Abstract
AIM: The aim of this study is to examine the effects of secondary traumatic stress and cognitive flexibility on the psychological well-being of nursing and midwifery students and to model these relationships with machine learning approaches. BACKGROUND: While nursing and midwifery students are at risk of secondary traumatic stress (STS), cognitive flexibility is an important factor in coping with this stress. This study aims to develop strategies to improve students' mental health by examining the effects of STS and cognitive flexibility on psychological well-being using machine learning methods. METHODS: This cross-sectional descriptive study was conducted with 620 nursing and midwifery students between March and August 2024. Data were collected using a Personal Information Form, the Cognitive Flexibility Scale, the Psychological Well-Being Scale, and the Secondary Traumatic Stress Scale. Data analysis was performed using SPSS 22.0, G*Power 3.1, and R programming language 4.1.3. RESULTS: Hierarchical regression estimation showed that the model was significant and usable (F(2,617) = 112.473, p = 0.001). Secondary traumatic stress level and cognitive flexibility levels together explained 26.7% (R2 = 0.267) of the total variance in psychological well-being. It was determined that the decrease in students' secondary traumatic stress level (t = -7.724, p < 0.001) and the increase in cognitive flexibility level (t = 10.755, p < 0.001) caused a statistical increase in the level of "Psychological Well-Being". Shapley Additive Explanations (SHAP) were used to understand the importance and contribution of each variable in the model. Cognitive Flexibility was found to be the most important variable in the prediction of Psychological Well-Being. CONCLUSIONS: It was determined that the decrease in the level of secondary traumatic stress and the increase in the level of cognitive flexibility caused an increase in the level of psychological well-being. Longitudinal studies on students' psychological well-being levels are recommended. CLINICAL IMPLICATIONS: This study emphasises the importance of cognitive flexibility strategies to support health education (nurse and midwife) candidates to cope with secondary traumatic stress. It may contribute to the training of healthier and more resilient professionals by increasing the psychological well-being of students in nursing and midwifery education.