Relationships among self-study ability, critical thinking ability, cooperative ability and problem-solving ability in Chinese undergraduate nursing students: An analysis of a longitudinal cohort via cross-lagged models

Relationships among self-study ability, critical thinking ability, cooperative ability and problem-solving ability in Chinese undergraduate nursing students: An analysis of a longitudinal cohort via cross-lagged models | 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 Relationships among self-study ability, critical thinking ability, cooperative ability and problem-solving ability in Chinese undergraduate nursing students: An analysis of a longitudinal cohort via cross-lagged models Dun Liu, Jianbin Lin, Jincheng Zhang, Xinchu Luo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6041228/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: There is currently a lack of research on the change in self-study ability, critical thinking ability, collaborative ability and problem-solving ability in undergraduate nursing students before and after completing professional courses with blending teaching, as well as the mutual influence of different abilities. Objective: The objective was to understand the longitudinal and bidirectional relationships amongself-study ability, critical thinking ability, collaborative ability and problem-solving ability in undergraduate nursing students. Method: A longitudinal research approach was adopted, with two time points selected (before and after completing professional nursing courses). Correlation analysis and a cross-lagged model were used to explore the changes in various abilities of undergraduate nursing students before and after completing professional courses, as well as the interactions between different abilities. Result: Problem-solving skills were correlated with various other variables. Self-directed learning ability at the initial time point was negatively correlated with certain variables. Self-study ability had a significant and negative predictive effect from Time 1 to Time 2. Collaborative ability significantly and positively influenced self-study ability from Time 1 to Time 2. Problem-solving ability showed a significant and positive predictive effect from Time 1 to Time 2 and positively influenced collaborative ability from Time 1 to Time 2. Self-study ability had a significant and negative impact on critical thinking from Time 1 to Time 2. Conclusion: Undergraduate Nursing students' self-study, collaborative and problem-solving abilities are interrelated. Beginning in the early years of study, educators should revamp teaching methods and models to assist students in unlearning conventional learning and thought processes. Teachers should aim to foster collaborative problem-solving skills by applying knowledge, thereby augmenting students’ overall problem-solving proficiency. self-study ability critical thinking ability collaborative ability problem-solving ability undergraduate students nursing Figures Figure 1 Figure 2 1 Introduction Nursing, as a first-level discipline in the medical field, is a discipline and profession centred on human health, with the goal of providing personalized and precise management and health education. The professional abilities, learning abilities, and thinking abilities of undergraduate nursing students, who are the backbone of future clinical nursing work, directly affect the innovation level, disciplinary development, and overall quality improvement of clinical nursing staff in China (Wang et al., 2019 ). In the context of new medical science construction, the internet, the Internet of Things, artificial intelligence, big data and genomics further expand the knowledge and extend the reach of nurses;therefore, nurses must stay up-to-date with the times and learn to remotely, accurately and dynamically monitor patients' health status, lifestyle, disease progress, treatment compliance, etc. to provide personalized and accurate treatment anytime and anywhere (Lin et al., 2020 ). Therefore, there is an urgent need to train many professional and practical nursing professionals with good comprehensive abilities and qualities to provide the appropriate conditions in clinical work for achieving personalized and precise health management and guidance. The core competencies of clinical nursing staff include self-study, critical thinking, collaborative, and problem-solving abilities. Self-study ability refers to the ability to use metacognition and objective human and material resources to acquire and master the necessary knowledge and skills to provide high-quality nursing services. The constituent elements of self-study ability include self-management ability, information acquisition ability, and collaborative ability (Jiang and Lin, 2005 ). One of the training objectives of undergraduate nursing education in China at present is to train nursing professionals with strong self-study and scientific thinking abilities (Li and Gao, 2015 ). Both domestically and internationally, nursing educators are gradually emphasizing the cultivation of undergraduate nursing students' self-study abilities and incorporating them into the teaching objectives of undergraduate nursing programs. Critical thinking is a purposeful, meaningful, and self-regulated process of judgement and reflection (Chen et al., 1998 ). In the process of training and educating undergraduate nursing students, critical thinking, which involves self-regulation and deep reflection in both academic and practical aspects, is essential. Critical thinking can serve as an effective basis for judging whether undergraduate nursing education meets quality standards (Li et al., 2010 ). Cooperative ability, as a core professional skill, refers to the ability to establish good cooperative relationships with others, organize tasks in practice, plan task division, and ultimately achieve common goals (Core skills for work developmental framework [EB/OL], 2018 ). Collaborative ability is an effective way to increase the sense of responsibility among nursing students (Bin, 2018 ). In the process of learning professional nursing knowledge, working together to manage the relationships between individuals and teams and solve problems can achieve twice the result with half the effort. Therefore, for nursing students, collaborative ability is an essential evaluation indicator. Social problem-solving ability is defined as an individual's ability to identify specific problems encountered in daily life and discover effective solutions (Dzurilla, 1984 ), which involves various aspects of human cognition, thought, emotion, behaviour, etc. (Ma, 2021 ). Problem-solving and social problem-solving abilities are essential skills for the nursing profession and have a significant impact on nurses’ psychological resilience and various skills (Abdollahi et al., 2018 ). The cultivation of nurses' problem-solving ability needs to start in the nursing student stage, and the earlier the implementation is, the better the effect (Luo and Li, 2020 ). Therefore, self-study, critical thinking, collaborative, and problem-solving abilities are important training objectives and evaluation indicators in nursing education. At present, in China, undergraduate nursing programs mostly have a duration of four years. Students usually complete basic medical and professional courses in the first and second years and begin professional courses in the third year. The completion of nursing courses is an important part of cultivating the comprehensive abilities of undergraduate nursing students. In China, undergraduate nursing courses mainly include core courses such as nursing fundamentals, internal medicine nursing, and surgical nursing. These courses focus on human health, are closely related to clinical practice, are guided by modern medical models and holistic nursing concepts, and are framed by nursing procedures. They emphasize the cultivation of comprehensive abilities such as holistic nursing, humanistic care, critical thinking, and the ability to identify, analyse, and solve problems (Liu et al., 2021 ). Therefore, the objective of nursing courses is not only to gain professional knowledge but also, more importantly, to cultivate the comprehensive abilities of undergraduate nursing students. The teaching quality and effectiveness of undergraduate nursing courses greatly affect the quality of nursing talent and the sustainable development of clinical nursing (Li and Gao, 2015 ). In addition, in the process of learning in nursing courses, the interactions among self-study, critical thinking, collaborative, and problem-solving abilities may be bidirectional. In the process of learning in professional courses, students need to apply critical thinking skills to better grasp knowledge through self-study. Moreover, in the case of professional courses, it is necessary to apply collaborative and problem-solving skills to improve learning effectiveness, and in the process of collaboration and problem-solving, critical thinking skills must be applied, which further enhances self-study ability. However, there is currently a lack of research on the change in the self-study, critical thinking, collaborative, and problem-solving abilities of undergraduate nursing students before and after completing professional courses with blending teaching, as well as the mutual influence of different abilities. Therefore, to understand the longitudinal and bidirectional relationships among self-study, critical thinking, collaborative, and problem-solving abilities, a longitudinal research approach was adopted in this study, with two time points selected (before and after completing professional nursing courses). The changes in the various abilities of undergraduate nursing students, as well as the interactions among different abilities, were explored before and after the completion of professional courses, providing a basis for teaching reform in nursing professional courses. 2 Methods 2.1 Study design Cluster sampling was used to select two cohorts of undergraduate students majoring in nursing from a medical university in Southeast of China for inclusion; the students voluntarily agreed to participate in this study. According to the training plan of the school, undergraduate nursing students complete basic medical courses in the first semester of their first year and complete professional nursing courses in the second semester of their junior year. Therefore, the first time point of this study was at the end of the first semester of the students’ first year, and the second time point was the end of the second semester of the students’ junior year. The first survey was conducted with undergraduate nursing students in the 2020 and 2021 cohort in December 2020 and 2021, respectively. The second survey was conducted with undergraduate nursing students in the 2020 and 2021 cohort in June 2023 and 2024, respectively. The training objectives, plans, modes and learning content of students in the two classes were completely consistent. Before the questionnaire was distributed, the researcher used unified guiding language to explain the questionnaire to the research participants, and after the students provided informed consent, the questionnaire was distributed on site. The completion time for the questionnaire was 15 minutes. The students were asked to complete the questionnaire carefully according to their actual situation. To ensure confidentiality, the questionnaire was anonymous; the purpose of the questionnaire, which was only for the study and not for any other purpose, was explained to the research participants. To ensure the validity of the questionnaire, explanations were provided for questions that the research participants did not understand, and missing items were promptly supplemented. All survey scales were distributed onsite by the researchers themselves for verification and collection. For participants whose questionnaires had missing data, timely guidance and supervision were provided. After the questionnaires were collected, the completeness and validity were verified again, and invalid questionnaires with too many missing responses or high repetition rates were excluded. 2.2 Population and sample In this study, we included nursing students studying at the undergraduate (bachelor) level. The inclusion criteria were as follows: ① full-time undergraduate nursing students and ② students aged ≥ 18 years. Students who took a leave of absence, transferred, or joined the military midway through the study were excluded for various reasons. We invited 368 eligible nursing students to participate in the study, including 151 students from the 2020 cohort and 217 students from the 2021 cohort. 2.3 Questionnaire 2.3.1 General information survey for undergraduate nursing students By referring to the relevant literature, a self-designed survey questionnaire was developed and used to understand the general information of the undergraduate nursing students, including the following: age, gender, ethnicity, whether the nursing major was the student’s first choice at the time of the college entrance examination, and whether the student like the nursing major. 2.3.2 Self-study ability In this study, the "Scale for Assessing the Self-study Ability of Nursing Undergraduate Students", developed by Lin Yi and Jiang Anli from the Second Military Medical University in 2004, was used to evaluate the self-study ability of the control group and the experimental group, respectively. The scale consists of 28 items, including subscales for self-management ability, information ability, and collaborative ability. There are 10 items for self-management ability, 11 items for information ability, and 7 items for collaborative ability. A 5-point Likert scale is used for scoring, which includes responses of "completely agree", "basically agree", "average", "basically disagree", and "completely disagree". The scores for forward-scored questions are 5, 4, 3, 2, and 1, whereas the scores for reverse-scored questions are the opposite: 1, 2, 3, 4, and 5, respectively. The score range is 28–140 points. The total score for self-study ability ranges from 28–140 points, that for self-management ability ranges from 10–50 points (1–10 questions), that for information ability ranges from 11–21 points, and that for collaborative ability ranges from 7–35 points (22–28 questions). The higher the score is, the stronger a student’s self-study ability. This scale has good content validity and construct validity, with a Cronbach's alpha coefficient of 0.86 (Lin and Jiang, 2004 ). 2.3.3 Critical thinking ability The Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) was translated and revised on the basis of the California Critical Thinking Attitude Disposition Test. The scale is suitable for use among college students, graduate students, and adult professionals and was translated into Chinese by experts such as Professor Peng Meici from the School of Nursing at Hong Kong Polytechnic University in 2004. This scale is divided into seven dimensions, namely, seeking truth, open-minded thinking, analytical thinking, systematic thinking, self-confidence, inquisitiveness, and maturity, with 10 items in each dimension. Each item is scored based on the degree of approval: "strongly agree", "completely agree", "somewhat agree", "generally agree", "completely disagree", and "strongly disagree". The positive items are assigned "6 points, 5 points, 4 points, 3 points, 2 points, or 1 point", whereas negative items are scored in reverse. The total score of the scale ranges from 70–420 points, with scores ≤ 210 points indicating negative evaluative thinking tendencies, score of 210–280 points indicating unclear evaluative thinking tendencies, scores ≥ 280 points indicating positive evaluative thinking tendencies, and scores ≥ 350 points indicating strong positive evaluative thinking tendencies. This scale is widely used in China and has high reliability and validity. The content validity index (CVI) is 0.89, the total Cronbach's alpha value is 0.90, and the alpha values of each dimension range from 0.54–0.77 (Peng et al., 2004 ). 2.3.4 Cooperative ability This study used the "Cooperative Ability Strength Scale" developed by Wang Bin and Li Furong from Central China Normal University in 2011. The scale consists of 42 questions divided into two aspects: cooperative awareness and cooperative skills. Cooperative awareness mainly includes three dimensions: cooperative cognition (Items 1–11), cooperative emotion (Items 12–17), and cooperative intention (Items 18–22). Cooperative skills include four dimensions: interpersonal interaction (Items 23–29), conflict management (Items 30–35), emotional control (Items 36–39), and organizational leadership (Items 40–42). The scale is scored on a 5-point Likert scale ranging from "completely disagree" to "completely agree". The internal consistency reliability of this scale is 0.94, and the split half reliability is 0.87. The homogeneity reliability of the 7 factors ranges from 0.74 to 0.92, and the split half reliability ranges from 0.70 to 0.88 (Li, 2011). 2.3.5 Problem-solving ability Social problems include various issues that affect people, including but not limited to personal behaviour problems, cognitive problems, interpersonal relationship problems, etc. The common social problems among college students in China include three categories: personal internal problems (47.53%), interpersonal relationship problems (40.66%), and learning problems (10.76%). Therefore, the revised D'Zurilla Social Problem Solving Questionnaire-Revised (SPSI-R), developed by Wang Fei and Liu Yan in 2009 in the context of Chinese culture, was adopted, with the aim of comprehensively and deeply exploring the problem-solving ability of undergraduate nursing students through a questionnaire. The Chinese version of the SPSI-R has good reliability and validity. The questionnaire consists of 32 items, including 5 factors: positive problem-solving tendency, negative problem-solving tendency, rational problem-solving tendency, avoidant problem-solving tendency, and impulsive negligent problem-solving tendency. The scores range from 1 "completely disagree" to 5 "completely agree". The total scale and each factor have good internal consistency coefficients (Cronbach's coefficient of 0.85) and test-retest reliability (r = 0.50) (Ma, 2021 ). 2.4 Data analysis First, descriptive statistics were performed on each variable to capture its fundamental distribution characteristics. Second, a correlation analysis was performed. The correlations between variables were investigated by calculating their correlation coefficients and p values at the two time points. A cross-lag model was constructed and evaluated via the Lavaan package to assess both self-lagged and cross-lagged effects among the variables. Time series data encompassing self-study, collaborative, critical thinking, and problem-solving abilities were employed in this study. The dataset comprises observations at two time points, with data recorded as independent and dependent variables at each time point. The fundamental principle of cross-lagged models is to analyse the dynamic relationships between variables by simultaneously considering their observed values across multiple time points. Within the framework of structural equation modelling (SEM), these models enable researchers to assess both autoregressive and cross-lagged effects simultaneously, thus exploring potential causal relationships among variables. This framework has been widely used to examine longitudinal and bidirectional associations between constructs in sociological and psychological research (Tak et al., 2017 ; Wang et al., 2020 ). Suppose that we have four variables, 𝑋1, 𝑋2, 𝑋3, and 𝑋4, representing self-study ability, collaborative ability, critical thinking ability, and problem-solving ability, respectively. At time points 𝑡1 and 𝑡2, the values of these variables are denoted as 𝑋𝑖,𝑡1 and 𝑋𝑖,𝑡2 (where 𝑖=1,2,3,4). The cross-lagged model can be represented by the following equation: 𝑋𝑖,𝑡2 = 𝛽𝑖𝑋𝑖,𝑡1 + ∑𝑗≠𝑖𝛾𝑖𝑗𝑋𝑗,𝑡1 + 𝜖𝑖 𝛽𝑖 denotes the self-lagged effect coefficient for variable 𝑋𝑖, indicating the stability of this variable over time. 𝛾𝑖𝑗 signifies the cross-lagged effect coefficient for variable 𝑋𝑗 relative to 𝑋𝑖 across different time points, reflecting the interaction between the variables across time. 𝜖𝑖 is the residual term, indicating the unexplained portion of the model. In this study, the specific model equation is as follows: Self-study𝑡2 = 𝛽Self-study × Self-study𝑡1 + 𝛾Collab × Collab𝑡1 + 𝜖Self-study Problem𝑡2 = 𝛽Problem × Problem𝑡1 + 𝜖Problem Collab𝑡2 = 𝛽Collab × Collab𝑡1 + 𝛾Problem × Problem𝑡1 + 𝜖Collab Critical𝑡2 = 𝛽Critical × Critical𝑡1 + 𝛾Self-study × Self-study𝑡1 + 𝜖Critical These equations describe how the value of each variable at time 𝑡2 is influenced by its value at time 𝑡1 and by other variables. The self-lagged effect coefficient 𝛽𝑖 represents the stability of the variable across different time points. A larger 𝛽𝑖 indicates stronger temporal consistency of the variable, implying that the state of the variable at time 𝑡1 provides a stronger prediction for its state at time 𝑡2. 2.4.1 Cross-lagged effect (𝛾𝑖𝑗) The cross-lagged effect coefficient 𝛾𝑖𝑗 reflects the influence of one variable at an earlier time point on another variable at a later time point. The significance of this coefficient is that it can be used to infer potential causal relationships between variables. For instance, a significant 𝛾Collab indicates that collaborative ability at time 𝑡1 significantly influences self-study ability at time 𝑡2. The goodness of fit of the Cross-Lagged Panel Model(CLPM) was comprehensively evaluated via the comparative fit index (CFI), Tucker‒Lewis index (TLI), and root mean square error of approximation (RMSEA). A CFI ≥ 0.9, a TLI ≥ 0.9, and an RMSEA ≤ 0.06 indicate that a model has a good fit, and a CFI and TLI ≥ 0.80 and an RMSEA ≤ 0.08 indicate acceptable fit (Hu, 2011 ). 2.5 Ethical considerations This study was approved by the institutional review board (IRB) of University. They contend that the study does not fall within the purview of ethical review for human biomedical research and have consented to execute it in accordance with the established protocol. All research was performed in accordance with relevant guidelines. All the data were anonymized for coding and analysis to safeguard participant privacy. Prior to the survey, the participants were informed of the voluntary and confidential principles of the study and that not all the data files contained sensitive information about the participants. All research participants provided informed consent prior to their involvement in this study. 3 Results 3.1 Summary of the study sample At the first time point, 368 research subjects participated in the survey. At the second time point, all research subjects participated in the survey again. The general information for the 2020 and 2021 cohorts is shown in Table 1 . There was no statistically significant difference between the two groups except for ethnicity and occupational status (P > 0.05), whereas all other differences were statistically significant (P < 0.05). Table 1 General information of the two cohorts [Person, percentage (%)]. Variable 2020 cohort(n = 151) 2021 cohort(n = 217) χ² P Sex 5.671 0.017 Male 38(25.2) 33(15.2) Female 113(74.8) 184(84.8) Ethnicity 0.083 0.773 Han 135(89.4) 196(90.3) Other 16(10.6) 21(9.7) Place of Origin 21.391 <0.001 Rural 104(68.9) 115(53.0) Urban 38(25.2) 69(31.8) Urban‒rural Fringe 9(6.0) 33(15.2) Nursing major is first choice 28.334 <0.001 Yes 17(11.3) 78(35.9) No 134(88.7) 139(64.1) Reason for Applying 21.391 <0.001 Voluntary Choice 45(29.8) 109(50.2) Parental Choice 15(9.9) 28(12.9) Teacher’s Choice 1(0.7) 3(1.4) Major Adjustment 90(59.6) 77(35.5) Serves as a student leader 3.931 0.047 Yes 79(52.3) 136(62.7) No 72(47.7) 81(37.3) Level of major preference 15.825 <0.001 Very much 54(35.8) 38(17.5) Neutral 88(58.3) 163(75.1) Dislike 9(6.0) 16(7.4) Engaged in this profession 0.096 0.953 Yes 81(53.6) 118(54.4) No 8(5.3) 10(4.6) Unsure 62(41.1) 89(41.0) The scores for self-study, critical thinking, cooperation, and problem-solving abilities were subjected to normality tests. Except for the scores for self-study ability of the 2020 and 2021 cohorts in the first year, which conformed to a normal distribution (P > 0.05), all the other scores did not (P < 0.05). Consequently, nonparametric tests were employed, as detailed in Table 2 . The scores for self-study, critical thinking, and collaborative abilities of the 2020 cohort in the third year were significantly higher than those in the first year (P < 0.05). Similarly, the scores for self-study, critical thinking, cooperative, and problem-solving abilities of the 2021 cohort in the third year were significantly higher than those in the first year (P < 0.05). Significant differences were observed in the scores for self-study, critical thinking, and collaborative abilities between the two cohorts in the first year (P < 0.05). Significant differences were also noted in the scores for self-study and collaborative abilities between the two cohorts in the junior year (P < 0.05). Table 2 Comparison of the Four Learning Abilities between the Two Cohorts in the Two Years [Score, M (P25, P75)]. Variable 2020 cohort(n = 151) 2021 cohort(n = 217) Z 1 P 1 Z 2 P 2 Z 3 P 3 Z 4 P 4 Freshmen Juniors Freshmen Juniors Self-study ability 78.00 (75.00, 82.00) 95.00 (89.00, 100.00) 76.00 (72.00, 80.00) 91.00 (87.00, 94.50) 7.250 <0.001 -16.726 <0.001 -3.279 0.001 -5.189 <0.001 Critical thinking ability 251.00 (240.00, 274.00) 264.00 (247.00, 286.00) 256.00 (245.00, 279.00) 266.00 (250.00, 290.00) 1.611 0.011 -2.974 0.003 -2.017 0.044 -1.034 0.301 Cooperative ability 146.00 (137.00, 153.00) 155.00 (148.00, 164.00) 106.00 (98.50, 114.00) 146.00 (139.00, 154.00) 3.453 <0.001 -16.371 <0.001 -14.034 <0.001 -6.045 <0.001 Problem-solving ability 103.00 (98.00, 108.00) 105.00 (98.00, 112.00) 103.00 (96.00, 108.00) 105.00 (98.00, 112.00) 1.151 0.141 -2.152 0.031 -0.263 0.792 -0.551 0.582 Note: Z1 and P1 are comparisons between freshmen and juniors in the 2020 cohort; Z2 and P2 are comparisons between freshmen and juniors in the 2021 cohort; Z3 and P3 are the two groups of freshmen for comparison; Z4 and P4 are the two groups of juniors for comparison. 3.2 Correlation analysis results Spearman correlation analysis revealed significant correlations among certain variables. Specifically, problem-solving ability was correlated with other variables across different time points. Problem-solving ability at the first time point was correlated with self-study, cooperative, critical thinking, and problem-solving abilities at the first time point (P < 0.05). Problem-solving ability at the second time point was correlated with self-study ability at the first time point, critical thinking and problem-solving abilities at the first time point, and self-study and collaborative abilities at the second time point (P < 0.05). This suggests potential interactions among these abilities. Additionally, collaborative ability at the first time point was correlated with self-study ability (P < 0.05). Self-study ability at the first time point was negatively correlated with critical thinking and problem-solving abilities at both time points and self-study ability at the second time point (P < 0.05) (Table 3 , Fig. 1 Results of the correlation analysis of self-study, cooperation, critical thinking and problem-solving abilities.). Table 3 Results of the correlation analysis of the four variables at the two time points. Variable Self-study ability − 1 Collaborative ability-1 Problem-solving ability-1 Critical thinking ability − 1 Self-study ability-1 1 0.166** -0.148** -0.248** Collaborative ability-1 0.166** 1 -0.025 -0.080 Problem-solving ability-1 -0.148** -0.025 1 0.243** Critical thinking ability − 1 -0.248** -0.080 0.243** 1 Self-study ability − 2 -0.215** 0.247** 0.135** 0.083 Collaborative ability-2 -0.025 0.070 0.158** 0.044 Problem-solving ability-2 -0.185** -0.065 0.179** 0.202** Critical thinking ability − 2 0.274** -0.057 0.119* 0.200** **: P < 0.01; *: P < 0.05 3.3 Cross-lagged model results The path coefficients and their significance levels revealed intriguing causal relationships. First, self-study ability had a significant and negative predictive effect from Time 1 to Time 2 (β=-0.342, p < 0.001). Second, collaborative ability had a significant and positive effect on self-study ability from Time 1 to Time 2 (γ = 0.088, p < 0.001). Third, problem-solving ability had a significant and positive self-predictive effect from Time 1 to Time 2 (β = 0.176, p < 0.01). Additionally, problem-solving ability had a significant and positive effect on collaborative ability from Time 1 to Time 2 (γ = 0.225, p < 0.01). Finally, self-study ability had a significant and negative effect on critical thinking ability from Time 1 to Time 2 (γ=-1.149, p < 0.001). We ultimately only selected paths that exhibited significant effects and could converge to establish the model. The primary reason is that other paths exhibited weak correlations, and their effects remained insignificant even when they were gradually incorporated into the model. Therefore, we ultimately did not include these paths (Table 4 , Fig. 2 Cross-lagged model results for self-study, cooperative, critical thinking and problem-solving abilities for the total sample). Table 4 Standardized coefficients of self-study, cooperation, critical thinking and problem-solving abilities for the overall sample on the basis of a cross-lagged panel model. Parameter β SE P Stability paths Self-study ability-1→Self-study ability-2 -0.264 0.063 < 0.001 Problem-solving ability-1→Problem-solving ability-2 0.151 0.057 0.002 Cross-lagged effects Self-study ability-1→Critical thinking ability-2 -0.212 0.257 < 0.001 Cooperation ability-1→Self-study ability-2 0.275 0.015 < 0.001 Problem-solving ability-1→Cooperation ability-2 0.141 0.081 0.006 3.4 Sensitivity analysis results Sensitivity analysis was performed to evaluate the robustness of the study. The model demonstrated acceptable fit (CFI = 0.943, TLI = 0.854, RMSEA = 0.078). 4 Discussion First, an unexpected finding of this study was that the self-study ability of junior nursing students negatively affected their self-study and critical thinking abilities as they progressed to more advanced learning stages. The results of the correlation analysis revealed that self-study ability at the first time point was negatively correlated with critical thinking ability and problem-solving ability at both time points and self-study ability at the second time point. Therefore, within the Chinese educational context, primary and secondary school students may focus primarily on exam-oriented education, leading to poor learning adaptation, with the result that lower-grade nursing students continue to adopt their original learning and thinking patterns after entering university. Although students demonstrate a strong ability to learn from classroom instruction and textbooks, they lack independent thinking and a questioning spirit and struggle with knowledge application (Chen et al., 2018 ). As they progress to higher-level professional courses, their traditional self-study methods prove inadequate in addressing the challenges posed by clinical applications (Sun et al., 2024 ). In China, blended learning is extensively employed in various nursing courses, including internal medicine nursing, surgical nursing, geriatric nursing, and obstetrics and gynaecology nursing courses. This presents significant challenges for nursing students in terms of critical thinking and problem-solving skills (Kong et al., 2022 ; Zhou et al., 2023 ). Clearly, exam-focused self-study ability is not applicable to the study of professional courses in later academic years, which may be the primary cause of their adverse effects. Although self-study and cooperative abilities are interrelated, the collaborative ability of lower-grade nursing students is limited to merely passing exams, not applying practical professional knowledge. Therefore, it is recommended that teachers enhance students' abilities to apply knowledge and facilitate a shift from traditional learning methods and mindsets by using innovating teaching methods during the foundational medical phase for nursing students. This will enable students to improve their critical thinking in both professional courses and clinical nursing practice (Hwang and Oh, 2021 ). Second, the problem-solving skills of junior nursing students positively affected their collaborative and problem-solving abilities in their senior year. Enhanced problem-solving skills lead to better application of professional knowledge. Only when students grasp how to apply knowledge do they understand how to proactively seek knowledge rather than solely focusing on exam preparation (Huang et al., 2023 ). This progressive enhancement of self-study and collaborative skills in obtaining and applying knowledge creates a virtuous cycle in terms of problem-solving abilities (Cheng et al., 2024 ). Third, the results of this study also indicated a close relationship between cooperative ability and self-study ability. In blended learning, students are required to collaborate with others, divide tasks, independently develop learning plans, set learning goals, and jointly solve problems through discussions and exchanges with others (Padugupati et al., 2021 ). This learning method enables students to demonstrate initiative and creativity, fosters students’ self-study ability, enhances students’ problem-solving skills, and improves learning outcomes. This is instrumental in fostering students' lifelong learning abilities. This is especially crucial for nursing students, as nursing work requires teamwork and a division of labour to assist patients in achieving their care goals. Furthermore, as clinical knowledge and concepts evolve rapidly, nurses must engage in lifelong learning to excel in their profession (Deng, 2022 ). With the advancement of the internet, students can access a wealth of educational resources and information online, utilizing digital technologies to proactively learn and obtain knowledge, which also creates more opportunities for collaboration with others. Students can use online collaboration tools and platforms to work with others on various tasks and projects, thus further improving their collaborative skills (Chen et al., 2020 ). This finding also suggests that during the learning process, teachers should utilize various activities, such as knowledge expansion, academic competitions, professional practices, innovation contests, and volunteer work, to encourage students to proactively seek, expand, and apply knowledge through the internet. This approach aims to enhance students' collaborative skills and, in turn, strengthen their autonomous learning abilities. Fourth, the correlation analysis results showed that critical thinking ability stands out as relatively independent, its beneficial impact on the development of critical thinking and problem-solving abilities cannot be overlooked. Critical thinking is the ability to engage in the in-depth analysis, evaluation, and reasoning of information (Liu et al., 2020 ). It helps individuals capture the essence of issues and avoid being misled by superficial appearances (Huang et al., 2020 ). In making judgements about various matters, it is essential for learners to employ problem-solving skills, which aid them in deeply understanding and assimilating knowledge, distinguishing between surface phenomena and underlying causes, pinpointing the essence of problems, and making accurate judgements about knowledge (Liang et al., 2019 ). The reason for the relative independence of critical thinking ability is that its development is a holistic process that requires the capacity for independent thought, a spirit of inquiry and discernment, judgement founded on rigorous inference, extensive cognitive training and knowledge reserves, multiple methods and stages of thinking, a spirit of critique and a capacity for rational thought, along with qualities such as curiosity, imagination, and a desire for knowledge. Consequently, any single aspect of learning ability is inadequate to significantly influence critical thinking ability, and further comprehensive assessment and analysis are necessary for research into the effect of critical thinking ability on nursing students. 5 Conclusion Undergraduate nursing students' self-study, collaborative and problem-solving abilities are interrelated, whereas their critical thinking ability is distinct. The factors influencing these abilities merit thorough analysis and investigation. Beginning in the early years of study, educators should revamp teaching methods and models, leveraging avenues such as intellectual exploration, academic contests, practical training, innovation fairs, and volunteer work to assist students in unlearning conventional learning and thought processes. Teachers should aim to foster collaborative problem-solving skills by applying knowledge, thereby augmenting students’ overall problem-solving ability. 5.1 Limitations This study has several limitations. First, only the data of undergraduate nursing students from one provincial medical university and one course were evaluated in this study, and data were not collected from students in other levels of medical colleges and other professional courses. Future research needs to expand the sample source range to make the data more representative. Second, data were collected at only two time points; we were unable to collect data at more time points, such as after the internship. Therefore, in the future, it is necessary to continue collected the data of nursing students during their internships and even after work to dynamically evaluate the changes in their critical thinking, collaborative ability, and self-study abilities. Abbreviations CTDI-CV Critical Thinking Disposition Inventory-Chinese Version CVI The Content Validity Index SPSI-R Social Problem Solving Questionnaire-Revised SEM Structural Equation Modelling CLPM Cross-Lagged Panel Model CFI Comparative fit index TLI Tucker‒Lewis index RMSEA Root Mean Square Error of Approximation IRB Institutional Review Board Declarations Funding information This study was funded in full by Fujian Province Undergraduate Education and Teaching Research Project. （grant no. FBJY20230133）and Fujian Medical University Undergraduate Education and Teaching Research Project（grant no.J23005）. Availability of supporting data Others can replicate and build upon the authors' published claims. The authors can make materials, data, code, and associated protocols promptly available to readers without undue qualifications. Any restrictions on the availability of materials or information must be disclosed to the editors at the time of submission. Any restrictions must also be disclosed in the submitted manuscript. Declaration of absence of conflicts of interest and consent to publish declaration The authors declare that there are no financial interests or relationships that would represent a conflict of interest concerning the subject matter of this manuscript. All authors approve the final version of this manuscript and consent to its submission for publication. Any disputes regarding authorship have been resolved prior to submission. All authors participated in the review of the study, interpretation and analysis of the data and review of the manuscript; Liu Dun conducted the study; Liu Dun and Lin Jianbin wrote the manuscript; Zhang Jincheng and Luo Xinchu collected and organized data. Informed consent statement All data were anonymized for coding and analysis to safeguard participant privacy. After researchers explained the research objectives and data collection methods, all willing students were asked to sign informed consent forms. While all participants were required to sign written informed consent forms, they were also informed of their right to withdraw from the study at any time. Ethics Not applicable. Declaration of generative AI and AI-assisted technologies in the writing process I promise to strictly adhere to the principle of academic integrity during the creative process, and have not employed any improper means (such as plagiarism, falsification of data, etc.) to obtain research results. Meanwhile, we use AI and AI-assisted technologies only in the writing process, these technologies only be used to improve readability and language of the work and not to replace any key authoring tasks. References Abdollahi, A., Hosseinian, S., Zamanshoar, E., Beh-Pajooh, A., Carlbring, P., 2018. The moderating effect of hardiness on the relationships between problem-solving skills and perceived stress with suicidal ideation in nursing students. Stud. Psychol. 1 (60), 30–41. https://doi.org/10.21909/sp.2018.01.750. Bin, X., 2018. Exploration of ways to cultivate cooperative abilities in nursing students. Contemp. Educ. Pract. Teach. Res. (7), 140–141. Chen, B., Jiang, A., Li, S., 1998. Discussion on several issues concerning the cultivation of critical thinking in higher nursing education. Chin. High. Med. Educ. 12 (1), 7–8+48. Chen, L., Lu, S., Zeng, F., et al., 2020. 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Educ. 12 (7), 490–495. Liang, J., Zhang, D., Li, G., et al., 2019. Impact of MOOC-based flipped classrooms on critical thinking and self-study ability of ICU nursing students. Gen. Nurs. 17 (14), 1675–1677. Lin, M., Chen, J., Zhu, J., et al., 2020. Trend analysis of nursing graduate education and training under the background of new medicine. 55 (5), 769–772. Lin, Y., Jiang, A., 2004. Development of a scale for assessing the self-study ability of nursing college students. J. PLA Nurs. 21 (6), 1–4. Liu, D., Jiang, X., Song, J., et al., 2021. The mediating effect of self-study ability on the critical thinking and psychological resilience of nursing undergraduate students. Chin. J. Nurs. Educ. 18 (6), 525–529. Liu, D., Song, J., Gao, J., 2020. Self-study and critical thinking ability of undergraduate nursing students under traditional teaching models: a correlation analysis. China High. Med. Educ. (11), 44–45. Luo, Y., Li, Y., 2020. Research progress on the problem-solving ability of nursing students. Chin. J. Mod. Nurs. 26 (27), 3838–3843. Ma, X., 2021. Study on the Influence and Intervention of Problem Solver Characteristics and Group Size on the Cooperative Problem Solving Ability of Adolescents. Huazhong Normal University. Padugupati, S., Joshi, K.P., Chacko, T.V., Jamadar, D., 2021. Designing flipped classroom using Kemp's instructional model to enhance deep learning and self-directed collaborative learning of basic science concepts. J. Educ. Health Promot. 10 (1), 187. https://doi.org/10.4103/jehp.jehp_1031_20. Peng, M., Wang, G., Chen, J., et al., 2004. A study on the reliability and validity testing of the critical thinking ability scale. Chin. J. Nurs. 39 (9), 7–10. Sun, Y., Zhou, Q., Ye, M., et al., 2024. Investigation and study on learning methods of nursing undergraduate students in blended teaching. Chin. J. Nurs. Educ. 21 (5), 557–562. Tak, Y.R., Brunwasser, S.M., Lichtwarck-Aschoff, A., Engels, R.C.M.E., 2017. The prospective associations between self-efficacy and depressive symptoms from early to middle adolescence: a cross-lagged model. J. Youth Adolesc. 46 (4), 744–756. https://doi.org/10.1007/s10964-016-0614-z. Wang, Y., Huang, L., Lv, H., 2019. Analysis of research ability and influencing factors of nursing graduate students. China Health Ind. 16 (15), 4–6. Wang, Y., Lynne, S.D., Witherspoon, D., Black, M.M., 2020. Longitudinal bidirectional relations between body dissatisfaction and depressive symptoms among Black adolescents: A cross-lagged panel analysis. PLoS One 15 (1), e0228585. https://doi.org/10.1371/journal.pone.0228585. Zhou, X., Feng, J., Gao, H., et al., 2023. Design and practice of the ideological and political plan for the undergraduate geriatric nursing course based on blended teaching. Chin. J. Nurs. Educ. 20 (2), 174–178. Additional Declarations No competing interests reported. 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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-6041228","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":425477026,"identity":"e7e038cc-0c43-4d32-ba91-44e92924b23f","order_by":0,"name":"Dun Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBACPmYGBgkGBhseNvnDBw58+EGEFjaIljQ5fgm2xIMze4jRwgDWcthYcgaP8WEONmK0sPMY3ubdwZy44XbPh8MMPAzy/GIHCDmMx9ia9wxb4oY7ZzccLrBgMJw5O4GgFjNp3jaexA0HcjccnsHDkGBwmzgtEkAtOQ8O87ARr8UA6P0cBmK1sBVbzm1LkOPnOWYADGQJwn7h5z+88cbbtv88bOzNjz98+GEjzy9NQAs6kCBN+SgYBaNgFIwC7AAAOow+QFkVeUsAAAAASUVORK5CYII=","orcid":"","institution":"Fujian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Dun","middleName":"","lastName":"Liu","suffix":""},{"id":425477027,"identity":"0b941e55-859a-4e02-86c8-5aa5ae22503a","order_by":1,"name":"Jianbin Lin","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jianbin","middleName":"","lastName":"Lin","suffix":""},{"id":425477029,"identity":"4e8c651b-9078-49c0-9f76-9de34014ce35","order_by":2,"name":"Jincheng Zhang","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jincheng","middleName":"","lastName":"Zhang","suffix":""},{"id":425477031,"identity":"8bd83d10-4779-457c-bccc-0ce21007cb9c","order_by":3,"name":"Xinchu Luo","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinchu","middleName":"","lastName":"Luo","suffix":""}],"badges":[],"createdAt":"2025-02-16 12:53:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6041228/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6041228/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78118573,"identity":"df272013-1097-40c3-a022-596a351f0524","added_by":"auto","created_at":"2025-03-10 06:39:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":415071,"visible":true,"origin":"","legend":"\u003cp\u003eResults of the correlation analysis of self-study, cooperation, critical thinking and problem-solving abilities.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6041228/v1/da50b3c2d0d959065387d10c.png"},{"id":78118590,"identity":"e2e915a8-c9e9-4d96-9d80-be1a69b497ac","added_by":"auto","created_at":"2025-03-10 06:39:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":162545,"visible":true,"origin":"","legend":"\u003cp\u003eCross-lagged model results for self-study, cooperative, critical thinking and problem-solving abilities for the total sample.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-6041228/v1/c83e86dea9ff91f4eb6b7b9d.png"},{"id":79882400,"identity":"8e80ed4a-1ab5-4e55-8405-f0e5f535ae0a","added_by":"auto","created_at":"2025-04-04 04:46:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1585451,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6041228/v1/b6fcc93f-5865-4874-803d-be4880750ae9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationships among self-study ability, critical thinking ability, cooperative ability and problem-solving ability in Chinese undergraduate nursing students: An analysis of a longitudinal cohort via cross-lagged models","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eNursing, as a first-level discipline in the medical field, is a discipline and profession centred on human health, with the goal of providing personalized and precise management and health education. The professional abilities, learning abilities, and thinking abilities of undergraduate nursing students, who are the backbone of future clinical nursing work, directly affect the innovation level, disciplinary development, and overall quality improvement of clinical nursing staff in China (Wang et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In the context of new medical science construction, the internet, the Internet of Things, artificial intelligence, big data and genomics further expand the knowledge and extend the reach of nurses;therefore, nurses must stay up-to-date with the times and learn to remotely, accurately and dynamically monitor patients' health status, lifestyle, disease progress, treatment compliance, etc. to provide personalized and accurate treatment anytime and anywhere (Lin et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Therefore, there is an urgent need to train many professional and practical nursing professionals with good comprehensive abilities and qualities to provide the appropriate conditions in clinical work for achieving personalized and precise health management and guidance.\u003c/p\u003e \u003cp\u003eThe core competencies of clinical nursing staff include self-study, critical thinking, collaborative, and problem-solving abilities. Self-study ability refers to the ability to use metacognition and objective human and material resources to acquire and master the necessary knowledge and skills to provide high-quality nursing services. The constituent elements of self-study ability include self-management ability, information acquisition ability, and collaborative ability (Jiang and Lin, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). One of the training objectives of undergraduate nursing education in China at present is to train nursing professionals with strong self-study and scientific thinking abilities (Li and Gao, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Both domestically and internationally, nursing educators are gradually emphasizing the cultivation of undergraduate nursing students' self-study abilities and incorporating them into the teaching objectives of undergraduate nursing programs. Critical thinking is a purposeful, meaningful, and self-regulated process of judgement and reflection (Chen et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). In the process of training and educating undergraduate nursing students, critical thinking, which involves self-regulation and deep reflection in both academic and practical aspects, is essential. Critical thinking can serve as an effective basis for judging whether undergraduate nursing education meets quality standards (Li et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Cooperative ability, as a core professional skill, refers to the ability to establish good cooperative relationships with others, organize tasks in practice, plan task division, and ultimately achieve common goals (Core skills for work developmental framework [EB/OL], \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Collaborative ability is an effective way to increase the sense of responsibility among nursing students (Bin, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In the process of learning professional nursing knowledge, working together to manage the relationships between individuals and teams and solve problems can achieve twice the result with half the effort. Therefore, for nursing students, collaborative ability is an essential evaluation indicator. Social problem-solving ability is defined as an individual's ability to identify specific problems encountered in daily life and discover effective solutions (Dzurilla, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1984\u003c/span\u003e), which involves various aspects of human cognition, thought, emotion, behaviour, etc. (Ma, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Problem-solving and social problem-solving abilities are essential skills for the nursing profession and have a significant impact on nurses\u0026rsquo; psychological resilience and various skills (Abdollahi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The cultivation of nurses' problem-solving ability needs to start in the nursing student stage, and the earlier the implementation is, the better the effect (Luo and Li, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Therefore, self-study, critical thinking, collaborative, and problem-solving abilities are important training objectives and evaluation indicators in nursing education.\u003c/p\u003e \u003cp\u003eAt present, in China, undergraduate nursing programs mostly have a duration of four years. Students usually complete basic medical and professional courses in the first and second years and begin professional courses in the third year. The completion of nursing courses is an important part of cultivating the comprehensive abilities of undergraduate nursing students. In China, undergraduate nursing courses mainly include core courses such as nursing fundamentals, internal medicine nursing, and surgical nursing. These courses focus on human health, are closely related to clinical practice, are guided by modern medical models and holistic nursing concepts, and are framed by nursing procedures. They emphasize the cultivation of comprehensive abilities such as holistic nursing, humanistic care, critical thinking, and the ability to identify, analyse, and solve problems (Liu et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Therefore, the objective of nursing courses is not only to gain professional knowledge but also, more importantly, to cultivate the comprehensive abilities of undergraduate nursing students. The teaching quality and effectiveness of undergraduate nursing courses greatly affect the quality of nursing talent and the sustainable development of clinical nursing (Li and Gao, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition, in the process of learning in nursing courses, the interactions among self-study, critical thinking, collaborative, and problem-solving abilities may be bidirectional. In the process of learning in professional courses, students need to apply critical thinking skills to better grasp knowledge through self-study. Moreover, in the case of professional courses, it is necessary to apply collaborative and problem-solving skills to improve learning effectiveness, and in the process of collaboration and problem-solving, critical thinking skills must be applied, which further enhances self-study ability.\u003c/p\u003e \u003cp\u003eHowever, there is currently a lack of research on the change in the self-study, critical thinking, collaborative, and problem-solving abilities of undergraduate nursing students before and after completing professional courses with blending teaching, as well as the mutual influence of different abilities. Therefore, to understand the longitudinal and bidirectional relationships among self-study, critical thinking, collaborative, and problem-solving abilities, a longitudinal research approach was adopted in this study, with two time points selected (before and after completing professional nursing courses). The changes in the various abilities of undergraduate nursing students, as well as the interactions among different abilities, were explored before and after the completion of professional courses, providing a basis for teaching reform in nursing professional courses.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eCluster sampling was used to select two cohorts of undergraduate students majoring in nursing from a medical university in Southeast of China for inclusion; the students voluntarily agreed to participate in this study. According to the training plan of the school, undergraduate nursing students complete basic medical courses in the first semester of their first year and complete professional nursing courses in the second semester of their junior year. Therefore, the first time point of this study was at the end of the first semester of the students\u0026rsquo; first year, and the second time point was the end of the second semester of the students\u0026rsquo; junior year. The first survey was conducted with undergraduate nursing students in the 2020 and 2021 cohort in December 2020 and 2021, respectively. The second survey was conducted with undergraduate nursing students in the 2020 and 2021 cohort in June 2023 and 2024, respectively. The training objectives, plans, modes and learning content of students in the two classes were completely consistent.\u003c/p\u003e \u003cp\u003e Before the questionnaire was distributed, the researcher used unified guiding language to explain the questionnaire to the research participants, and after the students provided informed consent, the questionnaire was distributed on site. The completion time for the questionnaire was 15 minutes. The students were asked to complete the questionnaire carefully according to their actual situation. To ensure confidentiality, the questionnaire was anonymous; the purpose of the questionnaire, which was only for the study and not for any other purpose, was explained to the research participants. To ensure the validity of the questionnaire, explanations were provided for questions that the research participants did not understand, and missing items were promptly supplemented. All survey scales were distributed onsite by the researchers themselves for verification and collection. For participants whose questionnaires had missing data, timely guidance and supervision were provided. After the questionnaires were collected, the completeness and validity were verified again, and invalid questionnaires with too many missing responses or high repetition rates were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Population and sample\u003c/h2\u003e \u003cp\u003eIn this study, we included nursing students studying at the undergraduate (bachelor) level. The inclusion criteria were as follows: ① full-time undergraduate nursing students and ② students aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years. Students who took a leave of absence, transferred, or joined the military midway through the study were excluded for various reasons. We invited 368 eligible nursing students to participate in the study, including 151 students from the 2020 cohort and 217 students from the 2021 cohort.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Questionnaire\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 General information survey for undergraduate nursing students\u003c/h2\u003e \u003cp\u003eBy referring to the relevant literature, a self-designed survey questionnaire was developed and used to understand the general information of the undergraduate nursing students, including the following: age, gender, ethnicity, whether the nursing major was the student\u0026rsquo;s first choice at the time of the college entrance examination, and whether the student like the nursing major.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Self-study ability\u003c/h2\u003e \u003cp\u003eIn this study, the \"Scale for Assessing the Self-study Ability of Nursing Undergraduate Students\", developed by Lin Yi and Jiang Anli from the Second Military Medical University in 2004, was used to evaluate the self-study ability of the control group and the experimental group, respectively. The scale consists of 28 items, including subscales for self-management ability, information ability, and collaborative ability. There are 10 items for self-management ability, 11 items for information ability, and 7 items for collaborative ability. A 5-point Likert scale is used for scoring, which includes responses of \"completely agree\", \"basically agree\", \"average\", \"basically disagree\", and \"completely disagree\". The scores for forward-scored questions are 5, 4, 3, 2, and 1, whereas the scores for reverse-scored questions are the opposite: 1, 2, 3, 4, and 5, respectively. The score range is 28\u0026ndash;140 points. The total score for self-study ability ranges from 28\u0026ndash;140 points, that for self-management ability ranges from 10\u0026ndash;50 points (1\u0026ndash;10 questions), that for information ability ranges from 11\u0026ndash;21 points, and that for collaborative ability ranges from 7\u0026ndash;35 points (22\u0026ndash;28 questions). The higher the score is, the stronger a student\u0026rsquo;s self-study ability. This scale has good content validity and construct validity, with a Cronbach's alpha coefficient of 0.86 (Lin and Jiang, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Critical thinking ability\u003c/h2\u003e \u003cp\u003eThe Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) was translated and revised on the basis of the California Critical Thinking Attitude Disposition Test. The scale is suitable for use among college students, graduate students, and adult professionals and was translated into Chinese by experts such as Professor Peng Meici from the School of Nursing at Hong Kong Polytechnic University in 2004. This scale is divided into seven dimensions, namely, seeking truth, open-minded thinking, analytical thinking, systematic thinking, self-confidence, inquisitiveness, and maturity, with 10 items in each dimension. Each item is scored based on the degree of approval: \"strongly agree\", \"completely agree\", \"somewhat agree\", \"generally agree\", \"completely disagree\", and \"strongly disagree\". The positive items are assigned \"6 points, 5 points, 4 points, 3 points, 2 points, or 1 point\", whereas negative items are scored in reverse. The total score of the scale ranges from 70\u0026ndash;420 points, with scores\u0026thinsp;\u0026le;\u0026thinsp;210 points indicating negative evaluative thinking tendencies, score of 210\u0026ndash;280 points indicating unclear evaluative thinking tendencies, scores\u0026thinsp;\u0026ge;\u0026thinsp;280 points indicating positive evaluative thinking tendencies, and scores\u0026thinsp;\u0026ge;\u0026thinsp;350 points indicating strong positive evaluative thinking tendencies. This scale is widely used in China and has high reliability and validity. The content validity index (CVI) is 0.89, the total Cronbach's alpha value is 0.90, and the alpha values of each dimension range from 0.54\u0026ndash;0.77 (Peng et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4 Cooperative ability\u003c/h2\u003e \u003cp\u003eThis study used the \"Cooperative Ability Strength Scale\" developed by Wang Bin and Li Furong from Central China Normal University in 2011. The scale consists of 42 questions divided into two aspects: cooperative awareness and cooperative skills. Cooperative awareness mainly includes three dimensions: cooperative cognition (Items 1\u0026ndash;11), cooperative emotion (Items 12\u0026ndash;17), and cooperative intention (Items 18\u0026ndash;22). Cooperative skills include four dimensions: interpersonal interaction (Items 23\u0026ndash;29), conflict management (Items 30\u0026ndash;35), emotional control (Items 36\u0026ndash;39), and organizational leadership (Items 40\u0026ndash;42). The scale is scored on a 5-point Likert scale ranging from \"completely disagree\" to \"completely agree\". The internal consistency reliability of this scale is 0.94, and the split half reliability is 0.87. The homogeneity reliability of the 7 factors ranges from 0.74 to 0.92, and the split half reliability ranges from 0.70 to 0.88 (Li, 2011).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.3.5 Problem-solving ability\u003c/h2\u003e \u003cp\u003eSocial problems include various issues that affect people, including but not limited to personal behaviour problems, cognitive problems, interpersonal relationship problems, etc. The common social problems among college students in China include three categories: personal internal problems (47.53%), interpersonal relationship problems (40.66%), and learning problems (10.76%). Therefore, the revised D'Zurilla Social Problem Solving Questionnaire-Revised (SPSI-R), developed by Wang Fei and Liu Yan in 2009 in the context of Chinese culture, was adopted, with the aim of comprehensively and deeply exploring the problem-solving ability of undergraduate nursing students through a questionnaire. The Chinese version of the SPSI-R has good reliability and validity. The questionnaire consists of 32 items, including 5 factors: positive problem-solving tendency, negative problem-solving tendency, rational problem-solving tendency, avoidant problem-solving tendency, and impulsive negligent problem-solving tendency. The scores range from 1 \"completely disagree\" to 5 \"completely agree\". The total scale and each factor have good internal consistency coefficients (Cronbach's coefficient of 0.85) and test-retest reliability (r\u0026thinsp;=\u0026thinsp;0.50) (Ma, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data analysis\u003c/h2\u003e \u003cp\u003eFirst, descriptive statistics were performed on each variable to capture its fundamental distribution characteristics. Second, a correlation analysis was performed. The correlations between variables were investigated by calculating their correlation coefficients and p values at the two time points. A cross-lag model was constructed and evaluated via the Lavaan package to assess both self-lagged and cross-lagged effects among the variables.\u003c/p\u003e \u003cp\u003eTime series data encompassing self-study, collaborative, critical thinking, and problem-solving abilities were employed in this study. The dataset comprises observations at two time points, with data recorded as independent and dependent variables at each time point. The fundamental principle of cross-lagged models is to analyse the dynamic relationships between variables by simultaneously considering their observed values across multiple time points. Within the framework of structural equation modelling (SEM), these models enable researchers to assess both autoregressive and cross-lagged effects simultaneously, thus exploring potential causal relationships among variables. This framework has been widely used to examine longitudinal and bidirectional associations between constructs in sociological and psychological research (Tak et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSuppose that we have four variables, \u0026#119883;1, \u0026#119883;2, \u0026#119883;3, and \u0026#119883;4, representing self-study ability, collaborative ability, critical thinking ability, and problem-solving ability, respectively. At time points \u0026#119905;1 and \u0026#119905;2, the values of these variables are denoted as \u0026#119883;\u0026#119894;,\u0026#119905;1 and \u0026#119883;\u0026#119894;,\u0026#119905;2 (where \u0026#119894;=1,2,3,4). The cross-lagged model can be represented by the following equation:\u003c/p\u003e \u003cp\u003e\u0026#119883;\u0026#119894;,\u0026#119905;2 = \u0026#120573;\u0026#119894;\u0026#119883;\u0026#119894;,\u0026#119905;1 + \u0026sum;\u0026#119895;\u0026ne;\u0026#119894;\u0026#120574;\u0026#119894;\u0026#119895;\u0026#119883;\u0026#119895;,\u0026#119905;1 + \u0026#120598;\u0026#119894;\u003c/p\u003e \u003cp\u003e\u0026#120573;\u0026#119894; denotes the self-lagged effect coefficient for variable \u0026#119883;\u0026#119894;, indicating the stability of this variable over time.\u003c/p\u003e \u003cp\u003e\u0026#120574;\u0026#119894;\u0026#119895; signifies the cross-lagged effect coefficient for variable \u0026#119883;\u0026#119895; relative to \u0026#119883;\u0026#119894; across different time points, reflecting the interaction between the variables across time.\u003c/p\u003e \u003cp\u003e\u0026#120598;\u0026#119894; is the residual term, indicating the unexplained portion of the model.\u003c/p\u003e \u003cp\u003eIn this study, the specific model equation is as follows:\u003c/p\u003e \u003cp\u003eSelf-study\u0026#119905;2 = \u0026#120573;Self-study \u0026times; Self-study\u0026#119905;1 + \u0026#120574;Collab \u0026times; Collab\u0026#119905;1 + \u0026#120598;Self-study\u003c/p\u003e \u003cp\u003eProblem\u0026#119905;2 = \u0026#120573;Problem \u0026times; Problem\u0026#119905;1 + \u0026#120598;Problem\u003c/p\u003e \u003cp\u003eCollab\u0026#119905;2 = \u0026#120573;Collab \u0026times; Collab\u0026#119905;1 + \u0026#120574;Problem \u0026times; Problem\u0026#119905;1 + \u0026#120598;Collab\u003c/p\u003e \u003cp\u003eCritical\u0026#119905;2 = \u0026#120573;Critical \u0026times; Critical\u0026#119905;1 + \u0026#120574;Self-study \u0026times; Self-study\u0026#119905;1 + \u0026#120598;Critical\u003c/p\u003e \u003cp\u003eThese equations describe how the value of each variable at time \u0026#119905;2 is influenced by its value at time \u0026#119905;1 and by other variables.\u003c/p\u003e \u003cp\u003eThe self-lagged effect coefficient \u0026#120573;\u0026#119894; represents the stability of the variable across different time points. A larger \u0026#120573;\u0026#119894; indicates stronger temporal consistency of the variable, implying that the state of the variable at time \u0026#119905;1 provides a stronger prediction for its state at time \u0026#119905;2.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Cross-lagged effect (\u0026#120574;\u0026#119894;\u0026#119895;)\u003c/h2\u003e \u003cp\u003eThe cross-lagged effect coefficient \u0026#120574;\u0026#119894;\u0026#119895; reflects the influence of one variable at an earlier time point on another variable at a later time point. The significance of this coefficient is that it can be used to infer potential causal relationships between variables. For instance, a significant \u0026#120574;Collab indicates that collaborative ability at time \u0026#119905;1 significantly influences self-study ability at time \u0026#119905;2. The goodness of fit of the Cross-Lagged Panel Model(CLPM) was comprehensively evaluated via the comparative fit index (CFI), Tucker‒Lewis index (TLI), and root mean square error of approximation (RMSEA). A CFI\u0026thinsp;\u0026ge;\u0026thinsp;0.9, a TLI\u0026thinsp;\u0026ge;\u0026thinsp;0.9, and an RMSEA\u0026thinsp;\u0026le;\u0026thinsp;0.06 indicate that a model has a good fit, and a CFI and TLI\u0026thinsp;\u0026ge;\u0026thinsp;0.80 and an RMSEA\u0026thinsp;\u0026le;\u0026thinsp;0.08 indicate acceptable fit (Hu, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Ethical considerations\u003c/h2\u003e \u003cp\u003eThis study was approved by the institutional review board (IRB) of University. They contend that the study does not fall within the purview of ethical review for human biomedical research and have consented to execute it in accordance with the established protocol. All research was performed in accordance with relevant guidelines. All the data were anonymized for coding and analysis to safeguard participant privacy. Prior to the survey, the participants were informed of the voluntary and confidential principles of the study and that not all the data files contained sensitive information about the participants. All research participants provided informed consent prior to their involvement in this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Summary of the study sample\u003c/h2\u003e\n \u003cp\u003eAt the first time point, 368 research subjects participated in the survey. At the second time point, all research subjects participated in the survey again. The general information for the 2020 and 2021 cohorts is shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. There was no statistically significant difference between the two groups except for ethnicity and occupational status (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), whereas all other differences were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGeneral information of the two cohorts [Person, percentage (%)].\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2020 cohort(n\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2021 cohort(n\u0026thinsp;=\u0026thinsp;217)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u0026sup2;\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33(15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113(74.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e184(84.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e135(89.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e196(90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16(10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21(9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlace of Origin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104(68.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e115(53.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69(31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban‒rural Fringe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33(15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNursing major is first choice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17(11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78(35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e134(88.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e139(64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReason for Applying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVoluntary Choice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45(29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109(50.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParental Choice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15(9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTeacher\u0026rsquo;s Choice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMajor Adjustment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90(59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eServes as a student leader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.931\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79(52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e136(62.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72(47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81(37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLevel of major preference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery much\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54(35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e88(58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e163(75.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDislike\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16(7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEngaged in this profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.953\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81(53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e118(54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnsure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62(41.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89(41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe scores for self-study, critical thinking, cooperation, and problem-solving abilities were subjected to normality tests. Except for the scores for self-study ability of the 2020 and 2021 cohorts in the first year, which conformed to a normal distribution (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), all the other scores did not (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Consequently, nonparametric tests were employed, as detailed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The scores for self-study, critical thinking, and collaborative abilities of the 2020 cohort in the third year were significantly higher than those in the first year (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Similarly, the scores for self-study, critical thinking, cooperative, and problem-solving abilities of the 2021 cohort in the third year were significantly higher than those in the first year (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Significant differences were observed in the scores for self-study, critical thinking, and collaborative abilities between the two cohorts in the first year (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Significant differences were also noted in the scores for self-study and collaborative abilities between the two cohorts in the junior year (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of the Four Learning Abilities between the Two Cohorts in the Two Years [Score, M (P25, P75)].\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"13\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2020 cohort(n\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2021 cohort(n\u0026thinsp;=\u0026thinsp;217)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003csub\u003e1\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csub\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003csub\u003e4\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003csub\u003e\u003cem\u003e4\u003c/em\u003e\u003c/sub\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFreshmen\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eJuniors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFreshmen\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eJuniors\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-study ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.00\u003c/p\u003e\n \u003cp\u003e(75.00, 82.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.00\u003c/p\u003e\n \u003cp\u003e(89.00, 100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.00\u003c/p\u003e\n \u003cp\u003e(72.00, 80.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.00\u003c/p\u003e\n \u003cp\u003e(87.00, 94.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-16.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCritical thinking ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e251.00\u003c/p\u003e\n \u003cp\u003e(240.00, 274.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e264.00\u003c/p\u003e\n \u003cp\u003e(247.00, 286.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e256.00\u003c/p\u003e\n \u003cp\u003e(245.00, 279.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e266.00\u003c/p\u003e\n \u003cp\u003e(250.00, 290.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.044\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCooperative ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146.00\u003c/p\u003e\n \u003cp\u003e(137.00, 153.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155.00\u003c/p\u003e\n \u003cp\u003e(148.00, 164.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106.00\u003c/p\u003e\n \u003cp\u003e(98.50, 114.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146.00\u003c/p\u003e\n \u003cp\u003e(139.00, 154.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-16.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-14.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-6.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProblem-solving ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103.00\u003c/p\u003e\n \u003cp\u003e(98.00, 108.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.00\u003c/p\u003e\n \u003cp\u003e(98.00, 112.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103.00\u003c/p\u003e\n \u003cp\u003e(96.00, 108.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.00\u003c/p\u003e\n \u003cp\u003e(98.00, 112.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.582\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\"\u003eNote: Z1 and P1 are comparisons between freshmen and juniors in the 2020 cohort; Z2 and P2 are comparisons between freshmen and juniors in the 2021 cohort; Z3 and P3 are the two groups of freshmen for comparison; Z4 and P4 are the two groups of juniors for comparison.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Correlation analysis results\u003c/h2\u003e\n \u003cp\u003eSpearman correlation analysis revealed significant correlations among certain variables. Specifically, problem-solving ability was correlated with other variables across different time points. Problem-solving ability at the first time point was correlated with self-study, cooperative, critical thinking, and problem-solving abilities at the first time point (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Problem-solving ability at the second time point was correlated with self-study ability at the first time point, critical thinking and problem-solving abilities at the first time point, and self-study and collaborative abilities at the second time point (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This suggests potential interactions among these abilities. Additionally, collaborative ability at the first time point was correlated with self-study ability (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Self-study ability at the first time point was negatively correlated with critical thinking and problem-solving abilities at both time points and self-study ability at the second time point (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig. 1 Results of the correlation analysis of self-study, cooperation, critical thinking and problem-solving abilities.).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of the correlation analysis of the four variables at the two time points.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSelf-study ability \u0026minus;\u0026thinsp;1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCollaborative ability-1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProblem-solving ability-1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCritical thinking ability \u0026minus;\u0026thinsp;1\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-study ability-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.166**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.148**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.248**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollaborative ability-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.166**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProblem-solving ability-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.148**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.243**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCritical thinking ability \u0026minus;\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.248**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.243**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-study ability \u0026minus;\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.215**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.247**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.135**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollaborative ability-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.158**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProblem-solving ability-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.185**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.179**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.202**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCritical thinking ability \u0026minus;\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.274**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.119*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.200**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e**: P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; *: P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Cross-lagged model results\u003c/h2\u003e\n \u003cp\u003eThe path coefficients and their significance levels revealed intriguing causal relationships. First, self-study ability had a significant and negative predictive effect from Time 1 to Time 2 (\u0026beta;=-0.342, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Second, collaborative ability had a significant and positive effect on self-study ability from Time 1 to Time 2 (\u0026gamma;\u0026thinsp;=\u0026thinsp;0.088, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Third, problem-solving ability had a significant and positive self-predictive effect from Time 1 to Time 2 (\u0026beta;\u0026thinsp;=\u0026thinsp;0.176, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, problem-solving ability had a significant and positive effect on collaborative ability from Time 1 to Time 2 (\u0026gamma;\u0026thinsp;=\u0026thinsp;0.225, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Finally, self-study ability had a significant and negative effect on critical thinking ability from Time 1 to Time 2 (\u0026gamma;=-1.149, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). We ultimately only selected paths that exhibited significant effects and could converge to establish the model. The primary reason is that other paths exhibited weak correlations, and their effects remained insignificant even when they were gradually incorporated into the model. Therefore, we ultimately did not include these paths (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, Fig. 2 Cross-lagged model results for self-study, cooperative, critical thinking and problem-solving abilities for the total sample).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eStandardized coefficients of self-study, cooperation, critical thinking and problem-solving abilities for the overall sample on the basis of a cross-lagged panel model.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStability paths\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-study ability-1\u0026rarr;Self-study ability-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProblem-solving ability-1\u0026rarr;Problem-solving ability-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCross-lagged effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-study ability-1\u0026rarr;Critical thinking ability-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCooperation ability-1\u0026rarr;Self-study ability-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProblem-solving ability-1\u0026rarr;Cooperation ability-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Sensitivity analysis results\u003c/h2\u003e\n \u003cp\u003eSensitivity analysis was performed to evaluate the robustness of the study. The model demonstrated acceptable fit (CFI\u0026thinsp;=\u0026thinsp;0.943, TLI\u0026thinsp;=\u0026thinsp;0.854, RMSEA\u0026thinsp;=\u0026thinsp;0.078).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eFirst, an unexpected finding of this study was that the self-study ability of junior nursing students negatively affected their self-study and critical thinking abilities as they progressed to more advanced learning stages. The results of the correlation analysis revealed that self-study ability at the first time point was negatively correlated with critical thinking ability and problem-solving ability at both time points and self-study ability at the second time point. Therefore, within the Chinese educational context, primary and secondary school students may focus primarily on exam-oriented education, leading to poor learning adaptation, with the result that lower-grade nursing students continue to adopt their original learning and thinking patterns after entering university. Although students demonstrate a strong ability to learn from classroom instruction and textbooks, they lack independent thinking and a questioning spirit and struggle with knowledge application (Chen et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). As they progress to higher-level professional courses, their traditional self-study methods prove inadequate in addressing the challenges posed by clinical applications (Sun et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In China, blended learning is extensively employed in various nursing courses, including internal medicine nursing, surgical nursing, geriatric nursing, and obstetrics and gynaecology nursing courses. This presents significant challenges for nursing students in terms of critical thinking and problem-solving skills (Kong et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Zhou et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Clearly, exam-focused self-study ability is not applicable to the study of professional courses in later academic years, which may be the primary cause of their adverse effects. Although self-study and cooperative abilities are interrelated, the collaborative ability of lower-grade nursing students is limited to merely passing exams, not applying practical professional knowledge. Therefore, it is recommended that teachers enhance students' abilities to apply knowledge and facilitate a shift from traditional learning methods and mindsets by using innovating teaching methods during the foundational medical phase for nursing students. This will enable students to improve their critical thinking in both professional courses and clinical nursing practice (Hwang and Oh, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSecond, the problem-solving skills of junior nursing students positively affected their collaborative and problem-solving abilities in their senior year. Enhanced problem-solving skills lead to better application of professional knowledge. Only when students grasp how to apply knowledge do they understand how to proactively seek knowledge rather than solely focusing on exam preparation (Huang et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This progressive enhancement of self-study and collaborative skills in obtaining and applying knowledge creates a virtuous cycle in terms of problem-solving abilities (Cheng et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThird, the results of this study also indicated a close relationship between cooperative ability and self-study ability. In blended learning, students are required to collaborate with others, divide tasks, independently develop learning plans, set learning goals, and jointly solve problems through discussions and exchanges with others (Padugupati et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This learning method enables students to demonstrate initiative and creativity, fosters students\u0026rsquo; self-study ability, enhances students\u0026rsquo; problem-solving skills, and improves learning outcomes. This is instrumental in fostering students' lifelong learning abilities. This is especially crucial for nursing students, as nursing work requires teamwork and a division of labour to assist patients in achieving their care goals. Furthermore, as clinical knowledge and concepts evolve rapidly, nurses must engage in lifelong learning to excel in their profession (Deng, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). With the advancement of the internet, students can access a wealth of educational resources and information online, utilizing digital technologies to proactively learn and obtain knowledge, which also creates more opportunities for collaboration with others. Students can use online collaboration tools and platforms to work with others on various tasks and projects, thus further improving their collaborative skills (Chen et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This finding also suggests that during the learning process, teachers should utilize various activities, such as knowledge expansion, academic competitions, professional practices, innovation contests, and volunteer work, to encourage students to proactively seek, expand, and apply knowledge through the internet. This approach aims to enhance students' collaborative skills and, in turn, strengthen their autonomous learning abilities.\u003c/p\u003e \u003cp\u003eFourth, the correlation analysis results showed that critical thinking ability stands out as relatively independent, its beneficial impact on the development of critical thinking and problem-solving abilities cannot be overlooked. Critical thinking is the ability to engage in the in-depth analysis, evaluation, and reasoning of information (Liu et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It helps individuals capture the essence of issues and avoid being misled by superficial appearances (Huang et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In making judgements about various matters, it is essential for learners to employ problem-solving skills, which aid them in deeply understanding and assimilating knowledge, distinguishing between surface phenomena and underlying causes, pinpointing the essence of problems, and making accurate judgements about knowledge (Liang et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The reason for the relative independence of critical thinking ability is that its development is a holistic process that requires the capacity for independent thought, a spirit of inquiry and discernment, judgement founded on rigorous inference, extensive cognitive training and knowledge reserves, multiple methods and stages of thinking, a spirit of critique and a capacity for rational thought, along with qualities such as curiosity, imagination, and a desire for knowledge. Consequently, any single aspect of learning ability is inadequate to significantly influence critical thinking ability, and further comprehensive assessment and analysis are necessary for research into the effect of critical thinking ability on nursing students.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eUndergraduate nursing students' self-study, collaborative and problem-solving abilities are interrelated, whereas their critical thinking ability is distinct. The factors influencing these abilities merit thorough analysis and investigation. Beginning in the early years of study, educators should revamp teaching methods and models, leveraging avenues such as intellectual exploration, academic contests, practical training, innovation fairs, and volunteer work to assist students in unlearning conventional learning and thought processes. Teachers should aim to foster collaborative problem-solving skills by applying knowledge, thereby augmenting students\u0026rsquo; overall problem-solving ability.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e5.1 Limitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, only the data of undergraduate nursing students from one provincial medical university and one course were evaluated in this study, and data were not collected from students in other levels of medical colleges and other professional courses. Future research needs to expand the sample source range to make the data more representative. Second, data were collected at only two time points; we were unable to collect data at more time points, such as after the internship. Therefore, in the future, it is necessary to continue collected the data of nursing students during their internships and even after work to dynamically evaluate the changes in their critical thinking, collaborative ability, and self-study abilities.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCTDI-CV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCritical Thinking Disposition Inventory-Chinese Version\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCVI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Content Validity Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSI-R\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSocial Problem Solving Questionnaire-Revised\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSEM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStructural Equation Modelling\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCLPM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCross-Lagged Panel Model\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCFI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComparative fit index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTLI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTucker‒Lewis index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRMSEA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRoot Mean Square Error of Approximation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIRB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitutional Review Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded in full by Fujian Province Undergraduate Education and Teaching Research Project. （grant no.\u0026nbsp;FBJY20230133）and\u0026nbsp;Fujian Medical University Undergraduate Education and Teaching Research Project（grant no.J23005）.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of supporting data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOthers can replicate and build upon the authors' published claims. The authors can make materials, data, code, and associated protocols promptly available to readers without undue qualifications. Any restrictions on the availability of materials or information must be disclosed to the editors at the time of submission. Any restrictions must also be disclosed in the submitted manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of absence of conflicts of interest and consent to publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no financial interests or relationships that would represent a conflict of interest concerning the subject matter of this manuscript.\u0026nbsp;All authors approve the final version of this manuscript and consent to its submission for publication. Any disputes regarding authorship have been resolved prior to submission.\u003c/p\u003e\n\u003cp\u003eAll authors participated in the review of the study, interpretation and analysis of the data and review of the manuscript; Liu Dun conducted the study; Liu Dun and Lin Jianbin wrote the manuscript; Zhang Jincheng and Luo Xinchu\u0026nbsp;collected and organized data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data were anonymized for coding and analysis to safeguard participant privacy. After researchers explained the research objectives and data collection methods, all willing students were asked to sign informed consent forms. While all participants were required to sign written informed consent forms, they were also informed of their right to withdraw from the study at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of generative AI and AI-assisted technologies in the writing process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI promise to strictly adhere to the principle of academic integrity during the creative process, and have not employed any improper means (such as plagiarism, falsification of data, etc.) to obtain research results. Meanwhile, we use AI and AI-assisted technologies only in the writing process, these technologies only be used to improve readability and language of the work and not to replace any key authoring tasks.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbdollahi, A., Hosseinian, S., Zamanshoar, E., Beh-Pajooh, A., Carlbring, P., 2018. The moderating effect of hardiness on the relationships between problem-solving skills and perceived stress with suicidal ideation in nursing students. Stud. Psychol. 1 (60), 30\u0026ndash;41. https://doi.org/10.21909/sp.2018.01.750.\u003c/li\u003e\n \u003cli\u003eBin, X., 2018. Exploration of ways to cultivate cooperative abilities in nursing students. Contemp. Educ. Pract. Teach. Res. (7), 140\u0026ndash;141.\u003c/li\u003e\n \u003cli\u003eChen, B., Jiang, A., Li, S., 1998. Discussion on several issues concerning the cultivation of critical thinking in higher nursing education. Chin. High. Med. 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Educ. 20 (2), 174\u0026ndash;178.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"self-study ability, critical thinking ability, collaborative ability, problem-solving ability, undergraduate students, nursing","lastPublishedDoi":"10.21203/rs.3.rs-6041228/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6041228/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThere is currently a lack of research on the change in self-study ability, critical thinking ability, collaborative ability and problem-solving ability in undergraduate nursing students before and after completing professional courses with blending teaching, as well as the mutual influence of different abilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e The objective was to understand the longitudinal and bidirectional relationships amongself-study ability, critical thinking ability, collaborative ability and problem-solving ability in undergraduate nursing students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e A longitudinal research approach was adopted, with two time points selected (before and after completing professional nursing courses). Correlation analysis and a cross-lagged model were used to explore the changes in various abilities of undergraduate nursing students before and after completing professional courses, as well as the interactions between different abilities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eProblem-solving skills were correlated with various other variables. Self-directed learning ability at the initial time point was negatively correlated with certain variables. Self-study ability had a significant and negative predictive effect from Time 1 to Time 2. Collaborative ability significantly and positively influenced self-study ability from Time 1 to Time 2. Problem-solving ability showed a significant and positive predictive effect from Time 1 to Time 2 and positively influenced collaborative ability from Time 1 to Time 2. Self-study ability had a significant and negative impact on critical thinking from Time 1 to Time 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eUndergraduate Nursing students' self-study, collaborative and problem-solving abilities are interrelated. Beginning in the early years of study, educators should revamp teaching methods and models to assist students in unlearning conventional learning and thought processes. Teachers should aim to foster collaborative problem-solving skills by applying knowledge, thereby augmenting students’ overall problem-solving proficiency.\u003c/p\u003e","manuscriptTitle":"Relationships among self-study ability, critical thinking ability, cooperative ability and problem-solving ability in Chinese undergraduate nursing students: An analysis of a longitudinal cohort via cross-lagged models","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-10 06:39:27","doi":"10.21203/rs.3.rs-6041228/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eb4fdc97-92e6-49e2-bb7e-586f2d800269","owner":[],"postedDate":"March 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-04T04:38:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-10 06:39:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6041228","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6041228","identity":"rs-6041228","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}