Associations among resilience, coping strategies, and anxiety in undergraduate nursing students: A mediation model

Associations among resilience, coping strategies, and anxiety in undergraduate nursing students: A mediation model | 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 Associations among resilience, coping strategies, and anxiety in undergraduate nursing students: A mediation model Yuling Liu, Xiaoxiao Mei, Cailin Chen, Jinhao Liang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7137549/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract background Over the years, anxiety has remained a research hotspot for nursing scholars. Th research aimed at understand the current situation of anxiety, psychological resilience, and coping styles among undergraduate nursing students throughout the middle and late stages of their internship, as well as to uncover the correlations among these three factors, so as to provide a reference for research in nursing psychology and nursing education. Methods This study employ a cross-sectional research and quantitative research method. Through convenient sampling, 185 students from a certain school in Guangdong Province were selected as the research subjects from November 2024 to January 2025. The Self-Rating Anxiety Scale (SAS), the Simplified Version of the Connor-Davidson Resilience Scale (CD-RISC-10), and the Simplified Coping Style Questionnaire (SCSQ) were used for revealing the current status of anxiety, resiliency, and the tendency of coping style selection during the internship of students, and to explore the correlations among anxiety, resilience, and coping styles. Results Subjects got an average standard score of SAS was 45.90 ± 10.30, and the anxious positive rate was 22.1%. The overall average score of psychological resilience was 22.4 ± 5.9, and the average scores of two coping styles dimension were 2.65 ± 0.05 (Positive) and 2.21 ± 0.04 (Negative) respectively. There were significant correlations one another with those. Multiple linear regression reported that resilience, negative coping styles were able to affect anxiety in some degree. Negative coping style didn’t played a completely mediating role between the anxiety and resilience. Conclusion This research outcome showed that enhancing the psychological resilience not only can effectively reduce negative coping styles, but alleviate the anxiety of undergraduate nursing students. Figures Figure 1 Introduction The China Mental Health Survey (CMHS) displayed that anxious disorders’ prevalence ranks first among all mental illness in China [ 1 ]. As a common psychological phenomenon, anxiety is defined by nursing scholars as the cognitive ability of potential, unclear, or non-objective threats, which may cause a variety of psycho-physiological changes [ 2 ]. According to a survey, the medical students around the world nearly 33.8% got diagnosed anxiety disorder, higher than that in other humans [ 3 ]. A narrative review figured out that the anxious positive rate of nursing students who from various countries during internship is higher than the domestic norm [4]. Nursing interns, who have just stepped out of campus and entered clinical placement, face a large gap between school teaching and actual clinical work, resulting in a disconnection between theory and practice. Nursing students cannot integrate the theoretical and specialized knowledge learned in school into clinical practice. The dual pressure of clinical learning and practice makes them timid, confused, prone to violating operational procedures, and prone to anxiety [ 5 ]. Graduation internship is the final undergraduate learning stage for nursing students. The mid-to-late internship period is the main stage for nursing students to transition to social roles. Compared with the early stage, nursing students' operational tension and unfamiliarity with the environment gradually waken, and their operational capabilities continue to improve. Interpersonal communication has improved compared with the early period, but they’re still lack of independent nursing ability, have incorrect cognition of nursing work, and have excessively high expectations for operational goals [ 6 ]. Under the effect of such contradictory situations, student’s psychological changes are inevitable, among which the dynamic changes in psychological status during the internship period are worthy of study [ 7 ]. Psychological resilience, also known as mental toughness, is a psychological trait closely related to individual development. Based on previous studies, resilience is typically regarded as a process of positive adaptation to stress and adversity, involving dynamic interactions among individuals, the environment, and resources [ 8 – 9 ]. Psychological resilience has been confirmed as a defensive factor in case suffer mental sickness and directly predict mental health [ 10 ]. A study taken out during the popular of SARS-Cov-2 presented that the psychological resilience of frontline nurses significantly and negatively predicted their anxiety levels [ 11 ]. Coping style refers to the ways person struggle to reduce stress, resolve emotional distress, or solve problems when getting into trouble [ 12 ]. It can be simplified divided into two types: positive or negative. Positive version refers to taking effective measures to solve problems, including seeking help and making efforts to change; negative coping style refers to adopting a passive attitude toward problems and stress, such as avoidance and venting [ 13 ]. Currently, when Chinese people encounter stressors, adversity, or negative emotions, they tend to look for someone help, adjust mindset and physical activity which belongs to non-negative dimension. Studies have proved that positive coping styles strategies can positively predict anxiety levels [ 14 ]. Relevant research has indicated that patients with lower psychological resilience are less likely to adopt positive coping styles [ 15 ]. In summary, although pairwise studies among the three psychological variables of anxiety, resilience, and coping strategy are relatively abundant, correlational studies among those are rarely reported, and systematic research is lacking. Additionally, the psychological changes of nursing students in the mid-to-late internship period still own research value. Consequently, the major purpose is to figure out the recent status of anxiety, resilience, and coping styles among the mid-to-late internship period of nursing students and look for the correlations among them, providing references for research in nursing psychology and nursing education. Research Subjects and Approach 1.1 participant A cross-sectional design and quantitative research was put to use. Through convenient sampling, 185 nursing students from a certain college in Guangdong Province were selected as the research volunteer from November 2024 to January 2025. Inclusion criteria: ①respondents were Informed the purpose of this research and participated of their own free will ; ② Nursing interns who have taken part in clinical practice for 4 months. Exclusion criteria: ① Completing the questionnaire less than 60 seconds; ② research subjects fill in any block with same options; ③ No matter when cut off the clinical internship midway; ④ Have diagnosed relevant mental illness. According to the principle of M Kendall [ 27 ], in this study, the number of independent variables was a = 17 (12 items of general information + 2 dimensions of SAS + 1 dimension of CD-RISC- 10 + 2 dimensions of SCSQ). Considering approximately 10% of invalid questionnaires, the sample size was calculated as follows: N = [17 × (5 ~ 10)] × (1 + 10%) = 94 ~ 187. Thus, the required sample size ranged from 94 to 187 cases. 203 questionnaires were distributed in this study in total. After excluding questionnaires with many blank or unanswered items and those with obvious logical errors, 185 questionnaires were collected rightly in the end, and 90.6% was effective questionnaire rate in this study . 1.2 Tools 1.2.1 General Information Questionnaire Researcher designed by referring to previous relevant study and combining with the research purpose[16、17]. The items include: gender, family income situation, household registration type, romantic relationship situation, only child situation, social practice experience, physical exercise habit, current clinical department, self-perceived family relationship, first-choice major situation, and employment intention. 1.2.2 Self-Rating Anxiety Scale (SAS) edited by Zung in 1971 [ 18 ], The Self-Rating Anxiety Scale is accustomed to evaluating the non-objective sense of anxious patients. Likert 4-level scoring method is used to quantify the extent of subjective anxiety of the volunteer during the test or in the past week. adding up the scores of the 20 items, researcher get the raw score, and the standardize score is calculated through formula conversion. The score get higher and higher, the anxiety situation of the subjects more severe and more severe. Rooted on Chinese norm [ 19 ], 50 points was recognized as the cut-off value of SAS. When score not more than 50 points indicates that the participant is out of the risk of anxiety. The Cronbach's alpha coefficient in this study is 0.818. 1.2.3 10-Item Connor-Davidson Resilience Scale (CD-RISC-10) Wang [ 20 ] translated the simplified version scale to form a single-dimensional Chinese version scale with his team, which not only proved that good reliability and validity in other studies ,but was used to qualify the psychological resilience of Chinese people. There are 10 items in the scale and each item adopt Likert 5-level scoring method, From 0 (Never) to 4 (always), the points of psychological resilience were higher and higher, research subject’s resilience was stronger and stronger. The Cronbach's alpha coefficient in the study is 0.952. 1.2.4 Simplified Coping Style Questionnaire (SCSQ) Based on a more comprehensive understanding of coping style theories at home and abroad and combined with the characteristics of the Chinese population, a scholar called Xie Yaning [ 21 ] revised the Coping Style Scale (WOC) compiled by Lazarus [ 22 ] and others and adapted it into a Chinese version fit for the characteristics of the Chinese population. Good reliability and validity were confirmed in the Chinese version of SCSQ by many nursing researcher. It uses a Likert 4-level scoring method: from 0(not) to 3(often). The subjects choose to answer according to their actual situations. Whichever dimension, the positive or the negative, has a higher average score proves which coping style is adopted [ 23 ]. 0.936 was Cronbach's alpha coefficient in this research of it. 1.3 Statistical Analysis All statistical data were inputted into the EXCEL by two people. After checking for errors, data was analysed Statistically by SPSS25.0, α = 0.05. The general information of undergraduate nursing students was described using frequencies and percentages; if the measurement data were normally distribution, they were could be described as the mean ± standard deviation[x ± s]; Contrary to the former, they tended to be described as the median and quartile [M (IQR)]. When analyzing the differences in the degree of anxiety, resilience, and coping styles of nursing students among the general information, independent sample t-tests, one-way ANOVA, or non-parametric test methods were used for analysis. The Spearman correlation analysis method had ability to test the correlations among anxiety, coping styles, and psychological resilience. the Process 3.4 plugin offer the test of mediation effect, and the Bootstrap method was used for further testing of the mediation effect. 1.4 Ethics the Declaration of Helsinki, all research steps were performed strictly. Ethics approval was provided by the review committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (No: K-2025-005). all respondents agreed to written consent prior to the formal investigation. Results 2.1 Overall Situation of Anxiety, Psychological Resilience, and Coping Styles of Undergraduate Nursing Students during the Middle and Late Stages of Internship The first factor could explain 31.12% of the variance, which was less than 50%, there was no doubt that serious common method bias didn’t exist[ 24 ]. After the normality test, the overall distribution of the research variables was not normally distributed. The average SAS score of 185 nursing students was 45.90 ± 10.30 points, which was higher than the scale norm of 33.4 ± 7.8 points [ 25 ] (t = 16.454, P < 0.01) and the Chinese nursing student norm of 37.8 ± 6.6 points [ 26 ] (t = 10.647, P < 0.01), and the median was 43.75 (10.00). There were 41 people with an anxious risk, and the positive rate of anxiety was 22.1%. the overall average score of psychological resilience was 22.4 ± 5.9, and the median was 22.0 (8.0), which was higher than the middle value of the scale of 20 points. the average scores of two dimension were 2.65 ± 0.05(Positive) and 2.21 ± 0.04(Negative) respectively, and the medians of those were 2.77 (1.08) and 2.14 (0.57) respectively. It was a obvious difference in the points of those (Z = 6.086, P < 0.01)that research suggested that undergraduate nursing students have tendency to choose positive coping styles when getting stuck in stressors. 2.2 Univariate Analysis of Anxiety of respondents in their mid-to-late internship As we can see, anxiety level had a only significant difference on social experience item (P 0.05). The specific detail are presented at Table 1 . Table 1 Descriptive statistics for sociodemographic characteristics(N = 185) item variety N(%) SAS score Z/H P gender Male 34(18.4) 44.3(12.0) 0.511 0.956 Female 151(81.6) 43.8(10.0) department Internal medicine 49(26.5) 43.3(5.0) 5.153 0.398 surgery 38(20.5) 44.4(11.3) emergency 48(25.9) 46.8(12.1) Orthopedics 10(5.4) 43.8(8.4) obstetrics 36(19.5) 44.4(13.8) oncology 4(2.2) 45.7(18.4) Household registration Urban 84(45.4) 43.8(10.0) 0.813 0.523 Rural 101(54.6) 45.0(9.4) Dating status Yes 52(28.1) 43.8(10.9) 0.605 0.858 NO 133(71.9) 45.0(10.6) Situation of only children Yes 55(29.7) 42.5(11.3) 0.935 0.347 No 130(70.3) 45.0(9.1) Social experience Yes 125(67.6) 45.0(10.0) 1.507 0.021 no 60(32.4) 41.3(7.5) family relationships Bad 14(7.6) 40.6(8.6) 2.408 0.492 Not good 40(21.6) 46.3(11.3) Not bad 61(33.0) 43.8(8.1) good 70(37.8) 45.0(9.4) Family’s monthly income 5000 82(44.3) 45.3(10.0) Physical habit Yes 80(43.2) 43.8(9.7) 0.497 0.966 No 105(56.8) 45.0(10.0) Nursing is the first major willing Yes 67(36.2) 43.8(8.8) 0.692 0.724 No 118(63.8) 45.0(10.0) Be engaged in nursing Yes 124(67.0) 43.8(8.8) 0.701 0.710 No 61(33.0) 45.0(11.9) 2.3 Correlation analysis among SAS, CD-RISC and SCSQ of subjects in their mid-to- late internship Spearman correlation analysis made good use of analysing the correlations among the three variables of nursing students. It was an evidently positive correlation that resilience and positive coping, anxiety with negative coping style (P < 0.01).psychological resilience and anxiety didn’t exist apparently positive correlations, It was a significantly negative correlation that psychological resilience and negative coping style, and between positive coping style and negative coping style (P < 0.05). Results are posed on Table 2 clearly. Table 2 Correlation analysis among SAS, CD-RISC and SCSQ (N = 185) resilience anxiety Positive coping Negative coping Resilience 1 anxiety -0.377 ** 1 Positive coping 0.605 ** -0.102 1 Negative coping -0.377 ** 0.305 ** -0.274 ** 1 * =P < 0.05 ,**= P < 0.01 2.3 Multiple Linear Regression of impact elements of Anxiety of nursing during their mid-to-late Internship The anxiety scores were chosen as the dependent variable. In multiple linear regression, the presence or absence of social experience, psychological resilience scores, and scores of the negative coping style dimension were taken as the independent variables. Researcher identified Categorical variables as dummy variables, and regression analysis was carried out in the form of dummy variables. The results showed that, after controlling for the influence of social practice experience, psychological resilience could negatively affect the degree of anxiety, and negative coping styles could positively affect the degree of anxiety, which could explain 39% of the total variance. The date was presented at Table 3 . Table 3 Analysis of Factors Affecting Anxious level in Mid-to-Late Stage Internships for Undergraduate Nursing Students(N = 185) predictors B SE β t P VIF Constant 44.416 4.364 10.179 0.001 Resilience 6.384 1.213 0.329 5.264 0.001 1.176 Negative coping -0.711 0.109 -0.409 -6.517 0.001 1.186 2.4 Mediating Effects of the Degree of Anxiety, Psychological Resilience and Coping strategy Based on the significant correlations among the above variables, the internal mechanism of how psychological resilience affects the degree of anxiety was explored. Positive and negative coping strategies were chosen as a mediating variable. A simple mediating effect test was conducted through Model 4 in the PROCESS plugin of SPSS, and the mediating effect of negative and positive coping styles were examined by the Bootstrap method. the total effect of psychological resilience on anxiety was significance (β = -1.02, P < 0.01). Psychological resiliency couldn’t positively affect anxiety (β = -0.58, P < 0.01) and negative coping styles (β = -0.32, P < 0.01). When negative coping and resiliency were added to the equation simultaneously, negative coping could actively affect anxiety (β = 0.36, P < 0.01). 95% CI of the mediating effect obtained by the Bootstrap method exclude 0 (LLCI = -0.40, ULCI = -0.06), indicating that the mediating effect of negative coping strategy between anxiety and psychological resilience had Statistical meaning, and effect size of the mediating effect was − 0.21, with accounting for 20.5% of total effect. The details are shown in Tables 3 , 4 and Fig. 1 . Table 3 Analysis of Mediating Effect of Anxiety, as well Resilience on Positive and Negative Coping Strategies(N = 185) Regression equation Overall fit index regression coefficients Outcome predictor R R 2 F β t anxiety resilience 0.41 0.17 7.58 -0.32 -10.49** Negative coping resilience 0.57 0.33 17.72 -0.58 -8.95** anxiety Negative coping 0.66 0.44 23.37 0.36 5.90** resilience -0.46 -7.38** anxiety resilience 0.57 0.33 17.72 -0.58 -8.96** positive coping resilience 0.71 0.51 37.92 0.46 8.33** anxiety positive coping 0.57 0.33 14.93 0.08 0.98 resilience -0.63 -8.19** Table 4 the Mediating Effect size of Anxiety and Resiliency on Passive Coping or negative coping(N = 185) Coeff. Se LLCI ULCI account Total effect -1.02 0.114 -1.24 -0.79 Direct effect -0.81 0.11 -1.03 -0.59 79.5% Indirect effect -0.21 0.08 -0.40 -0.06 20.5% Discussion 4.1 Analysis of the late Situation of Anxious level among subjects in their mid-to-late internship For the purpose of investigating the recent status of anxiety, resilience, and coping styles during the mid-to-late internship of nursing students and exploring the correlations among the three. First, the average SAS standard score of the study subjects was 45.90 ± 10.30 points, which were both higher than the scale norm and the domestic undergraduate nursing students' norm [ 25 , 26 ], and both were statistically significant. 22.1% of subjects was suffering anxious disorder in different extent. The anxiety level of the study subjects showed significant differences in social practice experience: undergraduate nursing students who had participated in social practice had lower anxiety scores than those who had not, and the former group had higher anxiety scores than the latter. Heuvel's study indicated that abundant relevant social practice experience promotes the improvement of comprehensive qualities and professional skills among nursing practitioners [ 27 ]. The reason why the results of this study differ from Heuvel's may be that the social practice activities who previously participated in were short-term, flexible, unstable, fragmented, and low in professionalism, which had limitations in enhancing the comprehensive qualities of nursing students. Second, nursing students who had unpleasant experiences in previous social activities—such as their professional skills and competences being questioned by service users—developed a sense of "shame" [ 28 ]. This shame further subtly influenced their internship life, aggravating anxiety in the mid-to-late internship period. Therefore, Whether social practice experience impinge on the anxiety of nursing interns needed to be further explored. 4.2 Mediating Effects of the Degree of Anxiety, Resiliency and Coping strategies in the mid-to-late internship of nursing students In this research, 22.4 ± 5.9 points was the mean score of CD-RISC 10 ,which higher than the scale median of 20 points, uncovering that the resilience level of research subject wasn’t generally out of a moderate level, roughly the same as previous research results [ 29 – 30 ]. In this survey, the study subjects tended to choose positive coping styles when facing difficulties, which was roughly in line with Folkman's research findings [ 31 ]. With social practice experience set as a control variable, Spearman correlation analysis and multiple linear regression affirmed that it was not significantly positive correlated with psychological resilience, but negative correlation. resiliency played a crucial role in affecting anxiety in this study. The experimental results were basically consistent with those of Savitsky [ 32 ]. The study results showed that four items—only-child status, family relationship, social practice experience, and whether have trend to hunt for a job about nursing after graduation—had significant effects on the psychological resilience, suggesting that the aspects of social support systems [ 33 ] and professional identity [ 34 ], can greatly help clinical relevant personnel improve psychological resiliency during nursing internship. With social practice experience set as a control variable, Spearman correlation analysis and multiple linear regression demonstrated that negative coping strategy was patently positive correlation with anxious level, that also were one of the most influencing elements of anxiety in this study. The experimental results were roughly the same as those of Ye [ 35 ], which pointed out that medical students' use of negative coping styles would strengthen the influence of stress perception on anxiety. It is suggested that clinical teaching teachers or relevant personnel can use the guided reflection method [ 36 ] to help nursing students improve dynamic cognition, reduce the use of negative coping styles, and thus alleviate nursing students’ anxiety from their internship. Spearman correlation analysis showed that anxiety level haven’t significant positive correlation with positive coping strategies, which were inconsistent with relevant studies [ 37 , 38 ], possibly because different scales were selected to measure coping styles, and the items of the brief scale were not clearly explained, leading to response deviations in the questionnaire and different results. A comparative study carried out by Taiwan, China and Australian nursing scholar showed that when nursing students face stressors, problem-focused coping ,which is equal to positive coping styles on broad sense, can decrease the anxious adverse effects [ 39 ]. Liu suggested that nursing students can adjust self-efficacy through physical exercise, adopt positive coping styles as much as possible, and reduce the impact of anxiety [ 40 ]. After controlling the effects of four covariates—only-child status, perceived family relationship, social practice experience, if make a decision to look for a job relative to nursing after graduation—psychological resilience could directly predict anxiety levels, roughly consistent with previous research results [41、42]. Psychological resilience could negatively predict negative coping styles, and the research results were similar to those of Li [ 43 ]. Guided by the cumulative prospect theory, when the anxiety level of nursing students is aggravated by life events, they often use negative coping methods to temporarily avoid the impact of anxiety [ 44 ], that as similar as the outcome of this study. When negative coping strategy and resilience were simultaneously brought into the equation, which showcased that negative coping did not make a wholly mediating contribution between anxious level and resilience with effect size having a 20.5% proportion. Research suggest that the higher the resilience scale score, the less likely they utilize negative coping to cope with problems. The less frequency of adopting negative coping styles can alleviate the anxiety of nursing students and maintain their mental health levels within a reasonable range. Current research suggests that clinical teaching teachers or responsible personnel can plan to use group psychological counseling [ 45 ], mentorship interviews [ 46 ], positive psychological intervention [ 47 ], and other measures to strengthen nursing students’ psychological resilience level, which is conducive to helping improve their psychological quality during the internship and providing a solid psychological foundation for future clinical work. 4.3 Limitations ① The research subjects selected by the researchers all came from a single institution, so the representativeness of the results had certain limitations. In the future, the scope of the research objectives can be further broadened, the sample size can be increased or multi-center sampling can be carried out, so as to have a more profound understanding of the mental health level of nursing interns. ② this research method only adopted a design belonging to cross-section and quantitative research. In future experiments, diversified research methods can be adopted, such as the combination of quantitative research and qualitative research, and longitudinal research design, in order to make the research results more persuasive and thus more clearly and accurately grasp the internal relationships among the anxiety situation, psychological resiliency, as well coping strategy of respondents in their mid-to-late internship. Conclusion In a word, less of the undergraduate nursing students who during the mid-to-late period of internship were out a state of moderate anxiety, their psychological resilience was at a moderate level, and when facing pressure, nursing students preferred to adopt positive coping rather than use negative. Psychological resilience was the influencing contributor of anxiety of undergraduate nursing students, negative coping strategies as well. The research results suggest that clinical teaching instructors or relevant internship supervisors can enhance resilience level of nursing students through a little measures such as psychological counsel and cognitive-behavioral intervention, so as to reduce the opportunities for nursing students to utilized negative coping and further relief anxiety in their mid-to-late internship. Declarations Ethics approval and consent to research subjective According to the Declaration of Helsinki,All research steps were performed strictly. Ethics approval was provided by the review committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (No: K-2025-005). all participants agreed to written and oral consent prior to the formal investigation. Consent for publication Not applicable. Funding No funding Data availability The data used or analyzed during the recent research are available from the corresponding author on reasonable request. Competing interests There is no competing interests with BMC. Author contribution 1.Y.L. is responsible for constructing research framework and looking for research subjective 2.X.M. is responsible for searching for reference and statistical analysis 3.C.C. is responsible for searching for reference and drawing the Table and Figure. 4.J.L. is responsible for paper writing and questionnaire collection References WANG X H, LIU Q Z. 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Anxiety, depression, psychological stress and coping style in medical postgraduates in southeastern China when restricted to commuting between the campus and hospital during the COVID-19 pandemic. Front Psychiatry. 2023 Jan 6;13:1035075. Wu X, Lu Y, Zeng Y, Han H, Sun X, Zhang J, Wei N, Ye Z. Personality portraits, resilience, and professional identity among nursing students: a cross-sectional study. BMC Nurs. 2024 Jun 21;23(1):420. Ye X, Yang G, Zhang W, Toussaint L, Zhao F. Relationship of negative life events with depression and anxiety in nursing students: a moderated mediation model of resilience and gender. BMC Nurs. 2025 Jan 17;24(1):58. Aloufi, M.A., Jarden, R.J., Gerdtz, M.F., Kapp, S., 2021. Reducing stress, anxiety and depression in undergraduate nursing students: systematic review. Nurse Educ. Today 102, 104877. Kupcewicz E, Cybulska AM, Schneider-Matyka D, Jastrzębski P, Bentkowska A, Grochans E. Global self-esteem and coping with stress by Polish students during the COVID-19 pandemic. Front Public Health. 2024 Oct 14;12:1419771. Miao Q, Xie L, Xing B, Wang X, Tang S, Luo H. Emotional states and coping methods in nursing and non-nursing students responding to COVID-19: a cross-sectional study in China. Yeh PM, Moxham L, Patterson C, Antoniou C, Liou JC. A Comparison of Psychological Well-Being, Coping Strategies, and Emotional Problems Between Taiwanese and Australian Nursing Students. J Nurs Res. Liu M, Liu H, Qin Z, Tao Y, Ye W, Liu R. Effects of physical activity on depression, anxiety, and stress in college students: the chain-based mediating role of psychological resilience and coping styles. Front Psychol. 2024 Jun 7;15:1396795. Berdida, D.J.E., Grande, R.A.N., 2023. Academic stress, COVID-19 anxiety, and quality of life among nursing students: the mediating role of resilience. Int. Nurs. Rev. 70 (1), 34–42. Devi, H.M., Purborini, N., Chang, H.J., 2021. Mediating effect of resilience on association among stress, depression, and anxiety in Indonesian nursing students. J. Prof. Nurs. 37 (4), 706–713. Li L, Hua R, Yang L. Coping styles play intermediary roles between resilience and clinical communication ability among nursing students in traditional Chinese Medical university: A structural equation model analysis. Medicine (Baltimore). 2021 Dec 23;100(51):e28284. Fennema H., Wakker P. Original and cumulative prospect theory: A discussion of empirical differences. J. Behav. Decis. Mak. 1997;10:53–64. Chan, J., Sit, E., & Lau, W. Conflict management styles, emotional intelligence and implicit theories of personality of nursing students: A cross-sectional study. Nurse Education Today, 34, 934-939. Henshall, C., Davey, Z. & Jackson, D. (2020) The implementation and evaluation of a resilience enhancement program for nurses working in the forensic setting. International Journal of Mental Health Nursing, 29(3), 508–520. Hart, P., Brannan, J. & de Chesnay, M. (2014). Resilience in nurses: an integrative review. Journal of Nursing Management, 22, 720–734. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 Aug, 2025 Reviews received at journal 06 Aug, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers agreed at journal 03 Aug, 2025 Reviews received at journal 03 Aug, 2025 Reviewers agreed at journal 02 Aug, 2025 Reviewers invited by journal 02 Aug, 2025 Editor invited by journal 25 Jul, 2025 Editor assigned by journal 25 Jul, 2025 Submission checks completed at journal 24 Jul, 2025 First submitted to journal 24 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-7137549","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496543189,"identity":"81619405-bcbf-425b-a492-8e08cc68606c","order_by":0,"name":"Yuling Liu","email":"","orcid":"","institution":"the First Affiliated Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yuling","middleName":"","lastName":"Liu","suffix":""},{"id":496543190,"identity":"43622071-0731-4099-9a1f-c2c3e61ce8a8","order_by":1,"name":"Xiaoxiao Mei","email":"","orcid":"","institution":"School of Nursing, The Hong Kong Polytechnic University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoxiao","middleName":"","lastName":"Mei","suffix":""},{"id":496543192,"identity":"98e7e5a7-ba15-485f-9318-9387a5a49af4","order_by":2,"name":"Cailin Chen","email":"","orcid":"","institution":"Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Cailin","middleName":"","lastName":"Chen","suffix":""},{"id":496543194,"identity":"36c148cd-37e3-4a82-a30e-1f0e7dbcf9ed","order_by":3,"name":"Jinhao Liang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACfvnHxz//+CEhx8/efIA4LZINaWnMjD02xpI9xxKI02JwIMeMmYEtLXHDDR8DIl124Fja4wKew4wzZ/B8vPGGwU5Ot4GADsbG5uPGMywOM/NL9262nMOQbGx2gIAWZma2BAkensNsknPObpPmYTiQuI2QFjY2HgMJHrbDPAY3cp4Rp4WHh8dMmoctTQKohY04LRISbMmGM3tsDICBbGw5x4AIv9jfYD744MMPifp+9uaHN95U2MkR1IJqJQ+xUYOkhVQdo2AUjIJRMCIAACO2Qv+6kqsgAAAAAElFTkSuQmCC","orcid":"","institution":"Guangzhou University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Jinhao","middleName":"","lastName":"Liang","suffix":""}],"badges":[],"createdAt":"2025-07-16 08:23:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7137549/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7137549/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88612516,"identity":"0a73c4a7-e7f3-41f4-87c0-91bb791ec1e4","added_by":"auto","created_at":"2025-08-08 10:00:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23842,"visible":true,"origin":"","legend":"\u003cp\u003ePath coefficient diagram of anxiety, resilience, and negative coping strategy\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7137549/v1/960d72416b5802ad66699ce3.png"},{"id":88613824,"identity":"caf644f8-b543-4018-91d0-6d863b4d6668","added_by":"auto","created_at":"2025-08-08 10:16:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1165820,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7137549/v1/98314cbc-d77e-4a2f-9b55-e432d71470e3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Associations among resilience, coping strategies, and anxiety in undergraduate nursing students: A mediation model","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe China Mental Health Survey (CMHS) displayed that anxious disorders\u0026rsquo; prevalence ranks first among all mental illness in China [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As a common psychological phenomenon, anxiety is defined by nursing scholars as the cognitive ability of potential, unclear, or non-objective threats, which may cause a variety of psycho-physiological changes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to a survey, the medical students around the world nearly 33.8% got diagnosed anxiety disorder, higher than that in other humans [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A narrative review figured out that the anxious positive rate of nursing students who from various countries during internship is higher than the domestic norm [4]. Nursing interns, who have just stepped out of campus and entered clinical placement, face a large gap between school teaching and actual clinical work, resulting in a disconnection between theory and practice. Nursing students cannot integrate the theoretical and specialized knowledge learned in school into clinical practice. The dual pressure of clinical learning and practice makes them timid, confused, prone to violating operational procedures, and prone to anxiety [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Graduation internship is the final undergraduate learning stage for nursing students. The mid-to-late internship period is the main stage for nursing students to transition to social roles. Compared with the early stage, nursing students' operational tension and unfamiliarity with the environment gradually waken, and their operational capabilities continue to improve. Interpersonal communication has improved compared with the early period, but they\u0026rsquo;re still lack of independent nursing ability, have incorrect cognition of nursing work, and have excessively high expectations for operational goals [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Under the effect of such contradictory situations, student\u0026rsquo;s psychological changes are inevitable, among which the dynamic changes in psychological status during the internship period are worthy of study [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003ePsychological resilience, also known as mental toughness, is a psychological trait closely related to individual development. Based on previous studies, resilience is typically regarded as a process of positive adaptation to stress and adversity, involving dynamic interactions among individuals, the environment, and resources [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Psychological resilience has been confirmed as a defensive factor in case suffer mental sickness and directly predict mental health [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A study taken out during the popular of SARS-Cov-2 presented that the psychological resilience of frontline nurses significantly and negatively predicted their anxiety levels [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCoping style refers to the ways person struggle to reduce stress, resolve emotional distress, or solve problems when getting into trouble [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It can be simplified divided into two types: positive or negative. Positive version refers to taking effective measures to solve problems, including seeking help and making efforts to change; negative coping style refers to adopting a passive attitude toward problems and stress, such as avoidance and venting [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Currently, when Chinese people encounter stressors, adversity, or negative emotions, they tend to look for someone help, adjust mindset and physical activity which belongs to non-negative dimension. Studies have proved that positive coping styles strategies can positively predict anxiety levels [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Relevant research has indicated that patients with lower psychological resilience are less likely to adopt positive coping styles [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn summary, although pairwise studies among the three psychological variables of anxiety, resilience, and coping strategy are relatively abundant, correlational studies among those are rarely reported, and systematic research is lacking. Additionally, the psychological changes of nursing students in the mid-to-late internship period still own research value. Consequently, the major purpose is to figure out the recent status of anxiety, resilience, and coping styles among the mid-to-late internship period of nursing students and look for the correlations among them, providing references for research in nursing psychology and nursing education.\u003c/p\u003e"},{"header":"Research Subjects and Approach","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.1 participant\u003c/h2\u003e\u003cp\u003eA cross-sectional design and quantitative research was put to use. Through convenient sampling, 185 nursing students from a certain college in Guangdong Province were selected as the research volunteer from November 2024 to January 2025. Inclusion criteria: ①respondents were Informed the purpose of this research and participated of their own free will ; ② Nursing interns who have taken part in clinical practice for 4 months. Exclusion criteria: ① Completing the questionnaire less than 60 seconds; ② research subjects fill in any block with same options; ③ No matter when cut off the clinical internship midway; ④ Have diagnosed relevant mental illness. According to the principle of M Kendall [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e], in this study, the number of independent variables was a\u0026thinsp;=\u0026thinsp;17 (12 items of general information\u0026thinsp;+\u0026thinsp;2 dimensions of SAS\u0026thinsp;+\u0026thinsp;1 dimension of CD-RISC- 10\u0026thinsp;+\u0026thinsp;2 dimensions of SCSQ). Considering approximately 10% of invalid questionnaires, the sample size was calculated as follows: N = [17 \u0026times; (5\u0026thinsp;~\u0026thinsp;10)] \u0026times; (1\u0026thinsp;+\u0026thinsp;10%)\u0026thinsp;=\u0026thinsp;94\u0026thinsp;~\u0026thinsp;187. Thus, the required sample size ranged from 94 to 187 cases. 203 questionnaires were distributed in this study in total. After excluding questionnaires with many blank or unanswered items and those with obvious logical errors, 185 questionnaires were collected rightly in the end, and 90.6% was effective questionnaire rate in this study .\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Tools\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e1.2.1 General Information Questionnaire\u003c/h2\u003e\u003cp\u003eResearcher designed by referring to previous relevant study and combining with the research purpose[16、17]. The items include: gender, family income situation, household registration type, romantic relationship situation, only child situation, social practice experience, physical exercise habit, current clinical department, self-perceived family relationship, first-choice major situation, and employment intention.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e1.2.2 Self-Rating Anxiety Scale (SAS)\u003c/h2\u003e\u003cp\u003eedited by Zung in 1971 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e], The Self-Rating Anxiety Scale is accustomed to evaluating the non-objective sense of anxious patients. Likert 4-level scoring method is used to quantify the extent of subjective anxiety of the volunteer during the test or in the past week. adding up the scores of the 20 items, researcher get the raw score, and the standardize score is calculated through formula conversion. The score get higher and higher, the anxiety situation of the subjects more severe and more severe. Rooted on Chinese norm [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e], 50 points was recognized as the cut-off value of SAS. When score not more than 50 points indicates that the participant is out of the risk of anxiety. The Cronbach's alpha coefficient in this study is 0.818.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e1.2.3 10-Item Connor-Davidson Resilience Scale (CD-RISC-10)\u003c/h2\u003e\u003cp\u003eWang [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e] translated the simplified version scale to form a single-dimensional Chinese version scale with his team, which not only proved that good reliability and validity in other studies ,but was used to qualify the psychological resilience of Chinese people. There are 10 items in the scale and each item adopt Likert 5-level scoring method, From 0 (Never) to 4 (always), the points of psychological resilience were higher and higher, research subject\u0026rsquo;s resilience was stronger and stronger. The Cronbach's alpha coefficient in the study is 0.952.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e1.2.4 Simplified Coping Style Questionnaire (SCSQ)\u003c/h2\u003e\u003cp\u003eBased on a more comprehensive understanding of coping style theories at home and abroad and combined with the characteristics of the Chinese population, a scholar called Xie Yaning [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e] revised the Coping Style Scale (WOC) compiled by Lazarus [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and others and adapted it into a Chinese version fit for the characteristics of the Chinese population. Good reliability and validity were confirmed in the Chinese version of SCSQ by many nursing researcher. It uses a Likert 4-level scoring method: from 0(not) to 3(often). The subjects choose to answer according to their actual situations. Whichever dimension, the positive or the negative, has a higher average score proves which coping style is adopted [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. 0.936 was Cronbach's alpha coefficient in this research of it.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e1.3 Statistical Analysis\u003c/h2\u003e\u003cp\u003eAll statistical data were inputted into the EXCEL by two people. After checking for errors, data was analysed Statistically by SPSS25.0, α\u0026thinsp;=\u0026thinsp;0.05. The general information of undergraduate nursing students was described using frequencies and percentages; if the measurement data were normally distribution, they were could be described as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation[x\u0026thinsp;\u0026plusmn;\u0026thinsp;s]; Contrary to the former, they tended to be described as the median and quartile [M (IQR)]. When analyzing the differences in the degree of anxiety, resilience, and coping styles of nursing students among the general information, independent sample t-tests, one-way ANOVA, or non-parametric test methods were used for analysis. The Spearman correlation analysis method had ability to test the correlations among anxiety, coping styles, and psychological resilience. the Process 3.4 plugin offer the test of mediation effect, and the Bootstrap method was used for further testing of the mediation effect.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e1.4 Ethics\u003c/h2\u003e\u003cp\u003ethe Declaration of Helsinki, all research steps were performed strictly. Ethics approval was provided by the review committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (No: K-2025-005). all respondents agreed to written consent prior to the formal investigation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003e2.1 Overall Situation of Anxiety, Psychological Resilience, and Coping Styles of Undergraduate Nursing Students during the Middle and Late Stages of Internship\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe first factor could explain 31.12% of the variance, which was less than 50%, there was no doubt that serious common method bias didn\u0026rsquo;t exist[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. After the normality test, the overall distribution of the research variables was not normally distributed. The average SAS score of 185 nursing students was 45.90\u0026thinsp;\u0026plusmn;\u0026thinsp;10.30 points, which was higher than the scale norm of 33.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8 points [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e] (t\u0026thinsp;=\u0026thinsp;16.454, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and the Chinese nursing student norm of 37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.6 points [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e] (t\u0026thinsp;=\u0026thinsp;10.647, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and the median was 43.75 (10.00). There were 41 people with an anxious risk, and the positive rate of anxiety was 22.1%. the overall average score of psychological resilience was 22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9, and the median was 22.0 (8.0), which was higher than the middle value of the scale of 20 points. the average scores of two dimension were 2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05(Positive) and 2.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04(Negative) respectively, and the medians of those were 2.77 (1.08) and 2.14 (0.57) respectively. It was a obvious difference in the points of those (Z\u0026thinsp;=\u0026thinsp;6.086, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01)that research suggested that undergraduate nursing students have tendency to choose positive coping styles when getting stuck in stressors.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e\u003cb\u003e2.2 Univariate Analysis of Anxiety of respondents in their mid-to-late internship\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eAs we can see, anxiety level had a only significant difference on social experience item (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Eleven sociological characteristics such as gender, current rotation department, household registration type, etc. shown no significant impact on the anxiety (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The specific detail are presented at Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics for sociodemographic characteristics(N\u0026thinsp;=\u0026thinsp;185)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eitem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003evariety\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSAS score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ/H\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003egender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34(18.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44.3(12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.511\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.956\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e151(81.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.8(10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003edepartment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49(26.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.3(5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e5.153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e0.398\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003esurgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38(20.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44.4(11.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eemergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48(25.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46.8(12.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrthopedics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10(5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.8(8.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eobstetrics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36(19.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44.4(13.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eoncology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.7(18.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHousehold registration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84(45.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.8(10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.813\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.523\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101(54.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0(9.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDating status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52(28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.8(10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.605\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.858\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e133(71.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0(10.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSituation of only children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55(29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42.5(11.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.935\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.347\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e130(70.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0(9.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSocial experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e125(67.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0(10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.507\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60(32.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.3(7.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003efamily relationships\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14(7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40.6(8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e2.408\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.492\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot good\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40(21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46.3(11.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot bad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61(33.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.8(8.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70(37.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0(9.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFamily\u0026rsquo;s monthly income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;3000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44(23.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.1(12.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.323\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.851\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3000\u0026ndash;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59(31.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0(8.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;5000\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82(44.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.3(10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePhysical habit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80(43.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.8(9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.497\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.966\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e105(56.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0(10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNursing is the first major willing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67(36.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.8(8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.692\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.724\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e118(63.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0(10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBe engaged in nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e124(67.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.8(8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.701\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.710\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61(33.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0(11.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Correlation analysis among SAS, CD-RISC and SCSQ of subjects in their mid-to- late internship\u003c/h2\u003e\u003cp\u003eSpearman correlation analysis made good use of analysing the correlations among the three variables of nursing students. It was an evidently positive correlation that resilience and positive coping, anxiety with negative coping style (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).psychological resilience and anxiety didn\u0026rsquo;t exist apparently positive correlations, It was a significantly negative correlation that psychological resilience and negative coping style, and between positive coping style and negative coping style (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Results are posed on Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e clearly.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation analysis among SAS, CD-RISC and SCSQ (N\u0026thinsp;=\u0026thinsp;185)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eresilience\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eanxiety\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePositive coping\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNegative coping\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eanxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.377\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.605\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.377\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.305\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.274\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e* =P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ,**= P\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Multiple Linear Regression of impact elements of Anxiety of nursing during their mid-to-late Internship\u003c/h2\u003e\u003cp\u003eThe anxiety scores were chosen as the dependent variable. In multiple linear regression, the presence or absence of social experience, psychological resilience scores, and scores of the negative coping style dimension were taken as the independent variables. Researcher identified Categorical variables as dummy variables, and regression analysis was carried out in the form of dummy variables. The results showed that, after controlling for the influence of social practice experience, psychological resilience could negatively affect the degree of anxiety, and negative coping styles could positively affect the degree of anxiety, which could explain 39% of the total variance. The date was presented at Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eAnalysis of Factors Affecting Anxious level in Mid-to-Late Stage Internships for Undergraduate Nursing Students(N\u0026thinsp;=\u0026thinsp;185)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003epredictors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eVIF\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44.416\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.364\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10.179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.329\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.176\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.711\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.409\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-6.517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.186\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Mediating Effects of the Degree of Anxiety, Psychological Resilience and Coping strategy\u003c/h2\u003e\u003cp\u003eBased on the significant correlations among the above variables, the internal mechanism of how psychological resilience affects the degree of anxiety was explored. Positive and negative coping strategies were chosen as a mediating variable. A simple mediating effect test was conducted through Model 4 in the PROCESS plugin of SPSS, and the mediating effect of negative and positive coping styles were examined by the Bootstrap method. the total effect of psychological resilience on anxiety was significance (β = -1.02, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Psychological resiliency couldn\u0026rsquo;t positively affect anxiety (β = -0.58, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and negative coping styles (β = -0.32, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). When negative coping and resiliency were added to the equation simultaneously, negative coping could actively affect anxiety (β\u0026thinsp;=\u0026thinsp;0.36, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). 95% CI of the mediating effect obtained by the Bootstrap method exclude 0 (LLCI = -0.40, ULCI = -0.06), indicating that the mediating effect of negative coping strategy between anxiety and psychological resilience had Statistical meaning, and effect size of the mediating effect was \u0026minus;\u0026thinsp;0.21, with accounting for 20.5% of total effect. The details are shown in Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e, \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnalysis of Mediating Effect of Anxiety, as well Resilience on Positive and Negative Coping Strategies(N\u0026thinsp;=\u0026thinsp;185)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRegression equation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eOverall fit index\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eregression coefficients\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003epredictor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eanxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eresilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-10.49**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eresilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-8.95**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eanxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNegative coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e23.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.90**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eresilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-7.38**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eanxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eresilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-8.96**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epositive coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eresilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.33**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eanxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003epositive coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e14.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eresilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-8.19**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ethe Mediating Effect size of Anxiety and Resiliency on Passive Coping or negative coping(N\u0026thinsp;=\u0026thinsp;185)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoeff.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSe\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLLCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eULCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eaccount\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e79.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndirect effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e20.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Analysis of the late Situation of Anxious level among subjects in their mid-to-late internship\u003c/h2\u003e\u003cp\u003eFor the purpose of investigating the recent status of anxiety, resilience, and coping styles during the mid-to-late internship of nursing students and exploring the correlations among the three. First, the average SAS standard score of the study subjects was 45.90\u0026thinsp;\u0026plusmn;\u0026thinsp;10.30 points, which were both higher than the scale norm and the domestic undergraduate nursing students' norm [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and both were statistically significant. 22.1% of subjects was suffering anxious disorder in different extent. The anxiety level of the study subjects showed significant differences in social practice experience: undergraduate nursing students who had participated in social practice had lower anxiety scores than those who had not, and the former group had higher anxiety scores than the latter. Heuvel's study indicated that abundant relevant social practice experience promotes the improvement of comprehensive qualities and professional skills among nursing practitioners [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The reason why the results of this study differ from Heuvel's may be that the social practice activities who previously participated in were short-term, flexible, unstable, fragmented, and low in professionalism, which had limitations in enhancing the comprehensive qualities of nursing students. Second, nursing students who had unpleasant experiences in previous social activities\u0026mdash;such as their professional skills and competences being questioned by service users\u0026mdash;developed a sense of \"shame\" [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This shame further subtly influenced their internship life, aggravating anxiety in the mid-to-late internship period. Therefore, Whether social practice experience impinge on the anxiety of nursing interns needed to be further explored.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.2 Mediating Effects of the Degree of Anxiety, Resiliency and Coping strategies in the mid-to-late internship of nursing students\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this research, 22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9 points was the mean score of CD-RISC 10 ,which higher than the scale median of 20 points, uncovering that the resilience level of research subject wasn\u0026rsquo;t generally out of a moderate level, roughly the same as previous research results [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In this survey, the study subjects tended to choose positive coping styles when facing difficulties, which was roughly in line with Folkman's research findings [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWith social practice experience set as a control variable, Spearman correlation analysis and multiple linear regression affirmed that it was not significantly positive correlated with psychological resilience, but negative correlation. resiliency played a crucial role in affecting anxiety in this study. The experimental results were basically consistent with those of Savitsky [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The study results showed that four items\u0026mdash;only-child status, family relationship, social practice experience, and whether have trend to hunt for a job about nursing after graduation\u0026mdash;had significant effects on the psychological resilience, suggesting that the aspects of social support systems [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and professional identity [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e], can greatly help clinical relevant personnel improve psychological resiliency during nursing internship.\u003c/p\u003e\u003cp\u003eWith social practice experience set as a control variable, Spearman correlation analysis and multiple linear regression demonstrated that negative coping strategy was patently positive correlation with anxious level, that also were one of the most influencing elements of anxiety in this study. The experimental results were roughly the same as those of Ye [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e], which pointed out that medical students' use of negative coping styles would strengthen the influence of stress perception on anxiety. It is suggested that clinical teaching teachers or relevant personnel can use the guided reflection method [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e] to help nursing students improve dynamic cognition, reduce the use of negative coping styles, and thus alleviate nursing students\u0026rsquo; anxiety from their internship.\u003c/p\u003e\u003cp\u003eSpearman correlation analysis showed that anxiety level haven\u0026rsquo;t significant positive correlation with positive coping strategies, which were inconsistent with relevant studies [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e38\u003c/span\u003e], possibly because different scales were selected to measure coping styles, and the items of the brief scale were not clearly explained, leading to response deviations in the questionnaire and different results. A comparative study carried out by Taiwan, China and Australian nursing scholar showed that when nursing students face stressors, problem-focused coping ,which is equal to positive coping styles on broad sense, can decrease the anxious adverse effects [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Liu suggested that nursing students can adjust self-efficacy through physical exercise, adopt positive coping styles as much as possible, and reduce the impact of anxiety [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAfter controlling the effects of four covariates\u0026mdash;only-child status, perceived family relationship, social practice experience, if make a decision to look for a job relative to nursing after graduation\u0026mdash;psychological resilience could directly predict anxiety levels, roughly consistent with previous research results [41、42]. Psychological resilience could negatively predict negative coping styles, and the research results were similar to those of Li [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Guided by the cumulative prospect theory, when the anxiety level of nursing students is aggravated by life events, they often use negative coping methods to temporarily avoid the impact of anxiety [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e44\u003c/span\u003e], that as similar as the outcome of this study. When negative coping strategy and resilience were simultaneously brought into the equation, which showcased that negative coping did not make a wholly mediating contribution between anxious level and resilience with effect size having a 20.5% proportion. Research suggest that the higher the resilience scale score, the less likely they utilize negative coping to cope with problems. The less frequency of adopting negative coping styles can alleviate the anxiety of nursing students and maintain their mental health levels within a reasonable range. Current research suggests that clinical teaching teachers or responsible personnel can plan to use group psychological counseling [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e45\u003c/span\u003e], mentorship interviews [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e46\u003c/span\u003e], positive psychological intervention [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e47\u003c/span\u003e], and other measures to strengthen nursing students\u0026rsquo; psychological resilience level, which is conducive to helping improve their psychological quality during the internship and providing a solid psychological foundation for future clinical work.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Limitations\u003c/h2\u003e\u003cp\u003e① The research subjects selected by the researchers all came from a single institution, so the representativeness of the results had certain limitations. In the future, the scope of the research objectives can be further broadened, the sample size can be increased or multi-center sampling can be carried out, so as to have a more profound understanding of the mental health level of nursing interns. ② this research method only adopted a design belonging to cross-section and quantitative research. In future experiments, diversified research methods can be adopted, such as the combination of quantitative research and qualitative research, and longitudinal research design, in order to make the research results more persuasive and thus more clearly and accurately grasp the internal relationships among the anxiety situation, psychological resiliency, as well coping strategy of respondents in their mid-to-late internship.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn a word, less of the undergraduate nursing students who during the mid-to-late period of internship were out a state of moderate anxiety, their psychological resilience was at a moderate level, and when facing pressure, nursing students preferred to adopt positive coping rather than use negative. Psychological resilience was the influencing contributor of anxiety of undergraduate nursing students, negative coping strategies as well. The research results suggest that clinical teaching instructors or relevant internship supervisors can enhance resilience level of nursing students through a little measures such as psychological counsel and cognitive-behavioral intervention, so as to reduce the opportunities for nursing students to utilized negative coping and further relief anxiety in their mid-to-late internship.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to research subjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the Declaration of Helsinki,All research steps were performed strictly. Ethics approval was provided by the review committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (No: K-2025-005). all participants agreed to written and oral consent prior to the formal investigation.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used or analyzed during the recent research are available from the corresponding author on reasonable request.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no competing interests with BMC.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.Y.L. is responsible for constructing research framework and looking for research subjective\u003c/p\u003e\n\u003cp\u003e2.X.M. is responsible for searching for reference and statistical analysis\u003c/p\u003e\n\u003cp\u003e3.C.C. is responsible for searching for reference and drawing the Table and Figure.\u003c/p\u003e\n\u003cp\u003e4.J.L. is responsible for paper writing and questionnaire collection\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWANG X H, LIU Q Z. 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A Comparison of Psychological Well-Being, Coping Strategies, and Emotional Problems Between Taiwanese and Australian Nursing Students. J Nurs Res.\u003c/li\u003e\n\u003cli\u003eLiu M, Liu H, Qin Z, Tao Y, Ye W, Liu R. Effects of physical activity on depression, anxiety, and stress in college students: the chain-based mediating role of psychological resilience and coping styles. Front Psychol. 2024 Jun 7;15:1396795. \u003c/li\u003e\n\u003cli\u003eBerdida, D.J.E., Grande, R.A.N., 2023. Academic stress, COVID-19 anxiety, and quality of life among nursing students: the mediating role of resilience. Int. Nurs. Rev. 70 (1), 34\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eDevi, H.M., Purborini, N., Chang, H.J., 2021. Mediating effect of resilience on association among stress, depression, and anxiety in Indonesian nursing students. J. Prof. Nurs. 37 (4), 706\u0026ndash;713. \u003c/li\u003e\n\u003cli\u003eLi L, Hua R, Yang L. Coping styles play intermediary roles between resilience and clinical communication ability among nursing students in traditional Chinese Medical university: A structural equation model analysis. Medicine (Baltimore). 2021 Dec 23;100(51):e28284. \u003c/li\u003e\n\u003cli\u003eFennema H., Wakker P. Original and cumulative prospect theory: A discussion of empirical differences. J. Behav. Decis. Mak. 1997;10:53\u0026ndash;64. \u003c/li\u003e\n\u003cli\u003eChan, J., Sit, E., \u0026amp; Lau, W. Conflict management styles, emotional intelligence and implicit theories of personality of nursing students: A cross-sectional study. Nurse Education Today, 34, 934-939. \u003c/li\u003e\n\u003cli\u003eHenshall, C., Davey, Z. \u0026amp; Jackson, D. (2020) The implementation and evaluation of a resilience enhancement program for nurses working in the forensic setting. International Journal of Mental Health Nursing, 29(3), 508\u0026ndash;520. \u003c/li\u003e\n\u003cli\u003eHart, P., Brannan, J. \u0026amp; de Chesnay, M. (2014). Resilience in nurses: an integrative review. Journal of Nursing Management, 22, 720\u0026ndash;734.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7137549/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7137549/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ebackground\u003c/h2\u003e\u003cp\u003eOver the years, anxiety has remained a research hotspot for nursing scholars. Th research aimed at understand the current situation of anxiety, psychological resilience, and coping styles among undergraduate nursing students throughout the middle and late stages of their internship, as well as to uncover the correlations among these three factors, so as to provide a reference for research in nursing psychology and nursing education.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study employ a cross-sectional research and quantitative research method. Through convenient sampling, 185 students from a certain school in Guangdong Province were selected as the research subjects from November 2024 to January 2025. The Self-Rating Anxiety Scale (SAS), the Simplified Version of the Connor-Davidson Resilience Scale (CD-RISC-10), and the Simplified Coping Style Questionnaire (SCSQ) were used for revealing the current status of anxiety, resiliency, and the tendency of coping style selection during the internship of students, and to explore the correlations among anxiety, resilience, and coping styles.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSubjects got an average standard score of SAS was 45.90\u0026thinsp;\u0026plusmn;\u0026thinsp;10.30, and the anxious positive rate was 22.1%. The overall average score of psychological resilience was 22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9, and the average scores of two coping styles dimension were 2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 (Positive) and 2.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04 (Negative) respectively. There were significant correlations one another with those. Multiple linear regression reported that resilience, negative coping styles were able to affect anxiety in some degree. Negative coping style didn\u0026rsquo;t played a completely mediating role between the anxiety and resilience.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis research outcome showed that enhancing the psychological resilience not only can effectively reduce negative coping styles, but alleviate the anxiety of undergraduate nursing students.\u003c/p\u003e","manuscriptTitle":"Associations among resilience, coping strategies, and anxiety in undergraduate nursing students: A mediation model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 10:00:44","doi":"10.21203/rs.3.rs-7137549/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-08-09T04:07:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-06T10:36:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242374456949900306226360818990703662644","date":"2025-08-06T10:22:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324323807880271604311504435021954950160","date":"2025-08-03T07:35:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-03T06:11:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10297943069081742262691479825574603109","date":"2025-08-02T16:28:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-02T16:15:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-25T06:30:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-25T06:21:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-24T10:08:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-07-24T10:05:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5512b3c9-d805-4ef0-9e0c-372edb7a3edb","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-08T10:00:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-08 10:00:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7137549","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7137549","identity":"rs-7137549","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}