The Impact of Nursing Students’ Anxiety in Clinical Decision-Making on Relationship-Centered Care: The Mediating Effects of Coherence and Emotional Intelligence

Abstract

Background:

Clinical decision-making anxiety impairs nursing students’ relationship-centered care (RCC) delivery, yet the underlying psychological mechanisms remain unclear.

Objectives:

This study examined the relationship between clinical decision-making anxiety and RCC and also explored the mediating roles of sense of coherence (SOC) and emotional intelligence among nursing students.

Methods:

A cross-sectional study was conducted from March to May 2024 with 185 nursing students from a 4-year undergraduate program in South Korea. Data were collected using 4 validated instruments: the Korean version of the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale, the RCC Scale, the 13-item SOC Scale, and the Wong and Law Emotional Intelligence Scale.

Results:

Clinical decision-making anxiety negatively affected RCC primarily through indirect pathways. Emotional intelligence significantly mediated this relationship (β = −0.067; 95% Confidence interval [CI], −0.122, −0.024), as did the sequential pathway through SOC to emotional intelligence (β = −0.037; 95% CI, −0.065, −0.014). SOC alone did not significantly mediate the relationship, and the direct effect of anxiety on RCC was nonsignificant (β = −0.027, P = .469). The total indirect effect was significant (β = −0.089; 95% CI, −0.147, −0.043).

Conclusion:

Clinical decision-making anxiety undermines RCC indirectly through emotional intelligence and the sequential SOC → emotional intelligence pathway rather than through direct effects. Educational interventions that reduce anxiety while systematically developing SOC and emotional intelligence may enhance nursing students’ RCC competency and improve patient outcomes.