Mediating role of self-efficacy and cognitive flexibility in the relationship between critical thinking and positive mental health in Turkish nursing students: A cross-sectional study

Abstract

Objectives Positive mental health is crucial for nursing students, impacting their well-being and professional performance. It facilitates stress management throughout nursing education and career development. Limited research has examined the relationship between critical thinking and perceived positive mental health. This study examines the relationship between critical thinking and positive mental health, exploring the mediating effects of self-efficacy and cognitive flexibility. Design A cross-sectional survey was used. Setting The study was conducted in different public universities in T & uuml;rkiye. The survey was administered via Google Forms, which included information about the purpose of the study and a consent form where participants declared their voluntary involvement. Participants A random sampling method was used to recruit 464 students from various health sciences faculties at different universities, consisting of 44.4% males and 55.6% females. The participants, aged 18-25, had a mean age of 19.52 (SD=1.24). Primary and secondary outcome measures The questionnaire included the following scales: Critical Thinking Disposition Scale, Positive Mental Health Scale, Cognitive Flexibility Scale and General Self-efficacy Scale. Descriptive analysis, correlation analysis and multiple mediation analysis were used to analyse the data. Results The findings indicate that critical thinking is positively associated with self-efficacy (beta=0.58, p<0.001), cognitive flexibility (beta=0.25, p<0.001) and positive mental health (beta=0.26, p<0.001). Self-efficacy also shows a positive relationship with cognitive flexibility (beta=0.51, p<0.001) and positive mental health (beta=0.27, p<0.001), while cognitive flexibility is positively associated with positive mental health (beta=0.21, p<0.001). Multiple mediation analyses revealed that self-efficacy and cognitive flexibility accounted for 51.85% of the total effects, with self-efficacy alone explaining 29.63%. Both self-efficacy and cognitive flexibility served as sequential and parallel mediators between critical thinking and positive mental health. Conclusion The study highlights the importance of integrating interventions that enhance self-efficacy and cognitive flexibility in nursing education programmes to promote positive mental health outcomes. These psychological resources can strengthen both critical thinking abilities and overall well-being among nursing students. The findings recommend implementing targeted training programmes in nursing education curricula and perceived positive mental health support services through problem-based learning and simulation-based education.