Despite growing recognition that nurses must be equipped with sustainability competencies to address climate-related health challenges, the psychological mechanisms through which nursing education fosters sustainability attitudes are not yet fully understood. This study examined the mediating role of clinical performance self-efficacy in the relationship between simulation-based learning quality and sustainability attitudes among undergraduate nursing students. A cross-sectional correlational design was employed with a main sample of 679 nursing students from four Egyptian universities. Data were collected using the CHEST, SECP Scale, and SANS₂. Mediation analysis used Hayes’ PROCESS macro with 5000 bootstrap resamples. Simulation-based learning quality significantly predicted both self-efficacy (β* = 0. 772) and sustainability attitudes (β* = 0. 613). Self-efficacy partially mediated this relationship, accounting for 68. 34% of the total effect (indirect β* = 0. 419, Boot 95% CI 0. 343, 0. 494). Nursing educators should design simulation curricula that deliberately cultivate self-efficacy while embedding sustainability content, producing clinically competent and environmentally responsible graduates.
Hemaida et al. (Tue,) studied this question.