Mediating roles of psychological empowerment and self-efficacy in the relationship between leadership and clinical decision-making among nursing students: A path-analysis approach
Alharbi A. Alkubati S.A. Albaqawi H. Ali A.Z. Hamed L.A. Mohammed S. Cornejo L.T.O. Almazan J.U.
June 2026Churchill Livingstone
Nurse Education Today
2026#161
Background: Understanding the factors that shape clinical decision-making (CDM) among nursing students is essential for strengthening their readiness for clinical practice and improving care quality. While factors like leadership abilities, psychological empowerment (PE), and self-efficacy are known to influence nursing students CDM, the specific mechanisms explaining these relationships are not fully understood. Specifically, how leadership capabilities translate into enhanced CDM, and the potential mediating roles of internal factors like PE and self-efficacy, warrant further investigation. Objectives: This study investigated the mediating roles of PE and self-efficacy in the relationship between leadership and CDM among nursing students. Methods: The researchers conducted a cross-sectional correlational study among 270 nursing students selected through convenience sampling from April to July 2025. We collected data using a structured, self-administered questionnaire containing demographic variables, the Abbreviated Self-Leadership Questionnaire, the CDM in Nursing Scale, the Student Self-Efficacy Scale, and the PE Scale. Path analysis was performed using AMOS 24.0 software. Results: The results revealed that leadership had an indirect positive effect on CDM through PE (β = 0.064, p = 0.028) and self-efficacy (β = 0.059, p = 0.006). CDM was significantly improved by leadership (β = 0.100, p = 0.009), with a total effect of β = 0.303 (p < 0.001). PE and self-efficacy both significantly improved CDM (β = 0.155, p = 0.035) and β = 0.184, p = 0.041, respectively. Conclusion: Leadership contributes to improved CDM of nursing students not only directly but also indirectly by enhancing students PE and self-efficacy, which act as partial mediators in this relationship. These results suggest that educational approaches that support leadership development and enhance students empowerment and self-efficacy may be beneficial for strengthening CDM competencies.
Clinical decision-making , Leadership , Nursing students , Psychological empowerment , Self-efficacy
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Department of Psychiatric and Mental Health Nursing, College of Nursing, University of Hail, Hail, 55424, Saudi Arabia
Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail City, Saudi Arabia
Department of Nursing Administration, College of Nursing, University of Hail, Hail City, Saudi Arabia
Department of Medicine, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khans St 5/1, Astana, 010000, Kazakhstan
Department of Psychiatric and Mental Health Nursing
Department of Medical Surgical Nursing
Department of Nursing Administration
Department of Medicine
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