What this article is about
In brief
In 91 first-year Thai nursing students, mean 'mental health power' scores were reported as below threshold on all three subscales, though the percentage breakdown showed most students scoring normal on two of the three. Age, home province, and income showed small but statistically significant correlations; gender and..
For nursing students
Study summary
This study looked at the mental health strength — the paper calls it "mental health power" — of nursing students in Thailand, and asked which personal factors relate to it. Researchers at Srimahasarakham Nursing College, part of the Praboromarajhanok Institute, surveyed 91 first-year nursing undergraduate students out of a total population of 416 students across all four years of the program. The 91 first-years were chosen using purposive sampling, meaning the research team deliberately selected this specific cohort rather than drawing a random sample from the whole college.
The researchers used a locally built 20-item questionnaire, sometimes described with the term "Resilience Quotient" (RQ), rated on a four-point scale from "untrue" to "very true." It measures three components: emotional stability (staying calm and managing feelings under pressure), morale, also called encouragement (staying determined and not giving up), and problem management (having a positive outlook on problems and workable solutions). The tool went through review by five content experts, who gave it a strong content-validity score (an item-objective congruence value of 0.90), and it was piloted on 30 second-year students, where it showed good ability to tell students apart and very high internal consistency (Cronbach's alpha of 0.958).
Most participants were 19 years old (67%), and the large majority were women (96.7%), which reflects the typical gender balance in nursing programs. About 43% had one or two siblings, over a third lived in the same province as the college, and just over half reported a monthly income between 3,001 and 5,000 baht.
The results are worth reading carefully because the paper reports them two different ways that don't fully agree. Looking at how many students fell into each performance category, most students actually scored in the "normal" range for emotional stability (58.2%) and problem management (74.7%), while most scored below the threshold for morale (72.5%). But when the researchers reported the average scores instead of the categories, they described the overall mean as below the study's own cutoff criteria — and this was stated to be true for all three subscales, including emotional stability and problem management, where the percentage table had shown most students as normal. This write-up reports both sets of numbers as the authors presented them, but flags that the two tables in the source paper appear internally inconsistent, and readers should treat the "below threshold on every measure" conclusion with some caution.
The study also tested whether age, gender, home province, birth order, and monthly income were statistically associated with mental health power, using Spearman's correlation coefficient. The authors reported statistically significant relationships (p < .05) for age, home province (domicile), and monthly income, labeling the age and income relationships as "moderate" and the domicile relationship as "low." Gender and sibling/birth order were not significantly related. One important caveat: the actual correlation coefficients reported for these "significant" factors were numerically very small (around .01 to .04), which is unusual for something described as a "moderate" relationship in standard statistical convention. Students and instructors reading this paper should treat those strength labels cautiously rather than taking them at face value.
For nursing students, the practical takeaway is that the first year of nursing school can be a period of measurable strain, particularly in morale, and that background factors such as income and place of residence may play some role alongside the academic and clinical stresses that nursing programs are known to create. Because the study surveyed only one cohort at one Thai nursing college, used purposive (non-random) sampling, and relied on a non-standardized local instrument, the specific numbers should not be generalized broadly to other schools or countries, including Canadian nursing programs. Still, the underlying message — that early nursing training is a vulnerable window for student wellbeing, and that programs may benefit from paying attention to it — lines up with broader research on nursing student stress that this paper itself cites in its introduction.
Original publication
Source abstract and study details
Read the source abstract
The purposes of this research were to study the level of mental health power and selected factors related to mental health power of nursing undergraduate students, Srimahamarakham Nursing College. The sample consisted of 91 first-year nursing undergraduate students at Srimahasarakham Nursing College, Faculty of Nursing, Praboromarajhanok Institute who were selected by purposive sampling. The research tool was the mental health power assessment questionnaire. The statistics used for data analysis were frequency, percentage, mean, standard deviation and the spearman's correlation coefficient. The results showed that the mean of overall mental health power was lower than the criteria ([x-bar]= 57.64). When considering mental health power on each aspect, it was found that emotional stability [x-bar]= 28.98, encouragement [x-bar] = 13.81 and problem management [x-bar] = 14.84 which is below the threshold level on all aspects. And factors that had a positive correlation with the mental health power of nursing undergraduate students statistical significance (p< 0.05). There was also a moderate correlation (r = 0.04) were associated homeland low level (r = 0.01) and monthly income had a moderate relationship (r = 0.03). The factors that did not relate with the mental health power of nursing undergraduate students were gender (r = 0.10) and the order of siblings or their children (r = 0.09).
Reviewed findings
Main findings
- In a sample of 91 first-year nursing students, the overall mean mental health power score (57.64) was reported as below the study's threshold criterion, with all three subscales — emotional stability (28.98), morale (13.81), and problem management (14.84) — also described as below threshold.
- Despite the mean-score finding above, the categorical breakdown showed most students scoring in the 'normal' range for emotional stability (58.2%) and problem management (74.7%), while morale was the weakest area, with 72.5% of students scoring below the threshold.
- Age, home province (domicile), and monthly income were reported as statistically significantly correlated with mental health power (p < .05), though the correlation coefficients themselves were small (r = .01 to .04).
- Gender (r = .10) and order of siblings/children (r = .09) were not significantly correlated with mental health power in this sample.
- The 20-item mental health power questionnaire, built specifically for this study, showed strong psychometric properties in pilot testing: item discrimination of 0.36–0.92 and Cronbach's alpha of 0.958.
For teaching and learning
Education implications
- Because morale (encouragement) showed the largest share of students below threshold, nursing programs could consider targeting persistence- and determination-building support specifically, rather than treating student stress as one undifferentiated problem.
- Given the introduction's emphasis on first-year transition stress (new environment, dormitory living, unfamiliar academic demands), resilience or coping-skills content could reasonably be introduced during first-year orientation rather than delayed until clinical years.
- The small but statistically significant associations with income and home province suggest student support services might account for financial and housing/commuting circumstances when identifying students who could benefit from extra support, while recognizing these effects were modest.
- The instrument's three domains (emotional stability, morale, problem management) could offer academic advisors a simple structure for asking targeted questions when a student appears to be struggling, rather than relying on a single global 'stress' label.
- Because of the study's single-site, purposive-sample design, any local implementation of similar screening should be paired with an institution's own needs assessment rather than assuming these exact percentages or correlations would transfer to another program or country.
For educators
Teaching and appraisal notes
This is a descriptive correlational survey study conducted at Srimahasarakham Nursing College (Praboromarajhanok Institute, Thailand) and published in the International Journal of Higher Education (Wongchantra et al., 2021). It examined the level of "mental health power" — a locally used construct roughly analogous to resilience, covering emotional stability, morale, and problem management — among 91 first-year nursing undergraduate students, drawn by purposive sampling from a total program population of 416 students across four years.
The instrument was a 20-item, four-point Likert questionnaire covering the three subscales noted above, developed specifically for this line of research. Psychometric development is reported in useful detail: content validity was checked by five experts (item-objective congruence = 0.90), a suitability rating of 4.77/5 was obtained, and a pilot with 30 second-year students yielded item discrimination indices of 0.36–0.92 and an overall Cronbach's alpha of 0.958 — strong internal consistency for a locally developed tool.
The results merit close appraisal-oriented reading with students. Table 3 (categorical breakdown) shows most first-years scoring "normal" on emotional stability (58.2%) and problem management (74.7%), with morale the weak point (72.5% below threshold). Table 4 (means), however, reports the overall mean (57.64) and all three subscale means as below the paper's own threshold criteria — including emotional stability and problem management, which the categorical table had shown as mostly normal. This is a genuine internal inconsistency in the published tables that the authors do not reconcile in their discussion; it is worth using as a live example in a research-appraisal exercise of why readers must check that a paper's tables and prose agree before accepting its stated conclusions.
For the correlational analysis, Spearman's coefficients were used to test five candidate factors against overall mental health power. Age (r = .04), domicile/home province (r = .01), and monthly income (r = .03) were reported as statistically significant at p < .05 and labeled "moderate," "low," and "moderate" respectively; gender (r = .10) and sibling/birth order (r = .09) were not significant. A key teaching point here: the magnitude of the significant coefficients is very small by conventional standards (typically negligible), which sits awkwardly with the "moderate" descriptor and with statistical significance at n = 91 — a useful discussion point about the difference between statistical significance and effect size, and about how significance in modest samples can arise from measurement or coding artifacts as much as from meaningful relationships.
Methodologically, the study is limited by its single-site, purposive (non-probability) sample restricted to first-year students; the cross-sectional design, which cannot establish causal direction; and its use of a non-standardized local instrument that is not benchmarked against internationally validated resilience measures (e.g., the Connor-Davidson Resilience Scale), limiting comparability across studies and settings.
For nursing faculty, the paper's most durable contribution is less its precise statistics and more its framing: it treats mental health power as a multidimensional, measurable construct (emotional stability, morale, problem management) that can be tracked across a program, and it foregrounds the first-year transition as a period warranting deliberate attention. Faculty could use this article to prompt discussion on critical appraisal of self-developed instruments, on the gap between statistical significance and practical/clinical significance, and on how a Canadian program might design its own first-year wellness check-in without assuming these Thai findings transfer directly.
Critical appraisal
Limitations
- The sample (91 first-year students, purposively selected from a total population of 416 across four years) is small, non-random, and limited to one institution, restricting generalizability to other cohorts, program years, or nursing schools.
- The cross-sectional, correlational design cannot establish causation between age, domicile, income and mental health power, only association.
- The published tables show an internal inconsistency: the percentage breakdown (Table 3) indicates most students scored 'normal' on emotional stability and problem management, while the mean-score table (Table 4) describes all three subscales as 'below the threshold' — a discrepancy the authors do not address or reconcile in the discussion.
Classroom use
Discussion Questions
- Why might first-year nursing students in particular be a focus for mental health power research, based on the transitions the paper's introduction describes (new environment, dormitory living, unfamiliar academic demands)?
- The percentage breakdown suggests most students were 'normal' on emotional stability and problem management, but the mean-score table describes all three subscales as 'below threshold.' How should a critical reader reconcile — or flag — this discrepancy when appraising the study?
- What does it mean for a correlation to be labeled 'moderate' when the coefficient itself is only .03–.04? Why is distinguishing statistical significance from effect size an important critical-appraisal skill?
- How might purposive sampling of a single first-year cohort limit the ability to generalize these findings to second-, third-, or fourth-year students, who the paper describes as facing different stressors?
- What role might a locally developed, non-standardized instrument like this 'mental health power' questionnaire play in limiting comparisons with international resilience research?
- If morale showed the largest proportion of students below threshold, what kinds of program-level supports might specifically target determination and persistence rather than general stress reduction?
Source-based questions
Frequently asked questions
What is 'mental health power' in this nursing student study?
It is the study's term for a resilience-like construct made up of three parts — emotional stability, morale, and problem management — measured with a locally developed 20-item questionnaire.
Where was the study conducted?
At Srimahasarakham Nursing College, Faculty of Nursing, Praboromarajhanok Institute, in Maha Sarakham, Thailand.
Is this study generalizable to nursing students in other countries, including Canada?
Caution is warranted: the study used purposive (non-random) sampling of one first-year cohort at a single Thai college, plus a non-standardized local instrument, so its specific figures should not be assumed to transfer directly to other nursing programs.
How reliable was the questionnaire used in this study?
Very reliable in pilot testing, with a Cronbach's alpha of 0.958 and item discrimination values between 0.36 and 0.92.
What practical implications does this study suggest for nursing education programs?
It suggests attention to first-year students' morale specifically, and consideration of resilience-building support early in nursing training, while recognizing the study's small, single-site, non-randomized design limits how far these implications should be extended.