Psychological resilience, metacognition, post-traumatic growth, and rumination among undergraduate nursing interns: A cross-sectional study.

BACKGROUND

Undergraduate nursing students, during their 9-12 month hospital internship in China, commonly experience rumination (repetitive negative thinking) in high-pressure clinical environments, which is closely associated with mental health problems. Previous researchers have suggested that psychological resilience, as a key protective factor, may alleviate this process. However, the underlying mechanisms remain unclear, particularly regarding the roles of metacognition and post-traumatic growth (positive psychological change following adversity), which warrant further investigation.

AIMS: We aimed to explore the mechanisms through which psychological resilience influenced rumination among undergraduate nursing interns and to clarify the mediating role of metacognition and the moderating role of post-traumatic growth in this relationship.

DESIGN

A descriptive, cross-sectional study.

METHODS

Using convenience sampling, we conducted an online questionnaire survey among 892 undergraduate nursing interns in China between and October 2025. A moderated mediation analysis was conducted.

RESULTS

Psychological resilience significantly negatively predicted rumination among participants (β = -0.326, p < 0.001). Metacognition partially mediated this relationship (indirect effect = -0.068, 95 % confidence interval [CI] -0.091, -0.047, accounting for 24.73 % of the total effect). Post-traumatic growth significantly moderated the path from psychological resilience to metacognition (interaction term β = 0.220, p < 0.001). Simple slope analysis showed that psychological resilience significantly positively predicted metacognition only at high levels of post-traumatic growth.

CONCLUSIONS

We found that psychological resilience was associated with reduced rumination, a relationship mediated by metacognition, with this indirect effect being more pronounced in individuals with higher post-traumatic growth. To support nursing interns' role transition and well-being, cultivating metacognitive ability and fostering post-traumatic growth may be recommended.