Exploring Stress Mediation: Self-Efficacy, Sense of Coherence, and Self-Esteem Among Nursing Students in Poland- A Multicentre Cross-Sectional Observational Study

Anna Maria Cybulska¹Kamila Rachubińska^1*Mariusz Panczyk²Anna Andruszkiewicz³Danuta Dyk⁴Aleksandra Gaworska-Krzeminska⁵Agnieszka Gniadek⁶Dorota Kozieł⁷Ewa Kupcewicz⁸Agnieszka Młynarska⁹Jolanta Lewko¹⁰Barbara Ślusarska¹¹Magdalena Śniegocka¹²Elżbieta Grochans¹Daria Schneider-Matyka¹

• ¹Department of Nursing, Pomeranian Medical University in Szczecin, Szczecin, Poland
• ²Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland,, Warsaw, Poland
• ³Department of Basic Clinical Skills and Postgraduate Education of Nurses and Midwives, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland, Bydgoszcz, Poland
• ⁴Department of Anaesthesiology and Intensive Care Nursing, Poznan University of Medical Sciences, Poznan, Poland;, Poznań, Poland
• ⁵Institute of Nursing and Midwifery, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdańsk, Poland, Gdańsk, Poland
• ⁶Department of Nursing Management and Epidemiology Nursing Institute of Nursing and Midwifery Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland, Krakow, Poland
• ⁷Uniwersytet Jana Kochanowskiego w Kielcach Collegium Medicum, Kielce, Poland
• ⁸Uniwersytet Warminsko-Mazurski w Olsztynie, Olsztyn, Poland
• ⁹Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland,, Katowice, Poland
• ¹⁰Department of Primary Health Care, Medical University Of Bialystok, Bialystok, Poland, Białystok, Poland
• ¹¹Department of Family and Geriatric Nursing, Chair of Integrated Nursing Care, Faculty of Health Sciences, Medical University of Lublin, Poland, Lublin, Poland
• ¹²Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland, Warsaw, Poland

Background: Nursing students frequently encounter stressful and demanding situations during clinical training, which may hinder their well-being and professional development. A strong sense of coherence is thought to buffer the negative effects of stress and support adaptive coping. Objective: This study aimed to examine levels of sense of coherence, self-esteem, and self-efficacy among undergraduate nursing students in Poland, and to investigate whether perceived stress mediates the relationships between sense of coherence and self-esteem, as well as between sense of coherence and self-efficacy. Material and methods: A cross-sectional observational survey was conducted among 2,689 nursing students enrolled in bachelor-level programs across multiple universities in Poland. Data collection utilized standardized tools, including the Sense of Coherence-29 Scale, the Generalized Self-Efficacy Scale, the Rosenberg Self-Esteem Scale, and the Perceived Stress Scale 10. Statistical analyses involved mediation modeling using Hayes’ PROCESS macro, with bootstrapping (5,000 resamples) to assess indirect effects. Results: Participants completed sociodemographic questionnaires along with standardized measures assessing sense of coherence, self-esteem, self-efficacy, and stress. The majority of students (84.0%) reported high stress levels, while two-thirds demonstrated average self-efficacy. Sex was associated with comprehensibility and manageability, and marital status was related to comprehensibility. Stress severity significantly mediated the relationships between specific components of sense of coherence and both self-esteem and self-efficacy. Conclusion: These findings emphasize the detrimental impact of stress on key components of sense of coherence and indicate that targeted educational and psychological interventions aimed at strengthening sense of coherence may help nursing students reduce stress, enhance self-efficacy, and promote overall well-being. The study underscores the multifaceted role of stress in shaping nursing students’ psychological resources and coping capacities.