Sustainability integration self-efficacy and sustainability attitudes among internship nurses: the role of professional self-identity

To examine cross-sectional associations among sustainability integration self-efficacy, professional self-identity, and attitudes toward sustainable development, including the statistical indirect association through professional self-identity. Sustainability is increasingly relevant to nursing education and practice, but evidence explaining how sustainability-related confidence is associated with professional identity and sustainability attitudes among internship nurses remains limited. A descriptive correlational cross-sectional study A consecutive sample of 617 internship nurses affiliated with the Faculty of Nursing, Damanhour University, Egypt, completed an electronic survey from March through April 2026. Measures included sociodemographic and educational characteristics, the Self-Efficacy Beliefs on Integrating Sustainability Instrument, the Professional Self-Identity Questionnaire, and the Attitudes toward Sustainable Development Scale. Pearson correlations and an unadjusted observed-variable path model were estimated using SPSS version 26.0 and AMOS version 24.0. Because the variables were measured at one time point, the indirect pathway was interpreted as a statistical cross-sectional association rather than causal mediation. Sustainability integration self-efficacy was moderate to high (38.08 ± 6.44), and attitudes toward sustainable development were favorable (85.10 ± 11.82). In the unadjusted cross-sectional path model, self-efficacy was positively associated with professional self-identity (unstandardized B = 0.668, SE = 0.057, standardized β = 0.427, p < .001), and professional self-identity was positively associated with sustainability attitudes (unstandardized B = 0.179, SE = 0.051, standardized β = 0.153, p < .001). The direct association between self-efficacy and attitudes was not statistically significant (unstandardized B = 0.108, SE = 0.080, standardized β = 0.059, p = .178). A nonparametric bootstrap analysis with 5,000 resamples showed a statistically significant indirect association through professional self-identity (unstandardized B = 0.120, bootstrap SE = 0.041, standardized β = 0.065, bias-corrected 95% CI [0.040, 0.203], bootstrap p = .002). The indirect-to-total unstandardized point-estimate ratio was approximately 53%; this is a descriptive cross-sectional ratio, not a proportion of a causal effect mediated. Because all variables were measured concurrently, the indirect association does not establish temporal or causal mediation. In this unadjusted cross-sectional analysis, professional self-identity statistically accounted for part of the association between sustainability integration self-efficacy and sustainability attitudes. Temporal sequence and causal mediation cannot be inferred.