In an era where the psychological well-being of healthcare providers is increasingly recognized as pivotal to quality patient care, a groundbreaking study has emerged that delves into the complex interplay between nursing students’ caring behaviors and anxiety levels during their clinical internships. This research employs structural equation modeling (SEM) to unravel how the ethical climate of clinical settings serves as a crucial mediator in this intricate relationship, shedding light on factors that could revolutionize nursing education and workplace environments.
Nursing internships represent a pivotal period during which theoretical knowledge is translated into practical skills, and students are exposed to real-world pressures that significantly impact their mental health. Anxiety, a common psychological response among nursing students during this phase, can adversely affect their capacity to demonstrate compassionate care — an essential element in healthcare delivery. The research conducted by Dokoohaki, Rambod, Pasyar, et al., published in BMC Psychology in 2026, advances our understanding by integrating psychosocial factors into a sophisticated statistical model that explicates the pathways influencing these phenomena.
At the heart of this study lies the concept of ethical climate — a shared perception among nursing students of the ethical standards, practices, and behaviors upheld within clinical environments. The study posits that this ethical climate is not just a backdrop but an active mediator that shapes how anxiety manifests and modulates caring behaviors. The application of structural equation modeling allowed the researchers to quantify these relationships systematically and test hypotheses about the direct and indirect effects of anxiety and ethical climate on caring actions.
Structural equation modeling, a powerful multivariate statistical technique, enables researchers to examine complex causal relationships by modeling latent variables that are not directly observable but inferred from measured variables. In this context, caring behaviors and anxiety are conceptualized as latent constructs influenced by observed indicators such as self-reported patient interaction experiences and physiological markers of stress. The ethical climate, another latent variable, encompasses dimensions such as perceived fairness, managerial support, and adherence to ethical codes within clinical units.
The study carefully recruited a diverse cohort of nursing students immersed in internships across various healthcare institutions, ensuring a representative sample. Data collection incorporated comprehensive psychometric instruments tailored to assess caring behaviors, anxiety symptoms, and perceptions of the ethical work environment. The robust dataset allowed for the rigorous testing of SEM models and cross-validation of findings, reinforcing the study’s validity and reliability.
Findings revealed a nuanced landscape wherein heightened anxiety correlates with diminished caring behaviors; however, this detrimental effect is significantly mitigated when students perceive a strong ethical climate. Specifically, an ethical environment characterized by transparent communication, ethical leadership, and supportive peer networks acts as a buffer against anxiety, enabling students to maintain empathetic and patient-centered care despite personal stressors. These results underscore the ethical climate’s pivotal role as a psychological safety net that fosters resilience.
The theoretical implications of this research are profound, challenging simplistic notions that anxiety merely erodes clinical performance. Instead, it paints a dynamic portrait in which contextual factors like ethical climate can modulate psychological distress and preserve nurturing behaviors. This insight aligns with contemporary organizational psychology theories emphasizing the interplay between individual emotions and systemic factors in shaping workplace outcomes.
Practically, the study urges nursing educators, administrators, and policymakers to prioritize the establishment and reinforcement of ethical climates in clinical training sites. Interventions might include ethical leadership development, clear communication of expectations regarding professional conduct, and the creation of mechanisms for students to voice concerns without fear of reprisal. Cultivating such environments may not only reduce anxiety-driven impairments but also enhance students’ moral development and commitment to compassionate care.
Moreover, this research highlights the interconnectedness of psychological well-being and ethical organizational culture, suggesting that efforts to bolster one domain automatically reinforce the other. It places ethical climate as a strategic target for improving both mental health outcomes and quality of care, potentially benefiting patient satisfaction, clinical outcomes, and retention rates of nursing professionals.
The methodology employed sets a benchmark for future studies in health psychology and nursing education, demonstrating how advanced statistical modeling can parse multifaceted psychosocial phenomena beyond traditional correlational analyses. The use of SEM in this context provides nuanced insights that chart causal pathways, offering precise targets for intervention development and evaluation.
This study also serves as a call to action for comprehensive mental health support tailored to nursing students, advocating for programs that integrate ethical climate enhancement with stress reduction techniques. Mindfulness training, counseling services, and peer support systems aligned with ethical organizational values could synergistically promote well-being and professional growth.
In the broader landscape of healthcare, where burnout and compassion fatigue are endemic, the findings resonate strongly. They illuminate foundational elements that can preserve the humanity and dedication of the upcoming generation of nurses, safeguarding the pillars of empathetic and ethical patient care amidst escalating demands and pressures.
Looking ahead, ongoing research expanding on this framework could explore longitudinal impacts, cultural variations in ethical climate perceptions, and the role of digital health tools in modulating anxiety and caregiving behaviors. Gathering data across diverse healthcare settings and countries will deepen the understanding of universal versus context-specific mechanisms.
The integration of such psychosocial insights with technological innovations holds promise for transforming clinical education and work environments into nurturing ecosystems where ethical standards and mental health mutually reinforce one another. By emphasizing ethical climate as a linchpin, this study carves a path for systemic reforms that transcend individual-level interventions.
Ultimately, the work of Dokoohaki, Rambod, Pasyar, and colleagues represents a landmark contribution that bridges psychological theory, nursing practice, and organizational ethics. It affirms that caring behaviors are not merely innate traits but dynamic expressions influenced by emotional states and ethical contexts. Addressing these interdependencies offers a roadmap to cultivating resilient, compassionate nurses equipped to meet the relentless challenges of modern healthcare.
As healthcare systems worldwide grapple with workforce shortages and escalating stressors, the insights from this research offer a beacon of hope and practical guidance. Ethical climates fortified by leadership commitment and collective responsibility emerge not only as moral imperatives but as vital instruments for sustaining the mental health and professional efficacy of nursing students.
This study exemplifies the power of interdisciplinary research in tackling complex real-world issues, leveraging methodological rigor and theoretical depth to inform meaningful change. It prompts a reconsideration of how clinical training environments are structured and evaluated, urging an ethos that harmonizes psychological wellness with ethical excellence.
In conclusion, the mediation effect of ethical climate in moderating anxiety and promoting caring behaviors among nursing students underscores the indispensable role of ethical organizational cultures in shaping future healthcare professionals. Investing in and nurturing these climates promises dividends not only in student well-being but in the very quality of care delivered to patients, marking a critical stride towards a more compassionate and resilient healthcare system.
Subject of Research: The relationship between caring behaviors and anxiety in nursing students during internship, with the mediating role of ethical climate.
Article Title: Structural equation modeling of caring behaviors and anxiety in nursing students during internship: the mediating role of ethical climate.
Article References:
Dokoohaki, R., Rambod, M., Pasyar, N. et al. Structural equation modeling of caring behaviors and anxiety in nursing students during internship: the mediating role of ethical climate. BMC Psychol (2026). https://doi.org/10.1186/s40359-025-03858-8
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