Moderating effect of self-control on the relationship between critical thinking disposition and nursing informatics competency among undergraduate nursing students
- Open Access
- 17.12.2025
- Research
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Abstract
Background
The rapid development of information and communication technology (ICT) has become a core element of the modern healthcare system; in particular, electronic health record (EHR) and electronic medical record (EMR) systems contribute to improving the efficiency of nursing work and the quality of care [1, 2]. Accordingly, nurses must be familiar with utilizing various digital devices and managing patient data. For this purpose, nursing informatics competency has become an essential professional abilities [3, 4].
Nursing informatics competency encompasses computer skills competence, informatics skills competence, and informatics knowledge competence—each essential for nursing practice—as well as the ability to integrate and apply them to nursing [5‐8]. Among the three sub-elements of nursing informatics competency, computer skills refer to the ability to use computers for nursing purposes and utilize clinical information systems, including document creation, use of database management programs and tools for communication, online use of information sharing and collaboration for individual and team tasks, and understanding of nursing information systems [8, 9]. The second sub-element, informatics skills competence, refers to the ability to understand the importance of various information structures and levels, systematically classify data, and use methods and tools related to information utilization, such as information search, data collection, and database literature search using the Internet [8, 9]. The last sub-element, informatics knowledge competence, includes the use of statistical analysis programs for nursing research and big data analysis, as well as ethical aspects such as personal information protection, the importance of confidentiality, information security, and information ethics [6, 8]. As ICT is an integral component of the global healthcare system and the use of healthcare systems in clinical practice is a critical part of nursing work, nursing informatics competency has become an essential prerequisite for nurses to perform their professional roles [3, 4]. It has also been reported that when nurses are proficient in using healthcare information systems, they can provide high-quality nursing care with greater efficiency and effectiveness [2]. In the current trend of changes in healthcare and nursing environments, nurses are the primary users of digital health technologies, and nursing informatics competency is becoming increasingly important for nursing students preparing to enter the profession [1, 7, 10]. Nursing informatics competency goes beyond simple technical skills, involving complex information processes such as the collection, analysis storage, and sharing of information. Within this framework, critical thinking is emphasized as a key component [11‐13]. Critical thinking is the ability to analyze a given situation, draw logical judgments based on evidence, and make the best decision [14]; the mindset or attitude to engage in such critical thinking is called critical thinking disposition [14]. In other words, critical thinking disposition refers to the characteristics or attitude of an individual who values critical thinking and tries to critically analyze and think based on objective evidence for claims or statements [14‐16]. In the recent healthcare environment characterized by rapid change and an explosion of information, nurses need the ability to think critically in order to flexibly identify the unique circumstances of each patient and make appropriate nursing judgments and decisions to Within this critically judgment process, critical thinking disposition improves the clinical performance of nurses [17‐19]. In addition, critical thinking disposition is positively correlated with nursing informatics competency [20], and in particular, it has been confirmed as a factor that significantly affects informatics skills competency, a sub-element of nursing informatics competency [21]. Moreover, it has been reported that informatics skills competency has a partial mediating effect in the relationship between critical thinking disposition and evidence-based practice competency [22]. Therefore, critical thinking disposition is an important factor for improving clinical performance and nursing informatics competency in informatized nursing practice [23]. Therefore, researchers must identify and promote the critical thinking disposition of prospective nursing students to improve their critical thinking skills. However, previous studies have primarily examined the relationship between critical thinking disposition and nursing informatics skills competence, a sub-element of nursing informatics competency, and have not identified a direct significant relationship between critical thinking disposition and nursing informatics competency. Therefore, further research is required to confirm the relationship between overall nursing informatics competency and critical thinking disposition.
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Self-control is defined as the effortful inhibition of an immediate impulse, including the effortful overriding of unwanted thoughts, feelings, and behaviors, and is composed of the subcomponents of concentration and self-discipline [24‐27]. Self-control refers to all means of resolving conflicts between competing goals [26]. Some studies have highlighted that self-control plays an important role in the clinical practice of nursing students [28, 29]. In particular, when nursing students use nursing information systems in clinical practice, they can access patients’ personal information, and there is a possibility of ethical problems, such as personal information leaks. In such situations, self-control serves as a basis for restraining unethical behavior and leading behavior in a socially desirable direction [30, 31]. It also works together with critical thinking tendencies to help nursing students concentrate on tasks such as searching, collecting, and analyzing necessary information [32, 33]. Previous studies have also reported that self-control is significantly related to the perception of attitudes toward patient personal information protection and information security compliance, which are sub-elements of nursing informatics competency [34, 35]. In this regard, critical thinking disposition and self-control are anticipated to be important variables in the nursing informatics competency of nursing college students; however, few studies have simultaneously explored the relationship between them. In addition, self-control is expected to act as a moderating variable in the process by which critical thinking disposition affects nursing informatics competency; however, there is no research related to this.
In this context, this secondary data analysis used survey data [36] to explore the relationship among critical thinking disposition, nursing informatics competency, and self-control in Korean nursing students and identify the moderating effect of self-control on the relationship between critical thinking disposition and nursing informatics competency. (Fig. 1) The proposed hypotheses are as follows:
Hypothesis 1
(H1): Critical thinking disposition is positively associated with nursing informatics competency.
Hypothesis 2
(H2): Self-control has a moderating effect on the relationship between critical thinking disposition and nursing informatics competency.
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Fig. 1
Study model
Methods
Study design and participants
This study constitutes a secondary data analysis of survey data. The participants of the survey data used in this secondary study are convenience sample of undergraduate nursing students attending universities located in cities G and P in South Korea. The inclusion criteria for the participants were as follows: undergraduate nursing students who (1) were in 3rd and 4th year of their study and had participated in clinical training and (2) understood the purpose of the study and voluntarily agreed to participate. The sample size for the regression analysis was calculated using G*Power 3.1.9.2 program. The minimum number of participants required for this study was 178, based on a statistical power of 0.95, a significance level of 0.05, 11 predictors, and an effect size of 0.15. Considering the possibility of participant dropout, 235 printed questionnaires with consent forms were distributed and returned. A total of 235 valid questionnaires were used in the final analysis, after excluding five questionnaires with missing data.
Survey data collection and procedure
Survey data from the primary study [36], used for this secondary analysis, were collected between October and November 2022. First, permission was obtained to conduct the study from the chief of the nursing department at each university. Thereafter, one of the researchers contacted the undergraduate nursing students directly after class and explained the purpose, procedure, and questionnaire content of the study. The undergraduate students were informed that participation was voluntary and that they could withdraw at any time during the study without any negative consequences. The questionnaires were then distributed along with consent forms. Participants who had difficulty understanding items in the questionnaires could ask the researcher for help in completing them. The completed questionnaires were collected by one of the researchers on the same day and gifts worth 5000 won were given to the participants who responded to and completed the questionnaire.
Measures
Critical thinking disposition
The critical thinking disposition scale developed by Yoon [37]was used to measure critical thinking disposition among undergraduate students. The scale comprises 27 items and 7 categories: intellectual eagerness/curiosity (5 items), prudence (4 items), self-confidence (4 items), systematicity (3 items), intellectual fairness (4 items), healthy skepticism (4 items), and objectivity (3 items). Each item is rated on a 5-point Likert scale (1 = not at all, 5 = always), with a total score ranging from 27 to 135. Higher scores indicate a higher critical thinking disposition. Two negatively worded items are reverse scored. Cronbach’s alpha in Yoon study [37] was 0.84 and it was 0.92 in this study.
Self-control
Self-control was measured using the Korean version of the self-control scale of undergraduate students developed by Tangney, Baumeister, and Boone [31]. Hong, Kim, Kim, and Kim [24] translated and validated the scale; it comprises 11 items across two components: self-discipline (7 items), concentration (4 items). Each item is rated on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). The total score ranges from 11 to 55, with higher scores indicating higher self-control. Eight negatively worded items are reverse scored. The Cronbach’s alpha was reported to be 0.89 in Tangney et al. [31]’s study, 0.78 in Hong et al.’s [24] study, and 0.764 in the present study.
Nursing informatics competency
The nursing informatics competency scale, developed by Choi, Kim, and Jeong [6], was used to measure nursing informatics competency among undergraduate students. The scale comprises 25 items and 3 categories: computer skills (12 items), informatics skills (5 items), and informatics knowledge (8 items). Each item is rated on a 4-pointed Likert scale (1 = not at all, 4 = a lot). The total score ranges from 25 to 100, with higher scores indicating higher nursing informatics competency. Cronbach’s alpha in Choi, Kim, and Jeong’s study [6] was 0.90, whereas it was 0.878 in the present study.
Covariates
The covariates measured included age, sex, grade, religion, reason for choosing a nursing major, satisfaction with a nursing major, subjective academic achievement, subjective health status, and degree of friendship.
Ethical considerations
The primary study [36] was approved by the institutional review board of Dongguk university (DGU IRB 20190012).
Data analysis
Datawere analyzed using SPSS (version 25.0; IBM Corp., Armonk, NY, USA) and SPSS PROCESS macro v3.4. The skewness and kurtosis for each main variable (critical thinking disposition, self-control, and nursing informatics competency) were checked to determine whether the data were normally distributed (skewness range of all main variables: -0.146 to -0.027; kurtosis range of all main variables: -0.496 to -0.127). The main variables and covariates were analyzed using descriptive statistics. Correlations among the study variables were analyzed using Pearson’s correlation coefficients. The PROCESS macro for SPSS (Model 1) was used to evaluate the moderating effect of self-control (Fig. 1) on the relationship between critical thinking disposition and nursing informatics competency. In addition, the Johnson-Neyman technique and pick-a-point method were used to plot conditional effects for low (mean-1 × SD), medium, and high (mean + 1 × SD) levels of self- control. The significance of the conditional effect of self-control was identified with p < .05, when the confidence interval did not include zero.
Results
General characteristics
Of the 235 participants, 80.9% (190) were female, and the mean age was 24.41 years (range 20–56). A total of 163 participants were in the 4th year (69.4%), and 172 participants (73.2%) reported having a religion. Half of the participants chose a nursing major due to its high employment rate (50.2%), and the majority (94.4%) reported above-average satisfaction with their choice of major. The number of participants who reported above-average levels of subjective academic achievement and health status were 178 (75.5%) and 189 (80.5%), respectively. Most participants (98.7%) indicated that degree of their friendship was above average (Table 1).
Table 1
General characteristics (N = 235)
Variables | Mean | SD | Range | N | % |
|---|---|---|---|---|---|
Age (years) | 24.41 | 4.60 | 20–56 | ||
Sex | |||||
Male | 45 | 19.1 | |||
Female | 190 | 80.9 | |||
Year | |||||
3rd | 72 | 30.6 | |||
4th | 163 | 69.4 | |||
Religion | |||||
Yes | 63 | 26.8 | |||
No | 172 | 73.2 | |||
Reason for choosing nursing major | |||||
High employment rate | 118 | 50.2 | |||
Aptitude | 65 | 27.7 | |||
Recommendation of family, teachers, or friends | 40 | 17.0 | |||
Grade (grade by high school or scholastic ability test) | 12 | 5.1 | |||
Satisfaction on nursing major | |||||
Very satisfied | 38 | 16.2 | |||
Satisfied | 112 | 47.7 | |||
Average | 72 | 30.6 | |||
Unsatisfied | 10 | 4.3 | |||
Very unsatisfied | 3 | 1.3 | |||
Subjective academy achievement level | |||||
Very high | 10 | 4.3 | |||
High | 65 | 27.7 | |||
Average | 103 | 43.8 | |||
Low | 53 | 22.6 | |||
Very low | 4 | 1.7 | |||
Subjective health status | |||||
Very healthy | 26 | 11.1 | |||
Healthy | 98 | 41.7 | |||
Average | 65 | 27.7 | |||
Unhealthy | 41 | 17.4 | |||
Very unhealthy | 5 | 2.1 | |||
Friendship | |||||
Very satisfied | 48 | 20.4 | |||
Satisfied | 132 | 56.2 | |||
Average | 52 | 22.1 | |||
Unsatisfied | 3 | 1.3 | |||
Very unsatisfied | 0 | 0 |
Descriptive statistics and correlations among critical thinking disposition, self-control, and nursing informatics competency
The mean scores for critical thinking disposition and self-control were 3.79 ± 0.52 and 3.42 ± 0.60, respectively (Table 2). The mean nursing informatics competency score was 3.80 ± 0.50. Self-control was positively correlated with critical thinking disposition (r = .48, p < .001). In addition, nursing informatics competency was positively correlated with critical thinking disposition (r = .45, p < .001) and positively correlated with self-control (r = .31, p < .001).
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Table 2
Descriptive statistics and correlations among critical thinking disposition, self-control, and nursing informatics competency variables
Mean | SD | Range | 1 | 2 | 3 | |
|---|---|---|---|---|---|---|
1. Critical thinking disposition | 3.79 | 0.52 | 2.37-5.00 | 1 | ||
2. Self-control | 3.42 | 0.60 | 1.91–4.82 | 0.48*** | 1 | |
3. Nursing informatics competency | 3.80 | 0.50 | 2.58-5.00 | 0.45*** | 0.31*** | 1 |
Moderating effect of self-control on the relationship between critical thinking disposition and nursing informatics competency
As shown in Table 3, the direct association between critical thinking disposition and nursing informatics competency was significant (ß = 0.433, p < .001), and H1 was supported. In the moderation analysis, self-control moderated the relationship between critical thinking disposition and nursing informatics competency (ß = 0.283, p < .001); H2 was supported. In other words, the higher the self-control, the higher the critical thinking disposition regarding nursing informatics competency.
Table 3
Impact of critical thinking disposition on nursing informatics competency and the moderating effect of self-control
Nursing informatics competency | |||||
|---|---|---|---|---|---|
Variable | ß | SE | P | LLCI | ULCI |
Constant | 4.297 | 0.339 | < 0.001 | 3.630 | 4.964 |
Critical thinking disposition | 0.433 | 0.07 | < 0.001 | 0.305 | 0.561 |
Self-control | 0.108 | 0.058 | 0.063 | -0.006 | 0.221 |
Critical thinking disposition X Self-control | 0.283 | 0.084 | < 0.001 | 0.117 | 0.449 |
F | 8.33 | < 0.001 | |||
R2 | 0.311 | < 0.001 | |||
△R2 | 0.035 | < 0.001 | |||
The moderating effect of self-control results from the Johnson-Neyman method indicated no significant effect for self-control scores ≤ -0.881 (6.81%). The pick-a-point method (Table 4) indicated that the positive association between critical thinking disposition and nursing informatics competency was significant at relatively low (ß = 0.283, p < .001), moderate (ß = 0.283, p < .001), and high levels (ß = 0.283, p < .001) of self-control. Therefore, the positive effect of critical thinking disposition on nursing informatics competency increased as self-control increased. The slope in Fig. 2 reflects a significant conditional effect of critical thinking disposition on nursing informatics competency when self-control was above − 0.881.
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Table 4
Conditional effect of critical thinking disposition on nursing informatics competency at different levels of self-control
Value of self-control | Effect | SE | t | P | LLCI | ULCI |
|---|---|---|---|---|---|---|
(Mean-1 × SD) | 0.264 | 0.078 | 3.383 | < 0.001 | 0.110 | 0.418 |
(Mean) | 0.433 | 0.065 | 6.669 | < 0.001 | 0.305 | 0.561 |
(Mean + 1 × SD) | 0.603 | 0.083 | 6.992 | < 0.001 | 0.433 | 0.773 |
Fig. 2
The conditional effect of critical thinking disposition on nursing informatics competency at the values of self-control
Discussion
This study investigated the association between critical thinking disposition and nursing informatics competency and the moderating effect of self-control.
The findings of this study show that critical thinking disposition is positively associated with nursing informatics competency and that self-control has a moderating effect on this relationship. This study makes an important contribution to the literature as it is the first to evaluate the association between critical thinking disposition, self-control, and nursing informatics competency and the moderating effect of self-control on the relationship between critical thinking disposition and nursing informatics competency in nursing students in Korea.
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Nursing informatics competency
The average nursing informatics competency score was 3.80 out of 5, which was similar to the scores ranging from 3.65 to 3.74 reported in previous studies [38, 39] conducted on Korean nursing students using the same tool. In a previous study [40] using a different tool (5-point Likert scale) targeting graduate students (nurses) in the United States, the average score was 3.70. In another study [41] targeting undergraduate and graduate students (nurses) in the United States, undergraduate students scored 3.01 and graduate students (nurses) scored 3.23 points. In a separate study [42] conducted on nursing undergraduate students and clinical nurses at the Department of Nursing, Medical University of Iran, undergraduate students scored 3.46 points and clinical nurses scored 3.54 points. These findings indicate that the nursing informatics competency of Korean nursing students is relatively high. In Korea, following the introduction of the Electronic Nursing Record (ENR) system in 2003, the adoption rate reached approximately 70% by 2012, indicating that computerized systems have been rapidly established in nursing settings [41]. In contrast, in the United States, the adoption rate of EHR in hospitals was 9.4% in 2008 [43]; after the implementation of the Health Information Technology for Economic and Clinical Health Act in 2009, it reached 27.6% in 2011 and 44.4% in 2012 [44]. Iran introduced the Integrated Electronic Health System (known as SIB, a Persian backronym meaning “apple”) in medical schools and primary care facilities in 2015 [45] . South Korea began the full-scale operation of the ENR system in 2003, establishing an early foundation for integrating information into nursing education and clinical practice. In contrast, the United States began building an EMR-based system in the late 2000s and Iran in the 2010s. This indicates that South Korean nursing students had access to a practical information utilization environment relatively early, which likely contributed to the high scores on the nursing informatics competency evaluations.
In addition, information literacy scores are influenced by differences in the availability of information devices and information technology education [39]. The survey period for this study was 2022, and according to the 2022 Survey on Internet Usage Statistical Table conducted by the National Information Society Agency, 100% of those aged 20 or younger owned ICT devices such as smartphones and tablet PCs, and 77.3% owned laptops, indicating a high level of information search and utilization capabilities through information technology devices. Moreover, nursing students’ nursing information literacy is reported to be influenced by experiences gained through the curriculum [46]. However, despite not completing any nursing information science-related courses, the participants in this study demonstrated higher nursing information literacy than nursing students in the United States [41] and Iran [42]. This suggests that the widespread use of information technology devices for information search, utilization, document creation, and information tool use—rather than that for nursing information science education itself—is a key factor influencing nursing information literacy. These results align with those of a previous study [40] that reported nursing information literacy scores of 3.70 for nurses who had not received undergraduate education in nursing informatics but had at least two years of experience using EHRs. Therefore, it is necessary to incorporate nursing informatics courses into the nursing bachelor’s degree program and develop and sustainably operate curricula and extracurricular programs that utilize various ICT devices to ensure their repeated use.
The relationship among critical thinking disposition, self-control, and nursing informatics competency
In this study, nursing students with high critical thinking disposition showed increased nursing informatics competency. The results are consistent with those of previous studies. Previous research has shown that nurses with a high critical thinking disposition have significantly higher nursing informatics competency [11, 20, 47, 48]. In addition, the critical thinking disposition of nursing students is a significant predictor of nursing informatics skills competence, which is a sub-area of nursing informatics competency [21, 22]. A study by [49] targeting Iranian medical students reported that critical thinking disposition showed a significant positive correlation with informatics skills competence. These results indicate that critical thinking disposition is an important factor contributing to the improvement of nursing informatics competency.
Few studies have directly examined the relationship between critical thinking tendencies and self-control, making direct comparison with this study difficult. However, self-regulation, a higher-order concept that includes self-control, has been found to be positively correlated with critical thinking tendencies [39]. In addition, previous studies on psychological control [50] analyzed the effect of parental psychological control on critical thinking among Chinese middle school students and found that self-control acted as a mediating factor, significantly influencing critical thinking. This suggests that self-control may serve as an important mediating factor in the formation of critical thinking tendencies and highlights the need to validate this relationship across various environments and groups. However, studies that directly or indirectly clarify the relationship between self-control and nursing informatics competency or treat these as mediating or moderating variables are currently insufficient. Therefore, research that comprehensively verifies the interconnections among these variables is required.
Moderating effect of self-control on the relationship between critical thinking disposition and nursing informatics competency
The results showed that self-control exerted a positive moderating effect on the process through which critical thinking disposition influenced nursing informatics competency. In addition, it was found that the higher the level of self-control, the stronger the influence of critical thinking disposition on nursing informatics competency. This suggests that self-control is an important factor related to critical thinking disposition and nursing informatics competency among nursing students. This can be explained in several ways. Critical thinking is a complex cognitive process that involves analyzing arguments, predicting potential outcomes, identifying alternative solutions appropriate to the situation, and ultimately making decisions [51, 52]. In this process, self-control acts as a means of controlling unnecessary thoughts or emotions and resolving conflicts between competing goals [26]. Moreover, concentration, a subcomponent of self-control, helps nurses focus on given tasks and avoid missing important information, while self-restraint enables them to remain calm and solve problems even in stressful situations [33, 53]. In other words, as nursing students’ self-control increases, their nursing informatics competency improves through the process of accurately collecting and analyzing the information necessary to solve clinical problems or ethical issues that arise in various situations, including clinical practice and performing tasks, while using information utilization tools along with document creation when necessary and solving problems. In this study, critical thinking disposition was significantly related to the nursing informatics competency of nursing students with low, medium, and high levels of self-control. Moreover, the association between critical thinking disposition and nursing informatics competency was stronger among participants with high levels of self-control. In other words, the higher the self-control, the higher the tendency to think critically, leading to improved nursing informatics competency. Therefore, it is necessary to increase self-control to improve nursing informatics competency of nursing students. These abilities play a key role in accurately collecting and analyzing the information required in clinical situations [23, 54], as well as enabling active participation in document writing and collaborative decision-making for problem solving, acting as essential factors in complex medical environments [23, 55]. Therefore, an educational approach that enhances self-control is necessary to strengthen nursing students’ nursing informatics competencies. This will serve as an important foundation for effectively improving the information collection, analysis, and problem-solving competencies required in clinical settings based on critical thinking abilities.
Limitations
The limitations of this study are as follows:
First, this study was conducted as a descriptive survey of nursing students in specific regions, which limits the generalizability of the results. Therefore, future studies should include nursing students from a wider range of regions and nurses from diverse backgrounds to increase the generalizability of the results.
Second, because data were collected through self-report surveys, there is a possibility of social desirability bias or recall bias. Therefore, future studies should use multiple data collection methods or incorporate objective evaluation indicators to minimize measurement bias.
Third, while this study analyzed the moderating effects of critical thinking tendencies, self-regulation, and nursing informatics competency, it did not sufficiently explore other potential mediating and moderating factors, such as internet ethics. Future studies should develop and validate a comprehensive theoretical model that integrates various personal and environmental factors to elucidate the determinants of nursing informatics competency.
Fourth, this study was conducted among nursing students in Korea, which limits the ability to make international comparisons. Future research should include nursing students from diverse countries and cultural contexts in cross-cultural comparative studies to explore universal and culture-specific factors influencing nursing informatics competency and provide evidence for the development of global curricula.
Strengths
In the absence of previous studies examining the relationship between critical thinking tendencies and nursing informatics competency among nursing students, as well as the moderating effect of self-control, this study demonstrates a positive correlation between self-control and critical thinking tendencies. In addition, it reveals that self-control moderates the relationship between critical thinking tendencies and nursing informatics competency, thereby contributing to the academic field. The findings of this study can serve as foundational data for educational programs aimed at enhancing nursing information literacy among nursing students and provide valuable evidence for the development of future programs focused on strengthening nursing information literacy.
Conclusion
In the current healthcare environment that is increasingly becoming informatized, nursing informatics competency is an essential prerequisite for performing the professional role of nurses in various aspects, such as the efficient use of electronic nursing records, data collection and analysis for problem solving, informatics tools utilization ability, and personal information protection. Therefore, for nurses to adapt flexibly to the rapidly changing clinical informatics environment, their nursing informatics competency should be enhanced starting from their student years. In this study, nursing informatics competency was positively associated with critical thinking disposition, and self-control moderated the relationship between critical thinking disposition and nursing informatics competency. Therefore, to improve nursing students’ nursing informatics competency, an education strategy that can promote both critical thinking disposition and self-control is needed, and the development of various teaching methods and educational programs is required to improve nursing informatics competency.
Acknowledgements
This study is a re-analysis of data from the first author’s master’s thesis.
Declarations
Ethics approval and consent to participate
This study was approved by the Institutional Review Board of Dongguk University, to which the authors belong (DGU IRB 20190012). This study was conducted on human participants in accordance with the Declaration of Helsinki and its subsequent amendments. Informed consent was obtained from all subjects.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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