Latent profile analysis of sense of coherence and relationship with meaning of life and professional identity among nursing undergraduate
In the context of the increasing complexity of today’s healthcare system, nurses play a more and more indispensable and important part of healthcare . The nursing profession is characterized by high work intensity, long working hours, and high occupational risk , which brings tremendous physical and mental stress to nurses and leads to burnout  and escalation of nurses’ turnover rate . Currently, the global nursing shortage is estimated to be 5.9 million. To effectively address this challenge, it is crucial not only to reduce the turnover rate of existing nursing staff but also to increase the number of nursing graduates by 8% annually . In this context, the fostering and strengthening of the mental health of nursing undergraduates is not only critical to their academic achievement, but also has a direct impact on the sustainability of their careers. Sense of coherence (SOC), which refers to an individual’s tendency to perceive life as relatively stable, including the dimensions of comprehensibility, controllability, and meaningfulness, is a central concept in the model theory of beneficial health proposed by psychologist Antonovsky . In the face of unexpected or stressful situations, individuals with a high SOC are more inclined to understand and cope with stress, more willing to view life events as explicable and logical, and thus are able to successfully manage them , thereby maintaining their health . Colomer et al.‘s research indicates that high levels of SOC among nursing assistant students are associated with the motivation to achieve high academic performance and seem to be more conducive to enhancing students’ stress resistance . Several studies have pointed out that the SOC is significantly negatively to willingness to leave, and that a higher SOC can reduce the psychological stress of nurses  and decrease the phenomenon of nurse burnout . The role of SOC in promoting health and well-being has now been demonstrated in numerous studies, but this research has rarely been presented to nursing undergraduates. Nursing undergraduate education, as a four-year bachelor’s degree programme, is committed to producing nurses with a solid professional theoretical foundation, clinical skills and a deep humanistic caring spirit. Compared with other disciplines, nursing undergraduates, while mastering basic medical knowledge and skills training, are also required to undertake heavy clinical practice, which poses a more serious challenge to their mental health . A scoping review by Urtubiaand et al. indicated that a SOC is a crucial element in the mental health of healthcare professionals and students, facilitating resilience to stress . Similar results were obtained in the study of SOC among dental students by Silva et al. . As a protective factor for the occupational health of healthcare-related professionals, sense of coherence is an important indicator of individual mental health and has a profound impact on the occupational adaptation of nursing undergraduates . Nevertheless, the current status of SOC among nursing undergraduates and the potential heterogeneity within this group remain uncertain. The meaning of life pertains to the process of determining life’s purpose through reflection on one’s values and goals , and it directly reflects the “meaning” dimension within the SOC . Emphasising life education for nursing students not only promotes their respect and reverence for life, but also helps to cultivate their concern for and understanding of patients’ spiritual needs . Research by Qiu et al. has confirmed that nursing students with a stronger sense of life meaning have a stronger sense of professional identity than those with a weaker sense of life meaning . A meta-analysis of cancer patients demonstrated that both the meaning of life and SOC are crucial for psychological adjustment . However, existing studies have predominantly focused on the role of meaning of life in cancer patients , PTSD  and other populations . The impact of meaning of life on the SOC among nursing undergraduates remains an area requiring further investigation. Professional identity, a personal factor closely related to SOC, is defined as an individual’s self-affirmation of occupation . For nursing undergraduates, the development of professional identity involves a dynamic transition from being a student to adopting the role of a nurse . Research indicates that a strong sense of professional identity not only enhances nursing undergraduates’ engagement in learning and retention in the nursing profession but also strengthens nursing undergraduates’ sense of professional mission . Zhang et al. have noted that SOC, as a positive psychological resource, can serve as a moderating variable in the relationship between professional identity and nurses’ overall well-being . However, the interplay between professional identity and meaning in life remains unclear, and there is limited understanding of how professional identity, meaning in life, and their interplay benefit SOC, particularly among nursing undergraduates. Nursing undergraduates are faced with the dual challenges of academic pressure and career planning. How to understand the role and interrelationship of these psychological factors in nursing undergraduates is still a topic that needs to be explored deeply. However, Existing studies on nursing undergraduates’ SOC have predominantly focused on overall coherence levels, using aggregate scores from scales to assess coherence without considering individual variations. To address these gaps, latent profile analysis (LPA) presents a more suitable method. LPA is an ‘individual-centred’ method of identifying potential heterogeneity within a group, which allows for the detection of latent variables that cannot be directly measured by traditional means, The ability to identify groups of nursing undergraduates in different psychological states . Thus, this study aims to identify distinct subgroups of nursing undergraduates’ SOC and analyze the influencing factors for these subgroups. This approach will facilitate the development of targeted interventions to enhance their SOC and provide a scientific basis for personalized educational strategies in nursing programs. Our research questions in this study are as follows: (1) What categories can the SOC among nursing undergraduates be classified into? (2) What are the characteristics of nursing undergraduates who exhibit lower levels of SOC? (3) How do sociodemographic characteristics and personal factors, such as professional identity and meaning in life, affect the different subgroups of nursing undergraduates? 

Design This study utilized a cross-sectional design. The reporting of this study follows the list of reports of observational studies (STROBE) (see Appendix 1). Participants The participants were recruited between May and June 2020, consisting of 1,251 nursing undergraduates from nine schools in Henan Province, China. A convenience sampling method was used to conduct the questionnaire survey. The sample size for this study was determined to be at least 500, as LPA requires a sample size greater than 500 . The inclusion criteria were: (1) nursing undergraduates; (2) informed consent and voluntary participation in the survey. The exclusion criteria were as follows: (1) students are unable to complete the questionnaire due to personal reasons or other circumstances; (2) Students identified by preliminary screening results as having psychological problems or diagnosed by clinical psychiatrists as having major mental illness. Instruments Participant characteristics The demographic information questionnaire was designed by the researcher based on relevant literature and research objectives. The questions included gender, college year, home location, religion, internships, high school grades, family financial status, etc. Sense of coherence scale (SOC-13) The Chinese version of the Sense of Coherence Scale (SOC-13), translated by Tak et al. , was utilized in this study. The scale contains 3 dimensions, which can be defined as sense of comprehensibility, sense of meaning and sense of controllability, with a total of 13 items. A 7-point Likert scale was used, with each item scored from 1 to 7 and the total score ranging from 13 to 91, with higher scores indicating a greater SOC. The scale has been validated in Finland, Japan, Brazil, and other countries, with Cronbach’s alpha coefficients ranging from 0.70 to 0.92 and test-retest reliability ranging from 0.55 to 0.75 . In this study, Cronbach’s alpha of the scale was 0.748. The meaning in life questionnaire (MLQ) The Meaning of Life was assessed using the Chinese version of the Meaning of Life Questionnaire (MLQ), adapted by Liu et al. . This questionnaire includes two subscales: Meaning of Life (MLQ-P) and Meaning Seeking (MLQ-S), comprising a total of 9 items. It uses a 7-point Likert scale, with scores ranging from 1 (totally disagree) to 7 (totally agree). Item 2 is reverse-scored, while the remaining items are scored positively. Total scores range from 9 to 63, with higher scores indicating a higher level of meaning in life. The MLQ has demonstrated good reliability and validity, with a Cronbach’s alpha coefficient of 0.71 for the total scale and 0.81 and 0.72 for the two subscales . In this study, Cronbach’s alpha of the questionnaire was 0.884, and that of presence and search for meaning were 0.851 and 0.827, respectively. Professional Identity Scale (PIS) Professional identity was measured using the Chinese version of the Professional Identity Scale (PIS) . The scale comprises three dimensions: knowledge of the profession, evaluation of the profession, and influence on the profession, with a total of 10 items. It uses a 5-point Likert scale ranging from “never” to “often,” with total scores ranging from 10 to 50. Higher scores indicate a stronger sense of professional identity. In this study, Cronbach’s alpha of the scale was 0.851. Data collection This study utilized the “Questionnaire Star” platform ( www.wjx.cn ) to design the online questionnaire, generate the QR code, and create a link for online distribution. The questionnaire was randomly distributed to nursing undergraduates from nine universities. The purpose, significance, and precautions of the survey were explained to participants in the questionnaire guidelines. Participants completed the questionnaire anonymously with their informed consent, and each IP address was restricted to a single entry to prevent duplication. A total of 1,260 questionnaires were distributed. After excluding those with a response time of less than one minute or inconsistent responses, 1,251 valid questionnaires were obtained, resulting in an effective response rate of 99.29%. Data analysis Since the scale scores were continuous variables and the results of the 13 entries of the SOC Scale were used as exogenous variables, the potential profile analysis was performed using Mplus 8.3. The main evaluation indicators of the latent profile model included the Akaike information criterion (AIC), Bayesian information criterion (BIC), and adjusted Bayesian information criterion (aBIC) . The smaller the AIC, BIC, and aBIC statistics, the better the model fit. In addition, the information entropy index (Entropy) Entropy is an index that assesses the accuracy of category classification, with a value between 0 and 1. Entropy ≥ 0.8 indicates that the accuracy of classification is more than 90%. lo-Mendell-Rubin likelihood ratio test (LMRT) and Bootstrap likelihood ratio test (BLRT) were used to compare the fitting differences of the category models, and if the corresponding P -values of LMRT and BLRT reached the significant level, it indicated that the kth category model was superior to the kth-1st category model . When the category models preferred by each evaluation indicator were inconsistent, the results of each indicator were measured comprehensively, and the best model was selected by combining the principles of interpretability and model simplicity. SPSS 26.0 was employed for descriptive analysis, with quantitative data presented as mean ± standard deviation and categorical data summarized using frequencies and percentages (%). Multiple logistic regression analysis was conducted with general information, professional identity, and meaning of life as independent variables and potential categories of SOC as dependent variables. Statistical significance was determined if P < 0.05. Ethics consideration The study was approved by the Ethics Committee of Zhengzhou University (ZZUIRB2020-53). After accessing the survey link, participants were informed of the study’s purpose and significance and gave their written consent by checking the box “Agree to participate in the study” in the questionnaire. The online survey guaranteed participants’ anonymity and confidentiality, and they could withdraw from the study at any time without having to provide a reason or face any consequences. 

This study utilized a cross-sectional design. The reporting of this study follows the list of reports of observational studies (STROBE) (see Appendix 1). 

The participants were recruited between May and June 2020, consisting of 1,251 nursing undergraduates from nine schools in Henan Province, China. A convenience sampling method was used to conduct the questionnaire survey. The sample size for this study was determined to be at least 500, as LPA requires a sample size greater than 500 . The inclusion criteria were: (1) nursing undergraduates; (2) informed consent and voluntary participation in the survey. The exclusion criteria were as follows: (1) students are unable to complete the questionnaire due to personal reasons or other circumstances; (2) Students identified by preliminary screening results as having psychological problems or diagnosed by clinical psychiatrists as having major mental illness. 

Participant characteristics The demographic information questionnaire was designed by the researcher based on relevant literature and research objectives. The questions included gender, college year, home location, religion, internships, high school grades, family financial status, etc. Sense of coherence scale (SOC-13) The Chinese version of the Sense of Coherence Scale (SOC-13), translated by Tak et al. , was utilized in this study. The scale contains 3 dimensions, which can be defined as sense of comprehensibility, sense of meaning and sense of controllability, with a total of 13 items. A 7-point Likert scale was used, with each item scored from 1 to 7 and the total score ranging from 13 to 91, with higher scores indicating a greater SOC. The scale has been validated in Finland, Japan, Brazil, and other countries, with Cronbach’s alpha coefficients ranging from 0.70 to 0.92 and test-retest reliability ranging from 0.55 to 0.75 . In this study, Cronbach’s alpha of the scale was 0.748. The meaning in life questionnaire (MLQ) The Meaning of Life was assessed using the Chinese version of the Meaning of Life Questionnaire (MLQ), adapted by Liu et al. . This questionnaire includes two subscales: Meaning of Life (MLQ-P) and Meaning Seeking (MLQ-S), comprising a total of 9 items. It uses a 7-point Likert scale, with scores ranging from 1 (totally disagree) to 7 (totally agree). Item 2 is reverse-scored, while the remaining items are scored positively. Total scores range from 9 to 63, with higher scores indicating a higher level of meaning in life. The MLQ has demonstrated good reliability and validity, with a Cronbach’s alpha coefficient of 0.71 for the total scale and 0.81 and 0.72 for the two subscales . In this study, Cronbach’s alpha of the questionnaire was 0.884, and that of presence and search for meaning were 0.851 and 0.827, respectively. Professional Identity Scale (PIS) Professional identity was measured using the Chinese version of the Professional Identity Scale (PIS) . The scale comprises three dimensions: knowledge of the profession, evaluation of the profession, and influence on the profession, with a total of 10 items. It uses a 5-point Likert scale ranging from “never” to “often,” with total scores ranging from 10 to 50. Higher scores indicate a stronger sense of professional identity. In this study, Cronbach’s alpha of the scale was 0.851. 

The demographic information questionnaire was designed by the researcher based on relevant literature and research objectives. The questions included gender, college year, home location, religion, internships, high school grades, family financial status, etc. 

The Chinese version of the Sense of Coherence Scale (SOC-13), translated by Tak et al. , was utilized in this study. The scale contains 3 dimensions, which can be defined as sense of comprehensibility, sense of meaning and sense of controllability, with a total of 13 items. A 7-point Likert scale was used, with each item scored from 1 to 7 and the total score ranging from 13 to 91, with higher scores indicating a greater SOC. The scale has been validated in Finland, Japan, Brazil, and other countries, with Cronbach’s alpha coefficients ranging from 0.70 to 0.92 and test-retest reliability ranging from 0.55 to 0.75 . In this study, Cronbach’s alpha of the scale was 0.748. 

The Meaning of Life was assessed using the Chinese version of the Meaning of Life Questionnaire (MLQ), adapted by Liu et al. . This questionnaire includes two subscales: Meaning of Life (MLQ-P) and Meaning Seeking (MLQ-S), comprising a total of 9 items. It uses a 7-point Likert scale, with scores ranging from 1 (totally disagree) to 7 (totally agree). Item 2 is reverse-scored, while the remaining items are scored positively. Total scores range from 9 to 63, with higher scores indicating a higher level of meaning in life. The MLQ has demonstrated good reliability and validity, with a Cronbach’s alpha coefficient of 0.71 for the total scale and 0.81 and 0.72 for the two subscales . In this study, Cronbach’s alpha of the questionnaire was 0.884, and that of presence and search for meaning were 0.851 and 0.827, respectively. 

Professional identity was measured using the Chinese version of the Professional Identity Scale (PIS) . The scale comprises three dimensions: knowledge of the profession, evaluation of the profession, and influence on the profession, with a total of 10 items. It uses a 5-point Likert scale ranging from “never” to “often,” with total scores ranging from 10 to 50. Higher scores indicate a stronger sense of professional identity. In this study, Cronbach’s alpha of the scale was 0.851. 

This study utilized the “Questionnaire Star” platform ( www.wjx.cn ) to design the online questionnaire, generate the QR code, and create a link for online distribution. The questionnaire was randomly distributed to nursing undergraduates from nine universities. The purpose, significance, and precautions of the survey were explained to participants in the questionnaire guidelines. Participants completed the questionnaire anonymously with their informed consent, and each IP address was restricted to a single entry to prevent duplication. A total of 1,260 questionnaires were distributed. After excluding those with a response time of less than one minute or inconsistent responses, 1,251 valid questionnaires were obtained, resulting in an effective response rate of 99.29%. 

Since the scale scores were continuous variables and the results of the 13 entries of the SOC Scale were used as exogenous variables, the potential profile analysis was performed using Mplus 8.3. The main evaluation indicators of the latent profile model included the Akaike information criterion (AIC), Bayesian information criterion (BIC), and adjusted Bayesian information criterion (aBIC) . The smaller the AIC, BIC, and aBIC statistics, the better the model fit. In addition, the information entropy index (Entropy) Entropy is an index that assesses the accuracy of category classification, with a value between 0 and 1. Entropy ≥ 0.8 indicates that the accuracy of classification is more than 90%. lo-Mendell-Rubin likelihood ratio test (LMRT) and Bootstrap likelihood ratio test (BLRT) were used to compare the fitting differences of the category models, and if the corresponding P -values of LMRT and BLRT reached the significant level, it indicated that the kth category model was superior to the kth-1st category model . When the category models preferred by each evaluation indicator were inconsistent, the results of each indicator were measured comprehensively, and the best model was selected by combining the principles of interpretability and model simplicity. SPSS 26.0 was employed for descriptive analysis, with quantitative data presented as mean ± standard deviation and categorical data summarized using frequencies and percentages (%). Multiple logistic regression analysis was conducted with general information, professional identity, and meaning of life as independent variables and potential categories of SOC as dependent variables. Statistical significance was determined if P < 0.05. 

The study was approved by the Ethics Committee of Zhengzhou University (ZZUIRB2020-53). After accessing the survey link, participants were informed of the study’s purpose and significance and gave their written consent by checking the box “Agree to participate in the study” in the questionnaire. The online survey guaranteed participants’ anonymity and confidentiality, and they could withdraw from the study at any time without having to provide a reason or face any consequences. 

Participants’ characteristics A total of 1251 nursing undergraduates were included in this study. 121 (9.7%) were males, 1130 (90.3%) were females, 226 (18.1%) were only children, and 1025 (81.9%) were not the only child of the family (Table ). Categorical results of total SOC scores and potential categories for nursing undergraduates The results of this study showed that the total score of nursing undergraduates’ SOC was (57.93 ± 8.217). Using the 13 entries of the SOC-13 scale as exogenous indicators, the potential profile analysis of the SOC status of nursing undergraduates was conducted. Beginning with one class of models and continuing until the fit metrics cannot be significantly improved. The results are presented in Table . aIC, BIC, and aBIC decreased with the number of profiles, and Entropy increased with the number of profiles. When four profiles were reached, the values of AIC, BIC, and aBIC were the smallest, suggesting that the model fit was better, the Entropy value was the largest at this time, and the BLRT values all showed P < 0.01, with statistically significant differences, suggesting that the model classification accuracy was the highest in four categories and better than that in the other three potential profiles. At the 5th category, LMRT did not reach the significance level ( P > 0.05) and the model was not concise. After comprehensively comparing the fitting indexes of the models and considering the practical significance of the models, model 4 was finally used as the best fitting model. Naming and characterizing potential categories of SOC in nursing undergraduates Based on the results of the potential classification, Fig. displays the scores for each of the four potential categories on the Sense of Coherence Scale: C1: Low Sensitivity-Low Coping Group: This category, accounting for 25.7% of the subjects, exhibited the lowest total score with scores more evenly distributed across items.C2: High Sensitivity-High Coping Group: This group showed relatively low scores on question 4 (“often feel unfairly treated”) and high scores on questions 10 and 11 (“often feel out of control” and “purposefulness in life”). This indicates a strong comprehension and coping ability, with high sensitivity to surrounding emotions and events.C3: Moderately Sensitive-Moderately Coping Group: Similar to C1, this group had average scores across all questions and similar scoring trends but with a slightly higher total score. This category, accounting for 17.8% of the study population, is referred to as the moderately sensitive-moderately coping group.C4: High Sensitivity-Low Coping Group: This group, which comprised 26.8% of the participants, had higher scores on questions 3 and 4 (“people they count on often let them down” and “often feel they are treated unfairly”) and lower scores on question 7 (“often have unwanted emotions”). Generally, a lower score in the dimension of sense of value indicates that this group is more sensitive to surrounding emotions and events but has poorer coping abilities. Multiple logistic regression analysis of factors influencing potential categories of SOC in nursing undergraduates Using the low-sensitivity-low coping type as the reference group, an unordered multicategorical logistic regression analysis was performed with the four categories—low-sensitivity-low coping type, high-sensitivity-high coping type, moderately sensitive-moderately coping type, and high-sensitivity-low coping type—as the dependent variables. The independent variables included gender, grade, whether the participant was an only child, family location type, religion, bereavement experience, high school track, per capita monthly family income, apprenticeship experience, internship experience, family members’ involvement in the healthcare industry, perception of good interpersonal relationships, caregiving responsibilities, experience as a class officer, volunteer experience, and the total scores of professional identity and meaning in life. The analysis revealed that family financial situation, high school subject choice, religious affiliation, perceived good interpersonal relationships, meaning in life, and professional identity scores had statistically significant effects on the potential categories of SOC among nursing undergraduates (all P < 0.05), as detailed in Table . 

A total of 1251 nursing undergraduates were included in this study. 121 (9.7%) were males, 1130 (90.3%) were females, 226 (18.1%) were only children, and 1025 (81.9%) were not the only child of the family (Table ). 

The results of this study showed that the total score of nursing undergraduates’ SOC was (57.93 ± 8.217). Using the 13 entries of the SOC-13 scale as exogenous indicators, the potential profile analysis of the SOC status of nursing undergraduates was conducted. Beginning with one class of models and continuing until the fit metrics cannot be significantly improved. The results are presented in Table . aIC, BIC, and aBIC decreased with the number of profiles, and Entropy increased with the number of profiles. When four profiles were reached, the values of AIC, BIC, and aBIC were the smallest, suggesting that the model fit was better, the Entropy value was the largest at this time, and the BLRT values all showed P < 0.01, with statistically significant differences, suggesting that the model classification accuracy was the highest in four categories and better than that in the other three potential profiles. At the 5th category, LMRT did not reach the significance level ( P > 0.05) and the model was not concise. After comprehensively comparing the fitting indexes of the models and considering the practical significance of the models, model 4 was finally used as the best fitting model. 

Based on the results of the potential classification, Fig. displays the scores for each of the four potential categories on the Sense of Coherence Scale: C1: Low Sensitivity-Low Coping Group: This category, accounting for 25.7% of the subjects, exhibited the lowest total score with scores more evenly distributed across items.C2: High Sensitivity-High Coping Group: This group showed relatively low scores on question 4 (“often feel unfairly treated”) and high scores on questions 10 and 11 (“often feel out of control” and “purposefulness in life”). This indicates a strong comprehension and coping ability, with high sensitivity to surrounding emotions and events.C3: Moderately Sensitive-Moderately Coping Group: Similar to C1, this group had average scores across all questions and similar scoring trends but with a slightly higher total score. This category, accounting for 17.8% of the study population, is referred to as the moderately sensitive-moderately coping group.C4: High Sensitivity-Low Coping Group: This group, which comprised 26.8% of the participants, had higher scores on questions 3 and 4 (“people they count on often let them down” and “often feel they are treated unfairly”) and lower scores on question 7 (“often have unwanted emotions”). Generally, a lower score in the dimension of sense of value indicates that this group is more sensitive to surrounding emotions and events but has poorer coping abilities. 

Using the low-sensitivity-low coping type as the reference group, an unordered multicategorical logistic regression analysis was performed with the four categories—low-sensitivity-low coping type, high-sensitivity-high coping type, moderately sensitive-moderately coping type, and high-sensitivity-low coping type—as the dependent variables. The independent variables included gender, grade, whether the participant was an only child, family location type, religion, bereavement experience, high school track, per capita monthly family income, apprenticeship experience, internship experience, family members’ involvement in the healthcare industry, perception of good interpersonal relationships, caregiving responsibilities, experience as a class officer, volunteer experience, and the total scores of professional identity and meaning in life. The analysis revealed that family financial situation, high school subject choice, religious affiliation, perceived good interpersonal relationships, meaning in life, and professional identity scores had statistically significant effects on the potential categories of SOC among nursing undergraduates (all P < 0.05), as detailed in Table . 

SOC among nursing undergraduates is in the medium level This study revealed that nursing undergraduates had a moderate level of SOC with a mean score of 48.41 ± 7.63. This result is similar to the findings of Wu et al. , suggesting although nursing undergraduates face the pressure of study and practice, they still have some coping ability. However, nursing undergraduates scored low on SOC compared to Betke et al.‘s study of nurses . This difference may be due to nursing undergraduates’ uncertainty about their nursing abilities prior to entering the workforce, which undermines their perception of “controllability” and further reduces their overall SOC. In contrast, nursing undergraduates in the present study scored higher on SOC than nursing students surveyed by Haricharan et al. , which may reflect differences in professional identity and psychological stress tolerance across cultural and national contexts. Group heterogeneity in nursing undergraduates’ SOC The LPA revealed four latent categories of SOC, reflecting individual heterogeneity among nursing undergraduates: (1) Low Sensitivity-Low Coping Type (C1, 25.7%): nursing undergraduates in this group exhibit minimal sensitivity to changes in their emotions and surroundings, and their coping abilities are average. Intervention programs should address their lack of sensitivity, incorporating targeted strategies to enhance their SOC and better adapt to their environment . (2) High Sensitivity-High Coping Type (C2, 29.7%): This group has a high overall SOC and demonstrates strong sensitivity and coping abilities. These students can serve as role models or mentors to help improve the SOC in other categories of nursing undergraduates. (3) Moderate Sensitivity-Moderate Coping Type (C3, 17.8%): Similar to C1 but with a higher total score, students in this group show moderate sensitivity and confidence in coping with external issues. This group might benefit significantly from targeted guidance or opportunities, making interventions potentially very effective for them . (4) High Sensitivity-Low Coping Type (C4, 26.8%): Students in this category are highly sensitive to their surroundings and their own emotions but lack confidence and effective coping skills. Interventions should focus on developing their coping abilities, providing more attention and encouragement to enhance their overall SOC. In conclusion, educators can help improve their SOC by analyzing the consistency among nursing undergraduates, tailored intervention programs tailored to the specific needs of each group, and special attention needs to be paid to those groups with low coping ability or high sensitivity. Influences on potential categories of nursing undergraduates’ SOC Meaning of life is a predictor of nursing undergraduates’ SOC in different situations. The results of this study showed that nursing undergraduates with a high meaning of life were more likely to belong to C2 or C4 compared to C1, indicating that nursing undergraduates with a high meaning of life may be able to acutely perceive environmental stimuli, enabling them to affirm the value of life, discover its goals and directions, and thus demonstrate higher psychological resilience, which echoes the findings of Zhao et al. . This result is supported by Cheng et al. study , which states that nursing students with high meaning in life are able to cope with stress effectively and improve their mental health. More notably, however, nursing undergraduates in the C4 category had lower levels of SOC despite their high meaning in life. This contradicts the study by Sales et al., which found a positive correlation between meaning of life and SOC . This suggests that although the meaning of life is a positive psychological resource, the process of transforming it into actual coping behaviors may be constrained by other factors. This reveals that nursing educators should develop personalized psychological support and intervention strategies and include education on life and living in the curriculum to further enhance nursing undergraduates’ sense of meaning in life. The results of this study indicated that nursing undergraduates with a high professional identity were more likely to belong to C2 compared to C1.This is consistent with the results of a previous study , which indicated that nursing student with a high professional identity were in a clearer state of awareness of themselves as well as their surroundings, and were more capable of coping with difficulties. The results of this study further confirms that nursing undergraduates’ professional identity is positively correlated with their SOC. Zhang et al.‘s study  on nurses similarly noted that professional identity was significantly and positively correlated with sense of coherence and work engagement. A strong professional identity serves as intrinsic motivation, leading individuals to positively evaluate and commit to their roles. Moreover, the study suggests that nursing educators can use innovative teaching methods, such as role models and civic teaching, to foster a positive professional identity and value among students. These approaches can enhance students’ psychological coping abilities and contribute to their overall SOC. Nursing undergraduates from adverse family financial situations are more likely to be categorized as C4. Differences in family financial levels may lead to different stressors that students face during their formative years . Most Chinese college students are supported by their families; therefore, students from adverse family financial situations may feel more financial pressure, and therefore also be more sensitive to their surroundings . At the same time, due to economic and resource constraints, this group of nursing undergraduates may lack effective coping strategies when facing challenges . Nurse educators should prioritize the mental health of nursing undergraduates from poorer family economic backgrounds. To support these students, universities can offer increased scholarships, bursaries, and other forms of financial assistance. Students with a liberal art background were more likely to be categorized as C2, aligning with findings by Gazarian et al. . Liberal art education emphasizes humanistic literacy and critical thinking, equipping students with skills that enhance their ability to perceive emotional conflicts and complex situations. This background likely contributes to a high sensitivity-high coping type of psychological coherence among these students . To build on these strengths, educators should consider integrating interdisciplinary courses and enhancing clinical practice teaching in nursing programs. Nursing undergraduates who perceived that they had better interpersonal relationships were more likely to fall into C3 compared to C1. Specifically, good interpersonal relationships provide not only emotional comfort but also practical help to individuals in stressful situations , thereby enhancing nursing undergraduates’ ability and confidence to cope with challenges and promoting their SOC. Nursing undergraduates with religious beliefs were more likely to be categorized as C3. A study showed that religious beliefs had a significant effect on the meaning of life, the SOC, and the level of spiritual development . As a spiritual support, religious beliefs can provide more psychological support when individuals face stress. Furthermore, students with religious beliefs tend to participate in religious groups on a regular basis, and this kind of close social network not only provides them with emotional support but also may provide substantial help in coping with challenges . Strengths and limitations This study has several limitations. First, the study was based on self-report questionnaires, which may have led to self-report bias; future research tails to use objective measures should be considered. Second, the study’s focus on nursing undergraduates in mainland China means that the results may not be directly applicable to nursing undergraduates in other countries with distinctive educational and professional context. Despite these limitations, the study has notable strengths. The use of LPA allowed for a detailed statistical examination of different perceptions and coping types among nursing undergraduates, providing valuable insights into the various categories of SOC. This approach helps identify potential interventions to enhance the SOC in specific groups, offering practical implications for improving nursing education and support strategies. Future research should consider expanding the survey scope and incorporating longitudinal and qualitative studies to provide a more comprehensive understanding of nursing undergraduates’ SOC. 

This study revealed that nursing undergraduates had a moderate level of SOC with a mean score of 48.41 ± 7.63. This result is similar to the findings of Wu et al. , suggesting although nursing undergraduates face the pressure of study and practice, they still have some coping ability. However, nursing undergraduates scored low on SOC compared to Betke et al.‘s study of nurses . This difference may be due to nursing undergraduates’ uncertainty about their nursing abilities prior to entering the workforce, which undermines their perception of “controllability” and further reduces their overall SOC. In contrast, nursing undergraduates in the present study scored higher on SOC than nursing students surveyed by Haricharan et al. , which may reflect differences in professional identity and psychological stress tolerance across cultural and national contexts. 

The LPA revealed four latent categories of SOC, reflecting individual heterogeneity among nursing undergraduates: (1) Low Sensitivity-Low Coping Type (C1, 25.7%): nursing undergraduates in this group exhibit minimal sensitivity to changes in their emotions and surroundings, and their coping abilities are average. Intervention programs should address their lack of sensitivity, incorporating targeted strategies to enhance their SOC and better adapt to their environment . (2) High Sensitivity-High Coping Type (C2, 29.7%): This group has a high overall SOC and demonstrates strong sensitivity and coping abilities. These students can serve as role models or mentors to help improve the SOC in other categories of nursing undergraduates. (3) Moderate Sensitivity-Moderate Coping Type (C3, 17.8%): Similar to C1 but with a higher total score, students in this group show moderate sensitivity and confidence in coping with external issues. This group might benefit significantly from targeted guidance or opportunities, making interventions potentially very effective for them . (4) High Sensitivity-Low Coping Type (C4, 26.8%): Students in this category are highly sensitive to their surroundings and their own emotions but lack confidence and effective coping skills. Interventions should focus on developing their coping abilities, providing more attention and encouragement to enhance their overall SOC. In conclusion, educators can help improve their SOC by analyzing the consistency among nursing undergraduates, tailored intervention programs tailored to the specific needs of each group, and special attention needs to be paid to those groups with low coping ability or high sensitivity. 

Meaning of life is a predictor of nursing undergraduates’ SOC in different situations. The results of this study showed that nursing undergraduates with a high meaning of life were more likely to belong to C2 or C4 compared to C1, indicating that nursing undergraduates with a high meaning of life may be able to acutely perceive environmental stimuli, enabling them to affirm the value of life, discover its goals and directions, and thus demonstrate higher psychological resilience, which echoes the findings of Zhao et al. . This result is supported by Cheng et al. study , which states that nursing students with high meaning in life are able to cope with stress effectively and improve their mental health. More notably, however, nursing undergraduates in the C4 category had lower levels of SOC despite their high meaning in life. This contradicts the study by Sales et al., which found a positive correlation between meaning of life and SOC . This suggests that although the meaning of life is a positive psychological resource, the process of transforming it into actual coping behaviors may be constrained by other factors. This reveals that nursing educators should develop personalized psychological support and intervention strategies and include education on life and living in the curriculum to further enhance nursing undergraduates’ sense of meaning in life. The results of this study indicated that nursing undergraduates with a high professional identity were more likely to belong to C2 compared to C1.This is consistent with the results of a previous study , which indicated that nursing student with a high professional identity were in a clearer state of awareness of themselves as well as their surroundings, and were more capable of coping with difficulties. The results of this study further confirms that nursing undergraduates’ professional identity is positively correlated with their SOC. Zhang et al.‘s study  on nurses similarly noted that professional identity was significantly and positively correlated with sense of coherence and work engagement. A strong professional identity serves as intrinsic motivation, leading individuals to positively evaluate and commit to their roles. Moreover, the study suggests that nursing educators can use innovative teaching methods, such as role models and civic teaching, to foster a positive professional identity and value among students. These approaches can enhance students’ psychological coping abilities and contribute to their overall SOC. Nursing undergraduates from adverse family financial situations are more likely to be categorized as C4. Differences in family financial levels may lead to different stressors that students face during their formative years . Most Chinese college students are supported by their families; therefore, students from adverse family financial situations may feel more financial pressure, and therefore also be more sensitive to their surroundings . At the same time, due to economic and resource constraints, this group of nursing undergraduates may lack effective coping strategies when facing challenges . Nurse educators should prioritize the mental health of nursing undergraduates from poorer family economic backgrounds. To support these students, universities can offer increased scholarships, bursaries, and other forms of financial assistance. Students with a liberal art background were more likely to be categorized as C2, aligning with findings by Gazarian et al. . Liberal art education emphasizes humanistic literacy and critical thinking, equipping students with skills that enhance their ability to perceive emotional conflicts and complex situations. This background likely contributes to a high sensitivity-high coping type of psychological coherence among these students . To build on these strengths, educators should consider integrating interdisciplinary courses and enhancing clinical practice teaching in nursing programs. Nursing undergraduates who perceived that they had better interpersonal relationships were more likely to fall into C3 compared to C1. Specifically, good interpersonal relationships provide not only emotional comfort but also practical help to individuals in stressful situations , thereby enhancing nursing undergraduates’ ability and confidence to cope with challenges and promoting their SOC. Nursing undergraduates with religious beliefs were more likely to be categorized as C3. A study showed that religious beliefs had a significant effect on the meaning of life, the SOC, and the level of spiritual development . As a spiritual support, religious beliefs can provide more psychological support when individuals face stress. Furthermore, students with religious beliefs tend to participate in religious groups on a regular basis, and this kind of close social network not only provides them with emotional support but also may provide substantial help in coping with challenges . 

This study has several limitations. First, the study was based on self-report questionnaires, which may have led to self-report bias; future research tails to use objective measures should be considered. Second, the study’s focus on nursing undergraduates in mainland China means that the results may not be directly applicable to nursing undergraduates in other countries with distinctive educational and professional context. Despite these limitations, the study has notable strengths. The use of LPA allowed for a detailed statistical examination of different perceptions and coping types among nursing undergraduates, providing valuable insights into the various categories of SOC. This approach helps identify potential interventions to enhance the SOC in specific groups, offering practical implications for improving nursing education and support strategies. Future research should consider expanding the survey scope and incorporating longitudinal and qualitative studies to provide a more comprehensive understanding of nursing undergraduates’ SOC. 

This study identified four distinct characteristics of nursing undergraduates’ SOC, revealing significant heterogeneity among them. Strategies that enhance the meaning of life and professional identity could be particularly effective in improving nursing undergraduates’ SOC. Nursing educators should focus on optimizing educational strategies tailored to the needs of different categories of nursing undergraduates. Developing individualized interventions and adjusting educational programs during teaching and internships can help improve their SOC. This targeted approach may not only bolster the SOC but also enhance nursing undergraduates’ commitment to pursuing a nursing career, thereby strengthening the overall nursing workforce. Future research should continue to explore and refine these strategies to ensure they effectively support nursing undergraduates in various contexts. 

