Structural equation modeling of caring behaviors and anxiety in nursing students during internship: the mediating role of ethical climate

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BACKGROUND: Internship in nursing education strengthens competence, confidence, and professional skills. It is essential to identify the clinical factors affecting anxiety and the ethical climate among nursing students in this era. This study aimed to (1) identify caring behaviors and ethical climate as predictors of nursing students' anxiety using hierarchical regression analysis, and (2) examine the mediating roles of students' age and ethical climate in the relationship between caring behaviors and anxiety during internship. METHODS: This is a cross-sectional study. 225 nursing students in Shiraz and Larestan Universities of Medical Sciences were selected to participate in this study using convenience sampling. Spielberger State-Trait Anxiety Inventory, Caring Behaviors Inventory, and Hospital Ethical Climate Survey were used for data collection. SPSS macro-PROCESS was used for data analysis. RESULTS: Nursing students reported moderate levels of state anxiety and mild levels of trait anxiety. The nursing students' caring behaviors and the hospital's ethical climate were the predictors of anxiety during the internship. Moreover, age, caring behaviors, and perception of hospital ethical climate accounted for an additional 23% of the anxiety variance. Furthermore, hospital ethical climate was a mediator in the correlation between caring behaviors and anxiety in nursing students (β=-0.06, CI=-0.11- -0.02). CONCLUSION: These findings suggest that enhancing caring behaviors and fostering a positive hospital ethical climate might help reduce nursing students' anxiety during internships. The mediating role of the ethical climate highlights its importance in the relationship between caring behaviors and anxiety, underscoring the need for supportive clinical environments.

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