To meet the requirements of clinical openings, it is necessary for nursing students not only to receive nursing education but also to rigorously train in nursing skills. Nursing skills include a variety of techniques such as monitoring vital signs, aseptic techniques, administering injections and performing intravenous infusions, specimen collection, rescue of critically ill patients, patient comfort, and psychological care. These skills are practical skills that every nursing staff member must master. The correct procedure directly affects the quality of treatment, quality of care, medical condition, and health and safety of patients. Therefore, nursing skills training is an indispensable part of nursing student training.

Nursing skill training is usually conducted through practical training courses. The traits and emotions exhibited by students in practical training courses are closely related to their academic achievement [1]. Pekrun, a German educational psychologist, conceived of the concept of academic emotion while studying the learning process [2]. According to Pekrun's theory, academic emotion refers to various emotional experiences related to students' academic activities in the teaching and learning process, which can be divided into two major categories: positive academic sentiment and negative academic sentiment. Positive academic emotions can stimulate student enthusiasm. Ma [3] divided the positive academic emotions into five types: interest, enjoyment, hope, pride, and relief. According to the degree of stimulation of various emotions, interest, happiness, and hope were considered positive activating dimensions referred to as positive-activating academic emotions (PAAE). Based on the theory, pride and relief were categorized as positive deactivating dimensions called positive-deactivating academic emotions (PDAE). Previous studies have demonstrated an interaction-promotion relationship between students' academic performance and PAAE and PDAE and a negative correlation with academic burnout [4]. Similar results have been found in studies on nursing students [5, 6]. It can be observed that elevating students' PAAE or PDAE in nursing skills training is an effective way to improve their professional competence. Positive-activating academic emotions have received more attention compared with PDAE, with many studies probing into the related mechanism. However, few studies have been conducted on PDAE, which leads to two questions: (1) What the factors influence the PDAE in students in training courses? (2) What is the specific mechanism of action of these factors? These questions have become hot topics in the field of nursing education and are investigated in this study.

The influence of stress on students' mental health and behavior is widely known [7]. Stress arises from threatening stimuli in the environment. Individuals use cognitive resources to process and evaluate the threatening stimuli, after which subjective feelings are produced. These feelings are referred to as “perceived stress” [8]. Previous studies have found a significant negative correlation between perceived stress and individual positive emotions [9, 10]. Another survey showed that students' perceived stress was negatively correlated with their positive emotions [11, 12]. It may be inferred that there are mediating factors between perceived stress and emotional behavior. Individual differences may be revealed by exploring the influence of these factors.

Learning motivation not only initiates learning but also maintains and directs learning. Learning motivation is an internal motivation and psychological resource that directly promotes student learning [13]. The direction, progress and effect of student learning are directly affected by the nature and intensity of learning motivation. Empirical data show that there is a significant correlation between stress and learning motivation [14]. Learning motivation has a positive effect on positive learning emotions [15]. From the perspective of resource preservation theory [16], the change in students' perceived stress can cause an imbalance in their psychological resources and then affect their emotions and behaviors [17]. Based on the theories of previous studies, this study explored the perceived stress and learning motivation of students undergoing nursing skills training as factors influencing PDAE and hypothesized that the relationship between perceived stress and PDAE is mediated by learning motivation during nursing skills training (Figure 1).

Figure 1
Hypothesis of the mediation model.

• Download Figure

Stress had a negative impact on the mental health of college students, and negative emotions changed with the fluctuation in stress. This view was supported by many studies [30, 31]. Owing to the influence of positive psychology, the perspective of researchers gradually shifted from negative emotions to positive emotions. Extensive research has been conducted on the mechanisms between stress and positive emotions [32]. Based on practical education of basic nursing skills, this study mainly discussed the mediating effect of learning motivation on perceived stress and PDAE. There were some significant findings for medical and nursing training courses. In the correlation analysis between perceived stress and academic emotion, there was a significant negative correlation among various factors, indicating that perceived stress can reduce positive emotions during the learning process. This result was consistent with those of a study by Shi et al. on stress, emotion, and mental resilience among college students [33]. Nervousness, a factor of perceived stress, had a significant predictive effect on PDAE. This result further showed that the more stress and nervousness an individual felt, the lower their enthusiasm for learning, and the less likely they were to show positive emotions, such as pride and relief, in their studies. The sense of loss of control, another dimension of perceived stress, also predicted PDAE. The mechanism of this result needs more study, and it was speculated that the mechanism was related to students' passive learning habits.

In this study, learning motivation was positively correlated with PDAE and predicted it in the model. This result was consistent with that of a study by Zhang et al. [15], and was based on the basic principles of motivation theory. The more students are motivated to learn, the more effort they make in learning, which leads to higher academic achievement and more positive academic emotions [34]. Furthermore, individuals with high levels of learning motivation are willing to seek more active and effective coping methods, thereby reducing negative emotions [35].

The data from this study confirmed the partial mediation of learning motivation in the relationship between perceived stress and PDAE. The results clarified the logical relationships among these concepts. In fact, the three concepts themselves have reflected this logical relationship to some extent. As mentioned earlier, the results of this study showed that perceived stress was negatively correlated with positive academic emotions, which had been confirmed by previous studies [36]. As a kind of mental resource characterized by coping, learning motivation had a very close relationship with perceived stress. When the perceived level of stress was too high, the resources were consumed, the assessment and transformation of stress was changed, and the balance between cognition and behavior was lost, thereby reducing positive emotions. Previous studies showed that highly motivated individuals tend to view life events and stress from a positive perspective [37] and tend to maintain positive emotions and a positive mentality. Individuals with higher motivation were better at adopting positive and optimistic attitudes and treatments in the face of high-stress situations and at gaining more social support, thus reducing their sense of nervousness and loss of control. These skills were beneficial to the generation and maintenance of positive academic emotions. These findings provide evidence for the logical relationships derived from this study. Advances had been made by previous researchers in understanding PDAE. This study focused on PDAE and explored the influential factors and pathological relationships of the deactivating dimensions of academic emotions rather than the activating dimensions. The results obtained further enrich the theoretical system of academic emotions and provide reference for subsequent related research.

Results of the correlation analysis indicated that some dimensions of learning motivation have an excessive correlation (>.70). Such data appears in the correlation between hankering for capability and interest of learning, and also between tendency of altruism and all other dimensions of learning motivation (see Table 3). Although the VIF of these dimensions in the regression test do not exceed the standard (<10), due to the high correlation with other dimensions, there may still be collinearity. However, the stepwise regression results show that hankering for capability and tendency of altruism have no predictive effect on the dependent variable. To further avoid the problem of collinearity, the ridge regression method was adopted to test the data. Ridge regression is an improved least squares estimation method that can be used for collinear data analysis [38]. The results indicated that the influence of interest in developing reputation and tendency of altruism on the dependent variable was not stable. The remaining curves were relatively stable, indicating that they had the significant interpretation or predictive effect on the dependent variable. This conclusion was calculated by ridge regression and the problem of collinearity was overcome. The stepwise multiple regression equation used in this study is also a commonly used method to eliminate multicollinearity and to select the “optimal” regression equation. The results of the ridge regression were the same as those obtained by the stepwise multiple regression, indicating that this conclusion was valid and overcame the collinearity problem.

Moreover, the results in this study provide inspiration for the training of nurses in teaching institutions. Because nursing students have a heavy burden with regard to the necessary skills to learn, they have to devote the majority of their time to training. These students often face critical situations and choices between life and death in the process of learning. The tremendous mental pressure brought about by these conditions has led nursing students to have a lower level of positive academic emotions, which influences their learning. The results of this study suggest that improving students' learning motivation may alleviate their learning pressure and promote positive emotions, such as pride and relief, in basic practical skills training in medical colleges. The establishment of learning motivation requires long-term cultivation and is influenced by many aspects, such as school education, social environment, family background, and self-awareness [39]. Therefore, schools, families, and medical institutions should pay more attention to learning motivation during nursing students' skills training. In specific educational practices, researchers and educators should formulate reasonable plans to alleviate the perceived pressure, such as nursing students' nervousness and loss of control, and avoid suppressing positive academic emotions. Furthermore, because interest in studying is the most important predictor of PDAE, it is suggested that educators start from this factor, pay attention to improving students' interest in nursing skills training, and thus enhance their PDAE, which may improve their academic performance and nursing competency.

There are several confounding factors in this study because it was based on self-report questionnaires. It was only possible to explain the correlation between factors and not to prove causality. Future research should adopt more objective methods in future research to improve the credibility of the data. In addition, the number of male and female nursing students participating in the questionnaire was not balanced, and the data obtained may not be generalizable. These issues need to be addressed through follow-up studies. The paths found in this study include incomplete mediation, which means that there may be other mediating or moderating variables between nursing students' perceived stress and PDAE that require further investigation.

The results of this study demonstrate that students' perceived stress was significantly negatively correlated with learning motivation and PDAE during nursing skills training. The significant predictors of PDAE were perceived stress and learning motivation. The study also showed that learning motivation in nursing skills training was an important mediating factor, providing nursing students with a bridge between perceived stress and PDAE, and buffering the damage of perceived stress on PDAE. Strategically improving students' motivation to learn could reduce their perceived stress and build more positive emotions. Positive emotions in learning played an important role in helping nursing students enhance their skills and improve their nursing competence.