self-reported measures may introduce response bias. Future research should incorporate objective indicators of academic performance. Forth, while sociodemographic and psychological factors were examined, other variables were not assessed. These omissions may influence academic achievement heterogeneity. 6. Conclusion This study used LPA to classify nursing students’ AA into three distinct profiles: holistically proficient type, moderate type, and high self-management with low learning cognition and interpersonal facilitation type. The largest proportion of participants fell into the moderate group, highlighting a significant opportunity to elevate the overall AA level within nursing education. Factors significantly influencing these latent profiles included only-child status, geographic origin, LE, and professional identity. Notably, this person-centered approach validates the existence of substantial heterogeneity in nursing students' AA, moving beyond traditional aggregate analyses. By grounding the study in SDT, the findings illuminate how key factors like LE and professional identity function as critical psychological resources fulfilling students' intrinsic needs and driving differential AA outcomes. The complex relationship observed, where stronger professional affect unexpectedly reduced the likelihood of belonging to the holistically proficient type (C3), further underscores the nuanced interplay of motivational components within SDT in the nursing education context. This provides a robust theoretical framework for understanding the mechanisms underlying AA diversity. To improve AA levels across the board, nursing educators should implement tailored strategies based on student profiles and prioritize fostering higher vigor and engagement and developing robust professional identity programs that address its multi-dimensional nature, utilizing these students belonging to C3 as peer mentors and role models to support others. For students belonging to C1, focus on developing higher-order cognitive skills (critical thinking, problem-solving) and collaborative abilities through methods like scenario simulations, case discussions, and team-based projects, leveraging their existing self-discipline. For students belonging to C2, enhance overall competency through increased exposure to complex simulations, reflective practice, and resilience-building support to bridge the gap towards higher proficiency. Through these evidence-based, profile-specific interventions, educators can cultivate nursing graduates equipped with high levels of competence and professional commitment—ultimately strengthening the nursing workforce and improving patient care outcomes. Declarations Ethics approval and consent to participate All methods used in this study fully complied with ethical guidelines and regulations. This study was reviewed and approved by the Ethics Committee of the Second Hospital Affiliated to Air Force Medical University (No. K202403-02). Participants provided informed consent prior to completing the online survey. This study was conducted in accordance with the principles of the Declaration of Helsinki ( https://www.wma.net/policies-post/wma-declaration-of-helsinki/ ). Declaration of competing interest The authors declare no competing interests. Clinical trial number Not applicable. Consent for publication Not applicable. Note Abbreviations: AIC Akaike Information Criterion; BIC Bayesian Information Criterion; aBIC Adjusted BIC; LMR Lo-Mendell-Rubin Test; BLRT Bootstrap Likelihood Ratio Test; —Not applicable. Funding This research was supported by grants from the Xijing Innovation Research Institute Joint Fund Project (LHJJ24HL01) and The Mid-Young Science and Technology Talent Program of the Nursing Department, Air Force Medical University Author Contribution Xiaoyan Peng: Writing – review & editing, Writing – original draft, Visualization, Resources, Methodology, Investigation, Formal analysis, Data curation. Chao Wu: Writing – review & editing, Writing – original draft, Methodology, Funding Acquisition. Ziyue Gai: Writing – review & editing, Writing – original draft, Formal analysis. Yonghong Yang: Investigation, Validation. Shizhe He: Investigation, Data curation. Shujie Guo: Investigation, Data curation. Baohua Cao: Writing –review & editing, Supervision. Hongjuan Lang: Writing – review & editing, Funding Acquisition. Yanling Du: Conceptualization, Resources, Supervision, Validation, Writing-Original Draft, Writing-Review & Editing. Acknowledgements We gratefully acknowledge all study participants, without them the study could not have been completed. Data Availability The data supporting the findings of this study are available upon request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. References State of the world's nursing report 2025. Retrieved July 7 from. https://www.who.int/publications/i/item/9789240110236 The WHO Global Strategic Directions for Nursing and Midwifery. (2021–2025). Retrieved July 7 from. https://www.who.int/publications/i/item/9789240033863 Mooring, Quanza E. Recruitment, advising, and retention programs — Challenges and solutions to the international problem of poor nursing student retention: A narrative literature review. Nurse Educ Today. 2016;40:204–8. Mitchell KM, et al. Social and academic integration strategies for retention of nursing students: a scoping review protocol. JBI Database Syst Rev Implement Rep. 2019;17(1):28–36. Brown J, et al. Nursing Students' Academic Success Factors: A Quantitative Cross-sectional Study. Nurse Educ. 2021;46(2):E23–7. Mohsenipouya H, et al. The effect of learning styles on the academic achievement of nursing students: a cross-sectional study. BMC Res Notes. 2024;17(1):294. Reina-Gutierrez S, et al. Maternal Education and Academic Achievement in Schoolchildren: The Role of Cardiorespiratory Fitness. J Pediatr. 2021;232:109–e1171. Qin X, et al. The Impact of Academic Achievement and Parental Practices on Depressive Symptom Trajectories Among Chinese Adolescents. Res Child Adolesc Psychopathol. 2021;49(10):1359–71. Bae SM. The Analysis of a Causal Relationship between Career Maturity and Academic Achievement on Korean Adolescents Using Autoregressive Cross-Lagged Modeling. Int J Environ Res Public Health, 2022. 19(9). Bae SM. An analysis of career maturity among Korean youths using latent growth modeling. School Psychol Int. 2017;38(2):014303431770952. Perry JC, Liu X, Pabian Y. School Engagement as a Mediator of Academic Performance Among Urban Youth: The Role of Career Preparation, Parental Career Support, and Teacher Support. Couns Psychol. 2010;38(2):269–95. Xiao F, et al. The relationship between a growth mindset and the learning engagement of nursing students: A structural equation modeling approach. Nurse Educ Pract. 2023;73:103796. Lillekroken D. A privilege but also a challenge. Nurse educators' perceptions about teaching fundamental care in a simulated learning environment: A qualitative study. J Clin Nurs. 2020;29(11–12):2011–22. Mohamed MBH, Alsayed S. Investigating Relationship of Perceived Learning Engagement, Motivation, and Academic Performance Among Nursing Students: A Multisite Study. Adv Med Educ Pract. 2021;12:351–69. Zou L, et al. The effect of professional identity on nursing academic achievement: the chain mediating effect of general self-efficacy and learning engagement. BMC Med Educ. 2024;24(1):1014. Wu X, et al. Stress/Resource Complex, Sense of Coherence and Professional Identity Among Nursing Students: A Latent Profile and Mediation Analysis. Psychol Res Behav Manag. 2022;15:2409–20. Zhang Y, et al. Professional identity and sense of coherence affect the between compassion fatigue and work engagement among Chinese hospital nurses. BMC Nurs. 2023;22(1):472. Mylrea MF, Gupta TS, Glass BD. Design and Evaluation of a Professional Identity Development Program for Pharmacy Students. Am J Pharm Educ. 2019;83(6):6842. Zhang Q. The Role of Teachers' Interpersonal Behaviors in Learners' Academic Achievements. Front Psychol. 2022;13:921832. Flannery M. Self-Determination Theory: Intrinsic Motivation and Behavioral Change. Oncol Nurs Forum. 2017;44(2):155–6. Howard JL, et al. Student Motivation and Associated Outcomes: A Meta-Analysis from Self-Determination Theory. Perspect Psychol Sci. 2021;16(6):1300–23. Zhouchen YB, et al. Impact of professional identity on learner well-being of undergraduate nursing students of double tops universities: Mediating effect of self-regulated learning. Nurse Educ Today. 2024;143:106382. Liao M, et al. Self-efficacy mediates the effect of professional identity on learning engagement for nursing students in higher vocational colleges: A cross-sectional study. Nurse Educ Today. 2024;139:106225. Kim SY. Determining the Number of Latent Classes in Single- and Multi-Phase Growth Mixture Models. Struct Equ Model. 2014;21(2):263–79. Luo Q, et al. The Mediating Role of Learning Engagement Between Self-Efficacy and Academic Achievement Among Chinese College Students. Psychol Res Behav Manag. 2023;16:1533–43. Wen-Bo C, et al. A Study of the Relationship among Mathematical Learning Ability, Professional Commitment and Academic Achievement of Ethnic University Science Students. Journal of Research on Education for Ethnic Minorities; 2019. Schaufeli WB, Salanova M. Efficacy or inefficacy, that's the question: burnout and work engagement, and their relationships with efficacy beliefs. Anxiety Stress Coping. 2007;20(2):177–96. Zhonghua H. Survey on professional identity of baccalaureate nursing students in Sichuan province. Sichuan University; 2007. Firestone C. Performance vs. competence in human-machine comparisons. Proc Natl Acad Sci U S A. 2020;117(43):26562–71. Rolls ET, Mills W. Computations in the deep vs superficial layers of the cerebral cortex. Neurobiol Learn Mem. 2017;145:205–21. Guo H, et al. The application of integrating medical humanities education into emergency skill-training scenario simulation teaching. Front Med (Lausanne). 2025;12:1561504. Fenzi G, et al. The expository phase of debriefing in clinical simulation: a qualitative study. BMC Nurs. 2025;24(1):476. Brittain H, Vaillancourt T. Longitudinal associations between academic achievement and depressive symptoms in adolescence: Methodological considerations and analytical approaches for identifying temporal priority. Adv Child Dev Behav. 2023;64:327–55. Khalaila R. The relationship between academic self-concept, intrinsic motivation, test anxiety, and academic achievement among nursing students: mediating and moderating effects. Nurse Educ Today. 2015;35(3):432–8. Aydan S, Capa-Aydin Y. What makes them self-regulated? Self-regulation procedures of academically successful students and key influences. Acta Psychol (Amst). 2025;257:105106. Park K, Moon S, Oh J. Predictors of academic achievement in distance learning for nursing students. Nurse Educ Today. 2022;108:105162. Pulido-Martos M et al. The Shirom-Melamed Vigor Measure for Students: Factorial Analysis and Construct Validity in Spanish Undergraduate University Students. Int J Environ Res Public Health, 2020. 17(24). Guidetti G, et al. Can mindfulness mitigate the energy-depleting process and increase job resources to prevent burnout? A study on the mindfulness trait in the school context. PLoS ONE. 2019;14(4):e0214935. Zhang Q, et al. Team-based learning vs. lecture-based learning in nursing: A systematic review of randomized controlled trials. Front Public Health. 2022;10:1044014. Brown J et al. Nursing Students' Academic Success Factors: A Quantitative Cross-sectional Study. Nurse Educ, 2021. 46. Li QL et al. The Association Among Achievement Goal Orientations, Academic Performance, and Academic Well-Being Among Chinese Medical Students: A Cross-Sectional Study. Front Psychol, 2021. 12. Michelle C, et al. Promoting emotional intelligence and resilience in undergraduate nursing students: An integrative review. Nurse Educ Today. 2018;68:112–20. Wei H, et al. Impacts of Nursing Student Burnout on Psychological Well-Being and Academic Achievement. J Nurs Educ. 2021;60(7):369–76. Parhi RK. Problem Solving Ability, Study Habits and Academic Achievement in Science of Tribal and Non-Tribal Students. Sci Cult. 2023;89(7/8):281–3. Dong X, et al. Emotional Intelligence and Personality Traits Based on Academic Performance. Front Psychol. 2022;13:894570. Johannsen M, et al. Who flourishes in school? The interplay of academic self-concept and personality and its role for academic performance in middle adolescence. J Pers Soc Psychol. 2024;127(6):1237–62. Abdullatif II. Influences of Structural Empowerment and Demographic Factors on Nurses' Psychological Empowerment. J Nurs Manag, 2023. 2023: p. 8827968. Falbo T, Poston DJ. The academic, personality, and physical outcomes of only children in China. Child Dev. 1993;64(1):18–35. Burrows B, Selvanathan HP, Lickel B. My Fight or Yours: Stereotypes of Activists from Advantaged and Disadvantaged Groups. Pers Soc Psychol Bull. 2023;49(1):110–24. Lao Y, Lin S. Comparison of educational performance between the only children and children in two-child families. Sci Rep. 2022;12(1):15355. Hong X, Liu Q, Zhao S. Approaches to Learning of Preschool Children in China: A Comparison between Only Children and Non-Only Children. Behav Sci. 2023;13(5):13. Haggerty T, et al. A Comparison of Rural and Academic Training Environments for Third-Year Medical Students on a Family Medicine Rotation. Fam Med. 2019;51(5):430–3. Guan H, et al. Examining the relationship between commuting time, academic achievement, and mental health in rural China: a cross-sectional analysis. BMC Public Health. 2025;25(1):1616. Hou T, et al. Education and subjective well-being in Chinese rural population: A multi-group structural equation model. PLoS ONE. 2022;17(3):e0264108. Chen X, Hesketh T. Educational Aspirations and Expectations of Adolescents in Rural China: Determinants, Mental Health, and Academic Outcomes. Int J Environ Res Public Health, 2021. 18(21). Zhang F et al. Educational Expectations and Academic Persistence among Rural Adolescents: The Protective Role of High Self-Esteem. Behav Sci (Basel), 2024. 14(10). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 10 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Editor invited by journal 18 Aug, 2025 Submission checks completed at journal 14 Aug, 2025 First submitted to journal 14 Aug, 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-7290531","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515397365,"identity":"fd7bc756-5a60-4f86-8f5c-660f0017c3f0","order_by":0,"name":"Xiaoyan Peng","email":"","orcid":"","institution":"Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyan","middleName":"","lastName":"Peng","suffix":""},{"id":515397366,"identity":"0cc8b396-6d1f-41a5-889d-5a359ecaddbb","order_by":1,"name":"Chao Wu","email":"","orcid":"","institution":"Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chao","middleName":"","lastName":"Wu","suffix":""},{"id":515397367,"identity":"41395324-30ce-458e-a99f-feba3fbe7f84","order_by":2,"name":"Ziyue Gai","email":"","orcid":"","institution":"Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ziyue","middleName":"","lastName":"Gai","suffix":""},{"id":515397368,"identity":"6d35f352-3838-4ea4-860a-65fbfcc66f55","order_by":3,"name":"Yonghong Yang","email":"","orcid":"","institution":"Shaanxi Provincial Traditional Chinese Medicine Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yonghong","middleName":"","lastName":"Yang","suffix":""},{"id":515397369,"identity":"c41ebcbe-7b35-48d3-8bbb-7ff629e891e8","order_by":4,"name":"Shizhe He","email":"","orcid":"","institution":"Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shizhe","middleName":"","lastName":"He","suffix":""},{"id":515397370,"identity":"986b4a98-526b-4c92-af94-c0cef2eabf01","order_by":5,"name":"Shujie Guo","email":"","orcid":"","institution":"Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shujie","middleName":"","lastName":"Guo","suffix":""},{"id":515397371,"identity":"7e52ee24-a264-447e-91c2-fc2619c484a5","order_by":6,"name":"Baohua Cao","email":"","orcid":"","institution":"Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"Baohua","middleName":"","lastName":"Cao","suffix":""},{"id":515397372,"identity":"f3955937-d76e-4e52-ac72-754d85e73997","order_by":7,"name":"Hongjuan Lang","email":"","orcid":"","institution":"Air Force Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hongjuan","middleName":"","lastName":"Lang","suffix":""},{"id":515397373,"identity":"3ffdb7c6-a30f-45da-952d-decaae306e4e","order_by":8,"name":"Yanling Du","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIie3PMQrCMBiG4YRCixD3iINXiIs4BDyIS0DIVEFwcSgYEXTJASIVeobeIOUHpx6gzl6gXkAsuLgl3QTzzt8zfAiFQj8YLipl2x3dF4nyJJGJqsrUHJfaepLExCsYnCRWjfAkw1wzQDFE+PIoG5TxpZOMrjWDDYE4GcvtHN3kWrnIVKUMDAWC83RGsQI3WdiOEAYU3WtPgo0UQIRkqCG+RIOtjOViqrsvwucLPh+O7fNFxSSBsmkz7ibfMSr6zD+krwiFQqH/6A26EEcrOuGYogAAAABJRU5ErkJggg==","orcid":"","institution":"Air Force Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yanling","middleName":"","lastName":"Du","suffix":""}],"badges":[],"createdAt":"2025-08-04 11:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7290531/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7290531/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91540539,"identity":"8e48c324-ab8b-4f57-a1e3-d79e36e5f763","added_by":"auto","created_at":"2025-09-17 13:52:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49564,"visible":true,"origin":"","legend":"\u003cp\u003eScores of nursing students’ AA across each dimension of the AA Scale for College Students\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7290531/v1/75e9d56b8ac12afc21029ce6.png"},{"id":91542054,"identity":"9f826ce4-aea1-497f-9158-81aac2affad9","added_by":"auto","created_at":"2025-09-17 14:08:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1224173,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7290531/v1/a223857f-3b10-404e-98cb-135da3cd6716.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mapping academic achievement in nursing students: Insights from a latent profile analysis","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eNurses constitute the largest professional cohort within a health workforce that is adequately staffed, equitably distributed, and well-supported, serving as an indispensable force. Despite global progress in addressing nursing shortages, the WHO predicts a persistent global shortfall of 4.1\u0026nbsp;million nurses by 2030, accompanied by ongoing inequities in workforce adequacy worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The Global Strategic Directions for Nursing and Midwifery Services (2021\u0026ndash;2025) underscores the necessity of improving educational training for nurses and midwives to realize universal health coverage (UHC) and population health objectives. This framework advocates aligning educational outcomes with the anticipated professional roles nurses and midwives assume within health and educational institutions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, high nursing student attrition rates persist globally and are expected to worsen [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], attracting significant international attention [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Enhancing nursing students\u0026rsquo; AA is therefore crucial for cultivating competent nursing professionals and effectively addressing public health challenges.\u003c/p\u003e\u003cp\u003eAA has both broad and narrow conceptualizations. The narrow definition exclusively refers to academic performance, such as grades, while the broad definition encompasses holistic student development throughout their academic tenure [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Current research primarily employs a narrow conceptualization, focusing on academic performance metrics [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, this approach uses oversimplified criteria that inadequately reflect students\u0026rsquo; growth in AA. Therefore, this study adopts a competency-based framework to operationalize AA. AA represents a critical measure for evaluating educational quality and student learning outcomes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It also directly influences nursing students\u0026rsquo; completion and graduation rates. Failure to meet academic standards significantly contributes to high nursing student attrition rates [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Qin et al. reported that academic success has protective effects, whereas poor academic performance elevates stress and depressive symptoms among adolescents [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Numerous studies have further indicated that AA significantly predicts career maturity, with higher academic attainment correlating with greater career maturity [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Extensive research underscores AA\u0026rsquo;s pivotal role in enhancing nursing education quality, promoting students\u0026rsquo; physical and psychological well-being, and advancing professional development. Although considerable research has explored factors influencing academic performance, the status of AA and potential heterogeneity among nursing students remain unclear.\u003c/p\u003e\u003cp\u003eLearning engagement (LE) describes the behavioral intensity with which students initiate and sustain learning activities, combined with the quality of their emotional experiences. Engagement involves behavioral and emotional dimensions, manifesting as observable behaviors such as task initiation, active participation, sustained effort, persistence during challenges, and positive emotions including optimism, enthusiasm, and curiosity. Engagement also aligns closely with academic objectives [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. LE is widely recognized as vital for effective learning and improving nursing education quality [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Mohamed et al. reported that higher engagement levels enhance knowledge acquisition and comprehension, improving academic performance and enabling nursing graduates to deliver high-quality patient care [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Nevertheless, existing studies on the relationship between LE and AA lack sufficient cultural adaptation to the Chinese context and neglect heterogeneity among nursing students, especially newly enrolled undergraduates.\u003c/p\u003e\u003cp\u003eProfessional identity is defined as a person's self-perception concerning their professional role, comprising fundamental occupational values, behaviors, beliefs, and attitudes. This multidimensional construct develops from individuals\u0026rsquo; sense of professional belonging and their commitment to professional ethics and practice standards [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Professional identity plays a crucial role in facilitating nursing students' successful transition into clinical settings, significantly enhancing their competencies and shaping their career development [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A strong sense of professional identity promotes both emotional attachment and active learning participation, subsequently influencing AA through this dual-pathway process [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Nevertheless, current research has not clearly elucidated the interplay between professional identity and LE. Furthermore, the combined influence of professional identity and LE on AA among nursing students requires additional exploration.\u003c/p\u003e\u003cp\u003eDespite overall improvements in AA, nursing students continue to encounter challenges such as uneven distribution of educational resources, mental health issues, professional burnout, and difficulties translating theoretical knowledge into clinical practice. Deepening our understanding of these factors and their interrelationships remains essential. Previous studies predominantly evaluated AA using aggregate measures, thereby neglecting individual variability. To overcome these shortcomings, LPA provides an appropriate methodological approach. LPA, as a person-centered analytic technique, identifies subgroups with distinct characteristics, revealing hidden heterogeneity within populations that traditional analytic methods cannot detect. By employing this method, distinct subgroups among nursing students based on AA can be effectively differentiated. Additionally, Self-Determination Theory (SDT), which highlights the intrinsic and extrinsic motivational aspects underlying individual actions, informs the conceptual framework of this research [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. SDT postulates that fundamental psychological needs drive human behaviors [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Within education, SDT frequently explains student motivation and engagement behaviors [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In this study, LE represents the external manifestation of nursing students\u0026rsquo; motivation, while professional identity aligns with their sense of autonomy and competence. Applying SDT facilitates understanding of how LE and professional identity fulfill these psychological needs, subsequently influencing AA. Consequently, the present study seeks to categorize nursing students into distinct AA profiles and explore influencing factors guided by SDT. This approach facilitates the formulation of precise interventions to strengthen AA, providing empirical evidence to support tailored educational practices within nursing education.\u003c/p\u003e\u003cp\u003eThe specific research questions explored include:\u003c/p\u003e\u003cp\u003e(a)What distinct AA subgroups exist among nursing students? (b) What characteristics distinguish nursing students demonstrating higher AA levels? (c) In what ways do sociodemographic variables and personal factors (LE and professional identity) influence membership within these AA subgroups?\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study design\u003c/h2\u003e\u003cp\u003eThis multi-site, cross-sectional, web-based study was conducted from\u003c/p\u003e\u003cp\u003eMarch and April 2025 in China.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Study setting and participants\u003c/h2\u003e\u003cp\u003eConvenience sampling was employed to enroll nursing students from diverse educational institutions in Fujian, Shaanxi, Hunan, and Guangdong Provinces from March to April 2025. The minimum required sample size was set at 500 to meet the recommendations for LPA [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], the final sample consisted of 1,011 respondents. Participants were included based on the following criteria: (1) full-time enrollment in nursing education programs, and (2) voluntary consent and participation. Students on medical leave or unable to complete the questionnaire properly due to special circumstances were excluded.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data collection instruments\u003c/h2\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.3.1 Demographics characteristics\u003c/h2\u003e\u003cp\u003eThe researchers independently developed the questionnaire based on nursing student characteristics and literature analysis findings. It consisted of six items: gender, only-child status, geographic region, educational attainment, motivations for selecting nursing as a major, relationship quality with nursing educators.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.3.2 AA Scale for College Students\u003c/h2\u003e\u003cp\u003eAA among nursing students was measured using the College Student AA Scale, which is well-established in Chinese contexts [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This instrument includes 19 items across four domains: learning cognition (4 items), communication skills (5 items), self-management (5 items), and interpersonal facilitation (5 items). Responses were scored on a 5-point Likert scale, from 1 (\u0026ldquo;strongly disagree\u0026rdquo;) to 5 (\u0026ldquo;strongly agree\u0026rdquo;), with five items reverse-scored. Higher scores denote greater competency-based AA. The scale\u0026rsquo;s reliability in this study was strong (Cronbach \u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.821).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.3.3 Chinese Version of the Utrech Work Engagement Scale-Student (UWES-S)\u003c/h2\u003e\u003cp\u003eLE among Chinese nursing students was evaluated using the UWES-S, originally formulated by Schaufeli et al. (2002) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and adapted to a Chinese context. This scale comprises 17 items distributed among three dimensions: motivation (6 items), vigor (6 items), and absorption (5 items). Items were rated on a 7-point Likert scale ranging from 0 (\u0026ldquo;never\u0026rdquo;) to 6 (\u0026ldquo;always\u0026rdquo;), with higher total scores indicating enhanced LE. In this study, the UWES-S demonstrated excellent internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.981).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.3.4 Professional Identity Scale for Nursing Students\u003c/h2\u003e\u003cp\u003eThe \u003cem\u003eProfessional Identity Scale for Nursing Students\u003c/em\u003e, developed by Hu Zhonghua at Sichuan University in 2007[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], assessed students\u0026rsquo; professional identity. This scale consists of 30 items across six dimensions: professional cognition (6 items), professional affect (5 items), professional volition (6 items), professional values (4 items), professional skills (5 items), and professional expectations (4 items). Items were scored on a 5-point Likert scale from 1 (strongly negative) to 5 (strongly positive), with higher cumulative scores reflecting a stronger professional identity. The scale exhibited excellent reliability in this study (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.902).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Data Collection\u003c/h2\u003e\u003cp\u003eWe conducted an anonymous online survey using Wenjuanxing, an online data collection platform. After receiving approval from relevant institutional authorities, the researchers briefed participants on the study's aims and procedures. Questionnaires were disseminated to nursing students through department supervisors, class advisors, or student peers, with explicit emphasis on voluntary and anonymous participation. Participants were assured that collected data would only be used for academic research purposes. Technical safeguards were implemented to restrict duplicate submissions, limiting respondents to one submission per IP address, device, and account. All questionnaire items required completion prior to submission. Of the 1,011 distributed questionnaires, 100% were validly completed and returned.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Data Analysis\u003c/h2\u003e\u003cp\u003eMplus 8.3 software was employed to conduct LPA, identifying nursing student subgroups based on AA, while SPSS 26.0 facilitated other statistical analyses. The 19 AA items served as observed indicators, and models comprising one to five latent profiles were sequentially assessed. Model fit evaluation utilized indices such as the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), adjusted BIC (aBIC), entropy, Lo-Mendell-Rubin test (LMRT), and the bootstrapped likelihood ratio test (BLRT). Optimal models were indicated by lower AIC, BIC, and aBIC values, while entropy values closer to 1 (\u0026ge;\u0026thinsp;0.8) indicated higher classification precision. LMRT and BLRT compared model fits between k-profile and (k-1)-profile solutions, with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 signifying a superior k-profile solution. Quantitative data conforming to normal distributions were expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations and analyzed using ANOVA. Categorical data were summarized using frequencies and percentages, with group comparisons conducted via chi-square tests. Logistic regression analyses were performed using subgroup membership from the optimal LPA model as the dependent variable, and factors significant in univariate analyses as independent predictors. A significance threshold of α\u0026thinsp;=\u0026thinsp;0.05 was adopted.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Ethics Considerations\u003c/h2\u003e\u003cp\u003eEthical approval for this study was granted by the Medical Ethics Committee of the Second Affiliated Hospital of Air Force Medical University (Approval No. K202403-02).\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e Nursing students from diverse educational institutions in Fujian, Shaanxi, Hunan, and Guangdong Provinces, China, were invited to participate in this study. Of the 1,011 distributed questionnaires, 1011 were validly completed and returned. The effective response rate was 1011%.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Participant Characteristics\u003c/h2\u003e\u003cp\u003eA total of 1011 nursing students participated in this study. Among them, 101 (10.0%) were male, 910 (90.0%) were female, 140 (13.8%) were only children, and 871 (86.2%) had siblings. Detailed demographic information is 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\u003eParticipants\u0026rsquo; demographic characteristics (N\u0026thinsp;=\u0026thinsp;1011).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e910\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly-child status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e871\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeographic region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e765\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e246\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational attainment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior college degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e717\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMotivations for selecting nursing as a major\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVoluntarily chosen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e559\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProgram transfer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship quality with nursing educators\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e582\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e429\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.4\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=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Exploratory latent profile analysis\u003c/h2\u003e\u003cp\u003eLPA of nursing students\u0026rsquo; AA was performed using the four dimensions of the AA Scale for College Students as manifest variables. Models from one to five classes were sequentially tested until model fit could no longer improve significantly. The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. When determining the number of latent profiles, model fit indices were comprehensively considered for rigorous selection: Information criteria (AIC, BIC, aBIC) decreased gradually with more profiles. At 3 profiles, indices dropped significantly and then slowed, indicating better fit. The entropy (0.944, close to 1) reflected high classification clarity, while it declined for 4 profiles. Likelihood ratio tests (LMRT, BLRT) showed 3 - profile model explained data better than 2 - profile; LMRT for 4 profiles neared the critical value, and 5 profiles risked \u0026ldquo;pseudo - classes\u0026rdquo; due to extreme probabilities. At 3 profiles, class probabilities (0.14/0.62/0.23) were balanced. In conclusion, 3 profiles achieved the best balance in fit goodness, classification clarity, test significance, and distribution rationality. Therefore, the 3 - profile model was considered the most reasonable and interpretable solution.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eModel fit indices for LPA of AA\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModels\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAIC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBIC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaBIC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEntropy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLMRT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBLRT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eProbabilities of classes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18941.822\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18981.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18955.763\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18326.608\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18390.551\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18349.262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.804\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.27/0.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17304.432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17392.968\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17335.799\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.944\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.14/0.62/0.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17050.120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17163.250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17090.201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.911\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.12/0.12/0.54/0.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16765.750\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16903.474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16814.544\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.905\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.11/0.03/0.49/0.14/0.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003e Optimal mode\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBased on latent profile results, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates scores for each of the three AA categories derived from the AA Scale for College Students: C1: High self-management with low learning cognition and interpersonal facilitation type (14.1%): This subgroup characterized by the lowest scores in learning cognition, communication skills, and interpersonal facilitation, but high scores in self-management. This indicated weaker cognitive and social competencies combined with strong self-management skills. C2: Moderate type (62.4%): Students in this category demonstrated average-level scores across all dimensions. C3: Holistically proficient type (23.5%): This subgroup obtained the highest scores across all dimensions, demonstrating strong cognitive and social competencies as well as effective self-management skills.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Characteristics of latent profile membership\u003c/h2\u003e\u003cp\u003eThe results of the univariate analyses indicated that the distribution of nursing students across the latent competency profiles differed significantly based on only-child status, geographic region, educational attainment, motivations for selecting nursing as a major, relationship quality with nursing educators, LE covering all dimensions: motivation, vigor and absorption, and professional identity covering all dimensions: professional cognition, professional affect, professional volition, professional values, professional skills and professional expectations (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDifferences in AA latent traits among nursing students in terms of demographics (N\u0026thinsp;=\u0026thinsp;1011).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClass 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClass 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eClass 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly-child status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.013\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.612\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e546\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeographic region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.004\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e475\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational attainment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e16.634\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior college degree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e419\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMotivations for selecting nursing as a major\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVoluntarily chosen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e28.265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProgram transfer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship quality with nursing educators\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e101.305\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote. *Significant at the 0.05 level.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDifferences in AA latent traits among nursing students in terms of LE and professional identity (N\u0026thinsp;=\u0026thinsp;1011).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal scale score and dimension scores\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eclass1(131)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eclass2(636)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eclass3(244)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal scale score 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e25.32\u0026thinsp;\u0026plusmn;\u0026thinsp;13.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e54.74\u0026thinsp;\u0026plusmn;\u0026thinsp;13.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e66.87\u0026thinsp;\u0026plusmn;\u0026thinsp;11.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e453.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMotivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e8.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e18.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e22.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e389.136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVigor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e8.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e19.62\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e24.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e443.108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsorption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e7.51\u0026thinsp;\u0026plusmn;\u0026thinsp;4.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.57\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e20.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e413.453\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal scale score 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e52.16\u0026thinsp;\u0026plusmn;\u0026thinsp;16.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.13\u0026thinsp;\u0026plusmn;\u0026thinsp;10.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e80.58\u0026thinsp;\u0026plusmn;\u0026thinsp;10.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e261.417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional cognition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e10.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e13.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e15.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e137.798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional affect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e9.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e13.23\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e15.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e159.186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional volition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e10.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e15.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e17.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e213.287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional values\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e9.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e10.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e91.932\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e6.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e9.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e11.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e209.406\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional expectations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e8.42\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e9.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e9.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.819\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote. *Significant at the 0.05 level.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Multiple Logistic Regression Analysis of Factors Influencing AA Profiles\u003c/h2\u003e\u003cp\u003eMultiple logistic regression analysis was then conducted, with the \" High self-management with low learning cognition and interpersonal facilitation type \" designated as the reference category. The dependent variable consisted of three latent profile groups: High self-management with low learning cognition and interpersonal facilitation type, Moderate type, and Holistically proficient type. Independent predictors included only-child status, geographic region, educational attainment, motivations for selecting nursing as a major, relationship quality with nursing educators, LE, and professional identity.\u003c/p\u003e\u003cp\u003eMultinomial logistic regression analysis showed: Class 2 variables significantly associated with membership were vigor (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.20, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026), professional skills (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.38, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Only - child status\u0026thinsp;=\u0026thinsp;1 (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.41, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035), and geographic region\u0026thinsp;=\u0026thinsp;1 (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.06, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031). Among these, geographic region\u0026thinsp;=\u0026thinsp;1 had the strongest positive impact on class 2. Class 3 variables positively predicting membership included vigor (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.38, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), professional cognition (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.21, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009), professional volition \u003cem\u003e(OR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.29, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), professional skills (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.81, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and geographic region\u0026thinsp;=\u0026thinsp;1 (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.89, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009); variables negatively associated with membership were professional affect (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.84, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.040) and only - child status\u0026thinsp;=\u0026thinsp;1 (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.34, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037). Among these, professional skills had the strongest positive impact on class 3. Additionally, geographic region\u0026thinsp;=\u0026thinsp;1 also showed a prominent positive effect on membership in class 3. Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e provides details on the coding scheme applied to these variables.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple logistic regression analysis of factors influencing latent AA profiles among nursing students\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eClass 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eClass 3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-7.573\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-18.727\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMotivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.555\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.04(0.91,1.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.02(0.88,1.18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVigor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.026\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.20(1.02,1.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.38(1.14,1.67)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsorption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.09(0.92,1.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.16(0.95,1.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional cognition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.258\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.07(0.95,1.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.009\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.21(1.05,1.39)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional affect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.080\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.92(0.81,1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.174\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.040\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.84(0.71,0.99)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional volition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.087\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.11(0.99,1.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.29(1.10,1.50)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional values\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.470\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.05(0.93,1.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.421\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.06(0.92,1.22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.38(1.17,1.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.592\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.81(1.50,2.18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional expectations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.11(0.96,1.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.10(0.93,1.31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly-child status\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.902\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.035\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.41(0.18,0.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.069\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.037\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.34(0.13,0.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egeographic region\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.721\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.031\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.06(1.07,3.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.009\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.89(1.30,6.40)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational attainment\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.183\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.931\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.83(0.01,53.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.613\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.811\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.85(0.01,276.92)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMotivations for selecting nursing as a major\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.707\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.14(0.58,2.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.258\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.514\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.77(0.36,1.67)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMotivations for selecting nursing as a major\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.683\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.51(0.14,1.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.083\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.34(0.08,1.46)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship quality with nursing educators\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.454\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.28(0.67,2.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.686\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.99(0.91,4.34)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote. Refer Reference group; *Significant at the 0.05 level; High self-management with low learning cognition and interpersonal facilitation type as the reference category.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVariable Assignment Methods\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssignment\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly-child status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u0026thinsp;=\u0026thinsp;1. No\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeographic region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u0026thinsp;=\u0026thinsp;1, City\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational attainment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior college degree\u0026thinsp;=\u0026thinsp;1, Bachelor\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMotivations for selecting nursing as a major\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVoluntarily chosen\u0026thinsp;=\u0026thinsp;1, Program transfer\u0026thinsp;=\u0026thinsp;2, Other\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship quality with nursing educators\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u0026thinsp;=\u0026thinsp;1, Positive\u0026thinsp;=\u0026thinsp;2\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"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e4.1. Group Heterogeneity in Nursing Students\u0026rsquo; AA\u003c/h2\u003e\u003cp\u003eThe LPA revealed three categories of AA, highlighting individual heterogeneity among nursing students: (1) High self-management with low learning cognition and interpersonal facilitation type (C1, 14.1%): Students in this subgroup displayed relatively weak skills in comprehending nursing knowledge, critical thinking, and self-directed learning. They faced difficulties in team communication and lacked strong collaborative awareness. However, they exhibited strict adherence to study schedules, precise time management, and timely task completion. They relied primarily on repetitive behaviors, such as mechanically recopying notes, to compensate for cognitive deficits, actively avoiding complex tasks requiring critical thinking or teamwork [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Nursing educators and administrators should therefore prioritize developing higher-order competencies among these students. Strategies include restructuring evaluation systems, emphasizing interpersonal interaction and clinical decision-making, increasing clinical practice opportunities, and employing scenario simulations and flipped classroom approaches to enhance practical adaptability [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. (2) Moderate type (C2, 62.4%): Students in this category demonstrated moderate overall AA, cognitive ability, and self-management skills. These students could fulfill basic academic requirements and handle routine nursing scenarios but might struggle in complex, high-pressure, or rapid decision-making situations. Although they have a foundation for professional development, there remains considerable room for improvement. Incorporating simulation scenarios and reflective practices into the curriculum [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], alongside mental health support to enhance professional resilience, could effectively address these gaps [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. (3) Holistically proficient type (C3, 23.5%): This subgroup demonstrated high overall AA, with robust cognitive abilities and self-management skills. Students in this category can serve as role models or mentors to support the development of peers in other categories. In conclusion, nursing educators can enhance AA by recognizing individual differences among nursing students and implementing targeted interventions tailored to each group\u0026rsquo;s needs. Special attention should be given to students exhibiting low cognitive and interpersonal facilitation skills.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e4.2. Influences on Potential Categories of Nursing Students\u0026rsquo; AA\u003c/h2\u003e\u003cp\u003eThe vigor dimension of LE predicted heterogeneity in nursing students\u0026rsquo; AA. Nursing students with higher vigor scores were more likely to belong to the C2 and C3 AA types. Students possessing higher energy and resilience typically dedicated sustained effort to their studies, persisted through difficulties, and subsequently attained higher academic performance and competency levels. This aligns with findings indicating that high-achieving students employ goal setting and motivational beliefs to initiate self-regulated learning [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Vigor amplifies achievement by enhancing proactive agency and resource utilization [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Nursing educators can therefore improve students\u0026rsquo; learning efficiency and reduce error rates through curricular reform based on students\u0026rsquo; circadian energy peaks [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Additionally, mindfulness-based energy management strategies\u0026mdash;such as relaxation exercises\u0026mdash;can reduce fatigue and extend focus duration [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Establishing robust social support systems, including heterogeneous small groups of three to four members, enhances students\u0026rsquo; belongingness and self-efficacy, replenishing their energy reserves [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eProfessional identity significantly influenced the latent AA classification of nursing students. Higher scores in professional cognition, professional volition and professional skills increased the likelihood of classification into C3. Paradoxically, higher scores in professional affect reduced this likelihood, predicting classification into C1 instead. Professional cognition, professional volition, and professional skills form a stable foundation for AA, driven by goal management, resilience maintenance, and efficacy feedback, consistent with prior research [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Students with strong professional cognition systematically structured their nursing knowledge, facilitating efficient learning through cognitive schemas [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Those with robust professional volition translated their professional calling into sustained motivation, recovering effectively from setbacks [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Skill proficiency directly enhanced operational self-efficacy, stimulating deeper learning [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. However, excessively strong professional affect may lead students into idealization, an aspect insufficiently explored in existing literature [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Consistent with the results reported by Abdullatif et al., this study indicates that nursing students with elevated expectations regarding their role perception and responsibilities may experience waning professional commitment due to unmet expectations during clinical placements, hindering the development of their academic achievement [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Educators should identify students\u0026rsquo; identity dimensions clearly. For affection-dominant students, reality-oriented training is essential; cognition-dominant students require complementary training in humanistic empathy. Integrated cognitive-affective curricula, such as film-based education to discuss ethical dilemmas, or clinical preceptorships enhancing both cognitive depth and emotional rationalization, are beneficial.\u003c/p\u003e\u003cp\u003eThis study found that only-child students were less likely to belong to categories C2 and C3, contradicting existing findings. Numerous studies based on Chinese data indicated that only children generally performed better academically due to concentrated family resources [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Typically, only children outperform peers with siblings in standardized tests. However, some studies noted only children demonstrated weaker willpower and extroversion compared to peers from two-child families. When sibling numbers were small, the economies-of-scale effect intensified, while the resource dilution effect weakened [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. These findings provide theoretical support for the current results. Future discussions should transcend simplistic only-child dichotomies and focus on equitable resource distribution at family and societal levels [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRural students were more likely to fall into categories C2 and C3, a finding seemingly contradictory to conventional perceptions of the urban-rural educational gap [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Deeper analysis, however, reveals logical foundations. High-achieving rural students typically enter university through highly competitive selection processes, representing rural student elites [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Additionally, rural families strongly emphasize education as a means of upward mobility, demonstrating significant willingness to sacrifice resources [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Moreover, rural students often develop resilience and self-directed learning skills as adaptive strategies in resource-limited environments [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Educational policymakers should therefore recognize the achievements of outstanding rural students while addressing structural inequalities. Future research should adopt longitudinal designs, distinguish rural student subgroups (e.g., left-behind vs. non-left-behind), and assess non-cognitive abilities to comprehensively understand urban-rural educational disparities.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Limitations","content":"\u003cp\u003eThis study has several limitations that warrant consideration. First, the use of a cross-sectional methodology restricts the ability to establish causal relationships between identified factors (e.g., learning engagement, professional identity) and academic achievement profiles. Longitudinal studies are needed to explore how these profiles evolve over time. Second, the sample comprised 90.0% female nursing students, reflecting gender disparities in the nursing field globally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This limits generalizability to male nursing students and underscores the need for gender-balanced sampling in future studies. Third, Reliance on self-reported measures may introduce response bias. Future research should incorporate objective indicators of academic performance. Forth, while sociodemographic and psychological factors were examined, other variables were not assessed. These omissions may influence academic achievement heterogeneity.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis study used LPA to classify nursing students\u0026rsquo; AA into three distinct profiles: holistically proficient type, moderate type, and high self-management with low learning cognition and interpersonal facilitation type. The largest proportion of participants fell into the moderate group, highlighting a significant opportunity to elevate the overall AA level within nursing education. Factors significantly influencing these latent profiles included only-child status, geographic origin, LE, and professional identity. Notably, this person-centered approach validates the existence of substantial heterogeneity in nursing students' AA, moving beyond traditional aggregate analyses. By grounding the study in SDT, the findings illuminate how key factors like LE and professional identity function as critical psychological resources fulfilling students' intrinsic needs and driving differential AA outcomes. The complex relationship observed, where stronger professional affect unexpectedly reduced the likelihood of belonging to the holistically proficient type (C3), further underscores the nuanced interplay of motivational components within SDT in the nursing education context. This provides a robust theoretical framework for understanding the mechanisms underlying AA diversity. To improve AA levels across the board, nursing educators should implement tailored strategies based on student profiles and prioritize fostering higher vigor and engagement and developing robust professional identity programs that address its multi-dimensional nature, utilizing these students belonging to C3 as peer mentors and role models to support others. For students belonging to C1, focus on developing higher-order cognitive skills (critical thinking, problem-solving) and collaborative abilities through methods like scenario simulations, case discussions, and team-based projects, leveraging their existing self-discipline. For students belonging to C2, enhance overall competency through increased exposure to complex simulations, reflective practice, and resilience-building support to bridge the gap towards higher proficiency. Through these evidence-based, profile-specific interventions, educators can cultivate nursing graduates equipped with high levels of competence and professional commitment\u0026mdash;ultimately strengthening the nursing workforce and improving patient care outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods used in this study fully complied with ethical guidelines and regulations. This study was reviewed and approved by the Ethics Committee of the Second Hospital Affiliated to Air Force Medical University (No. K202403-02). Participants provided informed consent prior to completing the online survey. This study was conducted in accordance with the principles of the Declaration of Helsinki (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wma.net/policies-post/wma-declaration-of-helsinki/\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\n\u003ch2\u003eDeclaration of competing interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eNote\u003c/h2\u003e\n\u003cp\u003eAbbreviations: AIC Akaike Information Criterion; BIC Bayesian Information Criterion; aBIC Adjusted BIC; LMR Lo-Mendell-Rubin Test; BLRT Bootstrap Likelihood Ratio Test; \u0026mdash;Not applicable.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research was supported by grants from the Xijing Innovation Research Institute Joint Fund Project (LHJJ24HL01) and The Mid-Young Science and Technology Talent Program of the Nursing Department, Air Force Medical University\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eXiaoyan Peng: Writing \u0026ndash; review \u0026amp; editing, Writing \u0026ndash; original draft, Visualization, Resources, Methodology, Investigation, Formal analysis, Data curation. Chao Wu: Writing \u0026ndash; review \u0026amp; editing, Writing \u0026ndash; original draft, Methodology, Funding Acquisition. Ziyue Gai: Writing \u0026ndash; review \u0026amp; editing, Writing \u0026ndash; original draft, Formal analysis. Yonghong Yang: Investigation, Validation. Shizhe He: Investigation, Data curation. Shujie Guo: Investigation, Data curation. Baohua Cao: Writing \u0026ndash;review \u0026amp; editing, Supervision. Hongjuan Lang: Writing \u0026ndash; review \u0026amp; editing, Funding Acquisition. Yanling Du: Conceptualization, Resources, Supervision, Validation, Writing-Original Draft, Writing-Review \u0026amp; Editing.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe gratefully acknowledge all study participants, without them the study could not have been completed.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data supporting the findings of this study are available upon request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eState of the world's nursing report 2025. Retrieved July 7 from. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240110236\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240110236\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe WHO Global Strategic Directions for Nursing and Midwifery. (2021\u0026ndash;2025). Retrieved July 7 from. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240033863\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240033863\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMooring, Quanza E. Recruitment, advising, and retention programs \u0026mdash; Challenges and solutions to the international problem of poor nursing student retention: A narrative literature review. Nurse Educ Today. 2016;40:204\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMitchell KM, et al. Social and academic integration strategies for retention of nursing students: a scoping review protocol. JBI Database Syst Rev Implement Rep. 2019;17(1):28\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown J, et al. Nursing Students' Academic Success Factors: A Quantitative Cross-sectional Study. Nurse Educ. 2021;46(2):E23\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMohsenipouya H, et al. The effect of learning styles on the academic achievement of nursing students: a cross-sectional study. BMC Res Notes. 2024;17(1):294.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReina-Gutierrez S, et al. Maternal Education and Academic Achievement in Schoolchildren: The Role of Cardiorespiratory Fitness. J Pediatr. 2021;232:109\u0026ndash;e1171.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQin X, et al. The Impact of Academic Achievement and Parental Practices on Depressive Symptom Trajectories Among Chinese Adolescents. Res Child Adolesc Psychopathol. 2021;49(10):1359\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBae SM. The Analysis of a Causal Relationship between Career Maturity and Academic Achievement on Korean Adolescents Using Autoregressive Cross-Lagged Modeling. Int J Environ Res Public Health, 2022. 19(9).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBae SM. An analysis of career maturity among Korean youths using latent growth modeling. School Psychol Int. 2017;38(2):014303431770952.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePerry JC, Liu X, Pabian Y. School Engagement as a Mediator of Academic Performance Among Urban Youth: The Role of Career Preparation, Parental Career Support, and Teacher Support. Couns Psychol. 2010;38(2):269\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiao F, et al. The relationship between a growth mindset and the learning engagement of nursing students: A structural equation modeling approach. Nurse Educ Pract. 2023;73:103796.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLillekroken D. A privilege but also a challenge. Nurse educators' perceptions about teaching fundamental care in a simulated learning environment: A qualitative study. J Clin Nurs. 2020;29(11\u0026ndash;12):2011\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMohamed MBH, Alsayed S. Investigating Relationship of Perceived Learning Engagement, Motivation, and Academic Performance Among Nursing Students: A Multisite Study. Adv Med Educ Pract. 2021;12:351\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZou L, et al. The effect of professional identity on nursing academic achievement: the chain mediating effect of general self-efficacy and learning engagement. BMC Med Educ. 2024;24(1):1014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu X, et al. Stress/Resource Complex, Sense of Coherence and Professional Identity Among Nursing Students: A Latent Profile and Mediation Analysis. Psychol Res Behav Manag. 2022;15:2409\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang Y, et al. Professional identity and sense of coherence affect the between compassion fatigue and work engagement among Chinese hospital nurses. BMC Nurs. 2023;22(1):472.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMylrea MF, Gupta TS, Glass BD. Design and Evaluation of a Professional Identity Development Program for Pharmacy Students. Am J Pharm Educ. 2019;83(6):6842.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang Q. The Role of Teachers' Interpersonal Behaviors in Learners' Academic Achievements. Front Psychol. 2022;13:921832.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFlannery M. Self-Determination Theory: Intrinsic Motivation and Behavioral Change. Oncol Nurs Forum. 2017;44(2):155\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoward JL, et al. Student Motivation and Associated Outcomes: A Meta-Analysis from Self-Determination Theory. Perspect Psychol Sci. 2021;16(6):1300\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhouchen YB, et al. Impact of professional identity on learner well-being of undergraduate nursing students of double tops universities: Mediating effect of self-regulated learning. Nurse Educ Today. 2024;143:106382.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiao M, et al. Self-efficacy mediates the effect of professional identity on learning engagement for nursing students in higher vocational colleges: A cross-sectional study. Nurse Educ Today. 2024;139:106225.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim SY. Determining the Number of Latent Classes in Single- and Multi-Phase Growth Mixture Models. Struct Equ Model. 2014;21(2):263\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLuo Q, et al. The Mediating Role of Learning Engagement Between Self-Efficacy and Academic Achievement Among Chinese College Students. Psychol Res Behav Manag. 2023;16:1533\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWen-Bo C, et al. A Study of the Relationship among Mathematical Learning Ability, Professional Commitment and Academic Achievement of Ethnic University Science Students. Journal of Research on Education for Ethnic Minorities; 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchaufeli WB, Salanova M. Efficacy or inefficacy, that's the question: burnout and work engagement, and their relationships with efficacy beliefs. Anxiety Stress Coping. 2007;20(2):177\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhonghua H. Survey on professional identity of baccalaureate nursing students in Sichuan province. Sichuan University; 2007.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFirestone C. Performance vs. competence in human-machine comparisons. Proc Natl Acad Sci U S A. 2020;117(43):26562\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRolls ET, Mills W. Computations in the deep vs superficial layers of the cerebral cortex. Neurobiol Learn Mem. 2017;145:205\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuo H, et al. The application of integrating medical humanities education into emergency skill-training scenario simulation teaching. Front Med (Lausanne). 2025;12:1561504.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFenzi G, et al. The expository phase of debriefing in clinical simulation: a qualitative study. BMC Nurs. 2025;24(1):476.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrittain H, Vaillancourt T. Longitudinal associations between academic achievement and depressive symptoms in adolescence: Methodological considerations and analytical approaches for identifying temporal priority. Adv Child Dev Behav. 2023;64:327\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhalaila R. The relationship between academic self-concept, intrinsic motivation, test anxiety, and academic achievement among nursing students: mediating and moderating effects. Nurse Educ Today. 2015;35(3):432\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAydan S, Capa-Aydin Y. What makes them self-regulated? Self-regulation procedures of academically successful students and key influences. Acta Psychol (Amst). 2025;257:105106.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark K, Moon S, Oh J. Predictors of academic achievement in distance learning for nursing students. Nurse Educ Today. 2022;108:105162.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePulido-Martos M et al. The Shirom-Melamed Vigor Measure for Students: Factorial Analysis and Construct Validity in Spanish Undergraduate University Students. Int J Environ Res Public Health, 2020. 17(24).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuidetti G, et al. Can mindfulness mitigate the energy-depleting process and increase job resources to prevent burnout? A study on the mindfulness trait in the school context. PLoS ONE. 2019;14(4):e0214935.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang Q, et al. Team-based learning vs. lecture-based learning in nursing: A systematic review of randomized controlled trials. Front Public Health. 2022;10:1044014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown J et al. Nursing Students' Academic Success Factors: A Quantitative Cross-sectional Study. Nurse Educ, 2021. 46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi QL et al. The Association Among Achievement Goal Orientations, Academic Performance, and Academic Well-Being Among Chinese Medical Students: A Cross-Sectional Study. Front Psychol, 2021. 12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMichelle C, et al. Promoting emotional intelligence and resilience in undergraduate nursing students: An integrative review. Nurse Educ Today. 2018;68:112\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWei H, et al. Impacts of Nursing Student Burnout on Psychological Well-Being and Academic Achievement. J Nurs Educ. 2021;60(7):369\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParhi RK. Problem Solving Ability, Study Habits and Academic Achievement in Science of Tribal and Non-Tribal Students. Sci Cult. 2023;89(7/8):281\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDong X, et al. Emotional Intelligence and Personality Traits Based on Academic Performance. Front Psychol. 2022;13:894570.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJohannsen M, et al. Who flourishes in school? The interplay of academic self-concept and personality and its role for academic performance in middle adolescence. J Pers Soc Psychol. 2024;127(6):1237\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdullatif II. Influences of Structural Empowerment and Demographic Factors on Nurses' Psychological Empowerment. J Nurs Manag, 2023. 2023: p. 8827968.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFalbo T, Poston DJ. The academic, personality, and physical outcomes of only children in China. Child Dev. 1993;64(1):18\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurrows B, Selvanathan HP, Lickel B. My Fight or Yours: Stereotypes of Activists from Advantaged and Disadvantaged Groups. Pers Soc Psychol Bull. 2023;49(1):110\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLao Y, Lin S. Comparison of educational performance between the only children and children in two-child families. Sci Rep. 2022;12(1):15355.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHong X, Liu Q, Zhao S. Approaches to Learning of Preschool Children in China: A Comparison between Only Children and Non-Only Children. Behav Sci. 2023;13(5):13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaggerty T, et al. A Comparison of Rural and Academic Training Environments for Third-Year Medical Students on a Family Medicine Rotation. Fam Med. 2019;51(5):430\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuan H, et al. Examining the relationship between commuting time, academic achievement, and mental health in rural China: a cross-sectional analysis. BMC Public Health. 2025;25(1):1616.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHou T, et al. Education and subjective well-being in Chinese rural population: A multi-group structural equation model. PLoS ONE. 2022;17(3):e0264108.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen X, Hesketh T. Educational Aspirations and Expectations of Adolescents in Rural China: Determinants, Mental Health, and Academic Outcomes. Int J Environ Res Public Health, 2021. 18(21).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang F et al. Educational Expectations and Academic Persistence among Rural Adolescents: The Protective Role of High Self-Esteem. Behav Sci (Basel), 2024. 14(10).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"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":"","lastPublishedDoi":"10.21203/rs.3.rs-7290531/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7290531/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eTo identify distinct subgroups based on academic achievement (AA) among nursing students and explore factors associated with each subgroup.\u003c/p\u003e\u003ch2\u003eDesign\u003c/h2\u003e\u003cp\u003eA cross-sectional survey was carried out between March and April 2025.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e1,011 nursing students were recruited via convenience sampling. Latent profile analysis (LPA) was applied to classify nursing students into distinct subgroups according to their AA characteristics. Additionally, multiple logistic regression was employed to investigate factors influencing subgroup membership.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eLPA revealed three distinct subgroups: Holistically proficient type (23.5%), Moderate type (62.4%), and High self-management with low learning cognition and interpersonal facilitation type (14.1%). Factors associated with AA heterogeneity included vigor, professional cognition, professional volition, professional skills, and geographic region of rural, professional affect and only - child status.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe presence of AA heterogeneity among nursing students implies a need for educators to implement individualized interventions tailored specifically to subgroup attributes. Moreover, educators are encouraged to foster higher learning engagement and bolster professional identity among students to enhance their overall AAs and contribute positively to the expansion of the nursing workforce.\u003c/p\u003e\u003ch2\u003eImpact\u003c/h2\u003e\u003cp\u003eExploring the subgroup of nursing students\u0026rsquo; AA, this study identified characteristics in those nursing students with high self-management but low cognitive learning and interpersonal facilitation. Our study provides insights for institutions to tailor educational interventions, enhancing understanding of academic achievement by LPA.\u003c/p\u003e\u003ch2\u003ePatient or Public Contribution\u003c/h2\u003e\u003cp\u003eNo patient or public contribution.\u003c/p\u003e","manuscriptTitle":"Mapping academic achievement in nursing students: Insights from a latent profile analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 13:52:03","doi":"10.21203/rs.3.rs-7290531/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-09-10T12:19:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T07:09:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-18T06:28:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-14T14:12:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-14T14:08:53+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":"2dcb2864-b47b-42ab-9e71-64aa08a00039","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-17T13:52:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 13:52:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7290531","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7290531","identity":"rs-7290531","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}