<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.3 20210610//EN" "JATS-journalpublishing1-3-mathml3.dtd">
<article xmlns:ali="http://www.niso.org/schemas/ali/1.0/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xml:lang="EN" article-type="research-article">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Med.</journal-id>
<journal-title-group>
<journal-title>Frontiers in Medicine</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Med.</abbrev-journal-title>
</journal-title-group>
<issn pub-type="epub">2296-858X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fmed.2026.1760650</article-id>
<article-version article-version-type="Version of Record" vocab="NISO-RP-8-2008"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Research</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Career commitment and sense of calling in nursing students: a longitudinal study</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Ding</surname> <given-names>Tingting</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; original draft" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-original-draft/">Writing &#x2013; original draft</role>
</contrib>
<contrib contrib-type="author">
<name><surname>Shi</surname> <given-names>Jiaqi</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/2204611/overview"/>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Conceptualization" vocab-term-identifier="https://credit.niso.org/contributor-roles/conceptualization/">Conceptualization</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Data curation" vocab-term-identifier="https://credit.niso.org/contributor-roles/data-curation/">Data curation</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Software" vocab-term-identifier="https://credit.niso.org/contributor-roles/software/">Software</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; original draft" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-original-draft/">Writing &#x2013; original draft</role>
</contrib>
<contrib contrib-type="author">
<name><surname>Li</surname> <given-names>Wenjing</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Formal analysis" vocab-term-identifier="https://credit.niso.org/contributor-roles/formal-analysis/">Formal analysis</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Funding acquisition" vocab-term-identifier="https://credit.niso.org/contributor-roles/funding-acquisition/">Funding acquisition</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Investigation" vocab-term-identifier="https://credit.niso.org/contributor-roles/investigation/">Investigation</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &amp; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &amp; editing</role>
</contrib>
<contrib contrib-type="author">
<name><surname>Xiong</surname> <given-names>Feifei</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Formal analysis" vocab-term-identifier="https://credit.niso.org/contributor-roles/formal-analysis/">Formal analysis</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Funding acquisition" vocab-term-identifier="https://credit.niso.org/contributor-roles/funding-acquisition/">Funding acquisition</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Investigation" vocab-term-identifier="https://credit.niso.org/contributor-roles/investigation/">Investigation</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &amp; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &amp; editing</role>
</contrib>
<contrib contrib-type="author">
<name><surname>Xu</surname> <given-names>Huihui</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Investigation" vocab-term-identifier="https://credit.niso.org/contributor-roles/investigation/">Investigation</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Methodology" vocab-term-identifier="https://credit.niso.org/contributor-roles/methodology/">Methodology</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Software" vocab-term-identifier="https://credit.niso.org/contributor-roles/software/">Software</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &amp; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &amp; editing</role>
</contrib>
<contrib contrib-type="author">
<name><surname>Zhao</surname> <given-names>Chengjia</given-names></name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1426214/overview"/>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Investigation" vocab-term-identifier="https://credit.niso.org/contributor-roles/investigation/">Investigation</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Methodology" vocab-term-identifier="https://credit.niso.org/contributor-roles/methodology/">Methodology</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Software" vocab-term-identifier="https://credit.niso.org/contributor-roles/software/">Software</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &amp; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &amp; editing</role>
</contrib>
<contrib contrib-type="author">
<name><surname>Zhang</surname> <given-names>Guohua</given-names></name>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/1184227/overview"/>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Project administration" vocab-term-identifier="https://credit.niso.org/contributor-roles/project-administration/">Project administration</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Supervision" vocab-term-identifier="https://credit.niso.org/contributor-roles/supervision/">Supervision</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Validation" vocab-term-identifier="https://credit.niso.org/contributor-roles/validation/">Validation</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &amp; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &amp; editing</role>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Cong</surname> <given-names>Chen</given-names></name>
<xref ref-type="aff" rid="aff7"><sup>7</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Validation" vocab-term-identifier="https://credit.niso.org/contributor-roles/validation/">Validation</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Visualization" vocab-term-identifier="https://credit.niso.org/contributor-roles/visualization/">Visualization</role>
<role vocab="credit" vocab-identifier="https://credit.niso.org/" vocab-term="Writing &#x2013; review &amp; editing" vocab-term-identifier="https://credit.niso.org/contributor-roles/writing-review-editing/">Writing &#x2013; review &amp; editing</role>
</contrib>
</contrib-group>
<aff id="aff1"><label>1</label><institution>The First Affiliated Hospital of Wenzhou Medical University</institution>, <city>Wenzhou</city>, <country country="cn">China</country></aff>
<aff id="aff2"><label>2</label><institution>School of Nursing, Wenzhou Medical University</institution>, <city>Wenzhou</city>, <country country="cn">China</country></aff>
<aff id="aff3"><label>3</label><institution>Department of Psychology, School of Mental Health, Wenzhou Medical University</institution>, <city>Wenzhou</city>, <country country="cn">China</country></aff>
<aff id="aff4"><label>4</label><institution>School of Education, Renmin University of China</institution>, <city>Beijing</city>, <country country="cn">China</country></aff>
<aff id="aff5"><label>5</label><institution>Key Research Center of Philosophy and Social Sciences of Zhejiang Province, Institute of Medical Humanities</institution>, <city>Wenzhou Medical University</city>, <country country="cn">China</country></aff>
<aff id="aff6"><label>6</label><institution>The Affiliated Kangning Hospital, Wenzhou Medical University</institution>, <city>Wenzhou</city>, <country country="cn">China</country></aff>
<aff id="aff7"><label>7</label><institution>Department of Publicity Wenzhou Medical University</institution>, <city>Wenzhou</city>, <country country="cn">China</country></aff>
<author-notes>
<corresp id="c001"><label>&#x002A;</label>Correspondence: Chen Cong, <email xlink:href="mailto:6948628@qq.com">6948628@qq.com</email></corresp>
</author-notes>
<pub-date publication-format="electronic" date-type="pub" iso-8601-date="2026-02-13">
<day>13</day>
<month>02</month>
<year>2026</year>
</pub-date>
<pub-date publication-format="electronic" date-type="collection">
<year>2026</year>
</pub-date>
<volume>13</volume>
<elocation-id>1760650</elocation-id>
<history>
<date date-type="received">
<day>08</day>
<month>12</month>
<year>2025</year>
</date>
<date date-type="rev-recd">
<day>20</day>
<month>01</month>
<year>2026</year>
</date>
<date date-type="accepted">
<day>26</day>
<month>01</month>
<year>2026</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2026 Ding, Shi, Li, Xiong, Xu, Zhao, Zhang and Cong.</copyright-statement>
<copyright-year>2026</copyright-year>
<copyright-holder>Ding, Shi, Li, Xiong, Xu, Zhao, Zhang and Cong</copyright-holder>
<license>
<ali:license_ref start_date="2026-02-13">https://creativecommons.org/licenses/by/4.0/</ali:license_ref>
<license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p>
</license>
</permissions>
<abstract>
<sec>
<title>Background</title>
<p>Under China&#x2019;s one-child policy, the new generation of nursing students has gradually entered the workforce. Their career commitment, career self-efficacy, and sense of calling have undergone changes. It is necessary to assess the relationships and underlying mechanisms among these factors in order to stabilize the nursing workforce and cultivate high-quality clinical nursing professionals.</p>
</sec>
<sec>
<title>Methods</title>
<p>A cross-lagged design was used, with a total of 693 nursing students participating in September and December 2022. The 27-item undergraduate career commitment scale, the Chinese version of career self-efficacy scale, and the brief calling scale were measured over time.</p>
</sec>
<sec>
<title>Results</title>
<p>The relationships between career commitment, career self-efficacy, and sense of calling differed by only child and non-only child nursing undergraduates.</p>
</sec>
<sec>
<title>Conclusion</title>
<p>It is important to introduce specific measures aimed at enhancing the quality of nursing education and implementing effective nursing management methods to ensure the stability of the nursing workforce.</p>
</sec>
</abstract>
<kwd-group>
<kwd>career commitment</kwd>
<kwd>career self-efficacy</kwd>
<kwd>nursing students</kwd>
<kwd>only child and non-only child</kwd>
<kwd>sense of calling</kwd>
</kwd-group>
<funding-group>
<funding-statement>The author(s) declared that financial support was not received for this work and/or its publication.</funding-statement>
</funding-group>
<counts>
<fig-count count="3"/>
<table-count count="5"/>
<equation-count count="0"/>
<ref-count count="51"/>
<page-count count="11"/>
<word-count count="7349"/>
</counts>
<custom-meta-group>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Healthcare Professions Education</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
<body>
<sec id="S1">
<label>1</label>
<title>Background</title>
<p>As the Chinese population continues to age, the demand for medical care is on the rise. Following the implementation of the one-child policy, the working-age population in China (aged 16&#x2013;59) decreased by over 40 million, while the proportion of the population aged 65 and above has reached 13.50% (<xref ref-type="bibr" rid="B1">1</xref>). However, China has approximately 5 million registered nurses, which remains insufficient to meet the increasing demands of population aging (<xref ref-type="bibr" rid="B2">2</xref>). The demographic dividend in China appears to be diminishing. Due to the high risks, intensity, and pressure involved in nursing work, the turnover rate among nurses remains relatively high (<xref ref-type="bibr" rid="B3">3</xref>). The extremely imbalanced supply and demand scenario further exacerbates the strain on medical and healthcare resources, underscoring the critical need to foster qualified nursing talent reserves. However, nursing students from the one-child generation appear to exhibit limited enthusiasm for pursuing careers in the nursing industry, and issues of low sense of belonging and a lack of professional identity are also observed (<xref ref-type="bibr" rid="B4">4</xref>). Therefore, it is particularly important to study the relationships between professional commitment, professional efficacy, and professional mission among nursing students. This effort aims to enhance their sense of belonging and identity toward the nursing profession, ultimately contributing to the stabilization of the nursing talent reserve.</p>
<sec id="S1.SS1">
<label>1.1</label>
<title>Career commitment and career self-efficacy</title>
<p>Career commitment refers to the commitment individuals make to their career goals and professional development, which is a set of values about their career (<xref ref-type="bibr" rid="B5">5</xref>). Career development theory (<xref ref-type="bibr" rid="B6">6</xref>) suggests that individuals&#x2019; entry into a particular industry is influenced by various factors, including interests, abilities, values, needs, education, degree of social resource utilization, social occupational structure, and trends. During the phase of acquiring professional knowledge and skills, nursing students&#x2019; interest and perception of the profession are crucial to their decision to pursuing nursing (<xref ref-type="bibr" rid="B7">7</xref>). Moreover, Career commitment plays an important role in the career development of nursing students. Nursing students who possess a strong career commitment are able to define their career goals and development trajectory, enhancing the effectiveness of their career advancement. This commitment also serves as a driving force, motivating them to consistently pursue growth and attain professional success in their nursing careers (<xref ref-type="bibr" rid="B8">8</xref>). Study (<xref ref-type="bibr" rid="B9">9</xref>) has also shown a negative correlation between career commitment and intention to leave the profession, further demonstrating the importance of career commitment in the career development of nursing students.</p>
<p>Career self-efficacy refers to an individual&#x2019;s confidence and belief in their ability to achieve expected goals and deliver commendable performance in their work. This confidence stems from personal experiences, skills, knowledge, and emotions, and serves as a pivotal gauge for individuals to assess their professional competence (<xref ref-type="bibr" rid="B10">10</xref>) Previous studies have demonstrated that nursing students with higher career self-efficacy can better cope with professional challenges and difficulties, This, in turn, results in enhanced work efficiency and quality, thereby augmenting their professional competitiveness and potential for career development (<xref ref-type="bibr" rid="B10">10</xref>). During the exploration stage (ages 19&#x2013;24), adolescents engage in a process of discovering their abilities, roles, and potential occupations through school activities, club engagements, part-time jobs, and other opportunities (<xref ref-type="bibr" rid="B11">11</xref>). As the preliminary determination and validation of a career as a viable long-term professional path takes shape, it gives rise to the formation of commitment to the profession (career commitment) and confidence in one&#x2019;s professional capabilities (career self-efficacy). Positive psychology (<xref ref-type="bibr" rid="B12">12</xref>) also reveals an intrinsic connection between these two aspects: positive cognition and emotions can play a constructive role in personal wellbeing development. In particular, when nursing students have a strong belief in the nursing profession, it promotes their professional confidence and enhances their sense of happiness (<xref ref-type="bibr" rid="B13">13</xref>). Previous cross-sectional studies have shown a positive correlation between career commitment and career self-efficacy (<xref ref-type="bibr" rid="B14">14</xref>). Therefore, this study hypothesizes that there is a reciprocal relationship between career commitment and career self-efficacy among nursing students over time (H1).</p>
</sec>
<sec id="S1.SS2">
<label>1.2</label>
<title>Career commitment and sense of calling</title>
<p>Due to the expansion of higher education in nursing and dissatisfaction with clinical nursing work, some nursing students may choose not to pursue the nursing profession after graduation. A lower sense of calling can be an internal factor contributing to this decision (<xref ref-type="bibr" rid="B15">15</xref>). Sense of calling refers to an individual&#x2019;s cognition and perception of the importance, significance, and value of their chosen profession. It is an emotional connection between individuals and their profession, serving as an intrinsic driving force (<xref ref-type="bibr" rid="B16">16</xref>). Individuals with a strong sense of calling tend to show greater enthusiasm for professional learning, strive for higher standards, and actively pursue career development. Also, sense of calling can help individuals overcome setbacks and difficulties in their work, enhancing their sense of self-worth and self-confidence (<xref ref-type="bibr" rid="B17">17</xref>).</p>
<p>Study (<xref ref-type="bibr" rid="B18">18</xref>) suggests that nurses with a stronger sense of calling exhibit heightened career commitment, a reduction in negative workplace behaviors, and an enhancement in mental wellbeing. In a study conducted by Afsar et al. (<xref ref-type="bibr" rid="B19">19</xref>), a questionnaire survey involving 294 nurses was carried out to explore the relationship between sense of calling and career commitment. The results indicates that sense of calling plays a complete mediator between career commitment, organizational citizenship behavior, workplace deviant behavior, and turnover intention. Based on these premises, this study hypothesizes the existence of a mutually predictive relationship between career commitment and sense of calling among nursing students (H2).</p>
</sec>
<sec id="S1.SS3">
<label>1.3</label>
<title>Career self-efficacy and sense of calling</title>
<p>According to the career development theory (<xref ref-type="bibr" rid="B20">20</xref>), during the late exploration stage, individuals select a specific occupational field and start experimenting with the feasibility of their career development goals. Brown and Lent (<xref ref-type="bibr" rid="B21">21</xref>) indicate that individuals with high career self-efficacy often have more confidence and positivity in achieving their aspirations, thus promoting work motivation. Conversely, the essence of a calling is rooted in individual interests, purpose, and motivation. Positive feedback from nursing students&#x2019; explorations of their career&#x2019;s feasibility can bolster their confidence in their chosen path, thereby reinforcing their commitment and dedication to their duties of their career&#x2019;s feasibility can bolster their confidence in their chosen path, thereby reinforcing their commitment and dedication to their duties. Zhang et al. (<xref ref-type="bibr" rid="B22">22</xref>) demonstrate a positive correlation between career self-efficacy and sense of calling. Similarly, Yang et al. (<xref ref-type="bibr" rid="B23">23</xref>) pointed out that nursing students&#x2019; career self-efficacy and sense of calling reach a moderate level after significant public health events, and occupational self-efficacy can predict the emergence of sense of calling. Additionally, when individuals perceive that their work has meaning and social impact, they are more inclined to enhance their skills and fully utilize their abilities (<xref ref-type="bibr" rid="B24">24</xref>). Consistently achieving success and attaining goals in their profession gradually strengthens individuals&#x2019; career self-efficacy (<xref ref-type="bibr" rid="B25">25</xref>). Building upon these observations, this study proposes a reciprocal predictive relationship between career self-efficacy and the sense of calling among nursing students over time (H3).</p>
</sec>
<sec id="S1.SS4">
<label>1.4</label>
<title>Differences between only child and non-only child nursing students</title>
<p>Over the past three decades of implementing the one-child policy in China, nursing students who have been influenced by it have gradually entered the workforce. Surprisingly, few attention have been paid to nursing students who are once again affected by this policy. In this context, a generation of young people with distinct characteristics has emerged (<xref ref-type="bibr" rid="B26">26</xref>). Raised in an environment fostering independent thought and autonomous problem-solving from an early age, they exhibit a strong sense of independence. Moreover, they benefit from diverse family resources and showcase higher intellectual and learning capabilities (<xref ref-type="bibr" rid="B27">27</xref>). However, some shortcomings are also evident: occasional unreliability, limited competitiveness, a propensity toward pessimism, and a somewhat subdued sense of responsibility, leading to them being colloquially referred to as the &#x201C;little emperors&#x201D; generation (<xref ref-type="bibr" rid="B28">28</xref>). The professional cognition and attitudes of this generation of nursing students will have an impact on the stability of the entire nursing team (<xref ref-type="bibr" rid="B29">29</xref>). Therefore, it is necessary to assess the relationships between career commitment, career self-efficacy, and sense of calling among nursing students, especially concerning whether they are from one-child households. This study hypothesizes that discernible disparities exist between one-child and non-one-child nursing students in terms of career commitment, career self-efficacy, and the sense of calling, as examined through a cross-lagged model (H4).</p>
</sec>
<sec id="S1.SS5">
<label>1.5</label>
<title>The present study</title>
<p>While numerous studies have explored the pairwise relationships between career commitment, career self-efficacy, and sense of calling, there remains a notable research gap concerning the interplay among these three factors. Furthermore, most of the existing studies are cross-sectional nature, limiting their ability to infer causal relationships accurately It is worth noting that China has implemented the one-child policy for over forty years, and the generation of nursing students affected by this policy is becoming the backbone of the nursing field. In this context, there is still a limited amount of research on nursing students. This study aims to elucidate the impacts of the one-child policy on the relationships and underlying mechanisms between career commitment, career self-efficacy and sense of calling among nursing students. The research hypotheses are as follows:</p>
<disp-quote>
<p><italic>H1</italic>: There is a reciprocal relationship between career commitment and career self-efficacy among nursing students over time.</p>
</disp-quote>
<disp-quote>
<p><italic>H2</italic>: There is a reciprocal relationship between career commitment and sense of calling among nursing students over time.</p>
</disp-quote>
<disp-quote>
<p><italic>H3</italic>: There is a reciprocal relationship between career self-efficacy and sense of calling among nursing students over time.</p>
</disp-quote>
<disp-quote>
<p><italic>H4</italic>: There are differences in the cross-lagged relationships among career commitment, career self-efficacy, and sense of calling between only-child and non-only-child student groups.</p>
</disp-quote>
</sec>
</sec>
<sec id="S2" sec-type="materials|methods">
<label>2</label>
<title>Materials and methods</title>
<sec id="S2.SS1">
<label>2.1</label>
<title>Participants and procedure</title>
<p>The initial number of young people available for participation was 744 participants, all participants were third-year undergraduate nursing students from a university in Zhejiang Province, China. Measurements were taken in September 2022 (T1) and December 2022 (T2), which corresponded to a key transition period in the nursing curriculum from pre-clinical learning to initial clinical placement exposure. Consequently, the final sample comprised 693 students (588 females and 105 males).</p>
<p>The sample size was considered adequate for cross-lagged panel modeling, as SEM guidelines (<xref ref-type="bibr" rid="B30">30</xref>) commonly recommend a minimum sample size of approximately N &#x2265; 200 for stable parameter estimation. Therefore, the final valid sample (<italic>N</italic> = 693) was more than sufficient for the proposed analyses.</p>
<p>This study was approved by the Research Ethics Committee at the first author&#x2019;s institution. Prior to the investigation and data collection, participants were informed of the purpose and procedures of the study. Each participant&#x2019;s student ID (but not their name) was recorded only for matching the longitudinal data. The researchers also assured the confidentiality of the data, which could only be accessed by authorized researchers. Thus, the data from this study would be anonymous. Self-report questionnaires were distributed to all students through Wenjuanxing, an online crowdsourcing platform in China, during each wave. Participants were provided with information about local professional help resources in case they needed them. The demographic information is presented in <xref ref-type="table" rid="T1">Table 1</xref>.</p>
<table-wrap position="float" id="T1">
<label>TABLE 1</label>
<caption><p>Demographic information of the sample.</p></caption>
<table cellspacing="5" cellpadding="5" frame="box" rules="all">
<thead>
<tr>
<th valign="top" align="center">Demographic information</th>
<th valign="top" align="center">Level</th>
<th valign="top" align="center"><italic>N</italic></th>
<th valign="top" align="center">Percentage</th>
<th valign="top" align="center"><italic>M</italic>(<italic>SD</italic>)</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="center" rowspan="2">Gender</td>
<td valign="top" align="center">Female</td>
<td valign="top" align="center">588</td>
<td valign="top" align="center">84.8</td>
<td valign="top" align="center" rowspan="16"/>
</tr>
<tr>
<td valign="top" align="center">Male</td>
<td valign="top" align="center">105</td>
<td valign="top" align="center">15.2</td>
</tr>
<tr>
<td valign="top" align="center" rowspan="2">Residence</td>
<td valign="top" align="center">Urban</td>
<td valign="top" align="center">281</td>
<td valign="top" align="center">40.5</td>
</tr>
<tr>
<td valign="top" align="center">Rural</td>
<td valign="top" align="center">412</td>
<td valign="top" align="center">59.5</td>
</tr>
<tr>
<td valign="top" align="center" rowspan="2">One-child family</td>
<td valign="top" align="center">No</td>
<td valign="top" align="center">448</td>
<td valign="top" align="center">64.6</td>
</tr>
<tr>
<td valign="top" align="center">Yes</td>
<td valign="top" align="center">245</td>
<td valign="top" align="center">35.4</td>
</tr>
<tr>
<td valign="top" align="center" rowspan="4">Father&#x2019;s education level</td>
<td valign="top" align="center">Elementary or lower</td>
<td valign="top" align="center">117</td>
<td valign="top" align="center">16.9</td>
</tr>
<tr>
<td valign="top" align="center">Junior middle school</td>
<td valign="top" align="center">320</td>
<td valign="top" align="center">46.2</td>
</tr>
<tr>
<td valign="top" align="center">Senior middle school</td>
<td valign="top" align="center">174</td>
<td valign="top" align="center">25.1</td>
</tr>
<tr>
<td valign="top" align="center">Bachelor&#x2019;s degree or higher</td>
<td valign="top" align="center">82</td>
<td valign="top" align="center">11.8</td>
</tr>
<tr>
<td valign="top" align="center" rowspan="4">Mother&#x2019;s education level</td>
<td valign="top" align="center">Elementary or lower</td>
<td valign="top" align="center">175</td>
<td valign="top" align="center">25.3</td>
</tr>
<tr>
<td valign="top" align="center">Junior middle school</td>
<td valign="top" align="center">303</td>
<td valign="top" align="center">43.7</td>
</tr>
<tr>
<td valign="top" align="center">Senior middle school</td>
<td valign="top" align="center">141</td>
<td valign="top" align="center">20.3</td>
</tr>
<tr>
<td valign="top" align="center">Bachelor&#x2019;s degree or higher</td>
<td valign="top" align="center">74</td>
<td valign="top" align="center">10.7</td>
</tr>
<tr>
<td valign="top" align="center" rowspan="2">Whether they have relatives practicing medicine</td>
<td valign="top" align="center">Yes</td>
<td valign="top" align="center">131</td>
<td valign="top" align="center">18.9</td>
</tr>
<tr>
<td valign="top" align="center">No</td>
<td valign="top" align="center">562</td>
<td valign="top" align="center">81.1</td>
</tr>
<tr>
<td valign="top" align="center" colspan="2">Age</td>
<td valign="top" colspan="2"/>
<td valign="top" align="center">20.3(1.2)</td>
</tr>
</tbody>
</table></table-wrap>
</sec>
<sec id="S2.SS2">
<label>2.2</label>
<title>Measures</title>
<sec id="S2.SS2.SSS1">
<label>2.2.1</label>
<title>Sociodemographic questionnaire</title>
<p>Demographic details included gender, age, place of origin (whether from a rural or urban area), and presence of other siblings. Responses to questions about educational and vocational status were also collected which included the highest completed level of the parent&#x2019;s education and whether they had relatives practicing medicine.</p>
</sec>
<sec id="S2.SS2.SSS2">
<label>2.2.2</label>
<title>Career commitment</title>
<p>The 27-item Undergraduate Career Commitment Scale was used to assess the four dimensions of career commitment among college students: (a) affective commitment, (b) continuance commitment, (c) normative commitment, and (d) ideal commitment (<xref ref-type="bibr" rid="B31">31</xref>). Participants were asked to indicate on a five-point scale ranging from 1 = <italic>totally disagree</italic> to 5 = <italic>absolutely agree</italic>. A higher score indicated a stronger commitment to the respective characteristic. Cronbach&#x2019;s alpha for the two time points were 0.94 and 0.95, respectively.</p>
</sec>
<sec id="S2.SS2.SSS3">
<label>2.2.3</label>
<title>Career self-efficacy</title>
<p>Career self-efficacy was measured by the Chinese adaptation (<xref ref-type="bibr" rid="B32">32</xref>) of the career-related self-efficacy scale (<xref ref-type="bibr" rid="B33">33</xref>). This scale comprises two items, which are divided into two dimensions: educational requirements (e.g., &#x201C;How confident you are to complete the education or training required of your career successfully&#x201D;) and job responsibilities (e.g., &#x201C;How confident you are to complete the duties of your career successfully&#x201D;). Responses were rated on a scale ranging from 1 (have no confidence) to 5 (very confident). A higher score indicated greater career self-efficacy. Cronbach&#x2019;s alpha for the two time points were 0.88 and 0.91, respectively.</p>
</sec>
<sec id="S2.SS2.SSS4">
<label>2.2.4</label>
<title>Sense of calling</title>
<p>The presence of sense of calling was tested using the Brief Calling scale developed by Steger et al. (<xref ref-type="bibr" rid="B34">34</xref>). The scale consists of two items (e.g., &#x201C;I have a calling to a particular kind of work.&#x201D; and &#x201C;I have a good understanding of my calling as it applies to my career.&#x201D;) rated on a scale ranging from 1 (not at all true of me) to 5 (totally true of me). A higher score indicated a stronger sense of calling for the respective characteristic. The scale has been demonstrated to be reliable and valid for assessing calling in the Chinese cultural context (<xref ref-type="bibr" rid="B35">35</xref>) Cronbach&#x2019;s alpha for the two time points were 0.91 and 0.93, respectively.</p>
</sec>
</sec>
<sec id="S2.SS3">
<label>2.3</label>
<title>Data analysis</title>
<p>Descriptive statistics, correlations, independent <italic>t</italic>-tests, and repeated measures analysis of variance were conducted using SPSS 24.0. To examine the longitudinal associations among career commitment, career self-efficacy, and sense of calling, cross-lagged panel models were estimated. Multi-group cross-lagged models were further conducted to compare path estimates between only-child and non-only-child students. Model interpretation emphasized standardized coefficients and confidence intervals, with attention to the overall pattern and consistency of effects across models. All models were tested via maximum likelihood (ML) estimation in Mplus 8.3 to estimate the structural equation model. Initially, we tested the configural, metric, and scalar invariance of measurement models by imposing equality constraints to ensure that the latent constructs had a comparable measurement structure across time. Subsequently, we conducted a two-wave cross-lagged model, including auto-regressions and regression paths, to examine the relationships among career commitment, career self-efficacy and sense of calling.</p>
<p>To evaluate the model fit, the following criteria (<xref ref-type="bibr" rid="B36">36</xref>) were used: the chi-square value divided by the degrees of freedom (&#x03C7;<sup>2</sup>/<italic>df</italic>) between 2 and 3, the root mean squared error of approximation (RMSEA) lower than 0.08, the standardized root mean square residual (SRMR) less than 0.08, the Tucker and Lewis Index (TLI) and the comparative fit index (CFI) values greater than 0.90 were considered as indicators of an acceptable model fit. Additionally, cognizing that &#x03C7;<sup>2</sup> is sensitive to sample size and frequently yields statistically significant values, the current study used &#x0394;CFI, &#x0394;TLI, and &#x0394;RMSEA to compare measurement models. The &#x0394;CFI and &#x0394;TLI values were both less than 0.010, and &#x0394;RMSEA values &#x003C; 0.015, indicating that the fit between the models was equivalent.</p>
</sec>
</sec>
<sec id="S3" sec-type="results">
<label>3</label>
<title>Results</title>
<sec id="S3.SS1">
<label>3.1</label>
<title>Descriptive statistics and difference test</title>
<p>In <xref ref-type="table" rid="T2">Table 2</xref>, means, standard deviations, and correlations for the measures of career commitment, career self-efficacy and calling are shown. The skewness and kurtosis of these variables fell within the acceptable range. Furthermore, all study variables were significant and positive in each wave. Then, the differences in career commitment, career self-efficacy, and sense of calling at T1 and T2 between participants with and without siblings were tested. Interestingly, the career commitment of only-child students was higher than that of non-only-child participants at both T1 and T2, as shown in <xref ref-type="table" rid="T3">Table 3</xref>. However, the pairwise comparisons revealed no significant differences in career commitment, career self-efficacy, and sense of calling between T1 and T2.</p>
<table-wrap position="float" id="T2">
<label>TABLE 2</label>
<caption><p>Descriptive statistics and correlations among variables of interest.</p></caption>
<table cellspacing="5" cellpadding="5" frame="box" rules="all">
<thead>
<tr>
<th valign="top" align="center">Variables</th>
<th valign="top" align="center">1</th>
<th valign="top" align="center">2</th>
<th valign="top" align="center">3</th>
<th valign="top" align="center">4</th>
<th valign="top" align="center">5</th>
<th valign="top" align="center">6</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="center">T1 career commitment</td>
<td valign="top" align="center">1</td>
<td valign="bottom" align="center" rowspan="2">1</td>
<td valign="bottom" align="center" rowspan="3">1</td>
<td valign="bottom" align="center" rowspan="4">1</td>
<td valign="bottom" align="center" rowspan="5">1</td>
<td valign="bottom" align="center" rowspan="6">1</td>
</tr>
<tr>
<td valign="top" align="center">T1 career self-efficacy</td>
<td valign="top" align="center">0.50<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">T1 calling</td>
<td valign="top" align="center">0.55<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.59<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">T2 career commitment</td>
<td valign="top" align="center">0.57<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.39<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.47<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">T2 career self-efficacy</td>
<td valign="top" align="center">0.41<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.50<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.45<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.53<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">T2 calling</td>
<td valign="top" align="center">0.45<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.43<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.53<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.55<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
<td valign="top" align="center">0.66<xref ref-type="table-fn" rid="t2fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">M</td>
<td valign="top" align="center">94.80</td>
<td valign="top" align="center">15.31</td>
<td valign="top" align="center">7.76</td>
<td valign="top" align="center">95.47</td>
<td valign="top" align="center">15.47</td>
<td valign="top" align="center">7.86</td>
</tr>
<tr>
<td valign="top" align="center">SD</td>
<td valign="top" align="center">14.19</td>
<td valign="top" align="center">3.07</td>
<td valign="top" align="center">1.68</td>
<td valign="top" align="center">14.82</td>
<td valign="top" align="center">3.21</td>
<td valign="top" align="center">1.67</td>
</tr>
<tr>
<td valign="top" align="center">Skewness</td>
<td valign="top" align="center">&#x2212;0.31</td>
<td valign="top" align="center">&#x2212;0.63</td>
<td valign="top" align="center">&#x2212;0.44</td>
<td valign="top" align="center">&#x2212;0.26</td>
<td valign="top" align="center">&#x2212;0.76</td>
<td valign="top" align="center">&#x2212;0.50</td>
</tr>
<tr>
<td valign="top" align="center">Kurtosis</td>
<td valign="top" align="center">1.25</td>
<td valign="top" align="center">0.89</td>
<td valign="top" align="center">&#x2212;0.09</td>
<td valign="top" align="center">1.43</td>
<td valign="top" align="center">1.07</td>
<td valign="top" align="center">0.06</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="t2fns3"><p>&#x002A;&#x002A;&#x002A;<italic>p</italic> &#x003C; 0.001, the same below.</p></fn>
</table-wrap-foot>
</table-wrap>
<table-wrap position="float" id="T3">
<label>TABLE 3</label>
<caption><p>Differences between only-child and non-only-child among research variables.</p></caption>
<table cellspacing="5" cellpadding="5" frame="box" rules="all">
<thead>
<tr>
<th valign="top" align="center">Variables</th>
<th valign="top" align="center" colspan="2">Only or non-only-child M (SD)</th>
<th valign="top" align="center"><italic>t</italic></th>
</tr>
<tr>
<th valign="top" align="center"/>
<th valign="top" align="center">Only-child<break/> <italic>(N</italic> = 245)</th>
<th valign="top" align="center">Non-only-child<break/> (<italic>N</italic> = 448)</th>
<th valign="top" align="center"/>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="center">T1 career commitment</td>
<td valign="top" align="center">96.64(15.77)</td>
<td valign="top" align="center">93.79(13.15)</td>
<td valign="top" align="center">&#x2212;2.54<xref ref-type="table-fn" rid="t3fns2">&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">T1 career self-efficacy</td>
<td valign="top" align="center">15.57(3.13)</td>
<td valign="top" align="center">15.16(3.03)</td>
<td valign="top" align="center">&#x2212;1.67</td>
</tr>
<tr>
<td valign="top" align="center">T1 sense of calling</td>
<td valign="top" align="center">7.90(1.70)</td>
<td valign="top" align="center">7.68(1.67)</td>
<td valign="top" align="center">&#x2212;1.61</td>
</tr>
<tr>
<td valign="top" align="center">T2 career commitment</td>
<td valign="top" align="center">97.25(14.25)</td>
<td valign="top" align="center">94.49(15.05)</td>
<td valign="top" align="center">&#x2212;2.35<xref ref-type="table-fn" rid="t3fns2">&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">T2 career self-efficacy</td>
<td valign="top" align="center">15.58(3.38)</td>
<td valign="top" align="center">15.42(3.12)</td>
<td valign="top" align="center">&#x2212;0.63</td>
</tr>
<tr>
<td valign="top" align="center">T2 sense of calling</td>
<td valign="top" align="center">7.89(1.78)</td>
<td valign="top" align="center">7.84(1.61)</td>
<td valign="top" align="center">&#x2212;0.32</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="t3fns2"><p>&#x002A;&#x002A;<italic>p</italic> &#x003C; 0.01.</p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="S3.SS2">
<label>3.2</label>
<title>Cross-lagged model testing</title>
<p>A cross-lagged panel model was analyzed to test the longitudinal and bidirectional relationships among the career commitment, career self-efficacy and sense of calling. To control for cross-sectional correlations, correlations among the three variables at the same measurement points were included. The results revealed significant within-time correlations between career commitment, career self-efficacy, and sense of calling at both measurement points within the cross-lagged panel model. The model exhibited a good fit to the data (&#x03C7;<sup>2</sup> = 216.577, <italic>df</italic> = 81, p &#x003C; 0.001; CFI = 0.987, TLI = 0.981, RMSEA = 0.049 [0.041, 0.057], SRMR = 0.020). As illustrated in <xref ref-type="fig" rid="F1">Figure 1</xref>, autoregressive paths were significant for the career commitment, career self-efficacy and calling across time. In terms of cross-lagged effects, it was observed that higher levels of career commitment at T1 positively predicted higher levels of calling at T2 (&#x03B2; = 0.184, <italic>p</italic> &#x003C; 0.005), and vice versa, higher levels of calling at T1 positively predicted higher levels of career commitment at T2 (&#x03B2; = 0.225, <italic>p</italic> &#x003C; 0.001). Furthermore, higher levels of career commitment at T1 predicted higher levels of career self-efficacy at T2 (&#x03B2; = 0.135, <italic>p</italic> &#x003C; 0.01), while the reverse relationship (career self-efficacy at T1 predicting career commitment at T2) was not significant (&#x03B2; = 0.048, <italic>p</italic> &#x003E; 0.05). As expected, the association between career self-efficacy and calling was bidirectional: career self-efficacy at T1 positively predicted calling at T2 (&#x03B2; = 0.145, <italic>p</italic> &#x003C; 0.01), and also calling at T1 positively predicted career self-efficacy at T2 (&#x03B2; = 0.192, <italic>p</italic> &#x003C; 0.01) (see <xref ref-type="table" rid="T4">Table 4</xref>).</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption><p>A cross-lagged model for all subjects. CC, career commitment; CSE, career self-efficacy; CA, sense of calling. Dashed lines indicate non-significant estimates. All the reported parameters are standardized. Coefficients represent standardized values. <italic>N</italic> = 693, the same below.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-13-1760650-g001.tif">
<alt-text content-type="machine-generated">Path diagram with two time points, T1 and T2, showing relationships among three variables: CC, CSE, and CA. Arrows indicate direct and cross-lagged effects with standardized coefficients, some labeled with asterisks for significance.</alt-text>
</graphic>
</fig>
<table-wrap position="float" id="T4">
<label>TABLE 4</label>
<caption><p>Structural paths result of all latent variables.</p></caption>
<table cellspacing="5" cellpadding="5" frame="box" rules="all">
<thead>
<tr>
<th valign="top" align="center">Path</th>
<th valign="top" align="center">Estimate (&#x03B2;)</th>
<th valign="top" align="center">SE</th>
<th valign="top" align="center">90% CI<break/> (Lower)</th>
<th valign="top" align="center">90% CI<break/> (Upper)</th>
<th valign="top" align="center"><italic>p</italic>-value</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="center">CC (T1) &#x2192; CC (T2)</td>
<td valign="top" align="center">0.418</td>
<td valign="top" align="center">0.04</td>
<td valign="top" align="center">0.34</td>
<td valign="top" align="center">0.496</td>
<td valign="top" align="center"><xref ref-type="table-fn" rid="t4fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">CSE (T1) &#x2192; CSE (T2)</td>
<td valign="top" align="center">0.345</td>
<td valign="top" align="center">0.038</td>
<td valign="top" align="center">0.271</td>
<td valign="top" align="center">0.419</td>
<td valign="top" align="center"><xref ref-type="table-fn" rid="t4fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">CA (T1) &#x2192; CA (T2)</td>
<td valign="top" align="center">0.361</td>
<td valign="top" align="center">0.042</td>
<td valign="top" align="center">0.279</td>
<td valign="top" align="center">0.443</td>
<td valign="top" align="center"><xref ref-type="table-fn" rid="t4fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">CC (T1) &#x2192; CSE (T2)</td>
<td valign="top" align="center">0.135</td>
<td valign="top" align="center">0.045</td>
<td valign="top" align="center">0.047</td>
<td valign="top" align="center">0.223</td>
<td valign="top" align="center"><xref ref-type="table-fn" rid="t4fns2">&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">CC (T1) &#x2192; CA (T2)</td>
<td valign="top" align="center">0.184</td>
<td valign="top" align="center">0.049</td>
<td valign="top" align="center">0.088</td>
<td valign="top" align="center">0.28</td>
<td valign="top" align="center"><xref ref-type="table-fn" rid="t4fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">CSE (T1) &#x2192; CC (T2)</td>
<td valign="top" align="center">0.048</td>
<td valign="top" align="center">0.04</td>
<td valign="top" align="center">&#x2212;0.03</td>
<td valign="top" align="center">0.126</td>
<td valign="top" align="center">0.23</td>
</tr>
<tr>
<td valign="top" align="center">CSE (T1) &#x2192; CA (T2)</td>
<td valign="top" align="center">0.145</td>
<td valign="top" align="center">0.05</td>
<td valign="top" align="center">0.047</td>
<td valign="top" align="center">0.243</td>
<td valign="top" align="center"><xref ref-type="table-fn" rid="t4fns2">&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">CA (T1) &#x2192; CC (T2)</td>
<td valign="top" align="center">0.225</td>
<td valign="top" align="center">0.046</td>
<td valign="top" align="center">0.135</td>
<td valign="top" align="center">0.315</td>
<td valign="top" align="center"><xref ref-type="table-fn" rid="t4fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
<tr>
<td valign="top" align="center">CA (T1) &#x2192; CSE (T2)</td>
<td valign="top" align="center">0.192</td>
<td valign="top" align="center">0.052</td>
<td valign="top" align="center">0.09</td>
<td valign="top" align="center">0.294</td>
<td valign="top" align="center"><xref ref-type="table-fn" rid="t4fns3">&#x002A;&#x002A;&#x002A;</xref></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="t4fns2"><p>&#x002A;&#x002A;<italic>p</italic> &#x003C; 0.01,</p></fn>
<fn id="t4fns3"><p>&#x002A;&#x002A;&#x002A;<italic>p</italic> &#x003C; 0.001.</p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="S3.SS3">
<label>3.3</label>
<title>A comparison of differences between only-child and non-only-child students</title>
<p>Multi-group comparative structural equation modeling was initially conducted to examine whether the career commitment, career self-efficacy and sense of calling were measured the same for both only-child and non-only-child students over time (see <xref ref-type="table" rid="T5">Table 5</xref>). As shown in <xref ref-type="table" rid="T4">Table 4</xref>, the &#x0394;CFI and &#x0394;TLI values &#x003C; 0.010, respectively, and &#x0394;RMSEA values &#x003C; 0.015. Therefore, the configural, metric, and scalar invariance of latent constructs were all established. We first tested configural, metric, and scalar invariance across groups. Configural invariance allowed parameters to vary freely across groups. Metric and scalar invariance were then examined by constraining factor loadings and item intercepts to be equal across groups., and the model demonstrated an acceptable fit to the data [&#x03C7;<sup>2</sup>(204) = 393.51, <italic>p</italic> &#x003C; 0.001; CFI = 0.98; TLI = 0.98; RMSEA = 0.05; SRMR = 0.07]. A fully unconstrained measurement model was then analyzed in which all parameters constrained to be the same for both groups, &#x03C7;<sup>2</sup>(198) = 382.91, <italic>p</italic> &#x003C; 0.001, CFI = 0.98, TLI = 0.98, RMSEA = 0.05, SRMR = 0.06. The chi-squared test of difference indicated that the fully unconstrained measurement model fit the data equally well compared to the unconstrained model [&#x0394;&#x03C7;<sup>2</sup>(6) = 10.60, <italic>p</italic> &#x003E; 0.05]. Thus, the unconstrained model was then used in subsequent analysis. In contrast to the general model, it was observed that in the non-only-child group, career commitment at T1 did not predict career self-efficacy at T2 (&#x03B2; = 0.095, <italic>p</italic> &#x003E; 0.05), and career self-efficacy at T1 also did not predict career commitment at T2 (&#x03B2; = &#x2212;0.025, <italic>p</italic> &#x003E; 0.05). However, in the only-child group, it was found that career commitment and career self-efficacy positively predicted each other (see <xref ref-type="fig" rid="F2">Figures 2</xref>, <xref ref-type="fig" rid="F3">3</xref>).</p>
<table-wrap position="float" id="T5">
<label>TABLE 5</label>
<caption><p>Measurement model tests of all latent variables.</p></caption>
<table cellspacing="5" cellpadding="5" frame="box" rules="all">
<thead>
<tr>
<th valign="top" align="center">Variables</th>
<th valign="top" align="center">&#x03C7;<italic>2/df</italic></th>
<th valign="top" align="center">CFI</th>
<th valign="top" align="center">TLI</th>
<th valign="top" align="center">RMSEA (90% CI)</th>
<th valign="top" align="center">SRMR</th>
<th valign="top" align="center">&#x0394;CFI</th>
<th valign="top" align="center">&#x0394;TLI</th>
<th valign="top" align="center">&#x0394;RMSEA</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="center">Configural invariance</td>
<td valign="top" align="center">2.67</td>
<td valign="top" align="center">0.987</td>
<td valign="top" align="center">0.981</td>
<td valign="top" align="center">0.049([0.041, 0.057])</td>
<td valign="top" align="center">0.020</td>
<td valign="top" colspan="3"/>
</tr>
<tr>
<td valign="top" align="center">Metric invariance</td>
<td valign="top" align="center">2.56</td>
<td valign="top" align="center">0.987</td>
<td valign="top" align="center">0.982</td>
<td valign="top" align="center">0.048([0.040, 0.055])</td>
<td valign="top" align="center">0.023</td>
<td valign="top" align="center">&#x003C; 0.001</td>
<td valign="top" align="center">0.001</td>
<td valign="top" align="center">0.001</td>
</tr>
<tr>
<td valign="top" align="center">Scalar invariance</td>
<td valign="top" align="center">2.54</td>
<td valign="top" align="center">0.987</td>
<td valign="top" align="center">0.983</td>
<td valign="top" align="center">0.047([0.040, 0.055])</td>
<td valign="top" align="center">0.022</td>
<td valign="top" align="center">&#x003C; 0.001</td>
<td valign="top" align="center">0.001</td>
<td valign="top" align="center">0.001</td>
</tr>
</tbody>
</table></table-wrap>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption><p>Cross-lagged panel model (non-only-child group). Same conventions as <xref ref-type="fig" rid="F1">Figure 1</xref>. All coefficients are standardized (&#x03B2;). <italic>N</italic> = 448.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-13-1760650-g002.tif">
<alt-text content-type="machine-generated">Path model diagram showing relationships among three variables at two time points: CC, CSE, and CA at T1 and T2. Arrows indicate standardized regression coefficients, with solid and dashed lines denoting significant and non-significant pathways, respectively.</alt-text>
</graphic>
</fig>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption><p>Cross-lagged panel model (only-child group). Same conventions as <xref ref-type="fig" rid="F1">Figure 1</xref>. All coefficients are standardized (&#x03B2;). <italic>N</italic> = 245.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fmed-13-1760650-g003.tif">
<alt-text content-type="machine-generated">Path diagram illustrating relationships among three variables&#x2014;CC, CSE, and CA&#x2014;at two time points labeled T1 and T2, with directional arrows indicating standardized coefficients and significance levels for each path.</alt-text>
</graphic>
</fig>
</sec>
</sec>
<sec id="S4" sec-type="discussion">
<label>4</label>
<title>Discussion</title>
<p>Based on Holland (1959)&#x2019;s career development theory (<xref ref-type="bibr" rid="B37">37</xref>), this study constructed a cross-lagged model of career commitment, career self-efficacy, and sense of calling among Chinese nursing undergraduates. Additionally, it compared the differences between students who are only children and those who are not. This holds both theoretical and practical significance in terms of sustaining a stable cohort of nursing professionals from the new generation and enhancing the psychological wellbeing of emerging nursing professionals.</p>
<sec id="S4.SS1">
<label>4.1</label>
<title>The cross-lagged relationships between career commitment, career self-efficacy, and sense of calling among nursing undergraduates</title>
<p>In this study, we found that career commitment at T1 significantly predicted career self-efficacy at T2, partially supporting H1. This finding aligns with previous research (<xref ref-type="bibr" rid="B10">10</xref>). From the perspective of positive psychology nursing students&#x2019; career commitment fosters a sense of identification and belonging to the nursing profession. These constructive cognitions accelerate their development and boost their confidence in career growth. For example, ceremonies like receiving the nursing cap and taking an oath enhance emotional attachment among nursing students, forming the basis for their future professional journey. However, contrary to the current research findings, career self-efficacy at T1 did not predict career commitment at T2 (<xref ref-type="bibr" rid="B38">38</xref>). This difference can be attributed to nursing students in the professional exploration phase (<xref ref-type="bibr" rid="B6">6</xref>), as they need to transition between the roles of a student and a nurse. During this phase, they face some obvious role conflicts: limited clinical experience, limited communication skills, and unfamiliarity with standardized nursing procedures. This hampers the development of robust career self-efficacy, consequently impeding the further enhancement of career commitment. Consequently, vocational educators should emphasize nurturing nursing students&#x2019; enthusiasm and positive perceptions of the nursing profession. To strengthen CSE in a more actionable way, educational approaches should prioritize mastery experiences, vicarious learning, and feedback-based performance improvemen. In nursing education, simulation-based learning and scenario-based practice offer structured opportunities for skills rehearsal and debriefing, and have been associated with improvements in self-efficacy and learning outcomes (<xref ref-type="bibr" rid="B39">39</xref>). Importantly, because the reverse pathway was not statistically supported in our model, capacity-building programs may be most effective when paired with strategies that reinforce professional meaning and identity formation, rather than relying solely on competence development to strengthen career commitment.</p>
<p>The research results indicate that there is a mutual-promoting relationship between career commitment and sense of calling, thus providing support for H2. This result is consistent with current research findings (<xref ref-type="bibr" rid="B17">17</xref>) and the career development theory (<xref ref-type="bibr" rid="B40">40</xref>) that states the more individuals invest in a certain role at a stage, the higher their likelihood of success. Career commitment serves as the emotional investment nursing students make in their professional paths. When nursing students have a higher level of career commitment, they are more likely to achieve greater professional success and subsequently foster the development of a sense of calling (<xref ref-type="bibr" rid="B41">41</xref>). Likewise, perceiving the profound significance of the nursing profession intensifies their commitment to it. Therefore, nursing educators should assist nursing students in comprehending the nobility and sanctity associated with the nursing profession. In practice, nurse leaders can strengthen nurses&#x2019; sense of calling by using structured reflection and narrative sharing around meaningful patient-care experiences. Reflection can focus on nurses&#x2019; value-based decisions, patient-centered interactions, and moments of professional growth, which helps connect everyday tasks with professional purpose and supports more stable career commitment (<xref ref-type="bibr" rid="B42">42</xref>, <xref ref-type="bibr" rid="B43">43</xref>).</p>
<p>Our research findings demonstrate that career self-efficacy and sense of calling of nursing students can predict each other over time; H3 was supported. This is consistent with current research results (<xref ref-type="bibr" rid="B44">44</xref>). High career self-efficacy among nursing students is manifested by their ability to control the pace of clinical work, make optimal use of clinical resources, and maintain positive expectations for their profession (<xref ref-type="bibr" rid="B22">22</xref>). In practice, training programs could be designed to combine meaning-centered components with competence-focused practice. For example, simulation scenarios can be framed around patient-centered ethical dilemmas or family communication challenges, followed by debriefing that explicitly links &#x201C;clinical competence&#x201D; with &#x201C;professional purpose,&#x201D; thereby strengthening both efficacy beliefs and perceived meaningfulness of nursing work. Simulation-based education is consistently described as beneficial for self-efficacy and learning outcomes, especially when paired with reflection and debriefing (<xref ref-type="bibr" rid="B45">45</xref>).</p>
</sec>
<sec id="S4.SS2">
<label>4.2</label>
<title>Differences in the cross-lagged model among only-child and non-only child undergraduates</title>
<p>The research findings indicate that there are no differences in the cross-lagged relationships between career commitment and sense of calling among only child. The association between career commitment and sense of calling is not influenced by family structure, but rather relates to individuals&#x2019; attitudes and values towards their chosen profession (<xref ref-type="bibr" rid="B16">16</xref>). Nursing students, influenced by humanistic nursing education, develop a deep love and sense of responsibility towards the nursing profession. They consider it their mission to serve patients and have a strong desire to listen to, care for, and assist patients (<xref ref-type="bibr" rid="B46">46</xref>). If pathways differ between only-child and non-only-child nurses, support should be tailored. Practical options include mentorship matching, peer support, and guided reflection to strengthen meaning at work and coping resources, which may support more stable career orientation (<xref ref-type="bibr" rid="B47">47</xref>).</p>
<p>Hypothesis 4 was partially supported, indicating that career commitment and career self-efficacy cannot predict each other in the non-only child group, while they can predict each other in the only child group. With relatively fewer siblings, only child nursing students may find it easier to obtain attention and support from their families and society, which may further strengthen their awareness of professional commitment (<xref ref-type="bibr" rid="B48">48</xref>). In contrast, non-only child nursing students, who likely compete for resources within the family, may exert more effort to gain support and attention, stimulating a stronger sense of career commitment (<xref ref-type="bibr" rid="B49">49</xref>). Interestingly, career self-efficacy and sense of calling exhibit a predictive relationship among non-only child nursing students but not among only child nursing students. The lack of same-generation companionship in the family environment may be a primary factor contributing to this difference. Research (<xref ref-type="bibr" rid="B50">50</xref>) suggests that individuals with siblings tend to be more motivated, work harder, display greater obedience, possess better social skills, and exhibit greater psychological stability compared to only children. The relatively limited competition and responsibility sharing experienced by only children may contribute to their lack of vocational calling (<xref ref-type="bibr" rid="B51">51</xref>). Non-only children may need to share family resources and responsibilities, motivating them to pursue their goals and mission more vigorously, thus developing a stronger sense of vocational calling. This highlights the importance for nursing educators to differentiate their approach and provide targeted guidance based on nursing students&#x2019; different family structures.</p>
</sec>
</sec>
<sec id="S5">
<label>5</label>
<title>Limitations and future directions</title>
<p>This study has the following limitations: Firstly, the research sample is relatively narrow, consisting only of nursing undergraduate students from a specific region. Generalizing the findings may require broader samples, and future studies could consider conducting multicenter research. Secondly, this study focused exclusively on nursing undergraduates. Future research could encompass a wider range of educational levels and professions. Thirdly, although a two-wave longitudinal design was adopted, the time interval between measurements was relatively short (three months). While this period corresponded to a key transition stage around the initiation of clinical placement, longer follow-up periods and additional measurement waves are needed to examine long-term developmental trajectories and stability of these constructs. Lastly, although this study is longitudinal, it has limited causal inference capacity compared to intervention studies. Future research could incorporate more intervention designs.</p>
<p>Despite these limitations, the current research has significant implications. This study conducted a longitudinal survey on career commitment, career self-efficacy, and calling among Chinese nursing undergraduates, further enriching the knowledge in the field of nursing Undergraduates&#x2019; professional psychology. It also highlights the importance of understanding the perspectives of nursing undergraduates who grew up under China&#x2019;s one-child policy. From a practical standpoint promoting nursing students&#x2019; passion for the profession, ensuring the stability of the future nursing workforce, and fostering the holistic development of nursing students&#x2019; physical and mental health are crucial concerns for nursing educators. This study provides intervention targets for nursing educators in addressing these critical issues. The gradual implementation of China&#x2019;s two-child and three-child policies, along with the evolving identity associated with being an only child, will also influence their perception of the nursing profession. This shift calls for further research and discussion in the future.</p>
</sec>
<sec id="S6" sec-type="conclusion">
<label>6</label>
<title>Conclusion</title>
<p>This study draws the following conclusions: Career commitment at T1 significantly predicts career self-efficacy at T2; There is a mutually reinforcing relationship between career commitment and sense of calling, as well as career self-efficacy and sense of calling over time; There are differences in the relationships between career commitment, career self-efficacy, and sense of calling among only child and non-only child. Our research underscores the importance of nurturing professional identity among nursing students for their success in the nursing field. It is essential to pay attention to the career mental health of nursing undergraduates who grew up under China&#x2019;s one-child policy.</p>
</sec>
</body>
<back>
<sec id="S7" sec-type="data-availability">
<title>Data availability statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec id="S8" sec-type="ethics-statement">
<title>Ethics statement</title>
<p>The studies involving humans were approved by the ethics committee of Wenzhou Medical University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.</p>
</sec>
<sec id="S9" sec-type="author-contributions">
<title>Author contributions</title>
<p>TD: Writing &#x2013; original draft. JS: Conceptualization, Data curation, Software, Writing &#x2013; original draft. WL: Formal analysis, Funding acquisition, Investigation, Writing &#x2013; review &#x0026; editing. FX: Formal analysis, Funding acquisition, Investigation, Writing &#x2013; review &#x0026; editing. HX: Investigation, Methodology, Software, Writing &#x2013; review &#x0026; editing. CZ: Investigation, Methodology, Software, Writing &#x2013; review &#x0026; editing. GZ: Project administration, Supervision, Validation, Writing &#x2013; review &#x0026; editing. CC: Validation, Visualization, Writing &#x2013; review &#x0026; editing.</p>
</sec>
<sec id="S11" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="S12" sec-type="ai-statement">
<title>Generative AI statement</title>
<p>The author(s) declared that generative AI was not used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p>
</sec>
<sec id="S13" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<label>1.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Abou Hashish</surname> <given-names>E</given-names></name> <name><surname>Bajbeir</surname> <given-names>E</given-names></name></person-group>. <article-title>The effect of managerial and leadership training and simulation on senior nursing students&#x2019; career planning and self-efficacy.</article-title> <source><italic>SAGE Open Nurs.</italic></source> (<year>2022</year>) <volume>8</volume>:<fpage>23779608221127952</fpage>. <pub-id pub-id-type="doi">10.1177/23779608221127952</pub-id> <pub-id pub-id-type="pmid">36160690</pub-id></mixed-citation></ref>
<ref id="B2">
<label>2.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lu</surname> <given-names>H</given-names></name> <name><surname>Hou</surname> <given-names>L</given-names></name> <name><surname>Zhou</surname> <given-names>W</given-names></name> <name><surname>Shen</surname> <given-names>L</given-names></name> <name><surname>Jin</surname> <given-names>S</given-names></name> <name><surname>Wang</surname> <given-names>M</given-names></name><etal/></person-group> <article-title>Trends, composition and distribution of nurse workforce in China: a secondary analysis of national data from 2003 to 2018.</article-title> <source><italic>BMJ Open.</italic></source> (<year>2018</year>) <volume>11</volume>:<fpage>e047348</fpage>. <pub-id pub-id-type="doi">10.1136/bmjopen-2020-047348</pub-id> <pub-id pub-id-type="pmid">34706946</pub-id></mixed-citation></ref>
<ref id="B3">
<label>3.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dall&#x2019;Ora</surname> <given-names>C</given-names></name> <name><surname>Ball</surname> <given-names>J</given-names></name> <name><surname>Reinius</surname> <given-names>M</given-names></name> <name><surname>Griffiths</surname> <given-names>P</given-names></name></person-group>. <article-title>Burnout in nursing: a theoretical review.</article-title> <source><italic>Hum Resour Health.</italic></source> (<year>2020</year>) <volume>18</volume>:<fpage>41</fpage>. <pub-id pub-id-type="doi">10.1186/s12960-020-00469-9</pub-id> <pub-id pub-id-type="pmid">32503559</pub-id></mixed-citation></ref>
<ref id="B4">
<label>4.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname> <given-names>M</given-names></name> <name><surname>Guan</surname> <given-names>H</given-names></name> <name><surname>Li</surname> <given-names>Y</given-names></name> <name><surname>Xing</surname> <given-names>C</given-names></name> <name><surname>Rui</surname> <given-names>B</given-names></name></person-group>. <article-title>Academic burnout and professional self-concept of nursing students: a cross-sectional study.</article-title> <source><italic>Nurse Educ Today.</italic></source> (<year>2019</year>) <volume>77</volume>:<fpage>27</fpage>&#x2013;<lpage>31</lpage>. <pub-id pub-id-type="doi">10.1016/j.nedt.2019.03.004</pub-id> <pub-id pub-id-type="pmid">30939399</pub-id></mixed-citation></ref>
<ref id="B5">
<label>5.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nesje</surname> <given-names>K</given-names></name></person-group>. <article-title>Personality and professional commitment of students in nursing, social work, and teaching: a comparative survey.</article-title> <source><italic>Int J Nurs Stud.</italic></source> (<year>2016</year>) <volume>53</volume>:<fpage>173</fpage>&#x2013;<lpage>81</lpage>. <pub-id pub-id-type="doi">10.1016/j.ijnurstu.2015.08.001</pub-id> <pub-id pub-id-type="pmid">26302656</pub-id></mixed-citation></ref>
<ref id="B6">
<label>6.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Super</surname> <given-names>DE</given-names></name></person-group>. <article-title>A life-span, life-space approach to career development.</article-title> <source><italic>J Vocat Behav.</italic></source> (<year>1980</year>) <volume>16</volume>:<fpage>282</fpage>&#x2013;<lpage>98</lpage>. <pub-id pub-id-type="doi">10.1016/0001-8791(80)90056-1</pub-id></mixed-citation></ref>
<ref id="B7">
<label>7.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Garc&#x00ED;a-Moyano</surname> <given-names>L</given-names></name> <name><surname>Altisent</surname> <given-names>R</given-names></name> <name><surname>Pellicer-Garc&#x00ED;a</surname> <given-names>B</given-names></name> <name><surname>Guerrero-Portillo</surname> <given-names>S</given-names></name> <name><surname>Arrazola-Alberdi</surname> <given-names>O</given-names></name> <name><surname>Delgado-Marroqu&#x00ED;n</surname> <given-names>MT</given-names></name></person-group>. <article-title>A concept analysis of professional commitment in nursing.</article-title> <source><italic>Nurs Ethics.</italic></source> (<year>2019</year>) <volume>26</volume>:<fpage>778</fpage>&#x2013;<lpage>97</lpage>. <pub-id pub-id-type="doi">10.1177/0969733017720847</pub-id> <pub-id pub-id-type="pmid">28812947</pub-id></mixed-citation></ref>
<ref id="B8">
<label>8.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wu</surname> <given-names>L</given-names></name> <name><surname>Norman</surname> <given-names>I</given-names></name></person-group>. <article-title>An investigation of job satisfaction, organizational commitment and role conflict and ambiguity in a sample of Chinese undergraduate nursing students.</article-title> <source><italic>Nurse Educ Today.</italic></source> (<year>2006</year>) <volume>26</volume>:<fpage>304</fpage>&#x2013;<lpage>14</lpage>. <pub-id pub-id-type="doi">10.1016/j.nedt.2005.10.011</pub-id> <pub-id pub-id-type="pmid">16338032</pub-id></mixed-citation></ref>
<ref id="B9">
<label>9.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chippendale</surname> <given-names>T</given-names></name></person-group>. <article-title>Factors associated with interest in working with older adults: implications for educational practices.</article-title> <source><italic>J Nurs Educ.</italic></source> (<year>2015</year>) <volume>54</volume>:<fpage>S89</fpage>&#x2013;<lpage>93</lpage>. <pub-id pub-id-type="doi">10.3928/01484834-20150814-16</pub-id> <pub-id pub-id-type="pmid">26334664</pub-id></mixed-citation></ref>
<ref id="B10">
<label>10.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gao</surname> <given-names>Z</given-names></name> <name><surname>Wei</surname> <given-names>X</given-names></name> <name><surname>Yang</surname> <given-names>L</given-names></name> <name><surname>Cui</surname> <given-names>D</given-names></name> <name><surname>Kong</surname> <given-names>L</given-names></name> <name><surname>Qi</surname> <given-names>L</given-names></name><etal/></person-group> <article-title>Mediating role of career self-efficacy between clinical learning environment and professional identity in nursing students.</article-title> <source><italic>J Adv Nurs.</italic></source> (<year>2022</year>) <volume>78</volume>:<fpage>1012</fpage>&#x2013;<lpage>9</lpage>. <pub-id pub-id-type="doi">10.1111/jan.15027</pub-id> <pub-id pub-id-type="pmid">34449912</pub-id></mixed-citation></ref>
<ref id="B11">
<label>11.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Perosa</surname> <given-names>S</given-names></name> <name><surname>Perosa</surname> <given-names>L</given-names></name></person-group>. <article-title>The mid-career crisis in relation to Super&#x2019;s career and Erikson&#x2019;s adult development theory.</article-title> <source><italic>Int J Aging Hum Dev.</italic></source> (<year>1984</year>) <volume>20</volume>:<fpage>53</fpage>&#x2013;<lpage>68</lpage>. <pub-id pub-id-type="doi">10.2190/yy3t-5vjf-1ewt-adk0</pub-id> <pub-id pub-id-type="pmid">6519840</pub-id></mixed-citation></ref>
<ref id="B12">
<label>12.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Han</surname> <given-names>J</given-names></name> <name><surname>Kang</surname> <given-names>K</given-names></name> <name><surname>Joung</surname> <given-names>J</given-names></name></person-group>. <article-title>Enhancing happiness for nursing students through positive psychology activities: a mixed methods study.</article-title> <source><italic>Int J Environ Res Public Health.</italic></source> (<year>2020</year>) <volume>17</volume>:<fpage>9274</fpage>. <pub-id pub-id-type="doi">10.3390/ijerph17249274</pub-id> <pub-id pub-id-type="pmid">33322448</pub-id></mixed-citation></ref>
<ref id="B13">
<label>13.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Guerrero</surname> <given-names>S</given-names></name> <name><surname>Ch&#x00EA;nevert</surname> <given-names>D</given-names></name> <name><surname>Kilroy</surname> <given-names>S</given-names></name></person-group>. <article-title>New graduate nurses&#x2019; professional commitment: antecedents and outcomes.</article-title> <source><italic>J Nurs Scholarsh.</italic></source> (<year>2017</year>) <volume>49</volume>:<fpage>572</fpage>&#x2013;<lpage>9</lpage>. <pub-id pub-id-type="doi">10.1111/jnu.12323</pub-id> <pub-id pub-id-type="pmid">28715609</pub-id></mixed-citation></ref>
<ref id="B14">
<label>14.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Shu</surname> <given-names>K</given-names></name></person-group>. <article-title>Teachers&#x2019; commitment and self-efficacy as predictors of work engagement and well-being.</article-title> <source><italic>Front Psychol.</italic></source> (<year>2022</year>) <volume>13</volume>:<fpage>850204</fpage>. <pub-id pub-id-type="doi">10.3389/fpsyg.2022.850204</pub-id> <pub-id pub-id-type="pmid">35558709</pub-id></mixed-citation></ref>
<ref id="B15">
<label>15.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname> <given-names>J</given-names></name> <name><surname>Guo</surname> <given-names>R</given-names></name> <name><surname>Liu</surname> <given-names>M</given-names></name> <name><surname>Zhang</surname> <given-names>X</given-names></name> <name><surname>Ren</surname> <given-names>L</given-names></name> <name><surname>Sun</surname> <given-names>M</given-names></name><etal/></person-group> <article-title>Career decision-making self-efficacy and professional commitment among master nursing students.</article-title> <source><italic>West J Nurs Res.</italic></source> (<year>2018</year>) <volume>40</volume>:<fpage>327</fpage>&#x2013;<lpage>45</lpage>. <pub-id pub-id-type="doi">10.1177/0193945916682236</pub-id> <pub-id pub-id-type="pmid">28322647</pub-id></mixed-citation></ref>
<ref id="B16">
<label>16.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gold</surname> <given-names>K</given-names></name></person-group>. <article-title>Combating burnout: back to medicine as a calling.</article-title> <source><italic>Ann Fam Med.</italic></source> (<year>2019</year>) <volume>17</volume>:<fpage>485</fpage>&#x2013;<lpage>6</lpage>. <pub-id pub-id-type="doi">10.1370/afm.2476</pub-id> <pub-id pub-id-type="pmid">31712285</pub-id></mixed-citation></ref>
<ref id="B17">
<label>17.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chen</surname> <given-names>J</given-names></name> <name><surname>Zhang</surname> <given-names>X</given-names></name></person-group>. <article-title>The impact of career calling on higher vocational nursing students&#x2019; learning engagement: the mediating roles of career adaptability and career commitment.</article-title> <source><italic>Front Psychol.</italic></source> (<year>2023</year>) <volume>14</volume>:<fpage>1111842</fpage>. <pub-id pub-id-type="doi">10.3389/fpsyg.2023.1111842</pub-id> <pub-id pub-id-type="pmid">37034956</pub-id></mixed-citation></ref>
<ref id="B18">
<label>18.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Petersen</surname> <given-names>C</given-names></name> <name><surname>Munk</surname> <given-names>D</given-names></name> <name><surname>Dalton</surname> <given-names>D</given-names></name></person-group>. <article-title>Finding your calling: an online seminar for undergraduate nursing students.</article-title> <source><italic>J Christ Nurs.</italic></source> (<year>2022</year>) <volume>39</volume>:<fpage>244</fpage>&#x2013;<lpage>9</lpage>. <pub-id pub-id-type="doi">10.1097/CNJ.0000000000001001</pub-id> <pub-id pub-id-type="pmid">36048597</pub-id></mixed-citation></ref>
<ref id="B19">
<label>19.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Afsar</surname> <given-names>B</given-names></name> <name><surname>Umrani</surname> <given-names>WA</given-names></name> <name><surname>Khan</surname> <given-names>A</given-names></name></person-group>. <article-title>The impact of perceived calling on work outcomes in a nursing context: the role of career commitment and living one&#x2019;s calling.</article-title> <source><italic>J Appl Biobehav Res.</italic></source> (<year>2019</year>) <volume>24</volume>:<fpage>e12154</fpage>. <pub-id pub-id-type="doi">10.1111/jabr.12154</pub-id></mixed-citation></ref>
<ref id="B20">
<label>20.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gbogbo</surname> <given-names>S</given-names></name></person-group>. <article-title>Early motherhood: voices from female adolescents in the Hohoe municipality, Ghana-a qualitative study utilizing Schlossberg&#x2019;s transition theory.</article-title> <source><italic>Int J Qual Stud Health Well-being.</italic></source> (<year>2020</year>) <volume>15</volume>:<fpage>1716620</fpage>. <pub-id pub-id-type="doi">10.1080/17482631.2020.1716620</pub-id> <pub-id pub-id-type="pmid">31975645</pub-id></mixed-citation></ref>
<ref id="B21">
<label>21.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Brown</surname> <given-names>S</given-names></name> <name><surname>Lent</surname> <given-names>R</given-names></name></person-group>. <article-title>Vocational psychology: agency, equity, and well-being.</article-title> <source><italic>Annu Rev Psychol.</italic></source> (<year>2016</year>) <volume>67</volume>:<fpage>541</fpage>&#x2013;<lpage>65</lpage>. <pub-id pub-id-type="doi">10.1146/annurev-psych-122414-033237</pub-id> <pub-id pub-id-type="pmid">26436716</pub-id></mixed-citation></ref>
<ref id="B22">
<label>22.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhang</surname> <given-names>S</given-names></name> <name><surname>Tang</surname> <given-names>Y</given-names></name> <name><surname>Yong</surname> <given-names>S</given-names></name></person-group>. <article-title>The influence of gratitude on pre-service teachers&#x2019; career goal self-efficacy: chained intermediary analysis of meaning in life and career calling.</article-title> <source><italic>Front Psychol.</italic></source> (<year>2022</year>) <volume>13</volume>:<fpage>843276</fpage>. <pub-id pub-id-type="doi">10.3389/fpsyg.2022.843276</pub-id> <pub-id pub-id-type="pmid">35967650</pub-id></mixed-citation></ref>
<ref id="B23">
<label>23.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yang</surname> <given-names>L</given-names></name> <name><surname>Xu</surname> <given-names>M</given-names></name> <name><surname>Kuang</surname> <given-names>J</given-names></name> <name><surname>Zhou</surname> <given-names>K</given-names></name> <name><surname>Zhu</surname> <given-names>X</given-names></name> <name><surname>Kong</surname> <given-names>L</given-names></name><etal/></person-group> <article-title>Has the COVID-19 pandemic affected nursing students&#x2019; career self-efficacy and professional calling? The mediating impact of professional identity.</article-title> <source><italic>BMC Med Educ.</italic></source> (<year>2022</year>) <volume>22</volume>:<fpage>757</fpage>. <pub-id pub-id-type="doi">10.1186/s12909-022-03833-6</pub-id> <pub-id pub-id-type="pmid">36335404</pub-id></mixed-citation></ref>
<ref id="B24">
<label>24.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>You</surname> <given-names>J</given-names></name> <name><surname>Kim</surname> <given-names>S</given-names></name> <name><surname>Kim</surname> <given-names>K</given-names></name> <name><surname>Cho</surname> <given-names>A</given-names></name> <name><surname>Chang</surname> <given-names>W</given-names></name></person-group>. <article-title>Conceptualizing meaningful work and its implications for HRD.</article-title> <source><italic>Eur J Training Dev.</italic></source> (<year>2020</year>): <pub-id pub-id-type="doi">10.1108/EJTD-01-2020-0005</pub-id> <comment>Online ahead of Print</comment>.</mixed-citation></ref>
<ref id="B25">
<label>25.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hirschi</surname> <given-names>A</given-names></name></person-group>. <article-title>Callings and work engagement: moderated mediation model of work meaningfulness, occupational identity, and occupational self-efficacy.</article-title> <source><italic>J Couns Psychol.</italic></source> (<year>2012</year>) <volume>59</volume>:<fpage>479</fpage>&#x2013;<lpage>85</lpage>. <pub-id pub-id-type="doi">10.1037/a0028949</pub-id> <pub-id pub-id-type="pmid">22774870</pub-id></mixed-citation></ref>
<ref id="B26">
<label>26.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chen</surname> <given-names>X</given-names></name> <name><surname>Zhuoga</surname> <given-names>C</given-names></name> <name><surname>Deng</surname> <given-names>Z</given-names></name></person-group>. <article-title>Adaptations to the one-child policy: Chinese young adults&#x2019; attitudes toward elder care and living arrangement after marriage.</article-title> <source><italic>Front Psychol.</italic></source> (<year>2021</year>) <volume>12</volume>:<fpage>608111</fpage>. <pub-id pub-id-type="doi">10.3389/fpsyg.2021.608111</pub-id> <pub-id pub-id-type="pmid">33762995</pub-id></mixed-citation></ref>
<ref id="B27">
<label>27.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Barrows</surname> <given-names>S</given-names></name></person-group>. <article-title>China&#x2019;s one-child policy.</article-title> <source><italic>JAMA.</italic></source> (<year>2016</year>) <volume>315</volume>:<fpage>2349</fpage>&#x2013;<lpage>50</lpage>. <pub-id pub-id-type="doi">10.1001/jama.2016.2192</pub-id> <pub-id pub-id-type="pmid">27272592</pub-id></mixed-citation></ref>
<ref id="B28">
<label>28.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cameron</surname> <given-names>L</given-names></name> <name><surname>Erkal</surname> <given-names>N</given-names></name> <name><surname>Gangadharan</surname> <given-names>L</given-names></name> <name><surname>Meng</surname> <given-names>X</given-names></name></person-group>. <article-title>Little emperors: behavioral impacts of China&#x2019;s one-child policy.</article-title> <source><italic>Science.</italic></source> (<year>2013</year>) <volume>339</volume>:<fpage>953</fpage>&#x2013;<lpage>7</lpage>. <pub-id pub-id-type="doi">10.1126/science.1230221</pub-id> <pub-id pub-id-type="pmid">23306438</pub-id></mixed-citation></ref>
<ref id="B29">
<label>29.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chiang-Hanisko</surname> <given-names>L</given-names></name></person-group>. <article-title>The legacy of China&#x2019;s one-child policy: a call for transcultural nursing.</article-title> <source><italic>J Transcult Nurs.</italic></source> (<year>2019</year>) <volume>30</volume>:<fpage>313</fpage>. <pub-id pub-id-type="doi">10.1177/1043659619828093</pub-id> <pub-id pub-id-type="pmid">30957717</pub-id></mixed-citation></ref>
<ref id="B30">
<label>30.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wolf</surname> <given-names>E</given-names></name> <name><surname>Harrington</surname> <given-names>K</given-names></name> <name><surname>Clark</surname> <given-names>S</given-names></name> <name><surname>Miller</surname> <given-names>M</given-names></name></person-group>. <article-title>Sample size requirements for structural Equation models: an evaluation of power, bias, and solution propriety.</article-title> <source><italic>Educ Psychol Meas.</italic></source> (<year>2013</year>) <volume>76</volume>:<fpage>913</fpage>&#x2013;<lpage>34</lpage>. <pub-id pub-id-type="doi">10.1177/0013164413495237</pub-id> <pub-id pub-id-type="pmid">25705052</pub-id></mixed-citation></ref>
<ref id="B31">
<label>31.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lian</surname> <given-names>R</given-names></name> <name><surname>Yang</surname> <given-names>L</given-names></name> <name><surname>Wu</surname> <given-names>L</given-names></name></person-group>. <article-title>The relationship between college students&#x2019; professional commitment and learning burnout, and the development of a scale (In Chinese).</article-title> <source><italic>Acta Psychol Sin.</italic></source> (<year>2005</year>) <volume>37</volume>:<fpage>632</fpage>&#x2013;<lpage>6</lpage>.</mixed-citation></ref>
<ref id="B32">
<label>32.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jiang</surname> <given-names>F</given-names></name> <name><surname>Guo</surname> <given-names>B</given-names></name></person-group>. <article-title>The occupational self-efficacy scale and lts revised.</article-title> <source><italic>J Huainan Normal Univer.</italic></source> (<year>2004</year>):<fpage>92</fpage>&#x2013;<lpage>5</lpage>.</mixed-citation></ref>
<ref id="B33">
<label>33.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Betz</surname> <given-names>N</given-names></name> <name><surname>Hackett</surname> <given-names>G</given-names></name></person-group>. <article-title>The relationship of career-related self-efficacy expectation to perceived career options in college women and men.</article-title> <source><italic>J Counseling Psychol.</italic></source> (<year>1981</year>) <volume>28</volume>:<fpage>399</fpage>&#x2013;<lpage>410</lpage>. <pub-id pub-id-type="doi">10.1037/0022-0167.28.5.399</pub-id></mixed-citation></ref>
<ref id="B34">
<label>34.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Steger</surname> <given-names>MF</given-names></name> <name><surname>Dik</surname> <given-names>BJ</given-names></name> <name><surname>Duffy</surname> <given-names>RD</given-names></name></person-group>. <article-title>Measuring meaningful work: the work and meaning inventory (WAMI).</article-title> <source><italic>J Career Assess.</italic></source> (<year>2012</year>) <volume>20</volume>:<fpage>322</fpage>&#x2013;<lpage>37</lpage>. <pub-id pub-id-type="doi">10.1177/1069072711436160</pub-id></mixed-citation></ref>
<ref id="B35">
<label>35.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cao</surname> <given-names>Y</given-names></name> <name><surname>Liu</surname> <given-names>J</given-names></name> <name><surname>Liu</surname> <given-names>K</given-names></name> <name><surname>Yang</surname> <given-names>M</given-names></name> <name><surname>Liu</surname> <given-names>Y</given-names></name></person-group>. <article-title>The mediating role of organizational commitment between calling and work engagement of nurses: a cross-sectional study.</article-title> <source><italic>Int J Nurs Sci.</italic></source> (<year>2019</year>) <volume>6</volume>:<fpage>309</fpage>&#x2013;<lpage>14</lpage>. <pub-id pub-id-type="doi">10.1016/j.ijnss.2019.05.004</pub-id> <pub-id pub-id-type="pmid">31508452</pub-id></mixed-citation></ref>
<ref id="B36">
<label>36.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wolf</surname> <given-names>M</given-names></name> <name><surname>McNeish</surname> <given-names>D</given-names></name></person-group>. <article-title>Dynamic: an R package for deriving dynamic fit index cutoffs for factor analysis.</article-title> <source><italic>Multivariate Behav Res.</italic></source> (<year>2023</year>) <volume>58</volume>:<fpage>189</fpage>&#x2013;<lpage>94</lpage>. <pub-id pub-id-type="doi">10.1080/00273171.2022.2163476</pub-id> <pub-id pub-id-type="pmid">36787513</pub-id></mixed-citation></ref>
<ref id="B37">
<label>37.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kazuyuki</surname> <given-names>M</given-names></name> <name><surname>Kuo-Lin</surname> <given-names>W.</given-names></name></person-group> <article-title>Illusion of Career Development Theories - For the Departure of Developing a Demonstrative Career Development Theory</article-title>. (<year>2006</year>).</mixed-citation></ref>
<ref id="B38">
<label>38.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Klassen</surname> <given-names>R</given-names></name> <name><surname>Wilson</surname> <given-names>E</given-names></name> <name><surname>Siu</surname> <given-names>AFY</given-names></name> <name><surname>Hannok</surname> <given-names>W</given-names></name> <name><surname>Jansem</surname> <given-names>A</given-names></name></person-group>. <article-title>Preservice teachers&#x2019; work stress, self-efficacy, and occupational commitment in four countries.</article-title> <source><italic>Eur J Psychol Educ.</italic></source> (<year>2013</year>) <volume>28</volume>.</mixed-citation></ref>
<ref id="B39">
<label>39.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nojima</surname> <given-names>K</given-names></name> <name><surname>Yoshida</surname> <given-names>R</given-names></name> <name><surname>Sato</surname> <given-names>S</given-names></name> <name><surname>Fukuda</surname> <given-names>T</given-names></name> <name><surname>Kakinuma</surname> <given-names>K</given-names></name></person-group>. <article-title>Simulation-based education and nursing student learning motivations: a scoping review.</article-title> <source><italic>Cureus.</italic></source> (<year>2025</year>) <volume>17</volume>:<fpage>e84375</fpage>. <pub-id pub-id-type="doi">10.7759/cureus.84375</pub-id> <pub-id pub-id-type="pmid">40539177</pub-id></mixed-citation></ref>
<ref id="B40">
<label>40.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Smart</surname> <given-names>R</given-names></name> <name><surname>Peterson</surname> <given-names>C</given-names></name></person-group>. <article-title>Super&#x2019;s career stages and the decision to change careers.</article-title> <source><italic>J Vocat Behav.</italic></source> (<year>1997</year>) <volume>51</volume>:<fpage>358</fpage>&#x2013;<lpage>74</lpage>. <pub-id pub-id-type="doi">10.1006/jvbe.1996.1544</pub-id></mixed-citation></ref>
<ref id="B41">
<label>41.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Duffy</surname> <given-names>R</given-names></name> <name><surname>Allan</surname> <given-names>B</given-names></name> <name><surname>Autin</surname> <given-names>K</given-names></name> <name><surname>Douglass</surname> <given-names>R</given-names></name></person-group>. <article-title>Living a calling and work well-being: a longitudinal study.</article-title> <source><italic>J Couns Psychol.</italic></source> (<year>2014</year>) <volume>61</volume>:<fpage>605</fpage>&#x2013;<lpage>15</lpage>. <pub-id pub-id-type="doi">10.1037/cou0000042</pub-id> <pub-id pub-id-type="pmid">25181588</pub-id></mixed-citation></ref>
<ref id="B42">
<label>42.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>van Oorschot</surname> <given-names>F</given-names></name> <name><surname>Brouwers</surname> <given-names>M</given-names></name> <name><surname>Muris</surname> <given-names>J</given-names></name> <name><surname>Veen</surname> <given-names>M</given-names></name> <name><surname>Timmerman</surname> <given-names>A</given-names></name> <name><surname>Dulmen</surname> <given-names>S</given-names></name></person-group>. <article-title>How does guided group reflection work to support professional identity formation in postgraduate medical education: a scoping review.</article-title> <source><italic>Med Teach.</italic></source> (<year>2025</year>) <volume>47</volume>:<fpage>425</fpage>&#x2013;<lpage>35</lpage>. <pub-id pub-id-type="doi">10.1080/0142159X.2024.2339409</pub-id> <pub-id pub-id-type="pmid">38626746</pub-id></mixed-citation></ref>
<ref id="B43">
<label>43.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Doerstler</surname> <given-names>M</given-names></name> <name><surname>Embree</surname> <given-names>J</given-names></name> <name><surname>Opsahl</surname> <given-names>A</given-names></name></person-group>. <article-title>Fostering civility in nursing academia and practice: an exemplar of integrating professional identity to promote healthy work environments.</article-title> <source><italic>J Contin Educ Nurs.</italic></source> (<year>2025</year>) <volume>56</volume>:<fpage>402</fpage>&#x2013;<lpage>5</lpage>. <pub-id pub-id-type="doi">10.3928/00220124-20250912-04</pub-id> <pub-id pub-id-type="pmid">41022389</pub-id></mixed-citation></ref>
<ref id="B44">
<label>44.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Goodin</surname> <given-names>J</given-names></name> <name><surname>Duffy</surname> <given-names>R</given-names></name> <name><surname>Borges</surname> <given-names>N</given-names></name> <name><surname>Ulman</surname> <given-names>C</given-names></name> <name><surname>D&#x2019;Brot</surname> <given-names>V</given-names></name> <name><surname>Manuel</surname> <given-names>R</given-names></name></person-group>. <article-title>Medical students with low self-efficacy bolstered by calling to medical speciality.</article-title> <source><italic>Perspect Med Educ.</italic></source> (<year>2014</year>) <volume>3</volume>:<fpage>89</fpage>&#x2013;<lpage>100</lpage>. <pub-id pub-id-type="doi">10.1007/s40037-014-0110-7</pub-id> <pub-id pub-id-type="pmid">24531931</pub-id></mixed-citation></ref>
<ref id="B45">
<label>45.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Oanh</surname> <given-names>T</given-names></name> <name><surname>Thuy</surname> <given-names>L</given-names></name> <name><surname>Huyen</surname> <given-names>N</given-names></name></person-group>. <article-title>The effect of simulation-based training on problem-solving skills, critical thinking skills, and self-efficacy among nursing students in Vietnam: a before-and-after study.</article-title> <source><italic>J Educ Eval Health Prof.</italic></source> (<year>2024</year>) <volume>21</volume>:<fpage>24</fpage>. <pub-id pub-id-type="doi">10.3352/jeehp.2024.21.24</pub-id> <pub-id pub-id-type="pmid">39308121</pub-id></mixed-citation></ref>
<ref id="B46">
<label>46.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Honkavuo</surname> <given-names>L</given-names></name></person-group>. <article-title>Ethics simulation in nursing education: nursing students&#x2019; experiences.</article-title> <source><italic>Nurs Ethics.</italic></source> (<year>2021</year>) <volume>28</volume>:<fpage>1269</fpage>&#x2013;<lpage>81</lpage>. <pub-id pub-id-type="doi">10.1177/0969733021994188</pub-id> <pub-id pub-id-type="pmid">33827328</pub-id></mixed-citation></ref>
<ref id="B47">
<label>47.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Geoghan Marold</surname> <given-names>S</given-names></name> <name><surname>Strouse</surname> <given-names>S</given-names></name> <name><surname>Butcher</surname> <given-names>D</given-names></name></person-group>. <article-title>Professional identity in nursinn and domains usage.</article-title> <source><italic>SAGE Open Nurs.</italic></source> (<year>2025</year>) <volume>11</volume>:<fpage>23779608251335240</fpage>. <pub-id pub-id-type="doi">10.1177/23779608251335240</pub-id> <pub-id pub-id-type="pmid">40291610</pub-id></mixed-citation></ref>
<ref id="B48">
<label>48.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhao</surname> <given-names>X</given-names></name> <name><surname>Ma</surname> <given-names>X</given-names></name> <name><surname>Yao</surname> <given-names>Y</given-names></name> <name><surname>Wan</surname> <given-names>C</given-names></name> <name><surname>Ng</surname> <given-names>E</given-names></name></person-group>. <article-title>China&#x2019;s little emperors show signs of success.</article-title> <source><italic>Science.</italic></source> (<year>2013</year>) <volume>339</volume>:<fpage>905</fpage>&#x2013;<lpage>6</lpage>. <pub-id pub-id-type="doi">10.1126/science.339.6122.905-b</pub-id> <pub-id pub-id-type="pmid">23430636</pub-id></mixed-citation></ref>
<ref id="B49">
<label>49.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liu</surname> <given-names>N</given-names></name> <name><surname>Chen</surname> <given-names>Y</given-names></name> <name><surname>Yang</surname> <given-names>X</given-names></name> <name><surname>Hu</surname> <given-names>Y</given-names></name></person-group>. <article-title>Do demographic characteristics make differences? demographic characteristics as moderators in the associations between only child status and cognitive/non-cognitive outcomes in China.</article-title> <source><italic>Front Psychol.</italic></source> (<year>2017</year>) <volume>8</volume>:<fpage>423</fpage>. <pub-id pub-id-type="doi">10.3389/fpsyg.2017.00423</pub-id> <pub-id pub-id-type="pmid">28421006</pub-id></mixed-citation></ref>
<ref id="B50">
<label>50.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Badi</surname> <given-names>JE</given-names></name></person-group>. <article-title>Personality of &#x2018;only children&#x2019; and &#x2018;children with a sibling&#x2019;.</article-title> <source><italic>Int J Indian Psychol.</italic></source> (<year>2017</year>) <volume>4</volume>: <pub-id pub-id-type="doi">10.25215/0402.057</pub-id></mixed-citation></ref>
<ref id="B51">
<label>51.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hvistendahl</surname> <given-names>M</given-names></name></person-group>. <article-title>China. Making a selfish generation by fiat.</article-title> <source><italic>Science.</italic></source> (<year>2013</year>) <volume>339</volume>:<fpage>131</fpage>. <pub-id pub-id-type="doi">10.1126/science.339.6116.131</pub-id> <pub-id pub-id-type="pmid">23307715</pub-id></mixed-citation></ref>
</ref-list>
<fn-group>
<fn id="n1" fn-type="custom" custom-type="edited-by"><p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1025645/overview">Michael J. Wolyniak</ext-link>, Hampden&#x2013;Sydney College, United States</p></fn>
<fn id="n2" fn-type="custom" custom-type="reviewed-by"><p>Reviewed by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/2951938/overview">Juan-Elicio Hernandez-Xumet</ext-link>, University of La Laguna, Spain</p>
<p><ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/3347155/overview">Zaihao Wu</ext-link>, Xihua University, China</p></fn>
</fn-group>
</back>
</article>