Effectiveness of A Psychosocial Intervention Program Based on Career Self-Efficacy Theory in Improving Professional Identity Among Nursing Interns: A Pre-Post Quasi-Experimental Study
# Fang Li and Liqian Wang are co-first authors, contributed equally to this work
Background: Professional identity (PI) forms the foundation of nursing practice and critically influences career adaptability, especially for interns transitioning from students to nurses. Developing effective interventions to enhance PI in this group is essential. Aim: To design a PI intervention program for nursing interns and evaluate its effectiveness. Methods: A quasi-experimental pre-post study was conducted with 116 nursing interns from a tertiary hospital in China (September December 2021). The intervention, grounded in career self-efficacy theory, incorporated mastery/vicarious experiences, social persuasion, and emotional regulation. Implemented every ten days over three mid-internship months, effectiveness was assessed using paired t-tests. Results: The total score for the PI scale increased from 61.03 (10.45) points to 70.48 (8.30) points (P<0.001). Similar significant increases were observed in the scores of all five dimensions of the scale. Conclusions: The PI intervention program was effective in improving the level of PI among nursing interns. Future randomized controlled trials with longer follow-ups are needed to provide robust evidence on its long-term effectiveness before its wide application in nursing education and training.
[1] Al-Noumani H., Al Zaabi O., Arulappan J., & George H. R. (2024). Professional identity and preparedness for hospital practice among undergraduate nursing students: A cross-sectional study. Nurse Education Today, 133, 106044.
[2] Bahmanbijari B., Beigzadeh A., Etminan A., Najarkolai A. R., Khodaei M., & Askari S. M. S. (2017). The perspective of medical students regarding the roles and characteristics of a clinical role model. Electronic Physician, 9(4), 4124-4130.
[3] Guo B., Zhao L., Gao Y., Peng X., & Zhu Y. (2017). The status of professional identity and professional self efficacy of nursing students in China and how the medical documentaries affect them: A quasi-randomized controlled trial. International Journal of Nursing Sciences, 4(2), 152-157.
[4] Hanum A. L., Hu Q., Wei W., Zhou H., & Ma F. (2023). Professional identity, job satisfaction, and intention to stay among clinical nurses during the prolonged COVID-19 pandemic: A mediation analysis. Japan Journal of Nursing Science, 20(2), e12515.
[5] Hao Y. (2011). Study of the model of self-education in enhancing the level of professional identity and professional self-efficacy in nurse students. Unpublished doctoral dissertation, The Second Military Medical University.
[6] Hensel D., & Laux M. (2014). Longitudinal study of stress, self-care, and professional identity among nursing students. Nurse Educator, 39(5), 227-231.
[7] Jack K., Hamshire C., & Chambers A. (2017). The influence of role models in undergraduate nurse education. Journal of Clinical Nursing, 26(23-24), 4707-4715.
[8] Lent R. W., & Hackett G. (1987). Career self-efficacy: Empirical status and future directions. Journal of Vocational Behavior, 30(3), 347-382.
[9] Lin S., Chen S., Tu Q., Xu X., Xie S., Yang B., ... & Chen L. (2024). Barriers and facilitators to the formation of professional identity among nursing students: A four-year longitudinal qualitative study. Nurse Education Today, 134, 106087.
[10] Liu Y. H., Lou S. J., & Shih R. C. (2014). The investigation of STEM self-efficacy and professional commitment to engineering among female high school students. South African Journal of Education, 34(2), 1-15.
[11] Mao A., Lu S. E., Lin Y., & He M. (2021). A scoping review on the influencing factors and development process of professional identity among nursing students and nurses. Journal of Professional Nursing : Official Journal of the American Association of Colleges of Nursing, 37(2), 391-398.
[12] Marañón A. A., & Pera M. P. I. (2015). Theory and practice in the construction of professional identity in nursing students: A qualitative study. Nurse Education Today, 35(7), 859-863.
[13] McEvoy M., Pollack S., Dyche L., & Burton W. (2016). Near-peer role modeling: Can fourth-year medical students, recognized for their humanism, enhance reflection among second-year students in a physical diagnosis course?. Medical Education Online, 21(1), 31940.
[14] National Health Commission. (2023). Statistical bulletin on the development of health care in China in 2022. Government of the People's Republic of China. https://www. gov. cn/lianbo/bumen/202310/content_6908685.htm
[15] Neishabouri M., Ahmadi F., & Kazemnejad A. (2017). Iranian nursing students' perspectives on transition to professional identity: A qualitative study. International Nursing Review, 64(3), 428-436.
[16] Ning L. (2019). The effect of staged group positive psychological intervention on resilience and professional identity of "post ‐ 90s" nursing students during internship. Chinese Journal of Modern Nursing, 25(21), 2759.
[17] Pan J. D., Ho K. Y., Liu H. L., Huang J. Y., Zhang X. L., Zeng Q. M., ... & Ling D. L. (2024). Implementation and effectiveness of a nurse navigation programme based on noddings' care theory in first-year undergraduate nursing students for professional identity and career planning: A quasi-experimental study. Nurse Education in Practice, 75, 103900.
[18] Plantinga L. C., Rickenbach F., Urbanski M., Hoge C., Douglas-Ajayi C., Morgan J. C., ... & Jaar B. G. (2023). Professional fulfillment, burnout, and turnover intention among US dialysis patient care technicians: A national survey. American Journal of Kidney Diseases: The Official Journal of The National Kidney Foundation, 82(1), 22-32.
[19] Ren H., Li P., Xue Y., Xin W., Yin X., & Li H. (2024). Global prevalence of nurse turnover rates: A meta ‐ analysis of 21 studies from 14 countries. Journal of Nursing Management, 2024(1), 1-15.
[20] Tang M., Sun Y., Zhang K., Luo R., Liu Y., Sun H., & Zhou F. (2022). Associated factors of professional identity among nursing undergraduates during COVID-19: A cross-sectional study. International Journal of Nursing Sciences, 9(1), 107-113.
[21] Tseng M. Y., & Hwang S. L. (2021). "SURVIVAL" intervention program effects on student nurses' transition to staff nurses: A quasi-experimental study. Nurse Education in Practice, 56, 103184.
[22] Wang A., Wu F., Lin C., Jia S., Guo Y., Zhang W., & Huang F. (2023). An online 5-week professional identity program for nursing student in clinical rotation practice during the first wave of COVID-19 pandemic: A two arm randomized trial. Nurse Education in Practice, 68, 103598.
[23] Wang L., & Yu P. (2021). Impact of exemplar education program on the professional commitment of nursing students: A quasi-experimental study. Nurse Education Today, 107, 105118.
[24] Wang P., Wang H. M., Qin Q. Y., Li Y. R., Hong J. F., & Li S. W. (2022). Effectiveness of a professional identity promotion strategy for nursing students during the COVID-19 pandemic: A quasi-experimental study. Japan Journal of Nursing Science: JJNS, 19(3), e12479.
[25] Wei L. Z., Zhou S. S., Hu S., Zhou Z., & Chen J. (2021). Influences of nursing students' career planning, internship experience, and other factors on professional identity. Nurse Education Today, 99, 104781.
[26] World Health Organization. (2020). State of the world's nursing 2020: Investing in education, jobs and leadership. https://www.who.int/publications/i/item/9789240003279
[27] World Health Organization. (2024). Nursing and midwifery. https://www. who. int/news-room/fact-sheets/de‐tail/nursing-and-midwifery
[28] Wu C., Palmer M. H., & Sha K. (2020). Professional identity and its influencing factors of first-year post associate degree baccalaureate nursing students: A cross sectional study. Nurse Education Today, 84, 104227.
[29] Zeng L., Chen Q., Fan S., Yi Q., An W., Liu H., ... & Huang H. (2022). Factors influencing the professional identity of nursing interns: A cross-sectional study. BMC Nursing, 21(1), 200.
[30] Zhang Z., Fu W., Tian C., Zhang F., Zhao B., Mao J., & Saligan L. N. (2021). Professional identity of Chinese nursing students during the COVID-19 pandemic outbreak: A nation-wide cross-sectional study. Nurse Education in Practice, 52, 103040.
[31] Zhao Y., Zhou Q., Li J., Luan J., Wang B., Zhao Y., ... & Chen H. (2021). Influence of psychological stress and coping styles in the professional identity of undergraduate nursing students after the outbreak of COVID-19: A cross-sectional study in China. Nursing Open, 8(6), 3527-3537.