A Multicenter Cross-Sectional Study on Resilience,Well-Being,and Mindful Self-Care Among Undergraduate Nursing Students in India

Abstract

Introduction

There is an increasing need to foster resilience among nursing students to prepare them for the challenges of the demanding healthcare field.

Objective

To assess resilience, well-being, and mindful self-care and to examine the factors that contribute to resilience among nursing students.

Methods

A multicenter, cross-sectional, correlational design was used, with participants recruited from four universities across Eastern, Western, Northern and Southern regions of India through convenience sampling. The participants completed an online survey incorporating the Brief Resilience Scale, World Health Organization Well-Being Index, and Mindful Self-Care Scale. Descriptive statistics were used to summarize the study variables, while independent t-tests and one-way ANOVA examined group differences. Pearson’s correlation was used to assess relationships among variables, and linear regression was used to identify factors associated with resilience.

Results

A total of 879 nursing students were included in the study. Most of the students demonstrated moderate resilience (63.7%), with 35.4% showing low resilience and 0.9% high resilience. Most reported good well-being (84.2%). The overall mean mindful self-care score was 104.46 ± 30.83 (64.08% of the maximum), with the highest subdomain scores in supportive relationships (67.48%), mindful awareness (67.00%), and general practices (66.87%) and the lowest in mindful relaxation (61.27%) and physical care (59.25%). Both mindful self-care (β = 0.011, p < 0.001) and well-being (β = 0.076, p < 0.001) were associated with resilience, explaining 5.1% of its variance (R² = 0.051), which remained significant after adjusting for demographic factors (final model R² = 0.060, Adjusted R² = 0.050).

Conclusion

The findings underscore the need for targeted interventions and strategies to strengthen the resilience and mindful selfcare capacities of nursing students. The study suggests that in addition to mindful selfcare and well-being, resilience is influenced by a broader range of determinants beyond those captured in the present study.

Keywords

well-being health care resilience self-care students mental health

Introduction

Resilience is defined as “the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands.”(Chbeir & Carrión, 2023; Ravi & Mohamed, 2022)Amid the growing global demand for nurses driven by demographic shifts, evolving healthcare landscapes, and recent health challenges, there is immense responsibility and opportunity to empower and strengthen a resilient nursing workforce (Olorunfemi et al., 2025; Wiig & O’Hara, 2021).

Nursing education programs empower students to develop a strong foundation of theoretical knowledge, clinical competence, critical thinking, and effective communication skills, enabling them to thrive in complex healthcare environments (Schepp et al., 2021; Sulaiman et al., 2023). Engaging with critically ill patients, supporting grieving families, and navigating challenging clinical experiences in their training provides nursing students with opportunities to develop emotional strength and deepen their compassion (Han et al., 2023; Mcdermott et al., 2020). Managing these responsibilities alongside their studies requires considerable strength and resilience, and may impose substantial challenges (Canzan et al., 2022; Mohamed et al., 2025).

In India, nursing students face distinctive challenges, including limited resources, heavy workloads, skill-demanding clinical tasks, and financial pressures, all of which test their resilience (Baby et al., 2024; Kanagaraj et al., 2024; Ravi et al., 2025). As members of Generation Z, they are also immersed in a digital environment that offers learning opportunities but also introduces distractions, digital fatigue, and increased anxiety due to multitasking and information overload (Cruz Araújo et al., 2022; Hack-Polay et al., 2023). In this context, cultivating resilience and mindful self-care is essential for maintaining emotional balance, mental clarity, and overall well-being (Hathaisaard et al., 2022; Tiol et al., 2024).

Hence, it is essential to build a strong support system for nursing students in India, as they represent the future healthcare workforce, and their well-being can enhance care quality, reduce attrition, and strengthen trust in healthcare systems (Ahad et al., 2023; Baharum et al., 2023; Sharma et al., 2025). Ensuring the health of future nurses can improve their caregiving experiences and contribute to more sustainable and effective healthcare delivery (Cummings et al., 2021). Studies have shown that resilience-building strategies help students adapt to challenging learning environments and ease their transition into professional nursing roles (Sandler, 2020; Çamveren et al., 2020).

Review of Literature

Resilience, mindful self-care, and well-being are interrelated constructs that collectively contribute to psychological health. Resilience enables recovery from setbacks and functioning under demanding conditions, while its development is supported by self-care practices that enhance well-being outcomes. Although emerging evidence has examined these constructs among nursing students, they have not yet been explored in an integrated framework.

Mindful self-care is defined as “an iterative process that involves mindful awareness and assessment of one’s internal needs and external demands, intentional engagement in specific self-care practices to address needs and demands in a manner that serves one’s well-being and personal effectiveness.”(Cook-Cottone & Guyker, 2018). A recent study found that nurses engaged in mindfulness practice experienced lower levels of burnout, increased job satisfaction, and better emotional regulation, all of which are key components of resilience (Green & Kinchen, 2021).

Well-being, encompassing psychological, emotional, and social functioning, is essential for fostering resilience and supporting academic and personal outcomes. Evidence suggests that nurses’ well-being differs from that of the general population, making it a critical area of focus (Bamforth et al., 2023; Patrician et al., 2022). Although no single definition exists, it is viewed as a multidimensional construct including emotional, physical, psychological, social, and workplace well-being (Browne & Chun Tie, 2024; Patrician et al., 2022). Poor well-being may lead to fatigue, emotional distress, and cognitive overload, adversely affecting learning and clinical performance (Cook-Cottone & Guyker, 2018; Hwang & Kim, 2022). Conversely, institutional support systems, including mental health services and academic flexibility, enhance nursing students’ preparedness (Worsley et al., 2022; Zhou et al., 2023). Given the interrelated nature of these constructs, this study assessed resilience, well-being, and mindful self-care among nursing students and examined factors associated with resilience to inform targeted interventions (Kunzler et al., 2022; Morse et al., 2021).

Conceptual Framework

To further elucidate the relationships among resilience, mindful self-care, and well-being, the conceptual framework (Figure 1), based on existing literature and the Mindful Self-Care Model by Cook-Cottone and Guyker, is proposed (Cook-Cottone & Guyker, 2018). Mindful self-care is conceptualized as a multidimensional construct comprising six domains that reflect intentional, mindfulness-based engagement with internal and external needs. The framework proposes that the six domains of mindful self-care collectively promote practices that enhance resilience and well-being (Cook-Cottone & Guyker, 2018; M. Li et al., 2024). Mindful self-care supports resilience by fostering emotional regulation, self-efficacy, and stress management, with activities such as mindful relaxation and self-compassion buffering the impact of stress, whereas supportive relationships provide social resources that strengthen coping (M. Li et al., 2024; Wells & Klocko, 2018). Simultaneously, these practices enhance well-being by promoting mental clarity, emotional balance, and social connectedness, thereby supporting nursing students’ academic and clinical performance, and reducing fatigue, emotional distress, and cognitive overload (Karakurt & Durmaz, 2025; Pan et al., 2022).

The relationship between well-being and resilience is also integral to the framework (Al Omari et al., 2023; Klainin-Yobas et al., 2021). Higher well-being may provide a psychological foundation that enables nursing students to better manage stress and recover from challenges, thereby reinforcing their resilience (Al Omari et al., 2023; Klainin-Yobas et al., 2021). Despite growing global evidence on mindful self-care, well-being, and resilience, studies in the Indian context remain limited. This highlights the need to examine how mindful self-care is associated with well-being and resilience among Indian undergraduate nursing students (Henshall et al., 2020). Understanding these associations provides a theoretical basis for developing targeted interventions that help nursing students thrive in demanding academic and clinical environments. This framework provides a theoretical rationale for examining the associations between mindful self-care, well-being, and resilience in this study.

Based on the existing literature and theoretical framework the study proposes the following hypotheses: (H1) Mindful selfcare is positively associated with resilience; (H2) Well-being is positively associated with resilience; (H3) Well-being is positively associated with Mindful selfcare; and (H4) Mindful selfcare and well-being are associated with resilience when considered together.

Materials and Methods

Research Design

The study adopted a cross-sectional correlational design. The study is reported in accordance with the STROBE guidelines for cross-sectional surveys.

Population and Setting

This study focused on undergraduate nursing students enrolled in the Bachelor of Science in Nursing program (B.Sc. Nursing) program. The B.Sc. Nursing program in India is a four-year undergraduate course that integrates theoretical instruction, clinical training, and community health practice to prepare students for professional nursing roles in diverse healthcare settings.

To ensure geographical representation, a multicentre design was used by selecting one nursing college from each major region of India: North, South, East, and West. Institutions were chosen through convenience sampling based on accessibility, permission, and willingness to participate. This enhanced regional diversity and provided a more representative sample within practical constraints. However, convenience sampling may limit the generalisability of findings to all nursing students in the country.

Sample and Sampling Technique

The study population included all undergraduate nursing students enrolled in the selected institutions during the academic years 2024–2025. Participants aged 18 years and above, from the first to the fourth year of the study, were eligible for inclusion. Students who were absent during data collection or who had experienced any major physical or mental illness in the previous three months were excluded from participation. Convenience sampling was employed to recruit participants from the selected institutions.

The sample size for this cross-sectional study was determined using the standard formula, N = Z² × P(1–P)/d², where Z represents the standard normal deviation corresponding to the desired confidence level, P is the expected proportion, and d is the allowable error. Based on a previous study, the prevalence of resilience was 34%, with an absolute precision of 5% and a 95% confidence level, and the minimum required sample size was calculated to be 345 (Shen et al., 2024). The final sample size was adjusted for an anticipated 15% non-response rate. It was calculated based on the number of variables in the model, and this confirmed that the required sample size was adequate (Riley et al., 2019).

Data Collection

The investigators, who were also faculty members, administered the survey during classroom sessions. After explaining the study’s purpose and duration, students were provided with a participant information sheet, consent form, and a Google Forms link. The survey was distributed via institutional emails and WhatsApp groups, and all eligible students were invited to participate voluntarily. Those not meeting eligibility criteria were advised not to participate.

Data were collected from selected institutes in Eastern and Southern India from 20^th to 30^th March 2024, and in Western and Northern India from 3^rd to 31^st January 2024. Only consenting students completed the data collection instructions. Confidentiality and anonymity were ensured throughout the study. No identifiers such as names, university ID numbers, or email addresses were collected.

Measures

Data were collected using a self-administered questionnaire having four sections.The instrument was administered in English, the official language of instruction and communication in the participating institutions.

Sociodemographic Information

This part assessed the characteristics of the study participants and included structured closed-ended questions to collect sociodemographic information. Participants were requested to provide self-reported details, such as age, gender, year of study, and marital status.

World Health Organization’s 5-Item Well-Being Index (WHO-5)

This was employed to assess well-being. It has demonstrated strong internal consistency, with Cronbach’s alpha coefficients ranging from 0.80 to 0.90 across various populations (Cosma et al., 2022; Pallabi Pattnaik, 2020; Ravi & Mohamed, 2022). This brief global tool measures subjective well-being over a two-week period, capturing both the negative and positive aspects within a single-dimensional framework. It consists of five statements reflecting an individual’s experiences over the past 14 days. Each statement was rated on a six-point Likert scale ranging from 0 (no time) to 5 (all the time), with higher scores indicating better self-reported well-being. The total score ranged from 0 (no well-being) to 25 (maximum well-being), with scores below 13 indicating poor well-being. The raw score was converted into a percentage from zero to 100 by multiplying it by four.

Brief Resilience Scale (BRS)

Developed by Smith et al., this is a validated and reliable scale with Cronbach’s alpha ranging from 0.80 to 0.91 across (Ravi & Mohamed, 2022; Saha et al., 2025). It measures resilience, defined as the ability to recover from stress, and assesses coping with health-related stressors. The scale consists of six items rated on a five-point Likert scale (1–5), with total scores ranging from 6 to 30; higher scores indicate greater resilience. The final score is obtained by dividing the total by the number of items. Interpretation is as follows: 1.00–2.99 (low resilience), 3.00–4.30 (normal resilience), and 4.31–5.00 (high resilience).

Mindful Self-Care Scale (MSCS)

This 33-item tool is designed to assess how often individuals engage in behaviors that reflect self-care practices (Cook-Cottone & Guyker, 2018). It demonstrated strong internal consistency, with a total Cronbach’s alpha of 0.89 and subscale reliabilities ranging from 0.69 to 0.92 (Cook-Cottone & Guyker, 2018; Dando et al., 2023). The scale comprises six domains: mindful relaxation, physical care, self-compassion and purpose, supportive relationships, supportive structures, and mindful awareness, along with three general items assessing overall self-care practices. Permission to use the scale was obtained from the authors, and subscale scores were computed by dividing the total item scores by the number of items in each domain.

Statistical Analysis

Data were extracted from Google Forms and systematically organized using Microsoft Excel. The collected data were analyzed using descriptive and inferential statistics to examine the patterns and relationships between the study variables. The analyses were conducted using IBM SPSS Statistics version 30 and Jamovi version 2.6.4.1. Normality was assessed using graphical (histograms and Q–Q plots) and statistical approaches. Although the sample size was large (n = 874), which invokes the Central Limit Theorem (CLT) and supports the use of parametric tests, the distribution of some variables showed mild deviations from normality. Therefore, the decision to apply parametric tests is guided by the robustness of these tests under large-sample conditions (Habibzadeh, 2024). For the regression model, residual diagnostics were examined to verify the model assumptions. The residual Q–Q plot showed no distinct curvature or funnel-shaped pattern, indicating that the linearity was maintained. Mild heteroscedasticity was observed, but not severe enough to violate model assumptions; hence, linear regression analysis was deemed appropriate (Rajh-Weber et al., 2025).

Descriptive statistics (mean, median, interquartile range, standard deviation, frequency, and percentage) were used to summarize the study variables. The independent t-test and one-way ANOVA were used to compare group differences when assumptions were met, while the Pearson correlation test was used to determine the relationships among resilience, well-being, and mindful self-care. Linear regression analysis was performed to assess whether mindful self-care and well-being were associated with resilience. Statistical significance was set at p < 0.05.

Ethical Considerations

Ethical approval was obtained from the Institutional Review Boards of the participating universities, and the study was conducted in accordance with institutional ethical guidelines and the Declaration of Helsinki. Confidentiality and anonymity were ensured throughout. Participants were informed of their right to withdraw at any tim e without penalty. No personally identifiable information was collected, and all data were securely stored to maintain privacy. Written study information was provided via Google Forms, and participants gave informed consent electronically before participation.

Results

Characteristics of Participants

A total of 945 nursing students were invited to participate, with a response rate of 93%, resulting in a final sample of 879 students. Participants’ ages ranged from 18 to 38 years. As shown in Table 1, the majority were female (81.1%), unmarried (98.7%), and reported no pre-existing illness (93.3%).

Table 1.

Frequency and Percentage Distribution of Demographic Variables of the Participants (N=879)

Variables	Categories	Frequency	Percentage
Age (in years), Mean ± SD		20.73 ± 2.40
Region	Western	153	17.4
	Southern	153	17.4
	Eastern	198	22.5
	Northern	375	42.7
Gender	Male	166	18.9
Gender	Female	713	81.1
Marital Status	Married	11	1.3
Marital Status	Single	868	98.7
Year of study	First	359	40.8
	Second	230	26.2
	Third	134	15.2
	Fourth	156	17.7
Pre-existing disease	Yes	59	6.7
Pre-existing disease	No	820	93.3
Living Situation	Alone	40	4.6
	Others	25	2.8
	Shared Apartment	281	32
	University residence	128	14.6
	With family	405	46.1

Reliability Analysis of Study Measures

Internal consistency was assessed using Cronbach’s alpha, showing good to excellent reliability for all scales: resilience (α = 0.81), well-being (α = 0.86), and mindful self-care (α = 0.97). The subscales of mindful selfcare also demonstrated high reliability with Cronbach’s values as follows: M1(0.85), M2 (0.89), M3 (0.93), M4 (0.93),M5(0.93), M6 (0.94), M7 (0.93).

Resilience, Well-Being, and Mindful Self-Care

In terms of resilience, 35.4% of the students demonstrated low resilience, 63.7% fell within the moderate range, and only 0.9% exhibited high resilience (Figure 2(A)). With respect to well-being, 15.8% of the students reported poor well-being, whereas the majority (84.2%) reported good well-being (Figure 2(B)).

The mean scores were 18.10 ± 2.40 for resilience (60.33% of the maximum), 17.31 ± 5.14 for well-being (69.24%), and 104.46 ± 30.83 for mindful self-care (64.08%) (Table 2). Among the subdomains of mindful self-care supportive relationships showed the highest engagement (67.48%), followed by mindful awareness (67.00%) (Figure 2(C)).

Table 2.

Mean, and Standard Deviation of Well-Being, Resilience, and Mindful Self-Care and Its Activities

Variables	Range	Mean ± SD	Mean %
Resilience	11 to 30	18.10 ± 2.40	60.33
Well Being	0 to 25	17.31 ± 5.14	69.24
Mindful Self-care	37 to 163	104.46 ± 30.83	64.08
Mindful relaxation	6 to 30	18.38 ± 5.95	61.27
Physical care	11 to 39	23.11 ± 6.69	59.25
Self-compassion and Purpose	6 to 30	19.42 ± 6.74	64.73
Supportive Relationship	5 to 25	16.87 ± 6.02	67.48
Supportive structure	4 to 20	13.26 ± 4.80	66.30
Mindful Awareness	4 to 20	13.40 ± 4.85	67.00
General	3 to 15	10.03 ± 3.72	66.87

Table 3 presents a comparison of resilience, well-being, and mindful self-care scores across gender, region, and year of study among undergraduate nursing students. An independent samples t-test revealed that male students had slightly higher mean resilience scores (M = 18.42, SD = 2.68) compared to female students (M = 18.04, SD = 2.34), though this difference was not statistically significant, t₍₈₇₇₎ = 1.85, p = 0.06. Similarly, males reported marginally higher well-being scores (M = 18.01, SD = 5.74) than females (M = 17.15, SD = 4.99), but the difference did not reach statistical significance, t₍₈₇₇₎ = 1.94, p = 0.053.

Table 3.

Comparison of Resilience, Well-Being, and Mindful Self-Care Between Gender, Region and Year

Variable	Resilience (mean ± SD)	Wellbeing (mean ± SD)	Mindful self-care (mean ± SD)
Gender
Male	18.42 ± 2.68	18.01 ± 5.74	105.02 ± 37.25
Female	18.04 ± 2.34	17.15 ± 4.99	104.34 ± 29.17
t Test(df)	1.85 (877)	1.94 (877)	0.22 (214.4)^†
P value	0.060	0.053	0.797
Region (India)
South	18.09 ± 2.19	15.16 ± 5.45	101.59 ± 24.35
North	18.03 ± 2.46	18.67 ± 4.53	100.11 ± 34.02
West	18.42 ± 2.66	16.88 ± 5.36	119.60 ± 23.27
East	18.04 ± 2.26	16.75 ± 5.15	103.24 ± 30.70
F value (df)	1.03 (3, 875)	20.05 (3, 875)	16.12 (3, 875)
P value	0.370	<0.001 **	<0.001 **
Year (B.Sc Nursing)
First	18.21 ± 2.49	17.65 ± 5.00	106.22 ± 31.32
Second	17.96 ± 2.30	16.74 ± 5.72	103.89 ± 31.21
Third	18.00 ± 2.51	17.34 ± 4.66	98.36 ± 29.34
Fourth	18.20 ± 2.31	17.37 ± 4.95	106.53 ± 29.97
F value (df)	1.49 (3, 875)	0.676 (3, 875)	2.40 (3, 875)
P value	0.210	0.560	0.060

Note. ** p<0.01, Significant; df: degree of freedom; SD: Standard Deviation; t-test: Independent t-test; F value: One-way ANOVA.

^†Levene’s test for equality of variances was significant (p < 0.05) for Mindful Self-care between genders; therefore, equal variances were not assumed, and adjusted degrees of freedom (Welch’s correction) were used.

One-way ANOVA results showed no significant difference in resilience scores among regions, F_{(3, 875)} = 1.03, p = 0.37. However, a highly significant regional variation was observed for well-being, F_{(3, 875)} = 20.05, p < 0.001, and mindful self-care, F_{(3, 875)} = 16.12, p < 0.001.

Correlation Between Mindful Self-Care, Well-Being, and Resilience

Figure 3 presents the interrelationships among resilience, well-being, and the various domains of mindful self-care. Resilience demonstrated a weak, but significant, positive correlation with well-being (r = 0.17, p < 0.01). Well-being weakly and significantly correlated with overall mindful self-care (r = 0.08, p < 0.05). The components of mindful self-care were strongly interrelated, with consistently positive correlations between the subscales (r = 0.59, 0.93, p < 0.01).

Factors Associated With Resilience

Multiple linear regression analysis was conducted to examine factors associated with resilience among nursing students, with mindful self-care and well-being entered as the independent variables. The overall regression model was statistically significant (F_(4,874) = 23.61, p < 0.01), however it explained only a small proportion of the variance in resilience scores (adjusted R² = 0.049). Both mindful selfcare (β = 0.011, 95% CI: 0.006–0.016, p < 0.01), and well-being (β = 0.075, 95% CI: 0.045–0.106, p < 0.01) showed a significant association though the magnitude of co-efficient was small (Table 4). As the unstandardized coefficients are small and only limited variance is explained these associations are interpreted as modest in magnitude.

Table 4.

Hierarchical Linear Regression Predicting Resilience Among Nursing Students

Factors (reference variable)	Model 1		Model 2
Factors (reference variable)	β (95% CI)	P value	β (95% CI)	P value
Mindful self-care	0.011 (0.006 – 0.017)	< .001	0.010 (0.005 – 0.016)	< .001
Well-being	0.076 (0.045 – 0.106)	< .001	0.082 (0.045 – 0.120)	< .001
Gender (Male)
Female	—	—	−0.40 (−0.82 – 0.01)	0.053
Region (South)
North	—	—	−0.46 (−0.94 – 0.03)	0.068
West	—	—	−0.04 (−0.60 – 0.51)	0.874
East	—	—	−0.24 (−0.79 – 0.30)	0.384
Year (4th year)
1st year	—	—	0.12 (−0.34 – 0.57)	0.625
2nd year	—	—	−0.07 (−0.59 – 0.45)	0.789
3rd year	—	—	−0.06 (−0.63 – 0.51)	0.837
Model Fit Indices
R²/Adj R²	0.051/0.049		0.060/0.050
ΔR²	—		0.009
F_{(df1, df2)}	23.62 _{(2, 876)}	< .001	6.13 _{(9, 869)}	< .001
AIC/BIC	4001/4020		4007/4060

Note. Model 1 = unadjusted; Model 2 = adjusted for gender, year, and region.

Values are unstandardized regression coefficients β (95% confidence interval).

AIC = Akaike information criterion; BIC = Bayesian information criterion.

Hierarchical linear regression analysis was conducted to examine the factors associated with resilience among undergraduate nursing students. Mindful self-care and well-being were entered as factors in Model 1. The results indicated that mindful self-care (β = 0.011, 95% CI: 0.006–0.017, p < .001) and well-being (β = 0.076, 95% CI: 0.045–0.106, p < .001) were significantly associated with resilience, explaining 5.1% of the variance in resilience (R² = 0.051, F (2, 876) = 23.62, p < .001). In Model 2, gender, region, and year of study were included as control variables. After controlling for these demographic factors, mindful self-care (β = 0.010, 95% CI: 0.005–0.016, p < .001) and well-being (β = 0.082, 95% CI: 0.045–0.120, p < .001) remained significantly associated with resilience. None of the control variables, including gender, region, or year of study, showed a significant association with resilience (p > .05). The inclusion of these demographic variables resulted in a small, non-significant increase in the explained variance (ΔR² = 0.009, F(7, 869) = 1.12, p = 0.347). The final model accounted for 6.0% of the variance in resilience (R² = 0.060, Adjusted R² = 0.050), indicating that mindful self-care and well-being were associated with greater resilience among nursing students even after adjusting for demographic factors.

The findings support the hypotheses that were proposed. H1 and H2 were supported as mindful selfcare and well-being showed significant positive associations with resilience, although the relationships were weak. Further H3 was supported with well-being demonstrating a significant positive correlation with mindful self-care. H4 was also supported as mindful selfcare and well-being were significantly associated with resilience.

Discussion

This study examined resilience, well-being, and mindful self-care among nursing students across India and identified factors associated with resilience. While most students reported moderate to good well-being, only a small proportion demonstrated high resilience. A non-significant trend towards higher resilience and well-being was observed among male students, whereas mindful self-care was similar across genders. Students reported greater engagement in social and psychological aspects of self-care, such as supportive relationships and mindful awareness, than in physical care and mindful relaxation. Resilience showed weak but significant positive associations with well-being and mindful self-care. Standardized beta coefficients indicated that well-being (β = 0.07) had a stronger association with resilience than mindful self-care (β = 0.01), with confidence intervals excluding zero, supporting the reliability of these associations. However, together these factors explained only 5.1% of the variance in resilience, indicating that resilience is largely influenced by other unexamined factors. Finally, the analyses examined associations rather than directional or mediated relationships.

In the Indian context, a constellation of factors including social and familial support systems, academic stressors inherent in nursing education, individual’s socio-economic status and other contextually relevant situations can explain the relatively limited variance explained by the model. In collectivist societies as India, interdependence, family dynamics and the cohesion and community level factors are central to coping process (Fritz et al., 2018). In a study among the medical students in India a similar lack of association was observed between resilience and well-being which explains that other factors influence the variation (Sonika et al., 2019) Further, the clinical and academic stressors inherent to nursing education are well documented psychological stressors that can influence resilience trajectories; explicating the limited variation observed in the study (Turner & McCarthy, 2017; Weitzel et al., 2022). In young adults as in the students of the present study, socioeconomic and social correlates also largely contribute to resilience implicating a multifactorial interplay justifying the observed variance gap in the model (Weitzel et al., 2022).

Resilience plays a vital role in how students handle stress and other challenges. There is ample evidence that students struggle to cope with difficult situations (Mohamed et al., 2025; Ravi & Mohamed, 2022). Nearly one-third of the students participated in the study had low resilience, about two-thirds had moderate resilience, and only a negligible percentage demonstrated high resilience. A systematic review found that nursing students worldwide experienced moderate resilience levels, which aligns with the findings of this study (Z.-S. Li & Hasson, 2020). Lower levels of resilience have been linked to an increased susceptibility to stress, anxiety, and poor well-being (Mohamed et al., 2025; Ravi & Mohamed, 2022). While the study did not specifically examine the characteristics of the subgroup with low resilience, to determine the plausible explanations for this outlier subset, protective factors such as higher intrinsic motivation, prior experience of challenging life experiences and effective coping strategies could possibly explain their characteristics.

The findings suggest that students engage moderately in self-care practices and physical self-care is less prioritized. This result aligns with earlier studies indicating that university students often neglect their physical well-being because of academic stress, limited time, and lifestyle choices, while nursing students tend to neglect exercise and sleep because of time constraints (Kundayi Ravi & Mohamed, 2024; Monserrat-Hernández et al., 2023). The highest subscale score was observed for Supportive Relationships. Taken together, the evidence indicates that students require strategies or interventions to enhance their mindful self-care practices. In particular, the low scores in the physical care domain suggest that interventions promoting physical well-being, such as structured wellness programs and awareness campaigns, may be particularly beneficial.

The majority of the students who participated in the study reported a “good” level of well-being, especially compared to studies involving university students from other areas. Studies from Hong Kong, Hungary, and a multinational study have reported lower mean WHO-5 scores of 13.68 (SD = 4.20), 10.65, and 15.9, respectively, indicating lower well-being compared to our findings (Kavvadas et al., 2023). Several factors may contribute to variations in students’ well-being. Academic workload, financial stress, lack of social support, and lifestyle habits, such as sleep and physical activity, have all been identified as potential influences on well-being (Barbayannis et al., 2022; Kundayi Ravi & Mohamed, 2024; Ravi & Mohamed, 2022). Future studies should thoroughly investigate these variables to identify the main factors associated with low well-being scores and the possible protective factors.

In this study, male students exhibited better well-being than their female counterparts and had marginally higher resilience. A study from India has observed that male nursing students have lesser perceived stress than the female counterparts, which may explain not only institutional dynamics which shape stress experience but also the performance expectations which may be different between genders (Singh et al., 2013). A systematic review by Zheng et al. discusses the gendered difference in stress perception among nursing students and highlights various factors including their differences in maintaining interpersonal relationship and communication. This can also be attributed to the more externalizing stress behaviours observed in males than females (Zheng et al., 2022). Compared to emotion-focused coping mechanisms in females, problem-focused coping strategies generally employed by males can also explain this difference (Van de Velde et al., 2023). These findings suggest the importance of equipping students with adaptive coping strategies irrespective of gender. Previous studies in this area have indicated that, among healthcare professionals, female students are more prone to anxiety, depression, and emotional exhaustion than male students (Worsley et al., 2022), and psychological resilience among male mental health professional tend to be greater than that of females (Özbay & Bülbül, 2025). It is also noteworthy that some studies have reported no significant gender differences in resilience as in the present study. A study examining nursing students found comparable resilience levels across genders, indicating that institutional and cultural factors may play a more significant role in shaping resilience than gender does (AL-Hammouri et al., 2024). The study revealed no significant disparities in mindful self-care practices between the boys and girls. This finding aligns with previous research, reinforcing that both male and female students acknowledge the equal importance of self-care. However, while overall engagement in mindful self-care practices showed no gender-based variation, it is worth noting that the specific types of self-care activities preferred may differ between sexes. This nuanced understanding suggests that, while the recognition of self-care values transcends gender lines, the manifestation of these practices might be influenced by gender-specific preferences or societal expectations (Garro et al., 2023).

Mindful self-care may lead to improved well-being though their association appears to modest in this study. This aligns with the findings of an earlier study from the US which showed that nursing students engaging in regular self-care had significantly lower levels of depression and stress (Mcdermott et al., 2020).

Mindful self-care and well-being were significantly but modestly associated with resilience, suggesting a limited but meaningful contribution to resilience development. Notably, 82% of participants reported good well-being, indicating restricted variability in this construct, which may have influenced the observed associations. The modest correlation coefficients and low variance explained in regression models may partly reflect this ceiling effect. Therefore, findings should be interpreted with caution, as sample characteristics may have affected the strength of relationships. Similar associations have been reported in previous studies; for instance, a randomized controlled trial in Eastern Turkey found that an eight-week mindfulness-based stress reduction program improved subjective well-being in nursing students, supporting the link between well-being and resilience (Karakurt & Durmaz, 2025). Likewise, a recent meta-analysis found that students engaging in self-care activities such as mindfulness and relaxation developed stronger resilience mechanisms (Han et al., 2023). Similarly, Thai nursing students with strong peer and faculty support networks demonstrated higher resilience (Aryuwat et al., 2024). However, mindful self-care and well-being explained only a small proportion of variance, suggesting that resilience is a complex, multifactorial construct influenced by additional factors such as personality traits, social support, coping strategies, and academic or environmental stressors. Therefore, caution is needed when attributing resilience primarily to mindful self-care and well-being. Other key areas, including social support, faculty mentorship, and structured mental health interventions, should also be explored to enhance resilience among nursing students (Worsley et al., 2022).

Strengths and Limitations

This study employed a multisite approach across India’s four regions, enhancing sample diversity and addressing the literature gap by examining the relationships between mindful self-care, well-being, and resilience among nursing students. Validated instruments (WHO-5, Brief Resilience Scale, and Mindful Self-Care Scale) and robust statistical methods strengthened the reliability of the findings.

Nevertheless, the study has limitations, including its cross-sectional design, which limits causal inference. The use of non-probability convenience sampling and self-reported data may introduce bias, affecting generalizability and validity. As the survey was administered via Google Forms, participation may have been limited to students with adequate internet access, indicating possible digital bias. Self-reported responses may also be influenced by recall and social desirability bias, particularly given that data collection was facilitated by faculty in classrooms. This may partly explain the discrepancy between high reported well-being and moderate resilience, suggesting cautious interpretation of findings. Although standardized scales with acceptable psychometric properties were used, their validity and reliability were not formally assessed in this cultural context, potentially limiting construct validity.

The conceptual framework proposes a model in which mindful self-care, well-being, and resilience are interrelated. This study examined their associations rather than testing indirect pathways; mediation analysis or structural equation modelling would be required to establish such relationships, which remains an important direction for future research. Although various demographic factors were considered this study did not explore other potential influences, such as socioeconomic status, academic stress, or institutional policies that may affect resilience and well-being. While mindful self-care and well-being were associated with resilience, they explained only a small proportion of its variance, indicating that additional factors need further exploration.

Future studies should use longitudinal designs and interventions to examine causal relationships between mindful self-care, well-being, and resilience over time. Tracking students from first to final year would provide insights into how academic demands, emotional labour, and clinical exposure shape resilience trajectories. Research should also explore the role of family support, community systems, family resilience, and social connectedness, particularly within the collectivist Indian context, to provide a broader understanding beyond individual factors. More rigorous sampling methods and objective data collection are recommended to improve generalizability and accuracy, along with evaluating tailored resilience-building and self-care interventions. Further, categorising resilience and using logistic regression may help estimate the likelihood of low or high resilience and complement current findings. Qualitative studies can also offer deeper insight into student experiences. Nursing curricula should integrate structured resilience and self-care training, emphasizing physical self-care, which was the lowest-scoring domain. Incorporating wellness hours, yoga, and recreational activities, along with dedicated spaces for physical activity and accessible mental health services, can normalize self-care as part of professional development. Routine wellness assessments and faculty sensitisation programmes are also recommended.

Given that mindful self-care and well-being explained only a small proportion of variance, future research should explore additional factors such as coping mechanisms, social support, and academic stress using longitudinal or mixed-methods designs to better understand resilience among nursing students. Further studies are needed to examine the long-term effects of resilience and self-care programs on students’ well-being and professional development, including their impact on patient care outcomes. Future research should also identify specific risk and protective factors to inform targeted interventions that enhance students’ mental health, resilience, and self-care practices.

Implications for Practice

The implications of these findings can be discussed at educational, practical, and policy levels. Nursing curricula should integrate resilience-building and mindful self -care training to enhance students’ coping skills and well-being. Regular assessments of nursing students’ resilience, well-being, and self-care practices should be implemented to identify those students needing additional support. Targeted interventions and support programs should be developed for students with low resilience and well-being. Nursing Deans and faculty can utilise this evidence to develop structured well-being initiatives in the institutions targeting identified gaps in physical well-being and mindful relaxation.

At the practice level, healthcare institutions should prioritize resilience building and self-care practices for nursing students and practicing nurses. Mentorship programs that pair experienced nurses with students should be promoted to foster resilience and to share coping strategies. Mindful self-care practices should be incorporated into clinical rotations and internships to help students develop more sustainable habits. Regarding policies, supporting initiatives that enhance mental health and well-being programs in nursing education and practice settings are crucial. National guidelines should be established to integrate resilience and self-care training into the nursing education curriculum, and funding should be allocated to effective research interventions to enhance resilience.

Conclusions

This study found statistically significant but modest relationships between resilience, mindful self-care, and well-being among nursing students. Although mindful self-care and well-being were associated with resilience, their influence was limited, suggesting the involvement of additional contributing factors. Lower engagement was observed in certain self-care domains, particularly physical care, indicating a need for targeted interventions to promote holistic well-being. Gender differences in resilience and well-being further highlight the importance of tailored support strategies. Strengthening institutional policies and support services related to student well-being, resilience, and self-care may enhance academic success and quality of life. In conclusion, addressing these interrelated factors in nursing education may improve students’ mental health, professional readiness, and ultimately healthcare outcomes.

Footnotes

Acknowledgements

The study team would like to express our sincere gratitude to all the participants of this study. and the administration for granting permission to conduct this study.

ORCID iDs

Ramya Kundayi Ravi

Md. Faisal Ahmed

Ethical Considerations

The study followed all the guidelines of the Declaration of Helsinki involving human participants, human data, or human tissue. Informed written consent was obtained from all participants. Ethical approval for this study was secured from the Institutional Review Boards of the participating universities: Internal Review Board of SUM Nursing College, Bhubaneswar, Odisha, India, (SOADU/SNC/EST/66/03-2024); Institutional Ethics Committee of Saraswati Professional & Higher Education College Of Nursing(IEC/SPHE/N/2024/175); Institutional Ethics Committee of Charotar University of Science and Technology (CHARUSAT), Gujarat (CHA/IEC/ADM/23/11/14620.1); Internal Review Board of St. Joseph’s College of Nursing, Dharmagiri,(SJD/2024/23; Dated 15-03-2024).

Authors’ Contributions

RKR and PB: Study conception and design, data collection, analysis, interpretation of results, and drafting of the manuscript. JJ, RV and IS: Study conception and design, data collection, analysis, interpretation of results, and drafting of the manuscript; AK, SR, MF, SR, JJ, BP, DK, SR, and KK: data collection and drafting of the manuscript. All authors reviewed and approved the final version of the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

All data relevant to the study are included within the article.*

AI Declaration

During the preparation of this work, the authors used ChatGPT, GPT-5.5 Thinking (OpenAI), to help with grammar and punctuation. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Appendix

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