BACKGROUND: The psychological conditions of nursing students are quite important, and professional identity is an important part of the stable development of the nursing profession. Nursing students' sense of coherence, academic emotion, and self-esteem may be related to professional identity. This study was designed to examine the specific relationships and effect pathways between sense of coherence, professional identity, academic emotion, and self-esteem in nursing students, and to evaluate the chain mediating role of academic emotion and self-esteem between sense of coherence and professional identity. METHODS: This study used a cross-sectional design for data collection and analysis. A total of 286 Chinese nursing undergraduates participated in this cross-sectional study and completed the sense of coherence scale, professional identity questionnaire for nursing students, general academic emotion questionnaire for college students, and self-esteem scale. A structural equation model was established to examine the effect pathways, and the chain mediating effect was verified by path analysis and bootstrap method. RESULTS: Pearson correlation analysis found significant relationships among sense of coherence, professional identity, academic emotion, and self-esteem. Path analysis indicated that sense of coherence not only directly predicted professional identity (effect value = 0.33), but also indirectly predicted professional identity through the mediating effect of academic emotion and self-esteem respectively: sense of coherence→ positive academic emotion→ professional identity (effect value = 0.32)
sense of coherence→ self-esteem→ professional identity (effect value = 0.04). In addition, academic emotion and self-esteem played a chain mediating role between sense of coherence and professional identity: sense of coherence→ positive academic emotion→ self-esteem→ professional identity (effect value = 0.05)
sense of coherence→ negative academic emotion→ self-esteem→ professional identity (effect value = 0.02). CONCLUSION: The study contributes to the understanding of the relationship between sense of coherence and professional identity among nursing students. Moreover, the results may provide insights for educators and health professionals, potentially contributing to improving the quality of nursing education and strengthening the professional identity of nursing students. CLINICAL TRIAL NUMBER: Not applicable.