Improving Nursing Team Collaboration Through Nurses' Digital Literacy: A Variable-Centered and Person-Centered Perspective

Improving Nursing Team Collaboration Through Nurses' Digital Literacy: A Variable-Centered and Person-Centered Perspective | 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 Improving Nursing Team Collaboration Through Nurses' Digital Literacy: A Variable-Centered and Person-Centered Perspective Xiaoping Zhang, Zhongcheng An, Haifang Zhou, Bing Wu, Lumeng Lu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7137326/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Digital technologies have transformed nursing practices, enhancing efficiency while increasing the complexity of information. Although digital literacy enables nurses to manage digital tools effectively, its impact on team collaboration remains underexplored. This study investigates the influence of digital literacy on nursing team collaboration ability and its underlying mechanisms. Method This study was conducted from March to May 2025 in a tertiary Grade A hospital in Hangzhou, China, involving 495 nurses. We employed scales for digital literacy, situational awareness, psychological safety climate, and team collaboration to collect data. The Process Model 6 was used to test the chain-like mediating effects of situational awareness and psychological safety climate on the relationship between nurses' digital literacy and their ability to collaborate within the nursing team. Latent profile analysis was applied to classify situational awareness and psychological safety climate into latent categories. Results Digital literacy significantly and positively influenced nursing team collaboration. Further mediation analysis revealed that situational awareness and psychological safety climate acted as chain-like mediators between digital literacy and team collaboration. From the individual-centered perspective, situational awareness and psychological safety climate were categorized into three subgroups: high psychological safety climate-high situational awareness, medium psychological safety climate-medium situational awareness, and low psychological safety climate-low situational awareness. Conclusion Hospital administrators and nursing team leaders should prioritize the development of nurses' digital literacy and optimize the situational awareness and psychological safety climate in nursing environments to enhance team collaboration and overall healthcare service quality. Nurses Digital literacy Nursing team collaboration ability Situational awareness Psychological safety climate Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction In the era of digitalized healthcare, the deep integration of information technology and intelligent tools has significantly improved the accuracy and accessibility of nursing services [1-3]. For instance, the application of AI-driven diagnostics, wearable sensors, and cross-language virtual assistants is driving healthcare towards a continuous, preventive [4, 5], and highly accessible model, extending nursing care into community and home settings [6-8]. However, this increasing reliance on technology has intensified the digital adaptation pressure on clinical nurses, defined as the cognitive overload and anxiety stemming from rapid technological advancements and the digitization of workflows [9-12]. For example, S Lee and MS Lee [13] found that 46% to 64% of nurses reported frequently managing updates to electronic health records (EHRs), operating remote monitoring platforms, and handling multi-device coordination tasks, with the complexity of these technologies often exceeding their current digital literacy. Consequently, recent research has focused on enhancing the digital literacy of clinical nurses [14-16]. Digital literacy refers to an individual's ability to acquire, understand, and apply digital technologies effectively. Existing research has primarily concentrated on issues such as information anxiety [17], digital proficiency [18], and digital health knowledge [19]. For example, M Kwon and J Oh [20] demonstrated a significant positive correlation between nurses' digital literacy and health-promoting behaviors. However, this study did not explore the relationship between digital literacy and team collaboration. This omission is unfortunate, as digital literacy enables nurses to operate tools such as electronic health records and telemedicine systems proficiently, facilitating real-time data updates and cross-departmental information sharing [21, 22]. For instance, through EHR systems, nursing teams can simultaneously access patient vital signs and medication records, reducing communication delays and errors [23]. Thus, examining the relationship between clinical nurses' digital literacy and nursing team collaboration is of significant clinical importance. Nursing team collaboration refers to the ability of nursing professionals to exchange professional knowledge, complement skills, provide emotional support, and collectively solve problems to maximize team effectiveness in healthcare institutions [24, 25]. Its core lies in goal alignment and action coordination [26], with key characteristics including goal-driven orientation, cross-professional collaboration, shared responsibility, mutual trust, and dynamic adaptability [27]. These features and advantages have gradually become a new research hotspot in the field of nursing. For example, L Dun [28] explored how critical thinking skills among nurses positively influence nursing team collaboration. Prior studies have analyzed factors such as leadership, role allocation, team culture and values, information sharing, and communication to understand how to improve nursing team collaboration [25, 29-32]. For instance, M Sharma and S Sharma [33] investigated how digital technologies, such as ChatGPT and the Metaverse, could enhance collaboration within nursing teams. These studies indicate that modern technologies have provided new momentum for improving the efficiency of nursing team collaboration [34, 35]. In this process, nurses' digital literacy plays a key role. For example, nurses can share patient case information in real-time through online systems and communicate with patients and their families via video conferencing, thereby enhancing the speed, accuracy, and efficiency of information transmission and team collaboration [36, 37]. However, few prior studies have analyzed the relationship between nurses' digital literacy and team collaboration. Therefore, this study attempts to address three key questions: (1) Does nurses' digital literacy have a positive impact on nursing team collaboration? (2) Do situational awareness and psychological safety climate act as chain-like mediators in this relationship? (3) Do situational awareness and psychological safety climate exhibit heterogeneity among nurses? 1.1 Variable-Centered Perspective 1.1.1 Psychological Safety Climate Psychological safety climate refers to the shared belief that individuals can learn from risks and uncertainties, emphasizing its importance for team learning behaviors and innovation in healthcare settings [38, 39]. Extensive research has introduced this concept into healthcare and nursing, linking it to team performance and patient safety [40, 41]. For example, nurses working in environments with higher psychological safety demonstrate better job performance, including enhanced decision-making skills, higher job satisfaction, and reduced psychological stress [42, 43]. Prior studies have consistently shown that psychological safety climate is closely associated with mature team collaboration, open communication, and supportive team environments [44]. However, previous research has not explored the relationship between psychological safety climate and digital literacy. With the increasing adoption of modern medical technologies, more researchers are attempting to validate the relationship between nurses' digital literacy and psychological safety climate, as this is crucial for enhancing nurses' adaptability in digitalized healthcare environments. In teams with high psychological safety, nurses are more willing to experiment with new technologies and integrate them into daily practice [45]. They are also more inclined to seek help and collaborate when encountering technical issues. Such an environment not only promotes individual digital literacy development but also provides a stronger foundation for nursing team collaboration. Further analysis reveals that psychological safety climate may influence clinical nurses' digital literacy and team collaboration through multiple pathways. On the one hand, a psychological safety climate fosters open communication and knowledge sharing, which in turn impacts nurses' acceptance and willingness to use digital tools [46, 47]. In safe environments, nurses are more likely to share experiences and learning opportunities with new technologies, thereby accelerating their individual digital literacy development [48, 49]. On the other hand, psychological safety climate reduces defensive thinking among nurses, making them more open to learning and experimenting with new technologies [50]. This further strengthens the accumulation of digital literacy. Regarding nursing team collaboration, psychological safety climate enhances mutual trust and a sense of belonging among team members by providing emotional support and avoiding a blame culture [51]. When facing technical issues or work conflicts, nurses are more likely to seek solutions through collaboration [52]. This not only improves the team's overall adaptability to new technologies but also optimizes collaborative patterns. Therefore, the psychological safety climate acts as a bridge between organizational culture and individual behavior, mediating the relationship between digital literacy and team collaboration by influencing information-sharing intentions and team trust. Based on the above analysis, this study proposes the following hypotheses: H1: Nurses' digital literacy has a positive impact on nursing team collaboration. H2: Psychological safety climate mediates the relationship between nurses' digital literacy and nursing team collaboration. 1.1.2 Situational Awareness Situational awareness refers to an individual's ability to perceive and understand their environment within a specific context, emphasizing the deep interaction between cognitive activities and situational factors [53, 54]. In nursing research, situational awareness has been increasingly recognized as a critical ability for clinical nurses to adapt and make informed decisions in complex work environments [55, 56]. The core dimensions of situational awareness include environmental perception, temporal perception, and social perception [57]. In nursing practice, these dimensions are dynamically perceived and integrated through multiple sensory channels, such as visual, auditory, and tactile inputs. For example, M Weigl, K Catchpole, M Wehler and A Schneider [58] demonstrated through empirical research that high levels of situational awareness significantly improve nurses' ability to quickly identify medical device malfunctions and optimize the efficiency of nursing workflows. However, prior research has not sufficiently explored how situational awareness influences nurses' team collaboration in the context of digitalized healthcare environments. To address this gap, this study posits that situational awareness enhances nurses' familiarity with digital tools in their environment, thereby indirectly promoting the development of digital literacy. According to Bandura and Wessels (59), social cognitive theory suggests that individual behavior and ability development are deeply influenced by environmental feedback. In complex clinical environments, nurses with high situational awareness can more quickly and accurately identify the functions and operational requirements of digital devices, thereby enhancing their confidence and ability to use digital tools. This capability extends beyond technical operation to include the development of digital information analysis and decision-making skills. Situational awareness also optimizes team collaboration by enhancing nurses' ability to perceive collaborative contexts dynamically. The development of nursing team collaboration depends on team members' clear understanding of their roles and task distributions [59, 60]. According to team collaboration theory [61], situational awareness enables nurses to understand potential conflict points better and the collaboration needs within the team, facilitating more effective information sharing and coordinated actions during nursing practice. For example, in high-pressure environments such as emergency rooms, nurses with high situational awareness can rapidly identify the workload and resource allocation needs of team members, thereby optimizing the configuration of nursing resources and improving overall team collaboration efficiency [62]. Moreover, situational awareness enhances nurses' ability to keenly perceive patient needs, significantly improving the quality of care as perceived by patients. Based on the above analysis, this study proposes the following hypothesis: H3: Situational awareness mediates the relationship between nurses' digital literacy and nursing team collaboration. 1.1.3 Chain-Like Mediating Role of Psychological Safety Climate and Situational Awareness Drawing from social cognitive theory and team effectiveness frameworks [62], psychological safety climate serves as a social cognitive premise for transforming digital literacy into effective situational awareness in digitalized nursing contexts. In such environments, high psychological safety reduces anxiety related to technology use, encouraging nurses to explore advanced features of EHR systems and clinical decision-support systems, and minimizing information avoidance behaviors caused by fear of technological errors [63, 64]. Simultaneously, psychological safety climate fosters knowledge sharing, as nurses are more willing to disclose technical operation challenges and data interpretation concerns, allowing them to address individual digital skill gaps through peer learning [65]. Self-efficacy theory further explains that psychological safety enhances efficiency beliefs in technology use [66], motivating nurses to proactively analyze and predict risks from multiple data sources rather than mechanically executing operational procedures. The high-quality situational awareness fostered by psychological safety climate further enhances nursing team collaboration. Nurses with high situational awareness can precisely communicate predictions of patient conditions, enabling the team to form shared mental models [67]. Additionally, psychological safety ensures that nurses have the authority to provide real-time feedback, guaranteeing that situational awareness information is promptly calibrated [68]. According to Salas' team collaboration model, this closed-loop communication based on accurate situational awareness reduces coordination delays, particularly in multi-tasking emergency scenarios [69]. Thus, digital literacy, supported by psychological safety climate, deepens situational awareness, and situational awareness, as a cognitive hub, translates individual digital capabilities into coordinated team actions. Based on the above analysis, this study proposes the following hypothesis: H4: Psychological safety climate and situational awareness act as chain-like mediators between nurses' digital literacy and nursing team collaboration. 1.2 Personal-Centered Perspective Recent studies have revealed significant discrepancies in the relationship between psychological safety climate and situational awareness [70, 71]. Some research indicates a strong positive correlation between the two, suggesting that a favorable psychological safety climate can significantly enhance nursing staff's situational awareness, thereby optimizing nursing decisions and team collaboration [72, 73]. However, other studies have found no significant relationship between the two, and in some cases, even a negative correlation, positing that an overemphasis on psychological safety climate may lead to a decline in nursing staff's ability to perceive complex situations [74, 75]. These contradictory research findings may stem from the variable-centered approach adopted in study designs, where psychological safety climate and situational awareness are treated as independent, static variables. This approach may overlook the dynamic interplay between the two constructs, potentially masking their deeper connections and resulting in inconsistent findings. We observed that the measurement tools and operational definitions of psychological safety climate and situational awareness vary significantly across different studies. For instance, some studies employ self-report scales to measure psychological safety climate, while others use observational methods or peer evaluations [76]. Such methodological differences may contribute to discrepancies in the results. Additionally, the specific contexts and backgrounds focused on in these studies differ. For example, some research targets high-intensity environments, such as emergency departments, while others focus on general wards, potentially neglecting contextual differences [77, 78]. Consequently, the inconsistencies in existing research may arise from an incomplete understanding of the complex relationship between psychological safety climate and situational awareness. To address these issues, this study employs latent profile analysis to uncover the underlying causal mechanisms and intrinsic logical relationships between psychological safety climate and situational awareness. Unlike traditional variable-centered analysis, latent profile analysis is better equipped to capture dynamic relationships within complex systems [79], revealing how psychological safety climate influences the formation and development of situational awareness through multiple pathways. This method not only handles non-linear relationships between variables but also reveals differences in the relationship between psychological safety climate and situational awareness across various contexts [80]. Through latent profile analysis, this study aims to provide a more comprehensive theoretical framework for the field of nursing, guiding hospital administrators and nursing team leaders in optimizing the psychological safety climate, enhancing nursing staff's situational awareness, and ultimately improving the quality of care and patient safety. 1.3 The Present Study This study examines the impact of nurses' digital literacy on nursing team collaboration ability from a variable-centered perspective, as well as the internal mechanisms underlying this relationship. From a variable-centered perspective, we analyzed the heterogeneity of nurses' psychological safety climate and situational awareness. The theoretical framework model is illustrated in Figure 1. 2. Method 2.1 Participants 2.1.1 Recruitment of Participants This study was approved by the Ethics Committee of the Affiliated Hangzhou Hospital of Zhejiang Chinese Medical University, allowing the conduct of this cross-sectional study. The sample was recruited between June and July 2025 at a tertiary Grade A hospital in Hangzhou, China. We contacted the director of the hospital's nursing department, informed them of the research purpose, procedures, and risks, and obtained their consent before commencing data collection. Participants completed the data collection via mobile electronic devices. Concurrently, all participants were required to sign an informed consent form before completing the online questionnaire. The informed consent information was presented at the beginning of the online survey, detailing the study's purpose, procedures, potential risks or benefits, and the voluntary nature of participation. Only participants who selected the option indicating their consent were allowed to proceed with the online questionnaire. Completing all the required questions took approximately 5 minutes. The study obtained informed consent from the all participants. 2.1.2 Inclusion and Exclusion Criteria Inclusion criteria: (1) Participants were clinical nurses with at least one year of clinical nursing experience. (2) Participants worked in a tertiary Grade A hospital. (3) Participants had used digital tools daily for at least 3 months to ensure basic digital literacy. (4) Participants voluntarily signed the informed consent form, explicitly agreeing to participate in the study after being informed of its purpose, data usage, and privacy protection measures. (5) Participants were proficient in Chinese and had no significant cognitive impairments. Exclusion criteria: (1) Exclusion of nurse managers, nursing department directors, nursing educators, and other non-direct-care nursing staff. (2) Exclusion of contract nurses, temporary workers, or part-time nurses. (3) Exclusion of nurses who rarely use digital tools. (4) Exclusion of nurses who could not understand Chinese or were non-native. (5) Exclusion of participants who had recently experienced significant life events. (6) Exclusion of participants with mental health conditions. 2.1.3 Demographic Information A total of 536 participants were recruited, resulting in 495 valid questionnaires, which yielded an effective response rate of 92.35%. The specific data cleaning process is shown in Figure 2. Among the participants, 84 (17.0%) were male nurses, and 411 (83.0%) were female. The age distribution included 154 nurses (31.1%) aged 18-30 years, 113 nurses (22.8%) aged 31-45 years, 169 nurses (34.1%) aged 46-60 years, and 59 nurses (11.9%) aged 61 years and older. In terms of education, 84 nurses (17.0%) held an associate degree, 168 nurses (33.9%) had a bachelor's degree, and 243 nurses (49.1%) had a master's degree or higher. Detailed demographic information is provided in Table 1. Table 1. Demographic Information of All Participants. Variables Items Number Proportion Gender Male 84 17.0% Female 411 83.0% Age 18-30 years old 154 31.1% 31-45 years old 113 22.8% 46-60 years old 169 34.1% Over 61 years old 59 11.9% Education background Junior college 84 17.0% Undergraduate college 168 33.9% Master degree or above 243 49.1% Place of residence Cities 336 67.9% Countryside 159 32.1% Marriage Married 292 59.0% unmarried 146 29.5% Get divorced 41 8.3% Widowed 16 3.2% Length of service 1-5 years 92 18.6% 6-10 years 76 15.4% 11-20 years 143 28.9% More than 20 years 184 37.1% Type of job Clinical Nursing Care 200 40.4% Specialized nursing care 112 22.6% Nursing management 134 27.1% Nursing education 49 9.9% Training on digital literacy Yes. 342 69.1% No. 153 30.9% Duration of digital tools ≤2 hours 49 9.9% 2-4 hours 59 11.9% 4-6 hours 163 32.9% ≥6 hours 224 45.3% 2.2 Research Instruments 2.2.1 Digital Literacy Scale The digital literacy scale was used to assess the digital literacy of clinical nurses. This scale, developed and validated by E Avinç and F Doğan [81], is a unidimensional scale consisting of 20 measurement items (e.g., "As a clinical nurse, do you frequently collaborate with other nurses using internet-based software?"). The scale has been widely used in Chinese populations and demonstrates good cultural adaptability [82]. A 5-point Likert scale was used for scoring, ranging from "1 = Strongly Disagree" to "5 = Strongly Agree." Higher scores indicate higher levels of digital literacy. In this study, the Cronbach's alpha for the digital literacy scale was 0.961. Confirmatory factor analysis using AMOS 29.0 confirmed good structural validity (CMIN/DF = 3.985, GFI = 0.883, AGFI = 0.835, RMSEA = 0.078, CFI = 0.945, TLI = 0.929). 2.2.2 Psychological Safety Climate Scale The Psychological Safety Climate Scale was adapted from AC Edmondson [38], who developed the original Psychological Safety Scale for team-level assessment. The scale consists of 7 measurement items (e.g., "As a clinical nurse, when a team member makes a mistake, they are not criticized"). A Chinese version of the scale, translated using the back-translation method by Y Liu, L Chen, L Zhao and C Li [83], was used in this study. The 5-point Likert scale was applied, ranging from "1 = Strongly Disagree" to "5 = Strongly Agree." Higher scores indicate higher levels of psychological safety climate. The Cronbach's alpha for this scale was 0.849, and confirmatory factor analysis indicated good structural validity (CMIN/DF = 1.871, GFI = 0.986, AGFI = 0.971, RMSEA = 0.042, CFI = 0.989, TLI = 0.984). 2.2.3 Situational Awareness Scale The situational awareness scale was adapted from S Schubert, H Ortwein, A Dumitsch, U Schwantes, O Wilhelm, C Kiessling, S Schubert, H Ortwein, A Dumitsch and U Schwantes [84]. To establish context, participants were instructed: "Imagine you are a nurse in the emergency department. Your surgical supervisor instructs you to suture a forearm laceration and then leaves the room. You have never performed this task before." Following this scenario, participants answered 5 measurement items (e.g., "As a clinical nurse, do you agree that you will call a familiar general practitioner to assist you over the phone?"). This method has been widely used, as seen in the work of A Hosseinpour and F Keshmiri [85], to assess professional evaluations of medical scenarios. A 5-point Likert scale was used, ranging from "1 = Strongly Disagree" to "5 = Strongly Agree." Higher scores indicate greater situational awareness. The Cronbach's alpha for this scale was 0.811, and confirmatory factor analysis confirmed good structural validity (CMIN/DF = 1.686, GFI = 0.993, AGFI = 0.980, RMSEA = 0.037, CFI = 0.995, TLI = 0.990). 2.2.4 Team Collaboration Ability Scale The Nurse Collaboration Scale, which measures team collaboration ability, consists of four dimensions: conflict management, shared goals, communication and coordination, and professionalism and autonomy, comprising a total of 23 items. Developed by C Liao, Y Qin, Y He and Y Guo [86], this scale was validated using a Chinese population and demonstrates good cultural adaptability (e.g., "As a clinical nurse, when disagreements or conflicts arise, do everyone's feelings and opinions get considered to achieve the best solution?"). A 5-point Likert scale was used, ranging from "1 = Strongly Disagree" to "5 = Strongly Agree." Higher scores indicate greater team collaboration ability. The Cronbach's alpha for this scale was 0.928, and confirmatory factor analysis confirmed good structural validity (CMIN/DF = 3.671, GFI = 0.880, AGFI = 0.830, RMSEA = 0.074, CFI = 0.933, TLI = 0.913). 2.3 Data Analysis First, we used AMOS 29.0 to evaluate the goodness of fit for each variable and validate its construct validity. We employed SPSS 27.0 for reliability testing, normality analysis, descriptive statistics, correlation analysis, and common method bias testing. Subsequently, we applied SPSS Process Model 6 to test the chain-like mediation effects of psychological safety climate and situational awareness from a variable-centered perspective. Third, we used Mplus to construct latent profile models of psychological safety climate and situational awareness, testing 1 to 5 profiles and selecting the optimal model based on fit indices. Finally, we conducted single-factor analysis of variance (ANOVA) and post-hoc tests to examine significant differences in team collaboration ability across latent profile categories. 3. Results 3.1 Analysis of Common Method Bias Common method bias can arise from the use of single measurement tools, consistent measurement environments, social expectations, and emotional states. To address this issue, we implemented anonymous data collection and avoided using guiding language in the questionnaires to minimize potential biases in responses. Simultaneously, we conducted Harman's single-factor test by performing exploratory factor analysis on all measured variables. The results showed that nine factors with eigenvalues greater than 1 were extracted, and the first factor explained 32.005% of the variance, which is below the critical threshold of 40%. This indicates that there is no common method bias in this study, supporting the validity of the data. 3.2 Descriptive Statistics and Correlation Analysis We conducted correlation and descriptive tests on digital literacy, situational awareness, psychological safety climate, and team collaboration ability to examine the relationships between these variables, as shown in Table 2 . According to RB Kline [ 87 ], the skewness of all variables in this study was less than ± 3, and the kurtosis was less than ± 8, indicating that the data followed a normal distribution. The correlation results revealed the following: digital literacy was significantly positively correlated with situational awareness (r = 0.433, P < 0.001), psychological safety climate (r = 0.463, P < 0.001), and team collaboration ability (r = 0.531, P < 0.001). Situational awareness was also significantly positively correlated with psychological safety climate (r = 0.727, P < 0.001) and team collaboration ability (r = 0.267, P < 0.001). Additionally, psychological safety climate was significantly positively correlated with team collaboration ability (r = 0.174, P < 0.001). Table 2 Descriptive statistics and correlation analysis of each variable. Variables M SD Skewness Kurtosis 1 2 3 4 1. Digital literacy 3.097 0.806 0.579 0.174 1 2. Psychological safety climate 3.167 0.798 -0.147 0.250 0.463*** 1 3. Situational awareness 3.095 0.849 -0.053 -0.162 0.433*** 0.727*** 1 4. Team collaboration ability 3.037 0.757 0.810 0.509 0.531*** 0.267*** 0.174*** 1 3.3 Variable-Centered Analysis Chain Mediation Test. We treated digital literacy as the independent variable, situational awareness and psychological safety climate as mediating variables, and team collaboration ability as the dependent variable. Using Process Model 6, we tested the chain mediation effects of situational awareness and psychological safety climate. The results showed that digital literacy had a significant impact on team collaboration ability (β = 0.504, 95% CI = [0.424, 0.584], P < 0.001); digital literacy also had significant effects on situational awareness (β = 0.130, 95% CI = [0.058, 0.202], P < 0.001) and psychological safety climate (β = 0.458, 95% CI = [0.380, 0.536], P < 0.001). Furthermore, psychological safety climate had a significant effect on situational awareness (β = 0.713, 95% CI = [0.641, 0.785], P < 0.001), and situational awareness had a significant effect on team collaboration ability (β = -0.137, 95% CI = [-0.235, -0.039], P < 0.01). Psychological safety climate also had a significant effect on team collaboration ability (β = 0.124, 95% CI = [0.017, 0.229], P < 0.05). Overall, situational awareness exhibited a significant partial mediating effect between digital literacy and team collaboration ability (β = -0.018, SE = 0.009, 95% CI = [-0.038, -0.004]); psychological safety climate also showed a significant partial mediating effect (β = 0.061, SE = 0.027, 95% CI = [0.008, 0.113]). Thus, both psychological safety climate and situational awareness had significant partial chain-mediated effects on the relationship between digital literacy and team collaboration ability (β = -0.045, SE = 0.019, 95% CI = [-0.084, -0.011]). The regression coefficients and chain-mediated pathway coefficients are detailed in Table 3 , and the corresponding graphical representation is shown in Fig. 3 . Table 3 Regression coefficient table of the chain-type intermediary. Regression Equation Overall Fit Index Significance of Regression Coefficient Outcome Variables Predictive Variables R R 2 F β t 95%CI Psychological safety climate Digital literacy 0.463 0.214 134.255*** 0.458 11.587*** [0.380, 0.536] Situational awareness Psychological safety climate 0.735 0.540 288.901*** 0.713 19.414*** [0.641, 0.785] Digital literacy 0.130 3.585*** [0.058, 0.202] Nursing team collaboration ability Digital literacy 0.541 0.293 67.849*** 0.504 12.386*** [0.424, 0.584] Psychological safety climate 0.124 2.294* [0.018, 0.229] Situational awareness -0.137 -2.752** [-0.235, -0.039] 3.4 Individual Centered Analysis 3.4.1 Latent Profile Analysis To further examine the predictive effect of digital literacy on different types of nurses and the differences in psychological safety climate and situational awareness they exhibit, we used Mplus software to construct a 5-class latent profile model to determine the best-fitting model, as shown in Table 4 . Specifically, we treated the individual measurement items of situational awareness and psychological safety climate as indicators and evaluated model fit, determining the optimal number of classes using indices such as AIC, BIC, aBIC, LMRT, BLRT, and entropy. Table 4 Fit analysis of psychological safety climate and situational awareness. Class AIC BIC aBIC Entropy LMR(P) BLRT(P) Smallest proportion per class 1 18102.378 18203.287 18127.111 2 16808.623 16964.192 16846.753 0.867 < 0.001 < 0.001 0.66 / 0.34 3 16201.125 16411.353 16252.652 0.914 < 0.001 < 0.001 0.11 / 0.64 / 0.25 4 16079.455 16344.342 16144.379 0.843 0.011 0.012 0.52 / 0.27 / 0.09 / 0.12 5 16013.601 16333.148 16091.922 0.843 0.075 0.077 0.06 / 0.09 / 0.44 / 0.28 / 0.13 The results indicated that the entropy values for the 2- to 5-latent profile models of perceived psychological climate and situational awareness all exceeded 0.80, suggesting that the classification accuracy of these models is acceptable. In the five-class model, the p-values for LMRT and BLRT were greater than 0.05, indicating that adding a fifth class did not significantly improve model fit compared to the 2- to 4-class models. However, entropy, which measures the clarity of classification into latent profiles, is closer to 1, indicating clearer classification. Therefore, compared to the 2- and 4-class models, the 3-class latent profile model was considered the most parsimonious with the clearest classification (Entropy = 0.914). 3.4.2 Subgroup Classification Based on the analysis in Table 4 , we constructed three subgroups, as illustrated in Fig. 4 . The first class was labeled as high psychological safety climate-high situational awareness, comprising 54 nurses and accounting for 11%. The second class was labeled as medium psychological safety climate-medium situational awareness, comprising 317 nurses and accounting for 64%. The third class was labeled as low psychological safety climate-low situational awareness, comprising 124 nurses and accounting for 25%. 3.4.3 Latent Profiles and Nursing Team Collaboration Ability We conducted ANOVA and post-hoc tests to examine the differences in team collaboration ability across the three latent profiles, as shown in Table 5 . The results indicated that the high situational awareness-high psychological safety climate group (M = 3.244, SD = 0.706) had significantly higher team collaboration ability compared to the low situational awareness-low psychological safety climate group (M = 2.621, SD = 0.717) and the medium situational awareness-medium psychological safety climate group (M = 3.029, SD = 0.754), P < 0.001, F = 13.347. These findings demonstrate significant differences in team collaboration ability across the three profiles, as detailed in Table 5 . Table 5 One-way ANOVA and post hoc tests for Latent categories and Nursing team collaboration ability. Class N M SD F p Post hoc test 1. High psychological safety climate - High situational awareness 55 3.244 0.706 13.347 2 > 3 2. Medium psychological safety climate - Medium situational awareness 320 3.029 0.754 3. Low psychological safety climate - Low situational awareness 121 2.621 0.717 4 Discussion 4.1 Personal-Centered Perspective This study employed latent profile analysis to identify three distinct latent profiles of situational awareness and psychological safety climate among clinical nurses. The first group, characterized by low psychological safety climate and low situational awareness, exhibited sluggish responses to dynamic changes in the work environment and a pervasive fear of negative evaluations resulting from speaking up or making mistakes. The second group, marked by medium psychological safety climate and situational awareness, demonstrated basic environmental interpretation skills, expressing concerns cautiously in most situations. The third group, characterized by a high psychological safety climate and situational awareness, demonstrated keen environmental awareness and the confidence to express opinions freely and take responsibility in a highly trusting atmosphere. These findings differ significantly from previous studies, which suggested that a high psychological safety climate leads to low situational awareness [ 88 ]. This discrepancy may stem from the unique characteristics of the healthcare industry, such as high risks, strong interdependence, and strict hierarchical systems [ 89 , 90 ], which make the coexistence of high psychological safety and low situational awareness unsustainable among nurses. The vigilance of clinical nurses may either decrease due to suppression or gradually build up in supportive interactions, ultimately leading to a collaborative development model where situational awareness and psychological safety climate evolve together. From the perspective of dynamic systems theory [ 91 ], situational awareness and psychological safety climate are not static traits but rather adaptive behavioral states that emerge in real-time within specific nursing contexts. These states are the immediate expressions of the complex interplay between nurses' internal cognitive-emotional traits and external environmental pressures. For instance, in high-pressure situations, nurses typically classified in the medium situational awareness and psychological safety climate group may shift to a high situational awareness state when facing a critically ill patient with rapidly deteriorating conditions. This highlights that the combination of high and low levels of situational awareness and psychological safety climate can provide a more comprehensive reflection of the psychological characteristics and behavioral patterns of clinical nurses. Specifically, the low situational awareness and low psychological safety climate state may indicate that nurses lack sensitivity to environmental information and the confidence to express their opinions in the work environment. In contrast, the high situational awareness and high psychological safety climate state reflect nurses' ability to efficiently process environmental information and express their opinions openly and confidently within the team. The distribution proportions of the latent profiles revealed the uneven existence of situational awareness and psychological safety climate states among clinical nurses. The high situational awareness and high psychological safety climate group accounted for the smallest proportion (11%), typically comprising experienced nurses in units with strong leadership support. The low situational awareness and low psychological safety climate group represented 25% of the sample, often associated with individuals experiencing long-term burnout or working in suppressive environments. The majority of nurses (64%) fell into the medium situational awareness and psychological safety climate group, forming the main body of clinical nurses. This distribution indicates that possessing high levels of both situational awareness and psychological safety is not common among nurses, but severely low-performing states are also rare. Most nurses possess basic environmental interpretation skills and can express opinions when risks are controllable. Yet, they remain cautious about potential interpersonal risks, especially during cross-hierarchical communication or when handling high-uncertainty clinical decisions. This structure highlights the substantial potential for enhancing situational awareness and psychological safety climate among nurses, particularly in transitioning from medium to high levels of psychological safety and situational awareness. Contemporary clinical nurses operate in an era dominated by digital information and social media, fostering a familiarity with immediate, transparent, and interactive communication patterns. However, the high uncertainty, strong hierarchical traditions, and ongoing digital transformation of healthcare environments shape their work realities. While abundant information sources could enhance situational awareness, information overload and fragmentation may lead to cognitive overload, weakening the ability to interpret critical situational cues. Additionally, the high-stakes nature of healthcare, the prevalence of medical litigation, and persistent resource constraints collectively foster psychological insecurity. The intersection of these era-specific and occupational characteristics renders nurses' situational awareness highly susceptible to disturbances from information flows. At the same time, their psychological safety becomes fragile under authoritative communication patterns and performance pressures, easily slipping into medium or low situational awareness and psychological safety states, particularly in the absence of strong team leadership. Given the significant impact of situational awareness and psychological safety climate on the work performance and professional development of clinical nurses, including their effects on nursing efficiency, team collaboration, and patient care quality, hospital administrators and nursing education institutions should prioritize addressing these issues. Specifically, healthcare organizations should establish supportive work environments, encourage nurses to express their opinions and suggestions, and provide psychological counseling resources to enhance the psychological safety climate. Additionally, nursing education departments should incorporate situational awareness training into nursing curricula to help nurses better perceive and respond to complex work environments. These measures could effectively improve clinical nurses' situational awareness and psychological safety climate, thereby enhancing the efficiency of medical teams and the quality of patient care. 4.2 Variable-Centered Perspective 4.2.1 Theoretical Implications This study validated the significant positive predictive effect of nurses' digital literacy on nursing team collaboration capability. This finding underscores the importance of nurses' ability to acquire, evaluate, and apply digital health information and tools in facilitating efficient collaboration during the digital transformation of healthcare. Nurses with high digital literacy can more accurately utilize digital tools to share critical patient data in real-time, coordinate task handoffs via mobile nursing terminals, and engage in cross-professional consultations via remote collaboration platforms. For instance, nurses skilled in using clinical decision support systems can quickly identify changes in patient risks and proactively initiate team alerts, reducing emergency response times [ 92 ]. This work efficiency, derived from digital capabilities, not only optimizes information flow but also minimizes communication friction and information errors [ 93 ]. This further strengthens the foundation of trust and the efficiency of team collaboration, providing a new pathway for high-quality nursing services. Improving nurses' digital literacy reduces work aversion caused by information errors and enhances their sense of psychological safety within the team. Specifically, when nurses are proficient in digital tools, their technical anxiety decreases significantly, enabling them to ask questions and report errors in digital work scenarios without fear of negative evaluations. For example, nurses proficient in using medication safety systems are more likely to identify potential drug incompatibilities during team meetings. This digitally enabled safe expression allows teams to transform technical advantages into open knowledge sharing and constructive debates. Notably, digital literacy reduces the suppressive effects of hierarchical notions on communication by enhancing nurses' control over technical interactions, making cross-level collaboration more fluid, and increasing team collaboration efficiency. In addition to psychological safety climate, situational awareness also plays a mediating role in the relationship between digital literacy and team collaboration capability. Nurses with high digital health literacy can more quickly and accurately identify changing clinical information when using electronic health records, remote monitoring systems, or smart assistive devices, thereby forming a more comprehensive situational awareness. This cognitive advantage is further translated into critical capabilities in multitasking, team coordination, and rapid response, enhancing the timeliness and consistency of collaborative behaviors. Furthermore, nurses' situational awareness helps strengthen their shared understanding of team goals, role distributions, and action plans, reducing information discrepancies and role conflicts in collaboration. Therefore, situational awareness not only serves as a cognitive bridge connecting digital literacy and collaboration capability but also provides cognitive support for nursing teams to maintain consistent operations in dynamic, high-risk environments. Nursing managers should promote situational awareness through simulations, multi-scenario exercises, and the integration of digital tools to maximize the functional transformation of digital literacy in team collaboration. 4.2.2 Practical Implications Traditional nursing education often emphasizes the mastery of basic nursing techniques and disease knowledge. Still, this study underscores the importance of incorporating digital literacy as a crucial component in the professional competence framework for nurses. It is essential to note that merely teaching the technical skills of digital tools is insufficient; it is also necessary to combine situational awareness training with the cultivation of a psychological safety culture to truly transform digital capabilities into team performance. Therefore, nursing education systems should introduce scenario-based digital interaction training, such as virtual reality-based team simulations and task coordination operations using electronic health record systems, to enhance nurses' environmental adaptability and technical sensitivity through highly realistic situational training. Additionally, psychological safety climate should be integrated into the educational process by fostering mutual trust, open feedback, and a culture of cooperation among students, laying the foundation for them to express opinions and collaborate efficiently in real clinical environments safely. This systemic nurturing approach not only helps improve nurses' abilities in information identification, risk judgment, and collaborative communication but also effectively shortens the transition period from student to clinical backbone, aligning education with practice. This study provides scientific evidence to support hospitals in optimizing their organizational management strategies and enhancing service quality. It clarifies the critical role of nurses' digital literacy in enhancing collaboration capability and identifies the mediating mechanisms of psychological safety climate and situational awareness in organizational behavior regulation. Managers can adjust human resource management practices accordingly, incorporating digital capabilities and collaboration performance into recruitment, training, promotion, and performance evaluation standards. For instance, performance evaluations could include not only the accuracy of nursing operations but also the quality of information processing, efficiency, and team communication feedback on digital platforms. Additionally, fostering a supportive psychological climate is an important direction for management reform. Hospitals can establish psychological safety feedback mechanisms, anonymous suggestion platforms, and leader-participatory management practices to encourage nurses to express their doubts and suggestions more freely during technical operations and clinical judgments, thereby enhancing transparency and collaboration. In summary, this study offers guidance for hospitals to cultivate a nursing organizational culture characterized by efficient collaboration, high situational responsiveness, and strong psychological safety, ultimately improving overall nursing quality and patient safety levels. 4.4 Limitations and Future Research Directions Despite revealing the chain-like mediating mechanism of psychological safety climate and situational awareness between nurses' digital literacy and team collaboration capability, this study has certain limitations that may affect the external validity of the results. First, the study employed a cross-sectional research design, with data collection concentrated in a specific time window, making it impossible to reveal the causal direction and long-term dynamic changes between variables. The formation and evolution of digital literacy, situational awareness, and psychological safety climate are influenced by various dynamic factors. Future studies should consider adopting longitudinal designs to dynamically observe how these psychological variables interact and impact team collaboration in digital environments. Second, the sample was drawn from Grade A tertiary hospitals in eastern China. The regional concentration and relatively uniform organizational culture of the sample limit the generalizability of the findings to other regions, different types of healthcare institutions, and diverse nursing populations. Future research should expand the sample coverage to include hospitals of different levels, regions with significant cultural differences, and diverse nursing professionals to enhance the study's representativeness and applicability. Third, this study only examined psychological safety climate and situational awareness as mediating variables and did not investigate whether any moderating variables exist between them, which may lead to some bias in the interpretation of the results. For example, factors such as nurses' age, clinical experience, technical training background, and the technical intensity of their departments may significantly influence their digital literacy and alter the roles of situational awareness and psychological safety climate. Additionally, the study did not fully consider the potential influence of organizational culture, leadership styles, and task complexity, which may play critical moderating roles in the mediating pathways. For instance, in authoritative or highly structured management environments, even nurses with high digital literacy may have their expressions and collaborative behaviors suppressed, preventing them from fully utilizing their potential. 5 Conclusion This study systematically explored how clinical nurses' digital literacy enhances nursing team collaboration capability through a chain-like mediating pathway involving situational awareness and psychological safety climate, adopting both variable-centered and individual-centered perspectives. The findings revealed the deep mechanisms by which nurses' cognitive and emotional systems influence the efficiency of team collaboration in the digital era. The results confirm that nurses' digital literacy not only significantly predicts their team collaboration capability but also transforms individual digital abilities into collaboration capabilities through enhanced psychological safety climate and situational awareness. Specifically, nurses with high digital literacy are better equipped to operate digital tools, process multi-source data, and actively participate in decision-making, reducing collaboration barriers caused by information errors or delays. Moreover, a high psychological safety climate encourages nurses to express opinions and provide feedback freely within the team, lowering communication costs and promoting the sharing of digital technology experiences. Furthermore, this sense of safety provides the emotional foundation for developing situational awareness, enabling nurses to more acutely perceive and understand dynamic clinical scenarios, thereby fostering efficient and precise team actions. The individual-centered analysis revealed significant differences in team collaboration capabilities among nurses with varying combinations of situational awareness and psychological safety climate. The subgroup characterized by "high situational awareness-high psychological safety climate" demonstrated the highest collaboration levels. This underscores the importance of optimizing situational awareness and psychological safety climate to enhance team collaboration capabilities among nurses. Overall, this study not only expands the theoretical boundaries of digital literacy in the nursing field but also provides evidence-based recommendations for hospital administrators on nurse training, organizational culture development, and the optimization of collaboration mechanisms. Future research should explore the cross-context applicability of this mechanism in multi-level nursing collaboration systems and adopt longitudinal designs to capture the dynamic evolution of digital literacy's influence, thereby driving the systematic upgrading and high-quality development of digitalized nursing systems. Declarations Ethics approval and consent to participate I confirm that all methods were performed according to the relevant guidelines. All procedures were performed by the ethical standards outlined in the 1964 Declaration of Helsinki and its subsequent amendments. The study obtained informed consent from the all participants. This study involved human participants, and we obtained review and approval from the Academic Ethics Committee of Affiliated Hangzhou Hospital of Zhejiang Chinese Medical University (No. 2025KLL174). Consent for publication Not applicable. Clinical trial number Not applicable. Competing Interests The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article. Funding No individual or organization funded the study. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Authors' contributionsAcknowledgements X.Z. and Z.A. contributed to the methodology, data organization, and writing; H.Z. contributed to the article's data and paper writing; B.W. contributed to the article's data; L.L. contributed to the methodology, data organization, and writing. Acknowledgements I would like to express my sincere gratitude to the editor and the reviewers for their hard work, which has greatly improved this manuscript. References Wang B, Shi X, Han X, Xiao G: The digital transformation of nursing practice: an analysis of advanced IoT technologies and smart nursing systems . Front Med (Lausanne) 2024, 11 :1471527. Alenezi A, Alshammari MH, Ibrahim IA: Optimizing Nursing Productivity: Exploring the Role of Artificial Intelligence, Technology Integration, Competencies, and Leadership . J Nurs Manag 2024, 2024 :8371068. Dailah HG, Koriri M, Sabei A, Kriry T, Zakri M: Artificial Intelligence in Nursing: Technological Benefits to Nurse's Mental Health and Patient Care Quality . Healthcare (Basel) 2024, 12 (24). Sai S, Gaur A, Sai R, Chamola V, Guizani M, Rodrigues JJ: Generative ai for transformative healthcare: A comprehensive study of emerging models, applications, case studies and limitations . IEEE Access 2024. Mishra S, Chaudhury P, Tripathy HK, Sahoo KS, Jhanjhi NZ, Hassan Elnour AA, Abdelmaboud A: Enhancing health care through medical cognitive virtual agents . Digit Health 2024, 10 :20552076241256732. Pavel M, Jimison HB, Wactlar HD, Hayes TL, Barkis W, Skapik J, Kaye J: The role of technology and engineering models in transforming healthcare . IEEE Rev Biomed Eng 2013, 6 :156-177. Vicente AM, Ballensiefen W, Jönsson JI: How personalised medicine will transform healthcare by 2030: the ICPerMed vision . J Transl Med 2020, 18 (1):180. Al-Natour A, Abuziad L, Hweidi LI: Nurses' experiences of workplace violence in the emergency department . Int Nurs Rev 2023, 70 (4):485-493. Provenzano M, Cillara N, Curcio F, Pisu MO, González CIA, Jiménez-Herrera MF: Electronic Health Record Adoption and Its Effects on Healthcare Staff: A Qualitative Study of Well-Being and Workplace Stress . Int J Environ Res Public Health 2024, 21 (11). Kräft J, Wirth T, Harth V, Mache S: Digital stress perception among German hospital nurses and associations with health-oriented leadership, emotional exhaustion and work-privacy conflict: a cross-sectional study . BMC Nurs 2024, 23 (1):213. Schmitt JB, Breuer J, Wulf T: From cognitive overload to digital detox: Psychological implications of telework during the COVID-19 pandemic . Comput Human Behav 2021, 124 :106899. Rutkowski A-F, Saunders C: Emotional and cognitive overload: the dark side of information technology : Routledge; 2018. Lee S, Lee MS: Nurses' Electronic Medical Record Workarounds in a Tertiary Teaching Hospital . Comput Inform Nurs 2021, 39 (7):367-374. Comparcini D, Simonetti V, Tomietto M, Pastore F, Totaro M, Ballerini P, Trerotoli P, Mikkonen K, Cicolini G: The Relationship Between Nurses' Digital Health Literacy and Their Educational Levels, Professional Roles, and Digital Attitudes: A Cluster Analysis Based on a Cross-Sectional Study . J Clin Nurs 2024. Holt KA, Overgaard D, Engel LV, Kayser L: Health literacy, digital literacy and eHealth literacy in Danish nursing students at entry and graduate level: a cross sectional study . BMC Nurs 2020, 19 :22. Dijkman EM, Ter Brake WWM, Drossaert CHC, Doggen CJM: Assessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review . Healthcare (Basel) 2023, 12 (1). Zhao BY, Chen MR, Lin R, Yan YJ, Li H: Influence of information anxiety on core competency of registered nurses: mediating effect of digital health literacy . BMC Nurs 2024, 23 (1):626. Abou Hashish EA, Alnajjar H: Digital proficiency: assessing knowledge, attitudes, and skills in digital transformation, health literacy, and artificial intelligence among university nursing students . BMC Med Educ 2024, 24 (1):508. Guillari A, Sansone V, Giordano V, Catone M, Rea T: Assessing digital health knowledge, attitudes and practices among nurses in Naples: a survey study protocol . BMJ Open 2024, 14 (6):e081721. Kwon M, Oh J: The relationship between depression, anxiety, e-health literacy, and health-promoting behavior in nursing students during COVID-19 . Medicine (Baltimore) 2023, 102 (6):e32809. Li J, Tian Y, Zhou T: Electronic Medical Record Systems . In: Healthcare Information Systems: Progress, Challenges and Future Directions. edn.: Springer; 2024: 29-68. BLOG RO: Blog Posts . Pain 2025, 6 :0. Despins LA, Wakefield BJ: The Role of the Electronic Medical Record in the Intensive Care Unit Nurse's Detection of Patient Deterioration: A Qualitative Study . Comput Inform Nurs 2018, 36 (6):284-292. McCallin A, Bamford A: Interdisciplinary teamwork: is the influence of emotional intelligence fully appreciated? J Nurs Manag 2007, 15 (4):386-391. Al-Hamdan ZM, Alyahia M, Al-Maaitah R, Alhamdan M, Faouri I, Al-Smadi AM, Bawadi H: The Relationship Between Emotional Intelligence and Nurse-Nurse Collaboration . J Nurs Scholarsh 2021, 53 (5):615-622. Witges KA, Scanlan JM: Does Synergy Exist in Nursing? A Concept Analysis . Nurs Forum 2015, 50 (3):189-195. Hurlburt M, Aarons GA, Fettes D, Willging C, Gunderson L, Chaffin MJ: Interagency collaborative team model for capacity building to scale-up evidence-based practice . Children and Youth Services Review 2014, 39 :160-168. Dun L: Relationships among self-study ability, critical thinking ability, cooperative ability and problem-solving ability in Chinese undergraduate nursing students: An analysis of a longitudinal cohort via cross-lagged models . Frontiers in Psychology 2025, 16 :1606156. Yamamoto K: Association Between Interdisciplinary Collaboration and Leadership Ability in Intensive Care Unit Nurses: A Cross-Sectional Study . J Nurs Res 2022, 30 (2):e202. Berduzco-Torres N, Choquenaira-Callañaupa B, Medina P, Chihuantito-Abal LA, Caballero S, Gallegos E, San-Martín M, Delgado Bolton RC, Vivanco L: Factors Related to the Differential Development of Inter-Professional Collaboration Abilities in Medicine and Nursing Students . Front Psychol 2020, 11 :432. Zhang J, Cui Q: Collaborative Learning in Higher Nursing Education: A Systematic Review . J Prof Nurs 2018, 34 (5):378-388. Weinberg DB, Cooney-Miner D, Perloff JN, Babington L, Avgar AC: Building collaborative capacity: promoting interdisciplinary teamwork in the absence of formal teams . Med Care 2011, 49 (8):716-723. Sharma M, Sharma S: A holistic approach to remote patient monitoring, fueled by ChatGPT and Metaverse technology: The future of nursing education . Nurse Educ Today 2023, 131 :105972. Kehyayan V, Yasin YM, Al-Hamad A: Toward a Clearer Understanding of Value-Based Healthcare: A Concept Analysis . J Nurs Manag 2025, 2025 :8186530. Yıldız E: Artificial Intelligence in Mental Health Nursing: Balancing Clinical Efficiency and the Human Touch-A Quest for a New Synthesis . J Psychiatr Ment Health Nurs 2025, 32 (4):946-952. Jayousi S, Barchielli C, Alaimo M, Caputo S, Paffetti M, Zoppi P, Mucchi L: ICT in Nursing and Patient Healthcare Management: Scoping Review and Case Studies . Sensors (Basel) 2024, 24 (10). Stevens ER, Alfaro Arias V, Luu S, Lawrence K, Groom L: Technology Integration to Support Nurses in an "Inpatient Room of the Future": Qualitative Analysis . J Med Internet Res 2025, 27 :e68689. Edmondson AC: Speaking up in the operating room: How team leaders promote learning in interdisciplinary action teams . Journal of management studies 2003, 40 (6):1419-1452. Ortega A, Van den Bossche P, Sánchez-Manzanares M, Rico R, Gil F: The influence of change-oriented leadership and psychological safety on team learning in healthcare teams . Journal of business and psychology 2014, 29 (2):311-321. O'Donovan R, McAuliffe E: A systematic review of factors that enable psychological safety in healthcare teams . Int J Qual Health Care 2020, 32 (4):240-250. Iyasere CA, Wing J, Martel JN, Healy MG, Park YS, Finn KM: Effect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams: A Randomized Clinical Trial . JAMA Intern Med 2022, 182 (11):1190-1198. Grailey KE, Murray E, Reader T, Brett SJ: The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis . BMC Health Serv Res 2021, 21 (1):773. Alharbi A, Alkubati SA, Albaqawi H, Ali AZ, Hamed LA, Mohammed S, Cornejo LTO, Pasay-An E: Relationship between nursing work environment and clinical decision-making among Saudi nurses: psychological empowerment as mediator . BMC Nurs 2025, 24 (1):682. Moake TR, Oh N, Steele CR: The importance of team psychological safety climate for enhancing younger team members’ innovation-related behaviors in South Korea . International Journal of Cross Cultural Management 2019, 19 (3):353-368. Edmondson AC: Managing the risk of learning: Psychological safety in work teams . International handbook of organizational teamwork and cooperative working 2008:255-275. El-Ashry AM, Mohamed Elsayed Abdo B, Khedr MA, El-Sayed MM, Abdelhay IS, Abou Zeid MG: Mediating effect of psychological safety on the relationship between inclusive leadership and nurses' absenteeism . BMC Nurs 2025, 24 (1):826. Noriega Del Valle M, Łaba K, Mayer C-H: Unlocking technology acceptance among South African employees: A psychological perspective . SA Journal of Industrial Psychology 2024, 50 :2177. Isidori V, Diamanti F, Gios L, Malfatti G, Perini F, Nicolini A, Longhini J, Forti S, Fraschini F, Bizzarri G et al : Digital Technologies and the Role of Health Care Professionals: Scoping Review Exploring Nurses' Skills in the Digital Era and in the Light of the COVID-19 Pandemic . JMIR Nurs 2022, 5 (1):e37631. Wynn M, Garwood-Cross L, Vasilica C, Griffiths M, Heaslip V, Phillips N: Digitizing nursing: A theoretical and holistic exploration to understand the adoption and use of digital technologies by nurses . J Adv Nurs 2023, 79 (10):3737-3747. Kang SJ, Min HY: Psychological Safety in Nursing Simulation . Nurse Educ 2019, 44 (2):E6-e9. Singh B, Shaffer MA, Selvarajan T: Antecedents of organizational and community embeddedness: The roles of support, psychological safety, and need to belong . Journal of Organizational Behavior 2018, 39 (3):339-354. Leever AM, Hulst MV, Berendsen AJ, Boendemaker PM, Roodenburg JL, Pols J: Conflicts and conflict management in the collaboration between nurses and physicians - a qualitative study . J Interprof Care 2010, 24 (6):612-624. Adams MJ, Tenney YJ, Pew RW: Situation awareness and the cognitive management of complex systems . Human factors 1995, 37 (1):85-104. Munir A, Aved A, Blasch E: Situational awareness: techniques, challenges, and prospects . AI 2022, 3 (1):55-77. Stubbings L, Chaboyer W, McMurray A: Nurses' use of situation awareness in decision-making: an integrative review . J Adv Nurs 2012, 68 (7):1443-1453. Tower M, Watson B, Bourke A, Tyers E, Tin A: Situation awareness and the decision-making processes of final-year nursing students . J Clin Nurs 2019, 28 (21-22):3923-3934. Stanton NA, Chambers PR, Piggott J: Situational awareness and safety . Safety science 2001, 39 (3):189-204. Weigl M, Catchpole K, Wehler M, Schneider A: Workflow disruptions and provider situation awareness in acute care: An observational study with emergency department physicians and nurses . Applied Ergonomics 2020, 88 :103155. Patel VL, Cytryn KN, Shortliffe EH, Safran C: The collaborative health care team: the role of individual and group expertise . Teach Learn Med 2000, 12 (3):117-132. Anderson JE, Ross AJ, Lim R, Kodate N, Thompson K, Jensen H, Cooney K: Nursing teamwork in the care of older people: A mixed methods study . Appl Ergon 2019, 80 :119-129. Siebdrat F, Hoegl M, Ernst H: Subjective distance and team collaboration in distributed teams . Journal of Product Innovation Management 2014, 31 (4):765-779. Wang X, Lian J, Ji M, Lee G, Hu Y: Nurse Managers' Experiences in Organisational Adaptation During Public Health Emergencies: A Qualitative Study . J Adv Nurs 2025, 81 (7):4172-4186. Alsyouf A, Alsubahi N, Alali H, Lutfi A, Al-Mugheed KA, Alrawad M, Almaiah MA, Anshasi RJ, Alhazmi FN, Sawhney D: Nurses' continuance intention to use electronic health record systems: The antecedent role of personality and organisation support . PLoS One 2024, 19 (10):e0300657. Wang J, Xu Y, Yang Z, Zhang J, Zhang X, Li W, Sun Y, Pan H: Factors Influencing Information Distortion in Electronic Nursing Records: Qualitative Study . J Med Internet Res 2025, 27 :e66959. Brown J, Pope N, Bosco AM, Mason J, Morgan A: Issues affecting nurses' capability to use digital technology at work: An integrative review . J Clin Nurs 2020, 29 (15-16):2801-2819. Bandura A, Wessels S: Self-efficacy : Cambridge University Press Cambridge; 1997. Lowe DJ, Ireland AJ, Ross A, Ker J: Exploring situational awareness in emergency medicine: developing a shared mental model to enhance training and assessment . Postgrad Med J 2016, 92 (1093):653-658. McLinton SS, Loh MY, Dollard MF, Afsharian A, Tuckey MM: A ‘living intervention’: evaluating a real-time feedback system to help teams co-create psychosocial safety climate . Safety Science 2025, 190 :106901. Salas E, Cooke NJ, Rosen MA: On teams, teamwork, and team performance: discoveries and developments . Hum Factors 2008, 50 (3):540-547. Saleem MS, Isha ASN, Awan MI: Exploring the pathways to enhanced task performance: the roles of supportive leadership, team psychological safety, and mindful organizing . Journal of hospitality and tourism insights 2024, 7 (5):2560-2581. Tang R, Lu G, Liu M, Zhu M, Li P: A unified driving behavior model based on psychological safety space . Transportation Research Part F: Traffic Psychology and Behaviour 2025, 109 :439-457. Mazzocato P, Del Villar Pérez J, Herber K, Keita M, Roczniewska M: Let's Talk About the Elephant in the Room: A Psychological Safety Climate Intervention Among Nursing Teams-A Qualitative Evaluation . J Adv Nurs 2025. Loh MY, Idris MA, Dollard MF, Isahak M: Psychosocial safety climate as a moderator of the moderators: Contextualizing JDR models and emotional demands effects . Journal of Occupational and Organizational Psychology 2018, 91 (3):620-644. Wang Z, Jiang Z, Blackman A: Linking emotional intelligence to safety performance: The roles of situational awareness and safety training . Journal of safety research 2021, 78 :210-220. Huang W, Zhong D, Chen Y: The relationship between construction workers’ emotional intelligence and safety performance . Engineering, Construction and Architectural Management 2024. Amoadu M, Obeng P, Cobbinah G, Salu PK, Ofori GO, Ansah EW: Methodological issues in measuring psychosocial safety climate: a systematic review protocol . BMJ Open 2024, 14 (8):e087315. Zadow A, Dollard M, McLinton S, Lawrence P, Tuckey M: Psychosocial safety climate, emotional exhaustion, and work injuries in healthcare workplaces . Stress and Health 2017, 33 :558. Wang JF, Wu CL, Tsai YT, Weng SJ, Hsu YC: The Effects of Safety Climate on Psychosocial Factors: An Empirical Study in Healthcare Workplaces . J Patient Saf 2022, 18 (2):e528-e533. Mustafić M, Yu J, Stadler M, Vainikainen MP, Bornstein MH, Putnick DL, Greiff S: Complex problem solving: Profiles and developmental paths revealed via latent transition analysis . Dev Psychol 2019, 55 (10):2090-2101. Hickendorff M, Edelsbrunner PA, McMullen J, Schneider M, Trezise K: Informative tools for characterizing individual differences in learning: Latent class, latent profile, and latent transition analysis . Learning and Individual Differences 2018, 66 :4-15. Avinç E, Doğan F: Digital literacy scale: Validity and reliability study with the rasch model . Education and information Technologies 2024, 29 (17):22895-22941. Ma H, Yang H, Li C, Ma S, Li G: The Effectiveness and Sustainability of Tier Diagnostic Technologies for Misconception Detection in Science Education: A Systematic Review . Sustainability 2025, 17 (7):3145. Liu Y, Chen L, Zhao L, Li C: The interactive effect of organizational identification and organizational climate on employees’ taking charge behavior: a complexity perspective . Complexity 2021, 2021 (1):7040620. Schubert S, Ortwein H, Dumitsch A, Schwantes U, Wilhelm O, Kiessling C, Schubert S, Ortwein H, Dumitsch A, Schwantes U: A situational judgement test of professional behaviour: development and validation . Medical teacher 2008, 30 (5):528-533. Hosseinpour A, Keshmiri F: Professionalism assessment of students in clinical education through Situational Judgment Test (SJT) . BMC Med Educ 2024, 24 (1):1291. Liao C, Qin Y, He Y, Guo Y: The nurse–nurse collaboration behavior scale: development and psychometric testing . International Journal of Nursing Sciences 2015, 2 (4):334-339. Kline RB: Software review: Software programs for structural equation modeling: Amos, EQS, and LISREL . Journal of psychoeducational assessment 1998, 16 (4):343-364. Fung IW, Tam VW, Sing CP, Tang K, Ogunlana SO: Psychological climate in occupational safety and health: the safety awareness of construction workers in South China . International journal of construction management 2016, 16 (4):315-325. Liberati EG, Peerally MF, Dixon-Woods M: Learning from high risk industries may not be straightforward: a qualitative study of the hierarchy of risk controls approach in healthcare . International Journal for Quality in Health Care 2018, 30 (1):39-43. Carroll JS, Rudolph JW: Design of high reliability organizations in health care . Qual Saf Health Care 2006, 15 Suppl 1 (Suppl 1):i4-9. Thelen E, Smith LB: Dynamic systems theories . Handbook of child psychology 2007, 1 . Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI: An overview of clinical decision support systems: benefits, risks, and strategies for success . NPJ Digit Med 2020, 3 :17. Adepoju AH, Austin-Gabriel B, Eweje A, Collins A: Framework for automating multi-team workflows to maximize operational efficiency and minimize redundant data handling . IRE Journals 2022, 5 (9):663-664. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7137326","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":506169803,"identity":"51a60100-de04-430f-a78d-f35bf28f92d6","order_by":0,"name":"Xiaoping Zhang","email":"","orcid":"","institution":"the Second Affiliated Hospital of Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoping","middleName":"","lastName":"Zhang","suffix":""},{"id":506169804,"identity":"0d1ac0e4-118b-41b8-923b-846902d3c1de","order_by":1,"name":"Zhongcheng An","email":"","orcid":"","institution":"the Second Affiliated Hospital of Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhongcheng","middleName":"","lastName":"An","suffix":""},{"id":506169806,"identity":"ad008cd2-6801-4876-9b12-8de7245a3474","order_by":2,"name":"Haifang Zhou","email":"","orcid":"","institution":"Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haifang","middleName":"","lastName":"Zhou","suffix":""},{"id":506169807,"identity":"24d49375-4463-4fd8-9403-95eda7b7640a","order_by":3,"name":"Bing Wu","email":"","orcid":"","institution":"Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Wu","suffix":""},{"id":506169809,"identity":"d16afd0a-64ce-46fe-ba4b-0decb2c5d85f","order_by":4,"name":"Lumeng Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYHACNgaGAgsGfiCLmQQtBhIMkg1QLTxEazE4QKwWg+Nnjz34YCARbXwj+eDnAoY7cvYEtZzJSzecYSCRu+1GWrL0DIZnxgRtMTuQYybNA9aSYyDNw3A4sYeglvNvzKT/ALVsnpH/+TdQSz1hLTeAtgC9n7tBIocNZEsCQYfZ33hjJtkD1DLjzDMzax6Dw4Y9BwhokezPMZP4UWGT29+e/Pg2T8VhefYGQtbAgUACkDAgWjkI8BNy0CgYBaNgFIxYAADIjTwcq6PFGwAAAABJRU5ErkJggg==","orcid":"","institution":"Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University","correspondingAuthor":true,"prefix":"","firstName":"Lumeng","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2025-07-16 08:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7137326/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7137326/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90070166,"identity":"86bbeb41-0274-4155-b322-91bfa749801b","added_by":"auto","created_at":"2025-08-28 06:39:32","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":116453,"visible":true,"origin":"","legend":"\u003cp\u003eTheoretical Framework Model.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7137326/v1/f60ec1041f4403a8492dd390.jpg"},{"id":90070138,"identity":"33f98776-984a-4695-a6f6-855a469d4dd8","added_by":"auto","created_at":"2025-08-28 06:39:29","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":106144,"visible":true,"origin":"","legend":"\u003cp\u003eData cleaning process.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7137326/v1/e6504a114dc394a974a3d576.jpg"},{"id":90070131,"identity":"d8343c10-d46a-4719-b0df-2e85cd57b3b6","added_by":"auto","created_at":"2025-08-28 06:39:26","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":56784,"visible":true,"origin":"","legend":"\u003cp\u003eGraph of chain mediation path coefficients.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7137326/v1/84ecbda4f846382058ff7899.jpg"},{"id":90070167,"identity":"4c3dbf4a-26b0-42da-bae2-02cd7bbcfb8f","added_by":"auto","created_at":"2025-08-28 06:39:32","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":93725,"visible":true,"origin":"","legend":"\u003cp\u003eProportion results of the three subgroups.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote. Measurement items 1-7 represent the psychological safety climate, while measurement items 8-12 represent situational awareness.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7137326/v1/2308990e8ffe23890620846d.jpg"},{"id":96916533,"identity":"be2fcc1a-aaeb-4799-b880-197c994b79aa","added_by":"auto","created_at":"2025-11-27 14:08:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5323828,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7137326/v1/c9420bd9-7c1b-443a-8433-04b0b3019291.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving Nursing Team Collaboration Through Nurses' Digital Literacy: A Variable-Centered and Person-Centered Perspective","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIn the era of digitalized healthcare, the deep integration of information technology and intelligent tools has significantly improved the accuracy and accessibility of nursing services [1-3]. For instance, the application of AI-driven diagnostics, wearable sensors, and cross-language virtual assistants is driving healthcare towards a continuous, preventive [4, 5], and highly accessible model, extending nursing care into community and home settings [6-8]. However, this increasing reliance on technology has intensified the digital adaptation pressure on clinical nurses, defined as the cognitive overload and anxiety stemming from rapid technological advancements and the digitization of workflows [9-12]. For example, S Lee and MS Lee [13] found that 46% to 64% of nurses reported frequently managing updates to electronic health records (EHRs), operating remote monitoring platforms, and handling multi-device coordination tasks, with the complexity of these technologies often exceeding their current digital literacy. Consequently, recent research has focused on enhancing the digital literacy of clinical nurses [14-16]. Digital literacy refers to an individual's ability to acquire, understand, and apply digital technologies effectively. Existing research has primarily concentrated on issues such as information anxiety [17], digital proficiency [18], and digital health knowledge [19]. For example, M Kwon and J Oh [20] demonstrated a significant positive correlation between nurses' digital literacy and health-promoting behaviors. However, this study did not explore the relationship between digital literacy and team collaboration. This omission is unfortunate, as digital literacy enables nurses to operate tools such as electronic health records and telemedicine systems proficiently, facilitating real-time data updates and cross-departmental information sharing\u0026nbsp;[21, 22]. For instance, through EHR systems, nursing teams can simultaneously access patient vital signs and medication records, reducing communication delays and errors\u0026nbsp;[23]. Thus, examining the relationship between clinical nurses' digital literacy and nursing team collaboration is of significant clinical importance.\u003c/p\u003e\n\u003cp\u003eNursing team collaboration refers to the ability of nursing professionals to exchange professional knowledge, complement skills, provide emotional support, and collectively solve problems to maximize team effectiveness in healthcare institutions [24, 25]. Its core lies in goal alignment and action coordination [26], with key characteristics including goal-driven orientation, cross-professional collaboration, shared responsibility, mutual trust, and dynamic adaptability [27]. These features and advantages have gradually become a new research hotspot in the field of nursing. For example, L Dun [28] explored how critical thinking skills among nurses positively influence nursing team collaboration. Prior studies have analyzed factors such as leadership, role allocation, team culture and values, information sharing, and communication to understand how to improve nursing team collaboration [25, 29-32]. For instance, M Sharma and S Sharma [33] investigated how digital technologies, such as ChatGPT and the Metaverse, could enhance collaboration within nursing teams. These studies indicate that modern technologies have provided new momentum for improving the efficiency of nursing team collaboration [34, 35]. In this process, nurses' digital literacy plays a key role. For example, nurses can share patient case information in real-time through online systems and communicate with patients and their families via video conferencing, thereby enhancing the speed, accuracy, and efficiency of information transmission and team collaboration [36, 37]. However, few prior studies have analyzed the relationship between nurses' digital literacy and team collaboration. Therefore, this study attempts to address three key questions: (1) Does nurses' digital literacy have a positive impact on nursing team collaboration? (2) Do situational awareness and psychological safety climate act as chain-like mediators in this relationship? (3) Do situational awareness and psychological safety climate exhibit heterogeneity among nurses?\u003c/p\u003e\n\u003ch2\u003e1.1 Variable-Centered Perspective\u003cbr\u003e\u0026nbsp;1.1.1 Psychological Safety Climate\u003c/h2\u003e\n\u003cp\u003ePsychological safety climate refers to the shared belief that individuals can learn from risks and uncertainties, emphasizing its importance for team learning behaviors and innovation in healthcare settings [38, 39]. Extensive research has introduced this concept into healthcare and nursing, linking it to team performance and patient safety [40, 41]. For example, nurses working in environments with higher psychological safety demonstrate better job performance, including enhanced decision-making skills, higher job satisfaction, and reduced psychological stress [42, 43]. Prior studies have consistently shown that psychological safety climate is closely associated with mature team collaboration, open communication, and supportive team environments [44]. However, previous research has not explored the relationship between psychological safety climate and digital literacy. With the increasing adoption of modern medical technologies, more researchers are attempting to validate the relationship between nurses' digital literacy and psychological safety climate, as this is crucial for enhancing nurses' adaptability in digitalized healthcare environments. In teams with high psychological safety, nurses are more willing to experiment with new technologies and integrate them into daily practice [45]. They are also more inclined to seek help and collaborate when encountering technical issues. Such an environment not only promotes individual digital literacy development but also provides a stronger foundation for nursing team collaboration.\u003c/p\u003e\n\u003cp\u003eFurther analysis reveals that psychological safety climate may influence clinical nurses' digital literacy and team collaboration through multiple pathways. On the one hand, a psychological safety climate fosters open communication and knowledge sharing, which in turn impacts nurses' acceptance and willingness to use digital tools [46, 47]. In safe environments, nurses are more likely to share experiences and learning opportunities with new technologies, thereby accelerating their individual digital literacy development [48, 49]. On the other hand, psychological safety climate reduces defensive thinking among nurses, making them more open to learning and experimenting with new technologies [50]. This further strengthens the accumulation of digital literacy.\u003c/p\u003e\n\u003cp\u003eRegarding nursing team collaboration, psychological safety climate enhances mutual trust and a sense of belonging among team members by providing emotional support and avoiding a blame culture [51]. When facing technical issues or work conflicts, nurses are more likely to seek solutions through collaboration [52]. This not only improves the team's overall adaptability to new technologies but also optimizes collaborative patterns. Therefore, the psychological safety climate acts as a bridge between organizational culture and individual behavior, mediating the relationship between digital literacy and team collaboration by influencing information-sharing intentions and team trust.\u003c/p\u003e\n\u003cp\u003eBased on the above analysis, this study proposes the following hypotheses:\u003cbr\u003e\u0026nbsp;H1: Nurses' digital literacy has a positive impact on nursing team collaboration.\u003cbr\u003e\u0026nbsp;H2: Psychological safety climate mediates the relationship between nurses' digital literacy and nursing team collaboration.\u003c/p\u003e\n\u003cp\u003e1.1.2 Situational Awareness\u003cbr\u003e\u0026nbsp;Situational awareness refers to an individual's ability to perceive and understand their environment within a specific context, emphasizing the deep interaction between cognitive activities and situational factors [53, 54]. In nursing research, situational awareness has been increasingly recognized as a critical ability for clinical nurses to adapt and make informed decisions in complex work environments [55, 56]. The core dimensions of situational awareness include environmental perception, temporal perception, and social perception [57]. In nursing practice, these dimensions are dynamically perceived and integrated through multiple sensory channels, such as visual, auditory, and tactile inputs. For example, M Weigl, K Catchpole, M Wehler and A Schneider [58] demonstrated through empirical research that high levels of situational awareness significantly improve nurses' ability to quickly identify medical device malfunctions and optimize the efficiency of nursing workflows. However, prior research has not sufficiently explored how situational awareness influences nurses' team collaboration in the context of digitalized healthcare environments.\u003c/p\u003e\n\u003cp\u003eTo address this gap, this study posits that situational awareness enhances nurses' familiarity with digital tools in their environment, thereby indirectly promoting the development of digital literacy. According to Bandura and Wessels (59), social cognitive theory suggests that individual behavior and ability development are deeply influenced by environmental feedback. In complex clinical environments, nurses with high situational awareness can more quickly and accurately identify the functions and operational requirements of digital devices, thereby enhancing their confidence and ability to use digital tools. This capability extends beyond technical operation to include the development of digital information analysis and decision-making skills.\u003c/p\u003e\n\u003cp\u003eSituational awareness also optimizes team collaboration by enhancing nurses' ability to perceive collaborative contexts dynamically. The development of nursing team collaboration depends on team members' clear understanding of their roles and task distributions [59, 60]. According to team collaboration theory [61], situational awareness enables nurses to understand potential conflict points better and the collaboration needs within the team, facilitating more effective information sharing and coordinated actions during nursing practice. For example, in high-pressure environments such as emergency rooms, nurses with high situational awareness can rapidly identify the workload and resource allocation needs of team members, thereby optimizing the configuration of nursing resources and improving overall team collaboration efficiency [62]. Moreover, situational awareness enhances nurses' ability to keenly perceive patient needs, significantly improving the quality of care as perceived by patients.\u003c/p\u003e\n\u003cp\u003eBased on the above analysis, this study proposes the following hypothesis:\u003cbr\u003e\u0026nbsp;H3: Situational awareness mediates the relationship between nurses' digital literacy and nursing team collaboration.\u003c/p\u003e\n\u003cp\u003e1.1.3 Chain-Like Mediating Role of Psychological Safety Climate and Situational Awareness\u003cbr\u003e\u0026nbsp;Drawing from social cognitive theory and team effectiveness frameworks [62], psychological safety climate serves as a social cognitive premise for transforming digital literacy into effective situational awareness in digitalized nursing contexts. In such environments, high psychological safety reduces anxiety related to technology use, encouraging nurses to explore advanced features of EHR systems and clinical decision-support systems, and minimizing information avoidance behaviors caused by fear of technological errors [63, 64]. Simultaneously, psychological safety climate fosters knowledge sharing, as nurses are more willing to disclose technical operation challenges and data interpretation concerns, allowing them to address individual digital skill gaps through peer learning [65]. Self-efficacy theory further explains that psychological safety enhances efficiency beliefs in technology use [66], motivating nurses to proactively analyze and predict risks from multiple data sources rather than mechanically executing operational procedures.\u003c/p\u003e\n\u003cp\u003eThe high-quality situational awareness fostered by psychological safety climate further enhances nursing team collaboration. Nurses with high situational awareness can precisely communicate predictions of patient conditions, enabling the team to form shared mental models [67]. Additionally, psychological safety ensures that nurses have the authority to provide real-time feedback, guaranteeing that situational awareness information is promptly calibrated [68]. According to Salas' team collaboration model, this closed-loop communication based on accurate situational awareness reduces coordination delays, particularly in multi-tasking emergency scenarios [69]. Thus, digital literacy, supported by psychological safety climate, deepens situational awareness, and situational awareness, as a cognitive hub, translates individual digital capabilities into coordinated team actions.\u003c/p\u003e\n\u003cp\u003eBased on the above analysis, this study proposes the following hypothesis:\u003cbr\u003e\u0026nbsp;H4: Psychological safety climate and situational awareness act as chain-like mediators between nurses' digital literacy and nursing team collaboration.\u003c/p\u003e\n\u003ch2\u003e1.2 Personal-Centered Perspective\u003c/h2\u003e\n\u003cp\u003eRecent studies have revealed significant discrepancies in the relationship between psychological safety climate and situational awareness [70, 71]. Some research indicates a strong positive correlation between the two, suggesting that a favorable psychological safety climate can significantly enhance nursing staff's situational awareness, thereby optimizing nursing decisions and team collaboration [72, 73]. However, other studies have found no significant relationship between the two, and in some cases, even a negative correlation, positing that an overemphasis on psychological safety climate may lead to a decline in nursing staff's ability to perceive complex situations [74, 75]. These contradictory research findings may stem from the variable-centered approach adopted in study designs, where psychological safety climate and situational awareness are treated as independent, static variables. This approach may overlook the dynamic interplay between the two constructs, potentially masking their deeper connections and resulting in inconsistent findings.\u003c/p\u003e\n\u003cp\u003eWe observed that the measurement tools and operational definitions of psychological safety climate and situational awareness vary significantly across different studies. For instance, some studies employ self-report scales to measure psychological safety climate, while others use observational methods or peer evaluations [76]. Such methodological differences may contribute to discrepancies in the results. Additionally, the specific contexts and backgrounds focused on in these studies differ. For example, some research targets high-intensity environments, such as emergency departments, while others focus on general wards, potentially neglecting contextual differences [77, 78]. Consequently, the inconsistencies in existing research may arise from an incomplete understanding of the complex relationship between psychological safety climate and situational awareness.\u003c/p\u003e\n\u003cp\u003eTo address these issues, this study employs latent profile analysis to uncover the underlying causal mechanisms and intrinsic logical relationships between psychological safety climate and situational awareness. Unlike traditional variable-centered analysis, latent profile analysis is better equipped to capture dynamic relationships within complex systems [79], revealing how psychological safety climate influences the formation and development of situational awareness through multiple pathways. This method not only handles non-linear relationships between variables but also reveals differences in the relationship between psychological safety climate and situational awareness across various contexts [80]. Through latent profile analysis, this study aims to provide a more comprehensive theoretical framework for the field of nursing, guiding hospital administrators and nursing team leaders in optimizing the psychological safety climate, enhancing nursing staff's situational awareness, and ultimately improving the quality of care and patient safety.\u003c/p\u003e\n\u003ch2\u003e1.3 The Present Study\u003c/h2\u003e\n\u003cp\u003eThis study examines the impact of nurses' digital literacy on nursing team collaboration ability from a variable-centered perspective, as well as the internal mechanisms underlying this relationship. From a variable-centered perspective, we analyzed the heterogeneity of nurses' psychological safety climate and situational awareness. The theoretical framework model is illustrated in Figure 1.\u003c/p\u003e"},{"header":"2. Method","content":"\u003cp\u003e2.1 Participants\u003cbr\u003e\u0026nbsp;2.1.1 Recruitment of Participants\u003cbr\u003e\u0026nbsp;This study was approved by the Ethics Committee of the Affiliated Hangzhou Hospital of Zhejiang Chinese Medical University, allowing the conduct of this cross-sectional study. The sample was recruited between June and July 2025 at a tertiary Grade A hospital in Hangzhou, China. We contacted the director of the hospital\u0026apos;s nursing department, informed them of the research purpose, procedures, and risks, and obtained their consent before commencing data collection. Participants completed the data collection via mobile electronic devices.\u003c/p\u003e\n\u003cp\u003eConcurrently, all participants were required to sign an informed consent form before completing the online questionnaire. The informed consent information was presented at the beginning of the online survey, detailing the study\u0026apos;s purpose, procedures, potential risks or benefits, and the voluntary nature of participation. Only participants who selected the option indicating their consent were allowed to proceed with the online questionnaire. Completing all the required questions took approximately 5 minutes. The study obtained informed consent from the all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.1.2 Inclusion and Exclusion Criteria\u003cbr\u003e\u0026nbsp;Inclusion criteria: (1) Participants were clinical nurses with at least one year of clinical nursing experience. (2) Participants worked in a tertiary Grade A hospital. (3) Participants had used digital tools daily for at least 3 months to ensure basic digital literacy. (4) Participants voluntarily signed the informed consent form, explicitly agreeing to participate in the study after being informed of its purpose, data usage, and privacy protection measures. (5) Participants were proficient in Chinese and had no significant cognitive impairments.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: (1) Exclusion of nurse managers, nursing department directors, nursing educators, and other non-direct-care nursing staff. (2) Exclusion of contract nurses, temporary workers, or part-time nurses. (3) Exclusion of nurses who rarely use digital tools. (4) Exclusion of nurses who could not understand Chinese or were non-native. (5) Exclusion of participants who had recently experienced significant life events. (6) Exclusion of participants with mental health conditions.\u003c/p\u003e\n\u003cp\u003e2.1.3 Demographic Information\u003cbr\u003e\u0026nbsp;A total of 536 participants were recruited, resulting in 495 valid questionnaires, which yielded an effective response rate of 92.35%. The specific data cleaning process is shown in Figure 2. Among the participants, 84 (17.0%) were male nurses, and 411 (83.0%) were female. The age distribution included 154 nurses (31.1%) aged 18-30 years, 113 nurses (22.8%) aged 31-45 years, 169 nurses (34.1%) aged 46-60 years, and 59 nurses (11.9%) aged 61 years and older. In terms of education, 84 nurses (17.0%) held an associate degree, 168 nurses (33.9%) had a bachelor\u0026apos;s degree, and 243 nurses (49.1%) had a master\u0026apos;s degree or higher. Detailed demographic information is provided in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Demographic Information of All Participants.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eItems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eProportion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e17.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e83.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e18-30 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e31.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e31-45 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e22.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e46-60 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e34.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eOver 61 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e11.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eEducation background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e17.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eUndergraduate college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e33.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMaster degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e49.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003ePlace of residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e67.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eCountryside\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e32.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eMarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e59.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eunmarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e29.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eGet divorced\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e3.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eLength of service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e1-5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e18.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e6-10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e15.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e11-20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e28.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMore than 20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e37.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eType of job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eClinical Nursing Care\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e40.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSpecialized nursing care\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e22.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNursing management\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e27.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNursing education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e9.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eTraining on digital literacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eYes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e69.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e30.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003eDuration of digital tools\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026le;2 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e9.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e2-4 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e11.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e4-6 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e32.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026ge;6 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e45.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e2.2 Research Instruments\u003cbr\u003e\u0026nbsp;2.2.1 Digital Literacy Scale\u003cbr\u003e\u0026nbsp;The digital literacy scale was used to assess the digital literacy of clinical nurses. This scale, developed and validated by E Avin\u0026ccedil; and F Doğan [81], is a unidimensional scale consisting of 20 measurement items (e.g., \u0026quot;As a clinical nurse, do you frequently collaborate with other nurses using internet-based software?\u0026quot;). The scale has been widely used in Chinese populations and demonstrates good cultural adaptability\u0026nbsp;[82]. A 5-point Likert scale was used for scoring, ranging from \u0026quot;1 = Strongly Disagree\u0026quot; to \u0026quot;5 = Strongly Agree.\u0026quot; Higher scores indicate higher levels of digital literacy. In this study, the Cronbach\u0026apos;s alpha for the digital literacy scale was 0.961. Confirmatory factor analysis using AMOS 29.0 confirmed good structural validity (CMIN/DF = 3.985, GFI = 0.883, AGFI = 0.835, RMSEA = 0.078, CFI = 0.945, TLI = 0.929).\u003c/p\u003e\n\u003cp\u003e2.2.2 Psychological Safety Climate Scale\u003cbr\u003e\u0026nbsp;The Psychological Safety Climate Scale was adapted from AC Edmondson [38], who developed the original Psychological Safety Scale for team-level assessment. The scale consists of 7 measurement items (e.g., \u0026quot;As a clinical nurse, when a team member makes a mistake, they are not criticized\u0026quot;). A Chinese version of the scale, translated using the back-translation method by Y Liu, L Chen, L Zhao and C Li [83], was used in this study. The 5-point Likert scale was applied, ranging from \u0026quot;1 = Strongly Disagree\u0026quot; to \u0026quot;5 = Strongly Agree.\u0026quot; Higher scores indicate higher levels of psychological safety climate. The Cronbach\u0026apos;s alpha for this scale was 0.849, and confirmatory factor analysis indicated good structural validity (CMIN/DF = 1.871, GFI = 0.986, AGFI = 0.971, RMSEA = 0.042, CFI = 0.989, TLI = 0.984).\u003c/p\u003e\n\u003cp\u003e2.2.3 Situational Awareness Scale\u003cbr\u003e\u0026nbsp;The situational awareness scale was adapted from S Schubert, H Ortwein, A Dumitsch, U Schwantes, O Wilhelm, C Kiessling, S Schubert, H Ortwein, A Dumitsch and U Schwantes [84]. To establish context, participants were instructed: \u0026quot;Imagine you are a nurse in the emergency department. Your surgical supervisor instructs you to suture a forearm laceration and then leaves the room. You have never performed this task before.\u0026quot; Following this scenario, participants answered 5 measurement items (e.g., \u0026quot;As a clinical nurse, do you agree that you will call a familiar general practitioner to assist you over the phone?\u0026quot;). This method has been widely used, as seen in the work of A Hosseinpour and F Keshmiri [85], to assess professional evaluations of medical scenarios. A 5-point Likert scale was used, ranging from \u0026quot;1 = Strongly Disagree\u0026quot; to \u0026quot;5 = Strongly Agree.\u0026quot; Higher scores indicate greater situational awareness. The Cronbach\u0026apos;s alpha for this scale was 0.811, and confirmatory factor analysis confirmed good structural validity (CMIN/DF = 1.686, GFI = 0.993, AGFI = 0.980, RMSEA = 0.037, CFI = 0.995, TLI = 0.990).\u003c/p\u003e\n\u003cp\u003e2.2.4 Team Collaboration Ability Scale\u003cbr\u003e\u0026nbsp;The Nurse Collaboration Scale, which measures team collaboration ability, consists of four dimensions: conflict management, shared goals, communication and coordination, and professionalism and autonomy, comprising a total of 23 items. Developed by C Liao, Y Qin, Y He and Y Guo [86], this scale was validated using a Chinese population and demonstrates good cultural adaptability (e.g., \u0026quot;As a clinical nurse, when disagreements or conflicts arise, do everyone\u0026apos;s feelings and opinions get considered to achieve the best solution?\u0026quot;). A 5-point Likert scale was used, ranging from \u0026quot;1 = Strongly Disagree\u0026quot; to \u0026quot;5 = Strongly Agree.\u0026quot; Higher scores indicate greater team collaboration ability. The Cronbach\u0026apos;s alpha for this scale was 0.928, and confirmatory factor analysis confirmed good structural validity (CMIN/DF = 3.671, GFI = 0.880, AGFI = 0.830, RMSEA = 0.074, CFI = 0.933, TLI = 0.913).\u003c/p\u003e\n\u003cp\u003e2.3 Data Analysis\u003cbr\u003e\u0026nbsp;First, we used AMOS 29.0 to evaluate the goodness of fit for each variable and validate its construct validity. We employed SPSS 27.0 for reliability testing, normality analysis, descriptive statistics, correlation analysis, and common method bias testing. Subsequently, we applied SPSS Process Model 6 to test the chain-like mediation effects of psychological safety climate and situational awareness from a variable-centered perspective. Third, we used Mplus to construct latent profile models of psychological safety climate and situational awareness, testing 1 to 5 profiles and selecting the optimal model based on fit indices. Finally, we conducted single-factor analysis of variance (ANOVA) and post-hoc tests to examine significant differences in team collaboration ability across latent profile categories.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Analysis of Common Method Bias\u003c/h2\u003e\u003cp\u003eCommon method bias can arise from the use of single measurement tools, consistent measurement environments, social expectations, and emotional states. To address this issue, we implemented anonymous data collection and avoided using guiding language in the questionnaires to minimize potential biases in responses. Simultaneously, we conducted Harman's single-factor test by performing exploratory factor analysis on all measured variables. The results showed that nine factors with eigenvalues greater than 1 were extracted, and the first factor explained 32.005% of the variance, which is below the critical threshold of 40%. This indicates that there is no common method bias in this study, supporting the validity of the data.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Descriptive Statistics and Correlation Analysis\u003c/h2\u003e\u003cp\u003eWe conducted correlation and descriptive tests on digital literacy, situational awareness, psychological safety climate, and team collaboration ability to examine the relationships between these variables, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. According to RB Kline [\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e], the skewness of all variables in this study was less than \u0026plusmn;\u0026thinsp;3, and the kurtosis was less than \u0026plusmn;\u0026thinsp;8, indicating that the data followed a normal distribution. The correlation results revealed the following: digital literacy was significantly positively correlated with situational awareness (r\u0026thinsp;=\u0026thinsp;0.433, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), psychological safety climate (r\u0026thinsp;=\u0026thinsp;0.463, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and team collaboration ability (r\u0026thinsp;=\u0026thinsp;0.531, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Situational awareness was also significantly positively correlated with psychological safety climate (r\u0026thinsp;=\u0026thinsp;0.727, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and team collaboration ability (r\u0026thinsp;=\u0026thinsp;0.267, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, psychological safety climate was significantly positively correlated with team collaboration ability (r\u0026thinsp;=\u0026thinsp;0.174, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\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\u003eDescriptive statistics and correlation analysis of each variable.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\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=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSkewness\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eKurtosis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Digital literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.097\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.806\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.579\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Psychological safety climate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.463***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Situational awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.849\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.433***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.727***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Team collaboration ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.757\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.810\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.509\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.531***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.267***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.174***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1\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=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Variable-Centered Analysis\u003c/h2\u003e\u003cp\u003eChain Mediation Test. We treated digital literacy as the independent variable, situational awareness and psychological safety climate as mediating variables, and team collaboration ability as the dependent variable. Using Process Model 6, we tested the chain mediation effects of situational awareness and psychological safety climate. The results showed that digital literacy had a significant impact on team collaboration ability (β\u0026thinsp;=\u0026thinsp;0.504, 95% CI = [0.424, 0.584], P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); digital literacy also had significant effects on situational awareness (β\u0026thinsp;=\u0026thinsp;0.130, 95% CI = [0.058, 0.202], P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and psychological safety climate (β\u0026thinsp;=\u0026thinsp;0.458, 95% CI = [0.380, 0.536], P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, psychological safety climate had a significant effect on situational awareness (β\u0026thinsp;=\u0026thinsp;0.713, 95% CI = [0.641, 0.785], P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and situational awareness had a significant effect on team collaboration ability (β = -0.137, 95% CI = [-0.235, -0.039], P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Psychological safety climate also had a significant effect on team collaboration ability (β\u0026thinsp;=\u0026thinsp;0.124, 95% CI = [0.017, 0.229], P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eOverall, situational awareness exhibited a significant partial mediating effect between digital literacy and team collaboration ability (β = -0.018, SE\u0026thinsp;=\u0026thinsp;0.009, 95% CI = [-0.038, -0.004]); psychological safety climate also showed a significant partial mediating effect (β\u0026thinsp;=\u0026thinsp;0.061, SE\u0026thinsp;=\u0026thinsp;0.027, 95% CI = [0.008, 0.113]). Thus, both psychological safety climate and situational awareness had significant partial chain-mediated effects on the relationship between digital literacy and team collaboration ability (β = -0.045, SE\u0026thinsp;=\u0026thinsp;0.019, 95% CI = [-0.084, -0.011]). The regression coefficients and chain-mediated pathway coefficients are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, and the corresponding graphical representation is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" 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\u003eRegression coefficient table of the chain-type intermediary.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\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=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\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\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003eOverall Fit Index\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e\u003cp\u003eSignificance of Regression Coefficient\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome Variables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePredictive Variables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychological safety climate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDigital literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e134.255***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11.587***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e[0.380, 0.536]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSituational awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePsychological safety climate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.735\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e288.901***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.713\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e19.414***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e[0.641, 0.785]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDigital literacy\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.585***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e[0.058, 0.202]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNursing team collaboration ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDigital literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.541\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e67.849***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.504\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e12.386***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e[0.424, 0.584]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePsychological safety climate\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.294*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e[0.018, 0.229]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSituational awareness\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e-0.137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-2.752**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e[-0.235, -0.039]\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\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Individual Centered Analysis\u003c/h2\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003e3.4.1 Latent Profile Analysis\u003c/h2\u003e\u003cp\u003eTo further examine the predictive effect of digital literacy on different types of nurses and the differences in psychological safety climate and situational awareness they exhibit, we used Mplus software to construct a 5-class latent profile model to determine the best-fitting model, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Specifically, we treated the individual measurement items of situational awareness and psychological safety climate as indicators and evaluated model fit, determining the optimal number of classes using indices such as AIC, BIC, aBIC, LMRT, BLRT, and entropy.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFit analysis of psychological safety climate and situational awareness.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClass\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAIC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBIC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaBIC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEntropy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLMR(P)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBLRT(P)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSmallest proportion per class\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18102.378\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18203.287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18127.111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16808.623\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16964.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16846.753\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.867\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.66 / 0.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16201.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16411.353\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16252.652\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.914\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.11 / 0.64 / 0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16079.455\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16344.342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16144.379\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.52 / 0.27 / 0.09 / 0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16013.601\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16333.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16091.922\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.075\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.06 / 0.09 / 0.44 / 0.28 / 0.13\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\u003eThe results indicated that the entropy values for the 2- to 5-latent profile models of perceived psychological climate and situational awareness all exceeded 0.80, suggesting that the classification accuracy of these models is acceptable. In the five-class model, the p-values for LMRT and BLRT were greater than 0.05, indicating that adding a fifth class did not significantly improve model fit compared to the 2- to 4-class models. However, entropy, which measures the clarity of classification into latent profiles, is closer to 1, indicating clearer classification. Therefore, compared to the 2- and 4-class models, the 3-class latent profile model was considered the most parsimonious with the clearest classification (Entropy\u0026thinsp;=\u0026thinsp;0.914).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003e3.4.2 Subgroup Classification\u003c/h2\u003e\u003cp\u003eBased on the analysis in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, we constructed three subgroups, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The first class was labeled as high psychological safety climate-high situational awareness, comprising 54 nurses and accounting for 11%. The second class was labeled as medium psychological safety climate-medium situational awareness, comprising 317 nurses and accounting for 64%. The third class was labeled as low psychological safety climate-low situational awareness, comprising 124 nurses and accounting for 25%.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003e3.4.3 Latent Profiles and Nursing Team Collaboration Ability\u003c/h2\u003e\u003cp\u003eWe conducted ANOVA and post-hoc tests to examine the differences in team collaboration ability across the three latent profiles, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The results indicated that the high situational awareness-high psychological safety climate group (M\u0026thinsp;=\u0026thinsp;3.244, SD\u0026thinsp;=\u0026thinsp;0.706) had significantly higher team collaboration ability compared to the low situational awareness-low psychological safety climate group (M\u0026thinsp;=\u0026thinsp;2.621, SD\u0026thinsp;=\u0026thinsp;0.717) and the medium situational awareness-medium psychological safety climate group (M\u0026thinsp;=\u0026thinsp;3.029, SD\u0026thinsp;=\u0026thinsp;0.754), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, F\u0026thinsp;=\u0026thinsp;13.347. These findings demonstrate significant differences in team collaboration ability across the three profiles, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\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 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOne-way ANOVA and post hoc tests for Latent categories and Nursing team collaboration ability.\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=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClass\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\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\u003ePost hoc test\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. High psychological safety climate - High situational awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.706\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13.347\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u0026thinsp;\u0026gt;\u0026thinsp;2\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Medium psychological safety climate - Medium situational awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Low psychological safety climate - Low situational awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.717\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Personal-Centered Perspective\u003c/h2\u003e\u003cp\u003eThis study employed latent profile analysis to identify three distinct latent profiles of situational awareness and psychological safety climate among clinical nurses. The first group, characterized by low psychological safety climate and low situational awareness, exhibited sluggish responses to dynamic changes in the work environment and a pervasive fear of negative evaluations resulting from speaking up or making mistakes. The second group, marked by medium psychological safety climate and situational awareness, demonstrated basic environmental interpretation skills, expressing concerns cautiously in most situations. The third group, characterized by a high psychological safety climate and situational awareness, demonstrated keen environmental awareness and the confidence to express opinions freely and take responsibility in a highly trusting atmosphere. These findings differ significantly from previous studies, which suggested that a high psychological safety climate leads to low situational awareness [\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e]. This discrepancy may stem from the unique characteristics of the healthcare industry, such as high risks, strong interdependence, and strict hierarchical systems [\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e], which make the coexistence of high psychological safety and low situational awareness unsustainable among nurses. The vigilance of clinical nurses may either decrease due to suppression or gradually build up in supportive interactions, ultimately leading to a collaborative development model where situational awareness and psychological safety climate evolve together.\u003c/p\u003e\u003cp\u003eFrom the perspective of dynamic systems theory [\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e], situational awareness and psychological safety climate are not static traits but rather adaptive behavioral states that emerge in real-time within specific nursing contexts. These states are the immediate expressions of the complex interplay between nurses' internal cognitive-emotional traits and external environmental pressures. For instance, in high-pressure situations, nurses typically classified in the medium situational awareness and psychological safety climate group may shift to a high situational awareness state when facing a critically ill patient with rapidly deteriorating conditions. This highlights that the combination of high and low levels of situational awareness and psychological safety climate can provide a more comprehensive reflection of the psychological characteristics and behavioral patterns of clinical nurses. Specifically, the low situational awareness and low psychological safety climate state may indicate that nurses lack sensitivity to environmental information and the confidence to express their opinions in the work environment. In contrast, the high situational awareness and high psychological safety climate state reflect nurses' ability to efficiently process environmental information and express their opinions openly and confidently within the team.\u003c/p\u003e\u003cp\u003eThe distribution proportions of the latent profiles revealed the uneven existence of situational awareness and psychological safety climate states among clinical nurses. The high situational awareness and high psychological safety climate group accounted for the smallest proportion (11%), typically comprising experienced nurses in units with strong leadership support. The low situational awareness and low psychological safety climate group represented 25% of the sample, often associated with individuals experiencing long-term burnout or working in suppressive environments. The majority of nurses (64%) fell into the medium situational awareness and psychological safety climate group, forming the main body of clinical nurses. This distribution indicates that possessing high levels of both situational awareness and psychological safety is not common among nurses, but severely low-performing states are also rare. Most nurses possess basic environmental interpretation skills and can express opinions when risks are controllable. Yet, they remain cautious about potential interpersonal risks, especially during cross-hierarchical communication or when handling high-uncertainty clinical decisions. This structure highlights the substantial potential for enhancing situational awareness and psychological safety climate among nurses, particularly in transitioning from medium to high levels of psychological safety and situational awareness.\u003c/p\u003e\u003cp\u003eContemporary clinical nurses operate in an era dominated by digital information and social media, fostering a familiarity with immediate, transparent, and interactive communication patterns. However, the high uncertainty, strong hierarchical traditions, and ongoing digital transformation of healthcare environments shape their work realities. While abundant information sources could enhance situational awareness, information overload and fragmentation may lead to cognitive overload, weakening the ability to interpret critical situational cues. Additionally, the high-stakes nature of healthcare, the prevalence of medical litigation, and persistent resource constraints collectively foster psychological insecurity. The intersection of these era-specific and occupational characteristics renders nurses' situational awareness highly susceptible to disturbances from information flows. At the same time, their psychological safety becomes fragile under authoritative communication patterns and performance pressures, easily slipping into medium or low situational awareness and psychological safety states, particularly in the absence of strong team leadership.\u003c/p\u003e\u003cp\u003eGiven the significant impact of situational awareness and psychological safety climate on the work performance and professional development of clinical nurses, including their effects on nursing efficiency, team collaboration, and patient care quality, hospital administrators and nursing education institutions should prioritize addressing these issues. Specifically, healthcare organizations should establish supportive work environments, encourage nurses to express their opinions and suggestions, and provide psychological counseling resources to enhance the psychological safety climate. Additionally, nursing education departments should incorporate situational awareness training into nursing curricula to help nurses better perceive and respond to complex work environments. These measures could effectively improve clinical nurses' situational awareness and psychological safety climate, thereby enhancing the efficiency of medical teams and the quality of patient care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Variable-Centered Perspective\u003c/h2\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003e4.2.1 Theoretical Implications\u003c/h2\u003e\u003cp\u003eThis study validated the significant positive predictive effect of nurses' digital literacy on nursing team collaboration capability. This finding underscores the importance of nurses' ability to acquire, evaluate, and apply digital health information and tools in facilitating efficient collaboration during the digital transformation of healthcare. Nurses with high digital literacy can more accurately utilize digital tools to share critical patient data in real-time, coordinate task handoffs via mobile nursing terminals, and engage in cross-professional consultations via remote collaboration platforms. For instance, nurses skilled in using clinical decision support systems can quickly identify changes in patient risks and proactively initiate team alerts, reducing emergency response times [\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e]. This work efficiency, derived from digital capabilities, not only optimizes information flow but also minimizes communication friction and information errors [\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e]. This further strengthens the foundation of trust and the efficiency of team collaboration, providing a new pathway for high-quality nursing services.\u003c/p\u003e\u003cp\u003eImproving nurses' digital literacy reduces work aversion caused by information errors and enhances their sense of psychological safety within the team. Specifically, when nurses are proficient in digital tools, their technical anxiety decreases significantly, enabling them to ask questions and report errors in digital work scenarios without fear of negative evaluations. For example, nurses proficient in using medication safety systems are more likely to identify potential drug incompatibilities during team meetings. This digitally enabled safe expression allows teams to transform technical advantages into open knowledge sharing and constructive debates. Notably, digital literacy reduces the suppressive effects of hierarchical notions on communication by enhancing nurses' control over technical interactions, making cross-level collaboration more fluid, and increasing team collaboration efficiency.\u003c/p\u003e\u003cp\u003eIn addition to psychological safety climate, situational awareness also plays a mediating role in the relationship between digital literacy and team collaboration capability. Nurses with high digital health literacy can more quickly and accurately identify changing clinical information when using electronic health records, remote monitoring systems, or smart assistive devices, thereby forming a more comprehensive situational awareness. This cognitive advantage is further translated into critical capabilities in multitasking, team coordination, and rapid response, enhancing the timeliness and consistency of collaborative behaviors. Furthermore, nurses' situational awareness helps strengthen their shared understanding of team goals, role distributions, and action plans, reducing information discrepancies and role conflicts in collaboration. Therefore, situational awareness not only serves as a cognitive bridge connecting digital literacy and collaboration capability but also provides cognitive support for nursing teams to maintain consistent operations in dynamic, high-risk environments. Nursing managers should promote situational awareness through simulations, multi-scenario exercises, and the integration of digital tools to maximize the functional transformation of digital literacy in team collaboration.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section3\"\u003e\u003ch2\u003e4.2.2 Practical Implications\u003c/h2\u003e\u003cp\u003eTraditional nursing education often emphasizes the mastery of basic nursing techniques and disease knowledge. Still, this study underscores the importance of incorporating digital literacy as a crucial component in the professional competence framework for nurses. It is essential to note that merely teaching the technical skills of digital tools is insufficient; it is also necessary to combine situational awareness training with the cultivation of a psychological safety culture to truly transform digital capabilities into team performance. Therefore, nursing education systems should introduce scenario-based digital interaction training, such as virtual reality-based team simulations and task coordination operations using electronic health record systems, to enhance nurses' environmental adaptability and technical sensitivity through highly realistic situational training. Additionally, psychological safety climate should be integrated into the educational process by fostering mutual trust, open feedback, and a culture of cooperation among students, laying the foundation for them to express opinions and collaborate efficiently in real clinical environments safely. This systemic nurturing approach not only helps improve nurses' abilities in information identification, risk judgment, and collaborative communication but also effectively shortens the transition period from student to clinical backbone, aligning education with practice.\u003c/p\u003e\u003cp\u003eThis study provides scientific evidence to support hospitals in optimizing their organizational management strategies and enhancing service quality. It clarifies the critical role of nurses' digital literacy in enhancing collaboration capability and identifies the mediating mechanisms of psychological safety climate and situational awareness in organizational behavior regulation. Managers can adjust human resource management practices accordingly, incorporating digital capabilities and collaboration performance into recruitment, training, promotion, and performance evaluation standards. For instance, performance evaluations could include not only the accuracy of nursing operations but also the quality of information processing, efficiency, and team communication feedback on digital platforms. Additionally, fostering a supportive psychological climate is an important direction for management reform. Hospitals can establish psychological safety feedback mechanisms, anonymous suggestion platforms, and leader-participatory management practices to encourage nurses to express their doubts and suggestions more freely during technical operations and clinical judgments, thereby enhancing transparency and collaboration. In summary, this study offers guidance for hospitals to cultivate a nursing organizational culture characterized by efficient collaboration, high situational responsiveness, and strong psychological safety, ultimately improving overall nursing quality and patient safety levels.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Limitations and Future Research Directions\u003c/h2\u003e\u003cp\u003eDespite revealing the chain-like mediating mechanism of psychological safety climate and situational awareness between nurses' digital literacy and team collaboration capability, this study has certain limitations that may affect the external validity of the results. First, the study employed a cross-sectional research design, with data collection concentrated in a specific time window, making it impossible to reveal the causal direction and long-term dynamic changes between variables. The formation and evolution of digital literacy, situational awareness, and psychological safety climate are influenced by various dynamic factors. Future studies should consider adopting longitudinal designs to dynamically observe how these psychological variables interact and impact team collaboration in digital environments.\u003c/p\u003e\u003cp\u003eSecond, the sample was drawn from Grade A tertiary hospitals in eastern China. The regional concentration and relatively uniform organizational culture of the sample limit the generalizability of the findings to other regions, different types of healthcare institutions, and diverse nursing populations. Future research should expand the sample coverage to include hospitals of different levels, regions with significant cultural differences, and diverse nursing professionals to enhance the study's representativeness and applicability.\u003c/p\u003e\u003cp\u003eThird, this study only examined psychological safety climate and situational awareness as mediating variables and did not investigate whether any moderating variables exist between them, which may lead to some bias in the interpretation of the results. For example, factors such as nurses' age, clinical experience, technical training background, and the technical intensity of their departments may significantly influence their digital literacy and alter the roles of situational awareness and psychological safety climate. Additionally, the study did not fully consider the potential influence of organizational culture, leadership styles, and task complexity, which may play critical moderating roles in the mediating pathways. For instance, in authoritative or highly structured management environments, even nurses with high digital literacy may have their expressions and collaborative behaviors suppressed, preventing them from fully utilizing their potential.\u003c/p\u003e\u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThis study systematically explored how clinical nurses' digital literacy enhances nursing team collaboration capability through a chain-like mediating pathway involving situational awareness and psychological safety climate, adopting both variable-centered and individual-centered perspectives. The findings revealed the deep mechanisms by which nurses' cognitive and emotional systems influence the efficiency of team collaboration in the digital era. The results confirm that nurses' digital literacy not only significantly predicts their team collaboration capability but also transforms individual digital abilities into collaboration capabilities through enhanced psychological safety climate and situational awareness. Specifically, nurses with high digital literacy are better equipped to operate digital tools, process multi-source data, and actively participate in decision-making, reducing collaboration barriers caused by information errors or delays. Moreover, a high psychological safety climate encourages nurses to express opinions and provide feedback freely within the team, lowering communication costs and promoting the sharing of digital technology experiences. Furthermore, this sense of safety provides the emotional foundation for developing situational awareness, enabling nurses to more acutely perceive and understand dynamic clinical scenarios, thereby fostering efficient and precise team actions. The individual-centered analysis revealed significant differences in team collaboration capabilities among nurses with varying combinations of situational awareness and psychological safety climate. The subgroup characterized by \"high situational awareness-high psychological safety climate\" demonstrated the highest collaboration levels. This underscores the importance of optimizing situational awareness and psychological safety climate to enhance team collaboration capabilities among nurses. Overall, this study not only expands the theoretical boundaries of digital literacy in the nursing field but also provides evidence-based recommendations for hospital administrators on nurse training, organizational culture development, and the optimization of collaboration mechanisms. Future research should explore the cross-context applicability of this mechanism in multi-level nursing collaboration systems and adopt longitudinal designs to capture the dynamic evolution of digital literacy's influence, thereby driving the systematic upgrading and high-quality development of digitalized nursing systems.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eI confirm that all methods were performed according to the relevant guidelines. All procedures were performed by the ethical standards outlined in the 1964 Declaration of Helsinki and its subsequent amendments.\u0026nbsp;The study obtained informed consent from the all participants. This study involved human participants, and we obtained review and approval from the Academic Ethics Committee of Affiliated Hangzhou Hospital of Zhejiang Chinese Medical University (No. 2025KLL174).\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNo individual or organization funded the study.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on\u0026nbsp;reasonable\u0026nbsp;request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributionsAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eX.Z. and Z.A. contributed to the methodology, data organization, and writing; H.Z. contributed to the article\u0026apos;s data and paper writing; B.W. contributed to the article\u0026apos;s data; L.L. contributed to the methodology, data organization, and writing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to express my sincere gratitude to the editor and the reviewers for their hard work, which has greatly improved this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWang B, Shi X, Han X, Xiao G: \u003cstrong\u003eThe digital transformation of nursing practice: an analysis of advanced IoT technologies and smart nursing systems\u003c/strong\u003e. \u003cem\u003eFront Med (Lausanne) \u003c/em\u003e2024, \u003cstrong\u003e11\u003c/strong\u003e:1471527.\u003c/li\u003e\n\u003cli\u003eAlenezi A, Alshammari MH, Ibrahim IA: \u003cstrong\u003eOptimizing Nursing Productivity: Exploring the Role of Artificial Intelligence, Technology Integration, Competencies, and Leadership\u003c/strong\u003e. \u003cem\u003eJ Nurs Manag \u003c/em\u003e2024, \u003cstrong\u003e2024\u003c/strong\u003e:8371068.\u003c/li\u003e\n\u003cli\u003eDailah HG, Koriri M, Sabei A, Kriry T, Zakri M: \u003cstrong\u003eArtificial Intelligence in Nursing: Technological Benefits to Nurse\u0026apos;s Mental Health and Patient Care Quality\u003c/strong\u003e. \u003cem\u003eHealthcare (Basel) \u003c/em\u003e2024, \u003cstrong\u003e12\u003c/strong\u003e(24).\u003c/li\u003e\n\u003cli\u003eSai S, Gaur A, Sai R, Chamola V, Guizani M, Rodrigues JJ: \u003cstrong\u003eGenerative ai for transformative healthcare: A comprehensive study of emerging models, applications, case studies and limitations\u003c/strong\u003e. \u003cem\u003eIEEE Access \u003c/em\u003e2024.\u003c/li\u003e\n\u003cli\u003eMishra S, Chaudhury P, Tripathy HK, Sahoo KS, Jhanjhi NZ, Hassan Elnour AA, Abdelmaboud A: \u003cstrong\u003eEnhancing health care through medical cognitive virtual agents\u003c/strong\u003e. \u003cem\u003eDigit Health \u003c/em\u003e2024, \u003cstrong\u003e10\u003c/strong\u003e:20552076241256732.\u003c/li\u003e\n\u003cli\u003ePavel M, Jimison HB, Wactlar HD, Hayes TL, Barkis W, Skapik J, Kaye J: \u003cstrong\u003eThe role of technology and engineering models in transforming healthcare\u003c/strong\u003e. \u003cem\u003eIEEE Rev Biomed Eng \u003c/em\u003e2013, \u003cstrong\u003e6\u003c/strong\u003e:156-177.\u003c/li\u003e\n\u003cli\u003eVicente AM, Ballensiefen W, J\u0026ouml;nsson JI: \u003cstrong\u003eHow personalised medicine will transform healthcare by 2030: the ICPerMed vision\u003c/strong\u003e. \u003cem\u003eJ Transl Med \u003c/em\u003e2020, \u003cstrong\u003e18\u003c/strong\u003e(1):180.\u003c/li\u003e\n\u003cli\u003eAl-Natour A, Abuziad L, Hweidi LI: \u003cstrong\u003eNurses\u0026apos; experiences of workplace violence in the emergency department\u003c/strong\u003e. \u003cem\u003eInt Nurs Rev \u003c/em\u003e2023, \u003cstrong\u003e70\u003c/strong\u003e(4):485-493.\u003c/li\u003e\n\u003cli\u003eProvenzano M, Cillara N, Curcio F, Pisu MO, Gonz\u0026aacute;lez CIA, Jim\u0026eacute;nez-Herrera MF: \u003cstrong\u003eElectronic Health Record Adoption and Its Effects on Healthcare Staff: A Qualitative Study of Well-Being and Workplace Stress\u003c/strong\u003e. \u003cem\u003eInt J Environ Res Public Health \u003c/em\u003e2024, \u003cstrong\u003e21\u003c/strong\u003e(11).\u003c/li\u003e\n\u003cli\u003eKr\u0026auml;ft J, Wirth T, Harth V, Mache S: \u003cstrong\u003eDigital stress perception among German hospital nurses and associations with health-oriented leadership, emotional exhaustion and work-privacy conflict: a cross-sectional study\u003c/strong\u003e. \u003cem\u003eBMC Nurs \u003c/em\u003e2024, \u003cstrong\u003e23\u003c/strong\u003e(1):213.\u003c/li\u003e\n\u003cli\u003eSchmitt JB, Breuer J, Wulf T: \u003cstrong\u003eFrom cognitive overload to digital detox: Psychological implications of telework during the COVID-19 pandemic\u003c/strong\u003e. \u003cem\u003eComput Human Behav \u003c/em\u003e2021, \u003cstrong\u003e124\u003c/strong\u003e:106899.\u003c/li\u003e\n\u003cli\u003eRutkowski A-F, Saunders C: \u003cstrong\u003eEmotional and cognitive overload: the dark side of information technology\u003c/strong\u003e: Routledge; 2018.\u003c/li\u003e\n\u003cli\u003eLee S, Lee MS: \u003cstrong\u003eNurses\u0026apos; Electronic Medical Record Workarounds in a Tertiary Teaching Hospital\u003c/strong\u003e. \u003cem\u003eComput Inform Nurs \u003c/em\u003e2021, \u003cstrong\u003e39\u003c/strong\u003e(7):367-374.\u003c/li\u003e\n\u003cli\u003eComparcini D, Simonetti V, Tomietto M, Pastore F, Totaro M, Ballerini P, Trerotoli P, Mikkonen K, Cicolini G: \u003cstrong\u003eThe Relationship Between Nurses\u0026apos; Digital Health Literacy and Their Educational Levels, Professional Roles, and Digital Attitudes: A Cluster Analysis Based on a Cross-Sectional Study\u003c/strong\u003e. \u003cem\u003eJ Clin Nurs \u003c/em\u003e2024.\u003c/li\u003e\n\u003cli\u003eHolt KA, Overgaard D, Engel LV, Kayser L: \u003cstrong\u003eHealth literacy, digital literacy and eHealth literacy in Danish nursing students at entry and graduate level: a cross sectional study\u003c/strong\u003e. \u003cem\u003eBMC Nurs \u003c/em\u003e2020, \u003cstrong\u003e19\u003c/strong\u003e:22.\u003c/li\u003e\n\u003cli\u003eDijkman EM, Ter Brake WWM, Drossaert CHC, Doggen CJM: \u003cstrong\u003eAssessment Tools for Measuring Health Literacy and Digital Health Literacy in a Hospital Setting: A Scoping Review\u003c/strong\u003e. \u003cem\u003eHealthcare (Basel) \u003c/em\u003e2023, \u003cstrong\u003e12\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eZhao BY, Chen MR, Lin R, Yan YJ, Li H: \u003cstrong\u003eInfluence of information anxiety on core competency of registered nurses: mediating effect of digital health literacy\u003c/strong\u003e. \u003cem\u003eBMC Nurs \u003c/em\u003e2024, \u003cstrong\u003e23\u003c/strong\u003e(1):626.\u003c/li\u003e\n\u003cli\u003eAbou Hashish EA, Alnajjar H: \u003cstrong\u003eDigital proficiency: assessing knowledge, attitudes, and skills in digital transformation, health literacy, and artificial intelligence among university nursing students\u003c/strong\u003e. \u003cem\u003eBMC Med Educ \u003c/em\u003e2024, \u003cstrong\u003e24\u003c/strong\u003e(1):508.\u003c/li\u003e\n\u003cli\u003eGuillari A, Sansone V, Giordano V, Catone M, Rea T: \u003cstrong\u003eAssessing digital health knowledge, attitudes and practices among nurses in Naples: a survey study protocol\u003c/strong\u003e. \u003cem\u003eBMJ Open \u003c/em\u003e2024, \u003cstrong\u003e14\u003c/strong\u003e(6):e081721.\u003c/li\u003e\n\u003cli\u003eKwon M, Oh J: \u003cstrong\u003eThe relationship between depression, anxiety, e-health literacy, and health-promoting behavior in nursing students during COVID-19\u003c/strong\u003e. \u003cem\u003eMedicine (Baltimore) \u003c/em\u003e2023, \u003cstrong\u003e102\u003c/strong\u003e(6):e32809.\u003c/li\u003e\n\u003cli\u003eLi J, Tian Y, Zhou T: \u003cstrong\u003eElectronic Medical Record Systems\u003c/strong\u003e. In: \u003cem\u003eHealthcare Information Systems: Progress, Challenges and Future Directions.\u003c/em\u003e edn.: Springer; 2024: 29-68.\u003c/li\u003e\n\u003cli\u003eBLOG RO: \u003cstrong\u003eBlog Posts\u003c/strong\u003e. \u003cem\u003ePain \u003c/em\u003e2025, \u003cstrong\u003e6\u003c/strong\u003e:0.\u003c/li\u003e\n\u003cli\u003eDespins LA, Wakefield BJ: \u003cstrong\u003eThe Role of the Electronic Medical Record in the Intensive Care Unit Nurse\u0026apos;s Detection of Patient Deterioration: A Qualitative Study\u003c/strong\u003e. \u003cem\u003eComput Inform Nurs \u003c/em\u003e2018, \u003cstrong\u003e36\u003c/strong\u003e(6):284-292.\u003c/li\u003e\n\u003cli\u003eMcCallin A, Bamford A: \u003cstrong\u003eInterdisciplinary teamwork: is the influence of emotional intelligence fully appreciated?\u003c/strong\u003e \u003cem\u003eJ Nurs Manag \u003c/em\u003e2007, \u003cstrong\u003e15\u003c/strong\u003e(4):386-391.\u003c/li\u003e\n\u003cli\u003eAl-Hamdan ZM, Alyahia M, Al-Maaitah R, Alhamdan M, Faouri I, Al-Smadi AM, Bawadi H: \u003cstrong\u003eThe Relationship Between Emotional Intelligence and Nurse-Nurse Collaboration\u003c/strong\u003e. \u003cem\u003eJ Nurs Scholarsh \u003c/em\u003e2021, \u003cstrong\u003e53\u003c/strong\u003e(5):615-622.\u003c/li\u003e\n\u003cli\u003eWitges KA, Scanlan JM: \u003cstrong\u003eDoes Synergy Exist in Nursing? A Concept Analysis\u003c/strong\u003e. \u003cem\u003eNurs Forum \u003c/em\u003e2015, \u003cstrong\u003e50\u003c/strong\u003e(3):189-195.\u003c/li\u003e\n\u003cli\u003eHurlburt M, Aarons GA, Fettes D, Willging C, Gunderson L, Chaffin MJ: \u003cstrong\u003eInteragency collaborative team model for capacity building to scale-up evidence-based practice\u003c/strong\u003e. \u003cem\u003eChildren and Youth Services Review \u003c/em\u003e2014, \u003cstrong\u003e39\u003c/strong\u003e:160-168.\u003c/li\u003e\n\u003cli\u003eDun L: \u003cstrong\u003eRelationships among self-study ability, critical thinking ability, cooperative ability and problem-solving ability in Chinese undergraduate nursing students: An analysis of a longitudinal cohort via cross-lagged models\u003c/strong\u003e. \u003cem\u003eFrontiers in Psychology \u003c/em\u003e2025, \u003cstrong\u003e16\u003c/strong\u003e:1606156.\u003c/li\u003e\n\u003cli\u003eYamamoto K: \u003cstrong\u003eAssociation Between Interdisciplinary Collaboration and Leadership Ability in Intensive Care Unit Nurses: A Cross-Sectional Study\u003c/strong\u003e. \u003cem\u003eJ Nurs Res \u003c/em\u003e2022, \u003cstrong\u003e30\u003c/strong\u003e(2):e202.\u003c/li\u003e\n\u003cli\u003eBerduzco-Torres N, Choquenaira-Calla\u0026ntilde;aupa B, Medina P, Chihuantito-Abal LA, Caballero S, Gallegos E, San-Mart\u0026iacute;n M, Delgado Bolton RC, Vivanco L: \u003cstrong\u003eFactors Related to the Differential Development of Inter-Professional Collaboration Abilities in Medicine and Nursing Students\u003c/strong\u003e. \u003cem\u003eFront Psychol \u003c/em\u003e2020, \u003cstrong\u003e11\u003c/strong\u003e:432.\u003c/li\u003e\n\u003cli\u003eZhang J, Cui Q: \u003cstrong\u003eCollaborative Learning in Higher Nursing Education: A Systematic Review\u003c/strong\u003e. \u003cem\u003eJ Prof Nurs \u003c/em\u003e2018, \u003cstrong\u003e34\u003c/strong\u003e(5):378-388.\u003c/li\u003e\n\u003cli\u003eWeinberg DB, Cooney-Miner D, Perloff JN, Babington L, Avgar AC: \u003cstrong\u003eBuilding collaborative capacity: promoting interdisciplinary teamwork in the absence of formal teams\u003c/strong\u003e. \u003cem\u003eMed Care \u003c/em\u003e2011, \u003cstrong\u003e49\u003c/strong\u003e(8):716-723.\u003c/li\u003e\n\u003cli\u003eSharma M, Sharma S: \u003cstrong\u003eA holistic approach to remote patient monitoring, fueled by ChatGPT and Metaverse technology: The future of nursing education\u003c/strong\u003e. \u003cem\u003eNurse Educ Today \u003c/em\u003e2023, \u003cstrong\u003e131\u003c/strong\u003e:105972.\u003c/li\u003e\n\u003cli\u003eKehyayan V, Yasin YM, Al-Hamad A: \u003cstrong\u003eToward a Clearer Understanding of Value-Based Healthcare: A Concept Analysis\u003c/strong\u003e. \u003cem\u003eJ Nurs Manag \u003c/em\u003e2025, \u003cstrong\u003e2025\u003c/strong\u003e:8186530.\u003c/li\u003e\n\u003cli\u003eYıldız E: \u003cstrong\u003eArtificial Intelligence in Mental Health Nursing: Balancing Clinical Efficiency and the Human Touch-A Quest for a New Synthesis\u003c/strong\u003e. \u003cem\u003eJ Psychiatr Ment Health Nurs \u003c/em\u003e2025, \u003cstrong\u003e32\u003c/strong\u003e(4):946-952.\u003c/li\u003e\n\u003cli\u003eJayousi S, Barchielli C, Alaimo M, Caputo S, Paffetti M, Zoppi P, Mucchi L: \u003cstrong\u003eICT in Nursing and Patient Healthcare Management: Scoping Review and Case Studies\u003c/strong\u003e. \u003cem\u003eSensors (Basel) \u003c/em\u003e2024, \u003cstrong\u003e24\u003c/strong\u003e(10).\u003c/li\u003e\n\u003cli\u003eStevens ER, Alfaro Arias V, Luu S, Lawrence K, Groom L: \u003cstrong\u003eTechnology Integration to Support Nurses in an \u0026quot;Inpatient Room of the Future\u0026quot;: Qualitative Analysis\u003c/strong\u003e. \u003cem\u003eJ Med Internet Res \u003c/em\u003e2025, \u003cstrong\u003e27\u003c/strong\u003e:e68689.\u003c/li\u003e\n\u003cli\u003eEdmondson AC: \u003cstrong\u003eSpeaking up in the operating room: How team leaders promote learning in interdisciplinary action teams\u003c/strong\u003e. \u003cem\u003eJournal of management studies \u003c/em\u003e2003, \u003cstrong\u003e40\u003c/strong\u003e(6):1419-1452.\u003c/li\u003e\n\u003cli\u003eOrtega A, Van den Bossche P, S\u0026aacute;nchez-Manzanares M, Rico R, Gil F: \u003cstrong\u003eThe influence of change-oriented leadership and psychological safety on team learning in healthcare teams\u003c/strong\u003e. \u003cem\u003eJournal of business and psychology \u003c/em\u003e2014, \u003cstrong\u003e29\u003c/strong\u003e(2):311-321.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Donovan R, McAuliffe E: \u003cstrong\u003eA systematic review of factors that enable psychological safety in healthcare teams\u003c/strong\u003e. \u003cem\u003eInt J Qual Health Care \u003c/em\u003e2020, \u003cstrong\u003e32\u003c/strong\u003e(4):240-250.\u003c/li\u003e\n\u003cli\u003eIyasere CA, Wing J, Martel JN, Healy MG, Park YS, Finn KM: \u003cstrong\u003eEffect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams: A Randomized Clinical Trial\u003c/strong\u003e. \u003cem\u003eJAMA Intern Med \u003c/em\u003e2022, \u003cstrong\u003e182\u003c/strong\u003e(11):1190-1198.\u003c/li\u003e\n\u003cli\u003eGrailey KE, Murray E, Reader T, Brett SJ: \u003cstrong\u003eThe presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis\u003c/strong\u003e. \u003cem\u003eBMC Health Serv Res \u003c/em\u003e2021, \u003cstrong\u003e21\u003c/strong\u003e(1):773.\u003c/li\u003e\n\u003cli\u003eAlharbi A, Alkubati SA, Albaqawi H, Ali AZ, Hamed LA, Mohammed S, Cornejo LTO, Pasay-An E: \u003cstrong\u003eRelationship between nursing work environment and clinical decision-making among Saudi nurses: psychological empowerment as mediator\u003c/strong\u003e. \u003cem\u003eBMC Nurs \u003c/em\u003e2025, \u003cstrong\u003e24\u003c/strong\u003e(1):682.\u003c/li\u003e\n\u003cli\u003eMoake TR, Oh N, Steele CR: \u003cstrong\u003eThe importance of team psychological safety climate for enhancing younger team members\u0026rsquo; innovation-related behaviors in South Korea\u003c/strong\u003e. \u003cem\u003eInternational Journal of Cross Cultural Management \u003c/em\u003e2019, \u003cstrong\u003e19\u003c/strong\u003e(3):353-368.\u003c/li\u003e\n\u003cli\u003eEdmondson AC: \u003cstrong\u003eManaging the risk of learning: Psychological safety in work teams\u003c/strong\u003e. \u003cem\u003eInternational handbook of organizational teamwork and cooperative working \u003c/em\u003e2008:255-275.\u003c/li\u003e\n\u003cli\u003eEl-Ashry AM, Mohamed Elsayed Abdo B, Khedr MA, El-Sayed MM, Abdelhay IS, Abou Zeid MG: \u003cstrong\u003eMediating effect of psychological safety on the relationship between inclusive leadership and nurses\u0026apos; absenteeism\u003c/strong\u003e. \u003cem\u003eBMC Nurs \u003c/em\u003e2025, \u003cstrong\u003e24\u003c/strong\u003e(1):826.\u003c/li\u003e\n\u003cli\u003eNoriega Del Valle M, Łaba K, Mayer C-H: \u003cstrong\u003eUnlocking technology acceptance among South African employees: A psychological perspective\u003c/strong\u003e. \u003cem\u003eSA Journal of Industrial Psychology \u003c/em\u003e2024, \u003cstrong\u003e50\u003c/strong\u003e:2177.\u003c/li\u003e\n\u003cli\u003eIsidori V, Diamanti F, Gios L, Malfatti G, Perini F, Nicolini A, Longhini J, Forti S, Fraschini F, Bizzarri G\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eDigital Technologies and the Role of Health Care Professionals: Scoping Review Exploring Nurses\u0026apos; Skills in the Digital Era and in the Light of the COVID-19 Pandemic\u003c/strong\u003e. \u003cem\u003eJMIR Nurs \u003c/em\u003e2022, \u003cstrong\u003e5\u003c/strong\u003e(1):e37631.\u003c/li\u003e\n\u003cli\u003eWynn M, Garwood-Cross L, Vasilica C, Griffiths M, Heaslip V, Phillips N: \u003cstrong\u003eDigitizing nursing: A theoretical and holistic exploration to understand the adoption and use of digital technologies by nurses\u003c/strong\u003e. \u003cem\u003eJ Adv Nurs \u003c/em\u003e2023, \u003cstrong\u003e79\u003c/strong\u003e(10):3737-3747.\u003c/li\u003e\n\u003cli\u003eKang SJ, Min HY: \u003cstrong\u003ePsychological Safety in Nursing Simulation\u003c/strong\u003e. \u003cem\u003eNurse Educ \u003c/em\u003e2019, \u003cstrong\u003e44\u003c/strong\u003e(2):E6-e9.\u003c/li\u003e\n\u003cli\u003eSingh B, Shaffer MA, Selvarajan T: \u003cstrong\u003eAntecedents of organizational and community embeddedness: The roles of support, psychological safety, and need to belong\u003c/strong\u003e. \u003cem\u003eJournal of Organizational Behavior \u003c/em\u003e2018, \u003cstrong\u003e39\u003c/strong\u003e(3):339-354.\u003c/li\u003e\n\u003cli\u003eLeever AM, Hulst MV, Berendsen AJ, Boendemaker PM, Roodenburg JL, Pols J: \u003cstrong\u003eConflicts and conflict management in the collaboration between nurses and physicians - a qualitative study\u003c/strong\u003e. \u003cem\u003eJ Interprof Care \u003c/em\u003e2010, \u003cstrong\u003e24\u003c/strong\u003e(6):612-624.\u003c/li\u003e\n\u003cli\u003eAdams MJ, Tenney YJ, Pew RW: \u003cstrong\u003eSituation awareness and the cognitive management of complex systems\u003c/strong\u003e. \u003cem\u003eHuman factors \u003c/em\u003e1995, \u003cstrong\u003e37\u003c/strong\u003e(1):85-104.\u003c/li\u003e\n\u003cli\u003eMunir A, Aved A, Blasch E: \u003cstrong\u003eSituational awareness: techniques, challenges, and prospects\u003c/strong\u003e. \u003cem\u003eAI \u003c/em\u003e2022, \u003cstrong\u003e3\u003c/strong\u003e(1):55-77.\u003c/li\u003e\n\u003cli\u003eStubbings L, Chaboyer W, McMurray A: \u003cstrong\u003eNurses\u0026apos; use of situation awareness in decision-making: an integrative review\u003c/strong\u003e. \u003cem\u003eJ Adv Nurs \u003c/em\u003e2012, \u003cstrong\u003e68\u003c/strong\u003e(7):1443-1453.\u003c/li\u003e\n\u003cli\u003eTower M, Watson B, Bourke A, Tyers E, Tin A: \u003cstrong\u003eSituation awareness and the decision-making processes of final-year nursing students\u003c/strong\u003e. \u003cem\u003eJ Clin Nurs \u003c/em\u003e2019, \u003cstrong\u003e28\u003c/strong\u003e(21-22):3923-3934.\u003c/li\u003e\n\u003cli\u003eStanton NA, Chambers PR, Piggott J: \u003cstrong\u003eSituational awareness and safety\u003c/strong\u003e. \u003cem\u003eSafety science \u003c/em\u003e2001, \u003cstrong\u003e39\u003c/strong\u003e(3):189-204.\u003c/li\u003e\n\u003cli\u003eWeigl M, Catchpole K, Wehler M, Schneider A: \u003cstrong\u003eWorkflow disruptions and provider situation awareness in acute care: An observational study with emergency department physicians and nurses\u003c/strong\u003e. \u003cem\u003eApplied Ergonomics \u003c/em\u003e2020, \u003cstrong\u003e88\u003c/strong\u003e:103155.\u003c/li\u003e\n\u003cli\u003ePatel VL, Cytryn KN, Shortliffe EH, Safran C: \u003cstrong\u003eThe collaborative health care team: the role of individual and group expertise\u003c/strong\u003e. \u003cem\u003eTeach Learn Med \u003c/em\u003e2000, \u003cstrong\u003e12\u003c/strong\u003e(3):117-132.\u003c/li\u003e\n\u003cli\u003eAnderson JE, Ross AJ, Lim R, Kodate N, Thompson K, Jensen H, Cooney K: \u003cstrong\u003eNursing teamwork in the care of older people: A mixed methods study\u003c/strong\u003e. \u003cem\u003eAppl Ergon \u003c/em\u003e2019, \u003cstrong\u003e80\u003c/strong\u003e:119-129.\u003c/li\u003e\n\u003cli\u003eSiebdrat F, Hoegl M, Ernst H: \u003cstrong\u003eSubjective distance and team collaboration in distributed teams\u003c/strong\u003e. \u003cem\u003eJournal of Product Innovation Management \u003c/em\u003e2014, \u003cstrong\u003e31\u003c/strong\u003e(4):765-779.\u003c/li\u003e\n\u003cli\u003eWang X, Lian J, Ji M, Lee G, Hu Y: \u003cstrong\u003eNurse Managers\u0026apos; Experiences in Organisational Adaptation During Public Health Emergencies: A Qualitative Study\u003c/strong\u003e. \u003cem\u003eJ Adv Nurs \u003c/em\u003e2025, \u003cstrong\u003e81\u003c/strong\u003e(7):4172-4186.\u003c/li\u003e\n\u003cli\u003eAlsyouf A, Alsubahi N, Alali H, Lutfi A, Al-Mugheed KA, Alrawad M, Almaiah MA, Anshasi RJ, Alhazmi FN, Sawhney D: \u003cstrong\u003eNurses\u0026apos; continuance intention to use electronic health record systems: The antecedent role of personality and organisation support\u003c/strong\u003e. \u003cem\u003ePLoS One \u003c/em\u003e2024, \u003cstrong\u003e19\u003c/strong\u003e(10):e0300657.\u003c/li\u003e\n\u003cli\u003eWang J, Xu Y, Yang Z, Zhang J, Zhang X, Li W, Sun Y, Pan H: \u003cstrong\u003eFactors Influencing Information Distortion in Electronic Nursing Records: Qualitative Study\u003c/strong\u003e. \u003cem\u003eJ Med Internet Res \u003c/em\u003e2025, \u003cstrong\u003e27\u003c/strong\u003e:e66959.\u003c/li\u003e\n\u003cli\u003eBrown J, Pope N, Bosco AM, Mason J, Morgan A: \u003cstrong\u003eIssues affecting nurses\u0026apos; capability to use digital technology at work: An integrative review\u003c/strong\u003e. \u003cem\u003eJ Clin Nurs \u003c/em\u003e2020, \u003cstrong\u003e29\u003c/strong\u003e(15-16):2801-2819.\u003c/li\u003e\n\u003cli\u003eBandura A, Wessels S: \u003cstrong\u003eSelf-efficacy\u003c/strong\u003e: Cambridge University Press Cambridge; 1997.\u003c/li\u003e\n\u003cli\u003eLowe DJ, Ireland AJ, Ross A, Ker J: \u003cstrong\u003eExploring situational awareness in emergency medicine: developing a shared mental model to enhance training and assessment\u003c/strong\u003e. \u003cem\u003ePostgrad Med J \u003c/em\u003e2016, \u003cstrong\u003e92\u003c/strong\u003e(1093):653-658.\u003c/li\u003e\n\u003cli\u003eMcLinton SS, Loh MY, Dollard MF, Afsharian A, Tuckey MM: \u003cstrong\u003eA \u0026lsquo;living intervention\u0026rsquo;: evaluating a real-time feedback system to help teams co-create psychosocial safety climate\u003c/strong\u003e. \u003cem\u003eSafety Science \u003c/em\u003e2025, \u003cstrong\u003e190\u003c/strong\u003e:106901.\u003c/li\u003e\n\u003cli\u003eSalas E, Cooke NJ, Rosen MA: \u003cstrong\u003eOn teams, teamwork, and team performance: discoveries and developments\u003c/strong\u003e. \u003cem\u003eHum Factors \u003c/em\u003e2008, \u003cstrong\u003e50\u003c/strong\u003e(3):540-547.\u003c/li\u003e\n\u003cli\u003eSaleem MS, Isha ASN, Awan MI: \u003cstrong\u003eExploring the pathways to enhanced task performance: the roles of supportive leadership, team psychological safety, and mindful organizing\u003c/strong\u003e. \u003cem\u003eJournal of hospitality and tourism insights \u003c/em\u003e2024, \u003cstrong\u003e7\u003c/strong\u003e(5):2560-2581.\u003c/li\u003e\n\u003cli\u003eTang R, Lu G, Liu M, Zhu M, Li P: \u003cstrong\u003eA unified driving behavior model based on psychological safety space\u003c/strong\u003e. \u003cem\u003eTransportation Research Part F: Traffic Psychology and Behaviour \u003c/em\u003e2025, \u003cstrong\u003e109\u003c/strong\u003e:439-457.\u003c/li\u003e\n\u003cli\u003eMazzocato P, Del Villar P\u0026eacute;rez J, Herber K, Keita M, Roczniewska M: \u003cstrong\u003eLet\u0026apos;s Talk About the Elephant in the Room: A Psychological Safety Climate Intervention Among Nursing Teams-A Qualitative Evaluation\u003c/strong\u003e. \u003cem\u003eJ Adv Nurs \u003c/em\u003e2025.\u003c/li\u003e\n\u003cli\u003eLoh MY, Idris MA, Dollard MF, Isahak M: \u003cstrong\u003ePsychosocial safety climate as a moderator of the moderators: Contextualizing JDR models and emotional demands effects\u003c/strong\u003e. \u003cem\u003eJournal of Occupational and Organizational Psychology \u003c/em\u003e2018, \u003cstrong\u003e91\u003c/strong\u003e(3):620-644.\u003c/li\u003e\n\u003cli\u003eWang Z, Jiang Z, Blackman A: \u003cstrong\u003eLinking emotional intelligence to safety performance: The roles of situational awareness and safety training\u003c/strong\u003e. \u003cem\u003eJournal of safety research \u003c/em\u003e2021, \u003cstrong\u003e78\u003c/strong\u003e:210-220.\u003c/li\u003e\n\u003cli\u003eHuang W, Zhong D, Chen Y: \u003cstrong\u003eThe relationship between construction workers\u0026rsquo; emotional intelligence and safety performance\u003c/strong\u003e. \u003cem\u003eEngineering, Construction and Architectural Management \u003c/em\u003e2024.\u003c/li\u003e\n\u003cli\u003eAmoadu M, Obeng P, Cobbinah G, Salu PK, Ofori GO, Ansah EW: \u003cstrong\u003eMethodological issues in measuring psychosocial safety climate: a systematic review protocol\u003c/strong\u003e. \u003cem\u003eBMJ Open \u003c/em\u003e2024, \u003cstrong\u003e14\u003c/strong\u003e(8):e087315.\u003c/li\u003e\n\u003cli\u003eZadow A, Dollard M, McLinton S, Lawrence P, Tuckey M: \u003cstrong\u003ePsychosocial safety climate, emotional exhaustion, and work injuries in healthcare workplaces\u003c/strong\u003e. \u003cem\u003eStress and Health \u003c/em\u003e2017, \u003cstrong\u003e33\u003c/strong\u003e:558.\u003c/li\u003e\n\u003cli\u003eWang JF, Wu CL, Tsai YT, Weng SJ, Hsu YC: \u003cstrong\u003eThe Effects of Safety Climate on Psychosocial Factors: An Empirical Study in Healthcare Workplaces\u003c/strong\u003e. \u003cem\u003eJ Patient Saf \u003c/em\u003e2022, \u003cstrong\u003e18\u003c/strong\u003e(2):e528-e533.\u003c/li\u003e\n\u003cli\u003eMustafić M, Yu J, Stadler M, Vainikainen MP, Bornstein MH, Putnick DL, Greiff S: \u003cstrong\u003eComplex problem solving: Profiles and developmental paths revealed via latent transition analysis\u003c/strong\u003e. \u003cem\u003eDev Psychol \u003c/em\u003e2019, \u003cstrong\u003e55\u003c/strong\u003e(10):2090-2101.\u003c/li\u003e\n\u003cli\u003eHickendorff M, Edelsbrunner PA, McMullen J, Schneider M, Trezise K: \u003cstrong\u003eInformative tools for characterizing individual differences in learning: Latent class, latent profile, and latent transition analysis\u003c/strong\u003e. \u003cem\u003eLearning and Individual Differences \u003c/em\u003e2018, \u003cstrong\u003e66\u003c/strong\u003e:4-15.\u003c/li\u003e\n\u003cli\u003eAvin\u0026ccedil; E, Doğan F: \u003cstrong\u003eDigital literacy scale: Validity and reliability study with the rasch model\u003c/strong\u003e. \u003cem\u003eEducation and information Technologies \u003c/em\u003e2024, \u003cstrong\u003e29\u003c/strong\u003e(17):22895-22941.\u003c/li\u003e\n\u003cli\u003eMa H, Yang H, Li C, Ma S, Li G: \u003cstrong\u003eThe Effectiveness and Sustainability of Tier Diagnostic Technologies for Misconception Detection in Science Education: A Systematic Review\u003c/strong\u003e. \u003cem\u003eSustainability \u003c/em\u003e2025, \u003cstrong\u003e17\u003c/strong\u003e(7):3145.\u003c/li\u003e\n\u003cli\u003eLiu Y, Chen L, Zhao L, Li C: \u003cstrong\u003eThe interactive effect of organizational identification and organizational climate on employees\u0026rsquo; taking charge behavior: a complexity perspective\u003c/strong\u003e. \u003cem\u003eComplexity \u003c/em\u003e2021, \u003cstrong\u003e2021\u003c/strong\u003e(1):7040620.\u003c/li\u003e\n\u003cli\u003eSchubert S, Ortwein H, Dumitsch A, Schwantes U, Wilhelm O, Kiessling C, Schubert S, Ortwein H, Dumitsch A, Schwantes U: \u003cstrong\u003eA situational judgement test of professional behaviour: development and validation\u003c/strong\u003e. \u003cem\u003eMedical teacher \u003c/em\u003e2008, \u003cstrong\u003e30\u003c/strong\u003e(5):528-533.\u003c/li\u003e\n\u003cli\u003eHosseinpour A, Keshmiri F: \u003cstrong\u003eProfessionalism assessment of students in clinical education through Situational Judgment Test (SJT)\u003c/strong\u003e. \u003cem\u003eBMC Med Educ \u003c/em\u003e2024, \u003cstrong\u003e24\u003c/strong\u003e(1):1291.\u003c/li\u003e\n\u003cli\u003eLiao C, Qin Y, He Y, Guo Y: \u003cstrong\u003eThe nurse\u0026ndash;nurse collaboration behavior scale: development and psychometric testing\u003c/strong\u003e. \u003cem\u003eInternational Journal of Nursing Sciences \u003c/em\u003e2015, \u003cstrong\u003e2\u003c/strong\u003e(4):334-339.\u003c/li\u003e\n\u003cli\u003eKline RB: \u003cstrong\u003eSoftware review: Software programs for structural equation modeling: Amos, EQS, and LISREL\u003c/strong\u003e. \u003cem\u003eJournal of psychoeducational assessment \u003c/em\u003e1998, \u003cstrong\u003e16\u003c/strong\u003e(4):343-364.\u003c/li\u003e\n\u003cli\u003eFung IW, Tam VW, Sing CP, Tang K, Ogunlana SO: \u003cstrong\u003ePsychological climate in occupational safety and health: the safety awareness of construction workers in South China\u003c/strong\u003e. \u003cem\u003eInternational journal of construction management \u003c/em\u003e2016, \u003cstrong\u003e16\u003c/strong\u003e(4):315-325.\u003c/li\u003e\n\u003cli\u003eLiberati EG, Peerally MF, Dixon-Woods M: \u003cstrong\u003eLearning from high risk industries may not be straightforward: a qualitative study of the hierarchy of risk controls approach in healthcare\u003c/strong\u003e. \u003cem\u003eInternational Journal for Quality in Health Care \u003c/em\u003e2018, \u003cstrong\u003e30\u003c/strong\u003e(1):39-43.\u003c/li\u003e\n\u003cli\u003eCarroll JS, Rudolph JW: \u003cstrong\u003eDesign of high reliability organizations in health care\u003c/strong\u003e. \u003cem\u003eQual Saf Health Care \u003c/em\u003e2006, \u003cstrong\u003e15 Suppl 1\u003c/strong\u003e(Suppl 1):i4-9.\u003c/li\u003e\n\u003cli\u003eThelen E, Smith LB: \u003cstrong\u003eDynamic systems theories\u003c/strong\u003e. \u003cem\u003eHandbook of child psychology \u003c/em\u003e2007, \u003cstrong\u003e1\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eSutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI: \u003cstrong\u003eAn overview of clinical decision support systems: benefits, risks, and strategies for success\u003c/strong\u003e. \u003cem\u003eNPJ Digit Med \u003c/em\u003e2020, \u003cstrong\u003e3\u003c/strong\u003e:17.\u003c/li\u003e\n\u003cli\u003eAdepoju AH, Austin-Gabriel B, Eweje A, Collins A: \u003cstrong\u003eFramework for automating multi-team workflows to maximize operational efficiency and minimize redundant data handling\u003c/strong\u003e. \u003cem\u003eIRE Journals \u003c/em\u003e2022, \u003cstrong\u003e5\u003c/strong\u003e(9):663-664.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nurses, Digital literacy, Nursing team collaboration ability, Situational awareness, Psychological safety climate","lastPublishedDoi":"10.21203/rs.3.rs-7137326/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7137326/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDigital technologies have transformed nursing practices, enhancing efficiency while increasing the complexity of information. Although digital literacy enables nurses to manage digital tools effectively, its impact on team collaboration remains underexplored. This study investigates the influence of digital literacy on nursing team collaboration ability and its underlying mechanisms.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eThis study was conducted from March to May 2025 in a tertiary Grade A hospital in Hangzhou, China, involving 495 nurses. We employed scales for digital literacy, situational awareness, psychological safety climate, and team collaboration to collect data. The Process Model 6 was used to test the chain-like mediating effects of situational awareness and psychological safety climate on the relationship between nurses' digital literacy and their ability to collaborate within the nursing team. Latent profile analysis was applied to classify situational awareness and psychological safety climate into latent categories.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eDigital literacy significantly and positively influenced nursing team collaboration. Further mediation analysis revealed that situational awareness and psychological safety climate acted as chain-like mediators between digital literacy and team collaboration. From the individual-centered perspective, situational awareness and psychological safety climate were categorized into three subgroups: high psychological safety climate-high situational awareness, medium psychological safety climate-medium situational awareness, and low psychological safety climate-low situational awareness.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eHospital administrators and nursing team leaders should prioritize the development of nurses' digital literacy and optimize the situational awareness and psychological safety climate in nursing environments to enhance team collaboration and overall healthcare service quality.\u003c/p\u003e","manuscriptTitle":"Improving Nursing Team Collaboration Through Nurses' Digital Literacy: A Variable-Centered and Person-Centered Perspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-28 06:38:37","doi":"10.21203/rs.3.rs-7137326/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a1de8523-36ea-4e4b-a2a6-4ae7665046e4","owner":[],"postedDate":"August 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T08:54:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-28 06:38:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7137326","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7137326","identity":"rs-7137326","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}