A dual path driven change model of innovative ability for nursing students: A longitudinal four-year follow-up study

Self-directed learning ability (SLA) and creative self-efficacy (CSE) are potential predictors of innovative ability (IA) in nursing students; however, the longitudinal relationships among these variables across different stages of nursing education remain unclear.

To examine the longitudinal relationships among SLA, CSE, and IA, and explore whether these relationships varied across four academic years among nursing students.

A four-year longitudinal study was conducted with 163 first-year nursing students recruited through convenience sampling from a medical university in southern China. SLA, CSE, and IA were measured annually from 2021 to 2024 (T1-T4). Data were analyzed using SPSS and AMOS, and multiple-group structural equation modelling was conducted to examine longitudinal relationships among the variables across T1-T4.

Of the participants, 144 (88.3%) completed the four-year follow-up. SLA, CSE, and IA remained at low-to-moderate levels across T1-T4. The structural equation models demonstrated acceptable model fit across all time points. SLA consistently predicted IA at all time points (β = 0.501-0.663, P < 0.001) and significantly predicted CSE at T1, T3, and T4 (β = 0.306-0.413, P < 0.001). CSE directly predicted IA only at T1 (β = 0.248, P < 0.001) and T2 (β = 0.157, P = 0.009), and mediated the relationship between SLA and IA at T1 (β = 0.076, P = 0.019). Most structural relationships remained stable across time points, with significant differences observed only for the effect of SLA on CSE between T2 and T3.

This study supported a dual-path driven change model of innovative ability among nursing students, showing that self-directed learning ability demonstrated sustained associations with innovative ability across four academic years, whereas creative self-efficacy was more strongly associated with innovative ability during the early stages of nursing education. These findings provide empirical support for cultivating nursing students' innovative ability by strengthening self-directed learning while integrating creative self-efficacy training, particularly in the initial stages of education.