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Psychological resilience, metacognition, post-traumatic growth, and rumination among undergraduate nursing interns: A
Hui Jiang1, Xiangqi Xu1, Yushang Li1
1School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, Tai'an, Shandong 271000, China.
Background:
Undergraduate nursing students, during their 9-12 month hospital internship in China, commonly experience rumination (repetitive negative thinking) in high-pressure clinical environments, which is closely associated with mental health problems. Previous researchers have suggested that psychological resilience, as a key protective factor, may alleviate this process. However, the underlying mechanisms remain unclear, particularly regarding the roles of metacognition and post-traumatic growth (positive psychological change following adversity), which warrant further investigation.
Aims:
We aimed to explore the mechanisms through which psychological resilience influenced rumination among undergraduate nursing interns and to clarify the mediating role of metacognition and the moderating role of post-traumatic growth in this relationship.
Design:
A descriptive, cross-sectional study.
Methods:
Using convenience sampling, we conducted an online questionnaire survey among 892 undergraduate nursing interns in China between and October 2025. A moderated mediation analysis was conducted.
Results:
Psychological resilience significantly negatively predicted rumination among participants (β = -0.326, p < 0.001). Metacognition partially mediated this relationship (indirect effect = -0.068, 95 % confidence interval [CI] -0.091, -0.047, accounting for 24.73 % of the total effect). Post-traumatic growth significantly moderated the path from psychological resilience to metacognition (interaction term β = 0.220, p < 0.001). Simple slope analysis showed that psychological resilience significantly positively predicted metacognition only at high levels of post-traumatic growth.
Conclusions:
We found that psychological resilience was associated with reduced rumination, a relationship mediated by metacognition, with this indirect effect being more pronounced in individuals with higher post-traumatic growth. To support nursing interns' role transition and well-being, cultivating metacognitive ability and fostering post-traumatic growth may be recommended.
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