Abstract
BACKGROUND: Nursing students frequently experience psychological distress due to the intensive academic and clinical demands of their training. This distress can undermine not only their personal well-being but also their academic performance and readiness for clinical practice. Recent studies have emphasized the importance of identifying modifiable psychological factors that may buffer such distress. Within this context, this study aimed to examine the associations between psychological flexibility, mindfulness, and valued living-defined as the extent to which individuals act in accordance with their personal values in daily life-and symptoms of psychological distress (depression, anxiety, and stress) among nursing students. METHODS: This cross-sectional descriptive study was conducted in October and November 2022. Participants included 631 nursing students enrolled in a nursing school located in western Türkiye. Data were collected using the Depression Anxiety and Stress Scale-21, Acceptance and Action Questionnaire-II, Mindful Attention Awareness Scale, and Valuing Questionnaire. Binary logistic regression analysis was used. RESULTS: Among nursing students, 53.6% reported symptoms of depression, 65.5% reported anxiety, and 40.3% reported stress. Lower psychological flexibility showed significant associations with higher odds of depression, anxiety, and stress. Higher mindfulness was associated with lower odds of these symptoms. Valued living was associated with lower odds of depression, but no significant associations were observed with anxiety or stress. CONCLUSIONS: The findings of this study indicate that enhancing psychological flexibility, mindfulness, and valued living may be beneficial for supporting the mental health of nursing students. Recommendations for practice include incorporating mindfulness exercises such as breathing practices and body scans into training sessions in nursing schools; organizing psychological flexibility workshops; and offering valued living-focused seminars and activities that support students in aligning their actions with personal values. In addition, online guides, short videos, or modules could be provided by universities to make these components more accessible to students. These concepts may also be incorporated into the design of mental health interventions to both alleviate distress and strengthen well-being among nursing students. However, due to the cross-sectional design, causal inferences cannot be made; thus, future longitudinal and experimental studies are needed to evaluate the feasibility and effectiveness of these approaches.