==== Front PLoS One PLoS One plos plosone PLoS ONE 1932-6203 Public Library of Science San Francisco, CA USA 10.1371/journal.pone.0243796 PONE-D-20-15550 Research Article Biology and Life Sciences Psychology Behavior Prosocial Behavior Social Sciences Psychology Behavior Prosocial Behavior Biology and Life Sciences Neuroscience Cognitive Science Cognitive Psychology Social Cognition Prosocial Behavior Biology and Life Sciences Psychology Cognitive Psychology Social Cognition Prosocial Behavior Social Sciences Psychology Cognitive Psychology Social Cognition Prosocial Behavior Biology and Life Sciences Psychology Social Psychology Social Cognition Prosocial Behavior Social Sciences Psychology Social Psychology Social Cognition Prosocial Behavior Medicine and Health Sciences Health Care Nursing Science Biology and Life Sciences Psychology Emotions Social Sciences Psychology Emotions Medicine and Health Sciences Mental Health and Psychiatry Social Sciences Sociology Education Schools Colleges Biology and Life Sciences Psychology Behavior Prosocial Behavior Altruistic Behavior Social Sciences Psychology Behavior Prosocial Behavior Altruistic Behavior Biology and Life Sciences Neuroscience Cognitive Science Cognitive Psychology Social Cognition Prosocial Behavior Altruistic Behavior Biology and Life Sciences Psychology Cognitive Psychology Social Cognition Prosocial Behavior Altruistic Behavior Social Sciences Psychology Cognitive Psychology Social Cognition Prosocial Behavior Altruistic Behavior Biology and Life Sciences Psychology Social Psychology Social Cognition Prosocial Behavior Altruistic Behavior Social Sciences Psychology Social Psychology Social Cognition Prosocial Behavior Altruistic Behavior Social Sciences Economics Labor Economics Employment Careers Social Sciences Anthropology Cultural Anthropology Religion Social Sciences Sociology Religion Mediating effects of general self-efficacy on the relationship between the source of meaning in life and prosocial behaviours in vocational college nursing students: A cross-sectional study The source of meaning in life, general self-efficacy and prosocial behavioursCheng Linan InvestigationMethodologyWriting – original draft1 Ye Yansheng InvestigationMethodology1¤ Zhong Zhaoyang InvestigationResourcesWriting – original draft2 Zhang Fengying InvestigationResourcesSupervision1‡ Hu Xiuying Investigation1‡ Cui Renshan SupervisionWriting – review & editing3* https://orcid.org/0000-0002-0953-3845Chen Qian Data curationFunding acquisitionResourcesSupervisionWriting – review & editing1* 1 West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China 2 Fenyang College of Shanxi Medical University, Fenyang, Shanxi, China 3 Jiaxing University College of Medicine, Jiaxing, Zhejiang, China Bulfone Giampiera Editor Universita degli Studi di Roma Tor Vergata Dipartimento di Medicina Sperimentale e Chirurgia, ITALY Competing Interests: The authors have declared that no competing interests exist. ¤ Current address: The People’s Hospital of Yuxi City, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China ‡ These authors also contributed equally to this work. * E-mail: 2594793790@qq.com (RC); chen_qian@scu.edu.cn (QC) 15 12 2020 2020 15 12 e024379624 5 2020 26 11 2020 © 2020 Cheng et al2020Cheng et alThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Objectives To examine the mediating effect of general self-efficacy on the relationship between the source of meaning in life (SML) and prosocial behaviours in vocational college nursing students. Methods Between March and June 2019, a cross-sectional descriptive study was conducted, and 799 nursing students from three vocational colleges completed the Source of Meaning in Life Scale, General Self-Efficacy Scale and Prosocial Behaviours Scale. Data were analyzed using structural equation modelling and statistical analysis by SPSS (version 23.0, IBM). Results The average SML, general self-efficacy and prosocial behaviours scores of the 799 nursing students were 6.43±0.83, 2.48±0.59 and 3.69±0.62, respectively. Correlation analysis showed that SML, general self-efficacy and prosocial behaviours were positively correlated (P<0.01). General self-efficacy partially mediated the relationship between SML and prosocial behaviours (P<0.01); this mediating effect contributed 22.97% of the total effect and explained 17.6% of the variance in the dependent variable. Conclusions Educators should focus on cultivating nursing students’ cognition and experience of meaning in life and their efficacy in life, study and work, which can improve students’ “people-oriented” service and prosocial behaviour and the quality of nursing services. http://dx.doi.org/10.13039/501100004829Department of Science and Technology of Sichuan Province2019YFS0386https://orcid.org/0000-0002-0953-3845Chen Qian This work was supported by Science & Technology Department of Sichuan Province,in the framework of assessment of symptoms and establishment of a multidisciplinary palliative care model for elderly patients with terminal frailty(2019YFS0386). The person in charge of the project is corresponding author Qian Chen in the manuscript. And there was no additional external funding received for this study. Data AvailabilityAll relevant data are within the paper and its Supporting information files.Data Availability All relevant data are within the paper and its Supporting information files. ==== Body Introduction In China, 3-year vocational college nursing students constitute an important part of the nursing work force and account for more than 60% of the total number of nursing students [1, 2]. “The national health and family planning talent development plan for the 13th five-year plan period in China” clearly called for the expansion of the scale of vocational training as a starting point for nursing personnel and the improvement of the humanistic care quality among nursing students to further strengthen professional and technical talents in health and family planning and to meet the increasing medical consumption [3]. Compared with the curricula of nursing colleges in other countries, the humanistic nursing curriculum in China was developed late, and it has not been universally applied [4]. In some colleges, the humanistic nursing curriculum has a low utilization rate and less content than in other colleges, and the forms and methods of teaching need to be improved. As part of the future nursing force, nursing students should have a certain level of humanistic care quality, an ability to adapt to changes in medical models and people’s needs and an ability to promote the development of their nursing careers. As reported, vocational college students are generally between the ages of 17 and 24 and are mostly new graduates from middle or high school. The majority of them are from only-child families, female, and unmarried [1]. They have relatively unique advantages but also lack positive motivation, have poor communication skills, lack a strong sense of self, have weak teamwork ability, and have poor self-bearing and poor self-management ability [5, 6]. In addition, these students are in an important period in the formation of their life and professional values, so it is very important to cultivate their knowledge and skills, provide them with a quality education and cultivate their humanistic care ability [7]. A source of meaning in life (SML) refers to an important, valuable event that people have experienced in their lives, and it is an important factor for individuals to perceive the value and meaning of life [8, 9]. The perception of SML can make the individual feel that life is full of meaning. In contrast, an individual’s failure to find meaning or purpose in existence can lead to feelings of emptiness, neurosis, substance abuse, and even suicide, which are negative effects that accompany a lack of “meaning” [10–13]. Prosocial behaviour refers to altruistic behaviours that are consistent with social expectations and bring benefits to others, the collective, society and the country [14]. Studies show that adolescents with higher prosocial behaviour are more responsible and sympathetic than those without such behaviour, are good at perspective taking, and have relatively high levels of prosocial moral reasoning [14–16]. Some studies show that college students’ sense of meaning in life has a significant predictive effect on prosocial behaviors [17, 18]. As an important internal psychological resource, general self-efficacy is necessary for individuals to perceive meaning in life, and it can enhance individuals’ positive life experience [9, 15] and prosocial behaviour [19–23]. Some researches also have shown that greater self-efficacy can predict lower impulsivity and better prosocial behavior for youth [24, 25]. Self-efficacy can explain the level of prosocial organizational behaviour [26]. And some literature has explored the mediating effect of life meaning of college students(or adolescents) between family cohesion [27], nostalgia [28], the moral sense of life [17] and post-traumatic stress disorder [18] and prosocial behaviors. While few researches explore the mediating effect of self-efficacy, the source of meaning in life (SML) and prosocial behaviors. However, there is indeed some correlation between them according to the contents of the literature. Vocational college nursing students represent the main component of the nursing workforce, and thus, their physical and mental development, career development and career recognition in nursing directly affect the balance and development of the nursing profession. According to the knowledge, attitude, belief, practice model [29–31] and motivation theory [32], SML can be regarded as a form of endogenous motivation and enhance the faith and values of vocational college nursing students, thus improving their altruistic prosocial behaviour. Based on previous literature, we developed a hypothetical model and predicted that general self-efficacy would have a mediating effect between SML and prosocial behaviours (Fig 1). Therefore, this study aimed to examine the mediating effect of general self-efficacy on the relationship between SML and prosocial behaviours in vocational college nursing students. 10.1371/journal.pone.0243796.g001Fig 1 Hypothesized theoretical model. Methods Study design and ethical considerations A cross-sectional design was used in this study. The STROBE cross-sectional reporting guidelines were used. Ethical approval of this study was granted by the West China Hospital of Sichuan University Biomedical Research Ethics Committee (ethics number: 2016–272). Ethical approval included the approval of the consent procedure and the written informed consent form. Participants voluntarily and anonymously participated in this study. All data collected were kept confidential and used only for this research study. Participants From March to June 2019, a total of 799 respondents from three colleges in three provinces (Shanxi, Zhejiang and Sichuan) were selected by convenience sampling. Students who met the following inclusion criteria were included: vocational college nursing students who a) provided informed consent to participate and b) had not yet graduated. The exclusion criteria were as follows: nursing students who a) were on sick leave during the investigation or b) had transferred to another specialty or had been transferred from another specialty to nursing less than six months prior to the study. Instruments The questionnaires included instruments assessing participants’ demographic characteristics (age, gender, grade, residence, religion, and only-child status), general self-efficacy, source of meaning in life and prosocial behaviours. The General Self-Efficacy Scale (GSES) was developed by Schwarzer and colleagues [33]. Based on the original version, Wang and colleagues created a new GSES suitable for Chinese people that includes 10 items [34]. Responses are provided on a 4-point scale from 1 (incorrect) to 4 (completely correct), with the total possible score ranging from 10 to 40 points. A higher score indicates stronger general self-efficacy. This scale is a reliable tool for measuring nurses’ general self-efficacy. In this study, the Cronbach’s alpha coefficient was 0.903. The Source of Meaning in Life Scale (SMLS) was developed by Cheng MM and colleagues [8, 9]. This scale consists of 30 items categorized into five subscales: social concern (9 items), self-growth (8 items), relationship harmony (6 items), enjoyment in life (4 items) and physical and mental health (3 items). Responses are provided on a seven-point scale from 1 (not at all meaningful) to 7 (totally meaningful). The Cronbach’s coefficient of the total scale was 0.94. In this study, the Cronbach’s alpha coefficient was 0.978. The Prosocial Behaviours Scale (PBS) was compiled by Carlo et al. in 2002 [15]. Kou and colleagues revised the scale to be suitable for Chinese people [35]. This revised scale consists of 26 items categorized into six subscales: open (4 items), anonymous (5 items), altruistic (4 items), compliant (5 items), emotional (5 items) and urgent (3 items). Responses are provided on a scale ranging from 1 (very unlike me) to 7 (very like me). The Cronbach’s coefficients of each dimension of the scale ranged from 0.494–0.778. In this study, the Cronbach’s alpha coefficient was 0.962. Quality control Before the survey, we selected a college class for a preliminary investigation and modified the questionnaire. Meanwhile, we conducted unified training to avoid bias caused by the investigators. To obtain participants’ informed consent, we informed all participants that their responses were anonymous and that they would experience no consequences as a result of their participation in or withdrawal from the study. We took adequate measures to minimize missing data. The ad hoc imputation method was used when there was a small amount of missing data (10%). In this study, EpiData 3.1 (The EpiData Association, Denmark) was used to input data to ensure the accuracy of the data. Data collection The data were collected between March and June 2019. We selected three colleges in Shanxi, Zhejiang and Sichuan Provinces in China by using convenience sampling. After the approval of college managers and instructors was obtained, three trained research assistants visited the colleges and briefly explained the purpose of the study. Participants involved in the study provided informed consent and spent 15~20 minutes completing the questionnaires. Among the 820 returned questionnaires, 21 were incomplete due to missing values or consistently repeated response options. Therefore, 799 questionnaires were suitable for analysis, for an effective response rate of 97.43%. More than 200 samples must be obtained for structural equation model analysis [36]. Therefore, the inclusion of 799 vocational college respondents was valid. Data analyses Structural equation model analysis We used analysis of moment structures to estimate the hypothetical model and the maximum likelihood (ML) method to confirm the relationships and predictions (AMOS, version 23.0). Bootstrapping was used to address the non-normal distribution of samples using the ML method. The measurement errors of the predictions were also considered. The goodness of fit standard for the structural equation model was mainly assessed by absolute fit indices (RMSEA<0.08, GFI>0.09 and AGFI>0.09), relative fit indices (NFI>0.90, CFI>0.90 and RFI>0.90), and simple fit indices (PGFI>0.50, PNFI>0.50, PCFI>0.50 and X2/df <5.00). It is necessary to modify the model to improve fit when modification indices are larger than ten [37, 38]. Primary analysis The general self-efficacy, SML and prosocial behaviours scores were used to calculate descriptive statistics and conduct t-tests, one-way analysis of variance (ANOVA), and multiple linear regression by SPSS 23.0 (IBM Corp, Armonk, NY, USA). Statistical significance was set at P < .05, two-tailed. Results Demographic characteristics A total of 799 nursing students participated in the survey. Participants had a mean age of 19.71 years (SD = 1.63; range = 17–25). Among the respondents, 91.1% were female (n = 728), 75.30% were ethnically Han (n = 602) and 53.30% were junior students (426). Additionally, 46.5% came from urban cities, 56.3% were from rural cities and 81.10% had no religion. Only 11.90% reported a religion, including Christianity, Catholicism and Buddhism. Of the participants, 27.20% were only children, while 72.80% had siblings. Ethnic minorities reported better prosocial behaviours than Han participants (t = 9.993, p = 0.002), and participants who lived in urban areas reported better prosocial behaviours than those who lived in rural areas (t = 9.018, p = 0.003) (Table 1). 10.1371/journal.pone.0243796.t001Table 1 Demographic characteristics and differences in prosocial behaviours (N = 799). Variable N(%) Mean±SD t(F) P Gender Male 71(8.9) 96.11±15.62 0.203 0.880 Female 728(91.1) 95.81±16.240 Ethnicity Han 602(75.3) 94.81±15.07 9.993 0.002 Ethnic minority 197(24.7) 98.98±18.87 Grade Freshman year 124(15.5) 95.55±15.31 0.257 0.773 Sophomore year 249(31.2) 95.33±15.38 Junior year 426(53.3) 96.21±16.88 Residence Urban 349(43.7) 97.78±16.83 9.018 0.003 Rural 450(56.3) 94.33±15.50 Religion Yes 95(11.9) 94.49±16.13 0.740 0.390 No 704(88.1) 96.02±16.19 Family with only child Yes 217(27.2) 96.05±16.02 0.051 0.822 No 582(72.8) 95.76±16.25 Age(year) ≦21 675(84.5) 95.93±16.27 0.142 0.706 ≧22 124(15.5) 95.33±16.18 Note. Abbreviation: N = number SD = standard deviation P < 0.05. General self-efficacy, SML and prosocial behaviours The mean SML score was above the moderate level (M = 6.43, SD = 0.83). Among the SML subscale scores, the highest score was for physical and mental health, while the lowest score was for social concern. The mean prosocial behaviour score was at an intermediate level (M = 3.69, SD = 0.62). The ranking of the subscale scores from high to low was as follows: urgent, altruistic, compliant, emotional, anonymous and open. The mean self-efficacy score was relatively low (M = 2.48, SD = 0.59) (Table 2). 10.1371/journal.pone.0243796.t002Table 2 The scores among general self-efficacy, the source of meaning in life and prosocial behaviours (Mean ± SD, N = 799). Items The Number of Items The Score of Items The Mean Score of Items SML 30 192.90±24.91 6.43±0.83 PMH 3 19.56±2.66 6.52±0.89 RH 6 38.98±4.96 6.50±0.83 SG 8 51.92±7.00 6.49±0.88 EL 4 25.61±3.65 6.40±0.91 SC 9 56.83±8.14 6.31±0.90 PB 26 95.83±16.18 3.69±0.62 Urgent 3 11.45±2.18 3.82±0.73 Altruistic 4 15.19±2.96 3.80±0.74 Compliant 5 18.71±3.40 3.74±0.68 Emotional 5 18.45±3.45 3.69±0.70 Anonymous 5 18.06±3.56 3.61±0.71 Open 4 13.97±2.94 3.49±0.74 SE 10 24.83±5.90 2.48±0.59 Note. Abbreviations: The source of meaning in life = SML;PMH = physical and mental health; RH = relationship harmony;EL = Enjoy in Life; SC = social concern;SG = self-growth; PB = prosocial behaviours;SE = Self-efficacy. **P < 0.01, *P < 0.05. Prosocial behaviours had significant positive correlations with general self-efficacy (r = 0.488, P < 0.01) and SML (r = 0.354, P < 0.01), which means that as self-efficacy and SML scores increase, prosocial behaviours scores also increase (Table 3). 10.1371/journal.pone.0243796.t003Table 3 Correlations among general self-efficacy, the source of meaning in life and prosocial behaviours (N = 799). Variable SML PMH RH EL SC SG PB Open Anonymous Altruistic Compliant Emotional Urgent SE SML 1 PMH .884** 1 RH .945** .840** 1 EL .936** .802** .857** 1 SC .944** .766** .854** .844** 1 SG .967** .862** .896** .915** .861** 1 PB 0.354 .292** .318** .310** .383** .317** 1 Open .233** .139** .205** .218** .287** .186** .772* 1 Anonymous .293** .252** .266** .249** .314** .262** .870** .546** 1 Altruistic .336** .312** .303** .288** .346** .309** .893* .543* .546** 1 Compliant .314** .261** .278** .269** .339** .287** .910** .645** .736** .797** 1 Emotional .351** .293** .319** .314** .374** .312** .917** .702** .742** .776** .789** 1 Urgent .334** .273** .300** .294** .351** .311** .880** .635** .698** .788** .790** .780** 1 SE .222** .163** .189** .191** .246** .208** .488** .389** .443** .410** .407** .479** .422** 1 Note. Abbreviations: The source of meaning in life = SML;PMH = physical and mental health; RH = relationship harmony;EL = Enjoy in Life; SC = social concern;SG = self-growth; PB = prosocial behaviours;SE = Self-efficacy. **P < 0.01, *P < 0.05. Moderating effect of general self-efficacy on SML and prosocial behaviours The hypothetical model showed no negative variance and a large standard error in the model, meaning that the model did not violate the identification rule [36] and the hypothesis model was modified according to the calculation results. The absolute fit indices of the model (X2/df = 3.546, GFI = 0.968, AGFI = 0.944, NFI = 0.984, RFI = 0.976, CFI = 0.988, PNFI = 0.671, PGFI = 0.5581, PCFI = 0.674, RMSEA = 0.056) all indicate the adequate fit to the data (Fig 2). SML was positively related to general self-efficacy (B = 0.21, P < 0.01), general self-efficacy was positively related to prosocial behaviours (B = 0.43, P < 0.01), and SML was related to prosocial behaviours (B = 0.26, P < 0.01). These findings suggest that general self-efficacy had a partial mediating effect between SML and prosocial behaviours among vocational college nursing students; this mediating effect contributed 22.97% to the total effect and explained 17.6% of the variance in the dependent variable (Table 4). 10.1371/journal.pone.0243796.g002Fig 2 Results of the effect of self-efficacy on the source of meaning in life and prosocial behaviours among the whole sample. Note. Abbreviations: PMH = physical and mental health; RH = relationship harmony; EL = Enjoy in Life; SC = social concern; SG = self-growth; PB = prosocial behaviours; The source of meaning in life = SML; SE = Self-efficacy. All the coefficients in this figure are standardized and significant at level 0.01. The numbers on the straight arrows indicate the standard path coefficients. 10.1371/journal.pone.0243796.t004Table 4 Regression of mediating effect among general self-efficacy, the source of meaning in life and prosocial behaviours (N = 799). Variable Model 1 Prosocial behaviours (dependent variable) Model 2 General self-efficacy (dependent variable) Model 3Prosocial behaviours (dependent variable) B SE β(CI) B SE β(CI) B SE β(CI) The source of meaning in life 0.230 0.022 0.354 (0.188~0.272) 0.053 0.008 0.222 (0.037~0.069) 0.168 0.020 0.259 (0.129~0.207) General self-efficacy 1.179 0.083 0.430 (1.016~1.343) R 0.354 0.222 0.549 Adjusted R2 0.124 0.048 0.300 F 114.212 41.282 171.642 P 0.000 0.000 0.000 Note: β coefficients in this figure are standardized. Effect M = 0.430*0.222/0.354 = 0.2297; The mediating effect explained that the variance variation of the dependent variable was sqrt (0.300–0.124) = 0.176(17.6%). **P<0.01. Discussion Our main aim was to verify the predictive ability of SML and self-efficacy for prosocial behaviours. We found that SML and general self-efficacy were significant predictors, but they worked through different mechanisms: general efficacy had a direct effect, while SML had an indirect effect that was partially mediated by general efficacy. Thus, we have a deeper understanding of the value and function of SML for vocational college nursing students. Additionally, our understanding of the mechanisms of self-efficacy in practical applications is extended. It could be argued that these findings indicate that there is a better way to improve prosocial behaviours in students and the quality of nursing service and to meet the health needs of the public. In the study, the mean SML score was above the median level, which implied that physical and mental health, relationship harmony, enjoyment in life, social concern and self-growth were ways to find meaning in life. The highest subscale score was for physical and mental health, which is in line with the attention to the physical and mental health of students among society and students’ families. In addition, the mean score for relationship harmony was consistent with the finding of Sheng et al. (2007) [39]. This result is consistent not only with previous findings on the trajectory of the growth and development of interpersonal relationships among Chinese nursing students in vocational colleges but also Maslow’s work on needs for love and a sense of belonging. Therefore, we should actively develop the humanistic nursing curriculum, strengthen nursing students’ interpersonal communication skills and develop their social functions. Nursing students are in a stage of learning and development and may lack the motivation and resources to grow, so they might not have fully recognized and achieved their self-growth; therefore, it is necessary to strengthen the career planning education of nursing students. The improvement of living standards and learning environments would facilitate their pursuit of enjoyment in life. Social concern refers to individuals’ willingness to contribute to society and to pay attention to and respect others; in this study, we hoped to find evidence of social concern among the nursing students, but the social concern subscale had the lowest mean score. Therefore, we should pay attention to the improvement and development of education in humanistic care, values and morality. In this study, the students’ self-efficacy scores indicated that we should also pay attention to the improvement of students’ self-confidence. The total mean prosocial behaviour score of vocational college nursing students and all subscale scores reached a relatively ideal level; the highest mean subscale score was for the urgent subscale, while the lowest score was for the public subscale. On the one hand, these results indicated that the prosocial behaviours of vocational college nursing students were more susceptible to urgent situations or emotional factors [40]. On the other hand, they showed that the nursing students all had good altruistic behaviours. In the face of a crisis, they would all be able to show their noble professional dedication to respecting life. The open subscale refers to prosocial tendencies implemented in the presence of others; the scores for this subscale further suggested that the nursing students were not willing to disclose their helpful behaviour, which reflects the fact that people who engage in social avoidance are more reluctant to engage in certain behaviours in public [41]. The finding that ethnic minorities had better prosocial behaviours than Han participants was related to the cultural environment, suggesting that students from ethnic minorities will communicate with mainland students more actively to better adapt to the learning and living environment and will in turn have better interpersonal skills and prosocial behaviours. Participants who lived in urban areas reported better prosocial behaviours than those who lived in rural areas, which may be related to their educational backgrounds. Additionally, rural students may lack interpersonal security, and their prosocial behaviours may be influenced by their rural identity. Our results suggest that general self-efficacy partially mediated the relationship between SML and prosocial behaviour. In other words, the cognition of SML among vocational nursing students not only directly predicts prosocial behaviours but also indirectly predicts general self-efficacy. If individuals lack meaning in life, they will have a more antisocial psychology and behaviour problems according to logotherapy theory [42, 43]. However, if individuals have accurate cognition and comprehension of meaning in life, they will actively devote themselves to contributing to society, better understand the existence of others and the significance of other people’s lives, and thus deliver humanistic nursing services that meet the needs of society [44], which may promote the development of good doctor-patient relationships. Therefore, as a dynamic motivating factor, SML can directly promote prosocial behaviours [45]. Pearson correlation analysis showed that there was a positive correlation between SML, general self-efficacy and prosocial behaviours in the study. Students with SML may have a higher sense of self-efficacy than those without SML, and a higher sense of self-efficacy is conducive to prosocial behaviours. Although different scholars and ideologists have different views on SML, they all believe that SML is a subjective consciousness that is influenced by one’s cultural background and is related to real life [46]. Studies show that SML endows individuals with meaning in life. According to a relativist perspective, if individuals believe that life is meaningful, they will form the belief that "life is meaningful" and will form their own goals and values in life [9], so these individuals can better adapt to society and engage in more prosocial behaviours than those who do not believe that life is meaningful. The level of general self-efficacy determines the individual’s attitude and actions related to prosocial behaviours [47]. Individuals with a high sense of self-efficacy have not only clear goals and directions for their own lives but also a sense of individual value and control; they will actively interact with society. The latest view proposes a multidimensional concept of a continuum of cognitive, emotional and behavioural tendencies [48]. Nursing students’ exploration and cognition of SML allow them to find purpose and meaning in life and experience emotions related to meaning in life; these emotions refer to one’s satisfaction and sense of achievement obtained from past experience and a completed goal [49]. Such emotions not only strengthen the individual’s confidence in the face of difficulties but also have an internal effect on the individual’s behaviour. Related research results also show that people with a higher sense of self-efficacy tend to perform more altruistic behaviours, such as sharing, offering and helping others [50]. Vocational college nursing students are the main part of the workforce who can meet the needs of medical and health services. Therefore, educators should improve training mechanisms and teaching methods through teaching reform or practice; pay attention to the cultivation of nursing students’ cognition and experience of meaning in life; develop nursing students’ inner strengths in life, study and work; and further enhance students’ abilities to provide humanistic nursing service and improve the quality of nursing care. For example, we could improve our teaching methods, such as increasing scene teaching method can improve students’ situational coping ability, self-confidence and empathy ability. Meanwhile, we encourage to increase more humanities courses to increase nursing students’ awareness of humanistic care and improve the quality of humanistic care. Moreover, some relevant lectures should be hold regularly to enlighten nursing students’ critical thinking and improve their confidence through the power of a good example. This study has several limitations. First, our use of convenience sampling (among vocational college nursing students from three colleges) might limit the generalizability and robustness of the study’s results. Therefore, nursing students with diverse educational backgrounds should be included in future research to verify our hypothesis. Second, the self-report questionnaires may not truly reflect the thoughts of nursing students due to the flaws in this method of data collection, but the limitation may not have negatively influenced the results, as we implemented strict quality control. Finally, our conclusions are based on cross-sectional data, meaning we make conclusions about cause-effect relationships between the studied variables. Therefore, a subsequent large-scale, longitudinal investigation is necessary. Nevertheless, we believe that these limitations do not nullify our conclusions. Conclusions We have confirmed the partial mediating effect of general self-efficacy on prosocial behaviours in vocational college nursing students. This finding implies that nursing educators should consider the importance of SML and general self-efficacy for improving the quality of nursing care. Additionally, effective measures should be taken to improve the training mechanisms and teaching methods through teaching reform or practice. While this study may be applicable only to undergraduate vocational college nursing students, our model can be used to improve prosocial behaviours models for nursing students and can provide a foundation for the improvement of theories, such as those on humanistic care or SML, and interventions. Supporting information S1 Statistics (SAV) Click here for additional data file. The authors are thankful for the supervisors and 799 vocational nursing students who took part in the study. 10.1371/journal.pone.0243796.r001 Decision Letter 0 Beam Nancy Staff Editor © 2020 Nancy Beam2020Nancy BeamThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Submission Version0 8 Oct 2020 PONE-D-20-15550 Mediating effects of general self-efficacy on the relationship between the source of meaning in life and prosocial behaviours in vocational college nursing students:a cross-sectional study PLOS ONE Dear Dr. Chen, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please pay particular attention to Reviewer 1's comments. Please submit your revised manuscript by Nov 20 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Nancy Beam, PhD Staff Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please ensure that you include a title page within your main document. We do appreciate that you have a title page document uploaded as a separate file, however, as per our author guidelines (http://journals.plos.org/plosone/s/submission-guidelines#loc-title-page) we do require this to be part of the manuscript file itself and not uploaded separately. Could you therefore please include the title page into the beginning of your manuscript file itself, listing all authors and affiliations. 3.  We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. 4.  Thank you for stating in your Funding Statement: This work was supported by Science & Technology Department of Sichuan Province,in the framework of assessment of symptoms and establishment of a multidisciplinary palliative care model for elderly patients with terminal frailty(2019YFS0386).The person in charge of the project is corresponding author Qian Chen in the manuscript. i) Please provide an amended statement that declares *all* the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now.  Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. ii) Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ********** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ********** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for the possibility to review this article. This study is very interesting for nursing educators and the quality of care for patients. However, I have some comments: 1) It could be interesting to have more critical background about general self-efficacy, the source of meaning in life (SML) and prosocial behaviours. Are there previous studies examining these dimensions? In a population of students? Or in Nursing Students? Which were the finding? There are similar models in other studies? 2) Why there is the need to improve the humanistic care quality among nursing students? can you give some information about this sentence? It is not clear in which way the general self-efficacy, the source of meaning in life (SML) and prosocial behaviours are linked with improvement of humanistic care quality among students. 3) Why in introduction about students’ characteristics? I have not clear the reasons for these information. 4) You had hypothesized a relation between general self-efficacy, the source of meaning in life (SML) and prosocial behaviours and for these reasons you had tested the model. But on the basis of what? Are there previous studies? 5) You said “Studies show that adolescents with higher prosocial behaviour are more responsible and sympathetic than those without such behaviour, are good at perspective taking, and have relatively high levels of prosocial moral reasoning” but in your study you are speaking about nursing students and not adolescents. Are there other studies about student’s population? about health care workers? 6) In pag 1, line 31 there are two and. 7) About the instruments there are only few information. GSES come from WANG but in which kind of population was it validated? In students? Nursing students? If not, there is the necessity to validate the GSES in nursing students. Can we have some information about explorative factor analysis with the identification of the dimensions and about confirmative factor analysis? You used the total score of the GSES but there is a secondary order factor? At the same way it should be reported information about SMLS and PBS. 8) In table 1 there are the differences in prosocial behaviour and demographic characteristics. Why we have not the same information about general self-efficacy and SLM? 9) The paper need more critical discussion. Which is the implication of these finding? Can you work on general self-efficacy to improve the humanistic care quality among nursing students? in which way? 10) In pag 15, line 270 there is ERROR?? Thank you very much. I think this study is very interesting and can be improved. Reviewer #2: Dear Author, thank you for the opportunity to read such an interesting paper. I agree that it`s very important to strenghten nursing students` interpersonal skills, social functions and career planing education also we shoud pay attantion to the improvement of students` self-confidence. please check the 270 line what the error means? and the reference list - the correctness of writing and editing Good luck ********** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachment Submitted filename: revison.docx Click here for additional data file. 10.1371/journal.pone.0243796.r002 Author response to Decision Letter 0 Submission Version1 1 Nov 2020 Dear Editors: Thank you for your comments concerning our manuscript entitled “Mediating effects of general self-efficacy on the relationship between the source of meaning in life and prosocial behaviours in vocational college nursing students:a cross-sectional study" (PONE-D-20-15550) .We have made correction carefully according to comments.The main corrections in the paper and the responds are as following : Response to Staff Editor Dr.Nancy Beam 'Comments 1.Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Response: Yes, our manuscript meets PLOS ONE's style requirements. 2.Could you therefore please include the title page into the beginning of your manuscript file itself, listing all authors and affiliations. Response: Yes,we have included the title page into the beginning of our manuscript file itself, listing all authors and affiliations. 3.We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Response: Yes,we will upload the minimal anonymized data set necessary as either Supporting Information files . 4.Funding Statement Response: Yes,we have provided an amended statement in cover letter and updated Funding Statement. Reviewers' comments Reviewer #1: 1. It could be interesting to have more critical background about general self-efficacy, the source of meaning in life (SML) and prosocial behaviours. Are there previous studies examining these dimensions? In a population of students? Or in Nursing Students? Which were the finding? There are similar models in other studies? Response: Thank you for your recognition and support of my article. As you said, I really should add more critical background .And I have added more critical background about general self-efficacy, the source of meaning in life (SML) and prosocial behaviours in (line 74-82 page 4). Some researches also have shown that greater self‐efficacy can predict lower impulsivity and better prosocial behavior for youth.Self-efficacy can explain the level of prosocial organizational behaviour.And some literature has explored the mediating effect of life meaning of college students(or adolescents) between family cohesion, nostalgia, the moral sense of life and post-traumatic stress disorder and prosocial behaviors. While few researches explore the mediating effect of self-efficacy, the source of meaning in life (SML) and prosocial behaviors. However, there is indeed some correlation between them according to the contents of the literature. 2.Why there is the need to improve the humanistic care quality among nursing students? can you give some information about this sentence? It is not clear in which way the general self-efficacy, the source of meaning in life (SML) and prosocial behaviours are linked with improvement of humanistic care quality among students. Response: Thank you for your good advice.First of all, strengthening the learning of humanistic knowledge and improving the humanistic quality of nursing students are based on the requirements of national policies and guidelines, such as:The National Health Commission's "Notice on Further Deepening quality Care and Improving Nursing Services" (No. 15 [2015] of the State Health Office) requires us to further strengthen the consciousness of humanistic care and improve the level of nursing services.Therefore, how to deepen the reform of nursing education and strengthen the humanistic quality of nursing has become one of the focuses of nursing educators and managers. Second, the development of prosocial behavior of nursing students conforms to the concept and essence of human concern in nursing discipline.According to the knowledge, attitude, belief, practice model and motivation theory, SML can be regarded as a form of endogenous motivation and enhance the faith and values of vocational college nursing students, thus improving their altruistic prosocial behaviour.It is reported that good prosocial behavior can not only stimulate nurses' social responsibility and strengthen their social functions, but also promote the improvement of people-oriented nursing service quality and meet people's increasing demands for diversified and multi-level medical and health services. 3.Why in introduction about students’ characteristics? I have not clear the reasons for these information? Response: Thank you,which is also something I considered before.I referred to a lot of literature, and other literature reported the demographic characteristics in this way,and they were very detailed.Based on previous literature,prosocial behavior is a dependent variable,it will be affected by demographic factors,in addition to the source of meaning in life and self-efficacy.So,when we think the the mediating value of self-efficacy ,we should consider other demographic factors. 4.You had hypothesized a relation between general self-efficacy, the source of meaning in life (SML) and prosocial behaviours and for these reasons you had tested the model. But on the basis of what? Are there previous studies? Response: Thank you for your very good suggestion. Based on previous literature,the knowledge, attitude, belief, practice model and motivation theory and rules of the mediating effect,we hypothesized a relation between general self-efficacy, the source of meaning in life (SML) and prosocial behaviours,and our objective is to examine the mediating effect of general self-efficacy on the relationship between the source of meaning in life (SML) and prosocial behaviours in vocational college nursing students.And some literature has explored the mediating effect of life meaning of college students(or adolescents) between family cohesion, nostalgia, the moral sense of life and post-traumatic stress disorder and prosocial behaviors. While few researches explore the mediating effect of self-efficacy, the source of meaning in life (SML) and prosocial behaviors. 5.You said “Studies show that adolescents with higher prosocial behaviour are more responsible and sympathetic than those without such behaviour, are good at perspective taking, and have relatively high levels of prosocial moral reasoning” but in your study you are speaking about nursing students and not adolescents. Are there other studies about student’s population? about health care workers? Response: Thank you for your valuable suggestions.At present, there are very few studies on prosocial behavior, most of which are about students or adolescents.Some investigations is for nurses,but the nurses’ values are basically stable,but vocational college students are generally between the ages of 17 and 24 and are mostly new graduates from middle or high school. The majority of them are from only-child families, female, and unmarried. They have relatively unique advantages but also lack positive motivation, have poor communication skills, lack a strong sense of self, have weak teamwork ability, and have poor self-bearing and poor self-management ability .In addition, these students are in an important period in the formation of their life and professional values, so it is very important to cultivate their knowledge and skills, provide them with a quality education and cultivate their humanistic care ability. 6.In page 1, line 31 there are two and. Response :Thank you for such a detailed suggestion, which is caused by my negligence. We have deleted a and. 7.About the instruments there are only few information. GSES come from WANG but in which kind of population was it validated? In students? Nursing students? If not, there is the necessity to validate the GSES in nursing students. Can we have some information about explorative factor analysis with the identification of the dimensions and about confirmative factor analysis? You used the total score of the GSES but there is a secondary order factor? At the same way it should be reported information about SMLS and PBS? Response :Thank you ,the GSES come from WANG but it was validated in all kinds of population,such as primary school students, college students, university teachers and hospitalized patients, etc.In different studies, its reliability is slightly different. In this study, its reliability is 0.903. We rechecked the original version of the WANG,the GSES were single-dimensional,and it’s universal across cultures.And the reliability of SMLS and PBS was 0.978 and 0.962, respectively. We showed that the results sf explorative factor analysis with the identification of the dimensions and about confirmative factor analysis.We showed the final dimensions of each questionnaire. 8.In table 1 there are the differences in prosocial behaviour and demographic characteristics. Why we have not the same information about general self-efficacy and SLM? Response :Thank you for your valuable advice, because our objective is to examine the mediating effect of general self-efficacy between the source of meaning in life (SML) and prosocial behaviours in vocational college nursing students and the effect size,so the factors of prosocial behaviors ,including demographic characteristics are very significant.But the demographic characteristics of self-efficacy and SLM have not very significant meaning to the overall results. 9.The paper need more critical discussion. Which is the implication of these finding? Can you work on general self-efficacy to improve the humanistic care quality among nursing students? in which way? Response :Thank you for your suggestions,we are grateful for the valuable and detailed suggestions. We really don't have a specific description about how to improve the humanistic care quality among nursing students by self-efficacy.Your suggestion gives us a clearer idea.So we added the discussion in page 18,line 331-337.For example,we could improve our teaching methods, such as increasing scene teaching method can improve students' situational coping ability, self-confidence and empathy ability .Meanwhile ,we encourage to increase more humanities courses to increase nursing students' awareness of humanistic care and improve the quality of humanistic care.Moreover, some relevant lectures should be hold regularly to enlighten nursing students' critical thinking and improve their confidence through the power of a good example. 10. In pag 15, line 270 there is ERROR?? Response :Thank you very much for your careful advice to my article. It was our negligence, and we has corrected it now. Reviewer #2 1.please check the 270 line what the error means? Response :Thank you for your comments on this study,It was our negligence, and we has corrected it now. 2.and the reference list - the correctness of writing and editing Response :Thank you ,we have do some correctness of writing and editing according to the styles of the PLOS ONE. We appreciate for your warm work earnestly, and hope that the correction will meet with approval. Once again, thank you very much for your suggestions. Attachment Submitted filename: Response to Reviewers.doc Click here for additional data file. 10.1371/journal.pone.0243796.r003 Decision Letter 1 Bulfone Giampiera Guest Editor © 2020 Giampiera Bulfone2020Giampiera BulfoneThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Submission Version1 26 Nov 2020 Mediating effect s  of general self-efficacy on the relationship between the source of meaning in life and prosocial behaviours in vocational college nursing students:a cross-sectional study PONE-D-20-15550R1 Dear Dr. Chen, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Giampiera Bulfone Guest Editor PLOS ONE Additional Editor Comments (optional): Thank for your revision. Every point meet my suggestion. Reviewers' comments: 10.1371/journal.pone.0243796.r004 Acceptance letter Bulfone Giampiera Guest Editor © 2020 Giampiera Bulfone2020Giampiera BulfoneThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 4 Dec 2020 PONE-D-20-15550R1 Mediating effects of general self-efficacy on the relationship between the source of meaning in life and prosocial behaviours in vocational college nursing students:a cross-sectional study Dear Dr. Chen: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Giampiera Bulfone Guest Editor PLOS ONE ==== Refs References 1 Zeng YL , Wang GF , Xie CX , Hu XY , Reinhardt JD . Prevalence and correlates of depression, anxiety and symptoms of stress in vocational college nursing students from Sichuan, China: a cross-sectional study . Psychology, Health & Medicine . 2019 ;24 (7 ):798 –811 . 10.1080/13548506.2019.1574358 30714819 2 Rodgers S , Zhu J , Melia K . Can education resolve nursing shortage in China? Athens Journal of Health . 2015 ;2 (3 ):177 –90 . 3 The Central People’s Government of the People’s Republic of China http://www.gov.cn/xinwen/2017-01/06/content_5157422.htm. Accessed May 5, 2020. 4 Li WJ , Kang FY . Some experience of nursing humanistic curriculum setting . China Health Human Resources . 2019 ; (8 ):62 –63 . 10.3969/j.issn.1008-7370.2019.08.019 5 Deng H , Hu Y . Discussion on the ways of ideological and political education for students in higher vocational colleges in the new period . Journal of Jiamusi Vocational Institute . 2020 ;36 (4 ):228 –229 . 6 Xiang XF , Li HM , Liu YH , Liu X . Strategies of Mathematics Teaching Based on Characteristics of Higher Vocational College Students . Journal of Chengde Petroleum College . 2018 ; 20 (1 ):71 –73 . 10.3969/j.issn.1008-9446.2018.01.018 . 7 Tan M , Zhang LY , Guo C , Li ZX . The relationship between the source of meaning in life and social adaptation of college students: the mediating role of the sense of life meaning . Journal of Southwest University(Natural Science) . 2018 ;40 (12 ):146 –154 . 10.13718/j.cnki.xdzk.2018.12.023 8 Cheng M , Fan F , Peng K . Psychological Structure and Measurement for Sources of Meaning in Life . Chinese Journal of Clinical Psychology . 2011 ; 19 (5 ):591 –594 . 9 Cheng M . Positive meaning and life meaning—theory, measurement and practice . Shanghai : China social science press ; 2015 . 10 Zhuang J. An intervention and research on the effect of sources of meaning and meaning in life on relapse tendency among drug abstainers. Master Dissertation. Shanghai, China: Shanghai Normal University, 2015. 11 Loeffler S , Poehlmann K , Hornemann B . Finding meaning in suffering?-Meaning making and psychological adjustment over the course of a breast cancer disease . Eur J Cancer Care (Engl) . 2018 ;27 (3 ):e12841 10.1111/ecc.12841 29575157 12 Landale S , Roderick M . Recovery from addiction and the potential role of sport: Using a life-course theory to study change . INT REV SOCIOL SPORT . 2014 ;49 (3–4 ):468 –484 . 10.1177/1012690213507273 . 13 Welter PR . Counseling and the search for meaning [M]. Waco, Tex :Word Books Press ,1987 . 14 Chen S. A Study on the Influence of College Students’ Dedication and Empathy on Prosocial Behavior. Master Dissertation. Shanghai, China: Shanghai Normal University, 2019. 15 Carlo G , Randall BA . The Development of a Measure of Prosocial Behaviors for Late Adolescents . J YOUTH ADOLESCENCE . 2002 ;31 (1 ):31 –44 . 10.1023/A:1014033032440 . 16 Falanga R , De Caroli M , Sagone E . Humor styles, self-efficacy and prosocial tendencies in middle adolescents. INTERNATIONAL CONFERENCE PSYCHOLOGY AND THE REALITIES OF THE CONTEMPORARY WORLD (PSIWORLD 2013), 4TH EDITION . Procedia-Social and Behavioral Science . 2014 ;127 :214 –218 . 10.1016/j.sbspro.2014.03.243 . 17 Chen D. The relationship between social support and prosocial behavior of college students: the mediating role of sense of life meaning. Master Dissertation. Chengdu, China: Sichuan Normal University,2020. 18 Wang WC , Wu XC , Tian YX and Zhou X . Effects of post-traumatic stress disorder and post-traumatic growth on prosocial behavior in adolescents: Mediating the meaning of life . Psychological Development and Education . 2018 ;34 (1 ):112 –119 . 19 Tabares A . Prosocial behaviors and their relationship with empathy and self-efficacy for emotional regulation in adolescents disconnected from illegal armed groups . REVISTA CRIMINALIDAD . 2019 ;61 (3 ):221 –46 . 20 Sari SV . Attaining Career Decision Self-Efficacy in Life: Roles of the Meaning in Life and the Life Satisfaction . CURR PSYCHOL . 2019 ;38 (5 ):1245 –52 . 10.1007/s12144-017-9672-y . 21 Liu Y , Ngai SY . The Impact of Social Capital, Self-Efficacy, and Resilience on the Prosocial Involvement of Adolescents from Families with and without Economic Disadvantages . CHILD INDIC RES . 2019 ;12 (5 ):1735 –1757 . 10.1007/s12187-018-9607-7 22 Jafary F , Farahbakhsh K , Shafiabadi A , Delavar A . Quality of life and menopause: Developing a theoretical model based on meaning in life, self-efficacy beliefs, and body image . Aging Ment Health .2011 ;15 (5 ):630 –637 . 10.1080/13607863.2010.548056 21815855 23 Gherghel C ; Nastas D ; Hashimoto T , Takai J ; Cargile AC . Culture, morality, and the effect of prosocial behavior motivation on positive affect . Ethics & Behaviour . 2020 ;30 (2 )126 –149 . 10.1080/10508422.2019.1651651 . 24 Midlarsky E , Hannah ME . Competence, reticence, and helping by children and adolescents . Developmental Psychology .1985 ;21 (3 ):534 –541 . 10.1037/0012-1649.21.3.534 . 25 McMahon SD , Todd NR , Martinez A , Coker C , Sheu CF , Washburn J , et al Aggressive and prosocial behavior: community violence, cognitive, and behavioral predictors among urban African American youth . Am J Community Psychol . 2013 ;51 (3–4 ):407 –421 . 10.1007/s10464-012-9560-4 .23229395 26 Lee HJ . Willingness and capacity: the determinants of prosocial organizational behaviour among nurses in the UK . INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT .2001 ;12 (6 ):1029 –1048 . 10.1080/09585190110063219 27 Li L , Ye BJ , Ni LY , Yang Q . Family Cohesion on Prosocial Behavior in College Students: Moderated Mediating Effect . Chinese Journal of Clinical Psychology . 2020 ;28 (1 )178 –180 . 28 Fang JD , Chang BR . A study between nostalgia and prosocial behavior: a mediated regulatory model . Psychological Development and Education .2019 ;35 (3 ):303 –311 . 29 Javaeed A , Kousar R , Farooq A , Hina S , Ghauri SK , Tabbasum T . Knowledge, Attitude, and Practice of Blood Donation Among Undergraduate Medical Students in Azad Kashmir . Cureus . 2020 ; 19 ;12 (4 ):e7733 10.7759/cureus.7733 32440380 30 Einaudi M , Gire C , Loundou A , Le Coz P , Auquier P . Quality of life assessment in preterm children: physicians’ knowledge, attitude, belief, practice—a KABP study . BMC Pediatr .2013 ;13 (1 ):58 10.1186/1471-2431-13-58 23601174 31 Li WY , Liu J , Yu GL , Xu JH . Application of the knowledge-belief-practice model in nursing practice: current status and prospects . Journal of Nursing Science . 2015 ; 30 (6 ):107 –110 . 10.3870/hlxzz.2015.06.107 . 32 Cuneo T . A Puzzle Regarding Reid’s Theory of Motives . BRITISH JOURNAL FOR THE HISTORY OF PHILOSOPHY .2011 ;19 (5 ):963 –981 . 10.1080/09608788.2011.599571 33 Schwarzer R , Bäßler J , Kwiatek P , Schröder K , Zhang J . The Assessment of Optimistic Self-beliefs: Comparison of the German, Spanish, and Chinese Versions of the General Self-efficacy Scale . Appl Psychol . 1997 ;46 (1 ):69 –88 . 10.1111/j.1464-0597.1997.tb01096.x . 34 Wang CK , Hu ZF , Liu Y . A study on reliability and validity of general self-efficacy scale . Chin J Appl Psychol . 2001 ;7 (1 ):37 –40 . 10.3969/j.issn.1006-6020.2001.01.007 . 35 Kou Y , Hong H , Tan C , Li L . Revision of the prosocial orientation scale for adolescents . Psychological Development and Education . 2007 ;23 (1 ):112 –117 . 10.3969/j.issn.1001-4918.2007.01.020 36 West SG ; Thoemmes F ; Wu W . Introduction to Structural Equation Modelling: Using SPSS and AMOS . APPLIED PSYCHOLOGICAL MEASUREMENT .2010 ;34 (3 ):211 –213 . 10.1177/0146621609360954 . 37 Ye YS , Hu RJ , Ni ZH , Jiang N , Jiang XL . Effects of perceived stress and professional values on clinical performance in practice nursing students: A structural equation modeling approach . Nurse Educ Today .2018 ;71 :157 –62 . 10.1016/j.nedt.2018.09.036 .30290318 38 Schreiber JB . Update to core reporting practices in structural equation modeling . Res Social AdmPharm .2017 ;13 (3 ):634 –43 . 10.1016/j.sapharm.2016.06.006 27567146 39 Sheng Z. Revision of meaning in life questionnaire for college students. Master Dissertation. Guangzhou, China: South China Normal University, 2007. 40 Tabares A . Prosocial behaviors and their relationship with empathy and self-efficacy for emotional regulation in adolescents disconnected from illegal armed groups . REVISTA CRIMINALIDAD . 2019 ;61 (3 ):221 –246 . 41 Cui YX , Li SS , Cui YF . Relationship between prosocial behavior, social avoidance and distress in nursing students . Journal of Nursing Science . 2011 ;26 (8 ):79 –81 . 10.3870/hlxzz.2011.08.079 . 42 Frankl V . Logotherapy and existential analysis—a review . Am J Psychother . 1966 ;2 (20 ):252 –260 . 10.1176/appi.psychotherapy.1966.20.2.252 .5327827 43 Bains KK , Turnbull T . Improving Health Outcomes and Serving Wider Society: The Potential Role of Understanding and Cultivating Prosocial Purpose Within Health Psychology Research and Practice to Address Climate Change and Social Isolation and Loneliness . Front Psychol .2019 ;2019.10 :1787 10.3389/fpsyg .31440182 44 Li JJ , Dou K , Wang YJ , Nie YG . Why Awe Promotes Prosocial Behaviors? The Mediating Effects of Future Time Perspective and Self-Transcendence Meaning of Life . FRONT PSYCHOL . 2019 ; 10 :1140 10.3389/fpsyg.2019.01140 .31191387 45 Roberts AEK , Bannigan K . Dimensions of personal meaning from engagement in occupations: A meta synthesis . CAN J OCCUP THER . 2018 ;85 (5 ):386 –396 . 10.1177/0008417418820358 .30866683 46 Zhou L. Research on the Current Situation and Promotion Strategies of the Meaning in Life of College. Master Dissertation. Wuhan, China: Central China Normal University, 2019. 47 Shin JY , Kim TS , Ahn J . Calling, Career Preparation Behaviors, and Meaning in Life Among South Korean College Students . J COLL STUDENT DEV . 2018 ;59 (6 ):734 –748 . 48 Yang Y , Li PP , Fu XY , Kou Y . Orientations to Happiness and Subjective Well-Being in Chinese Adolescents: The Roles of Prosocial Behavior and Internet Addictive Behavior . J HAPPINESS STUD . 2017 ;18 (6 ):1747 –62 . 10.1007/s10902-016-9794-1 49 Patrick R , Bodine A , Gibbs J , Basinger K . What Accounts for Prosocial Behavior? Roles of Moral Identity, Moral Judgment, and Self-Efficacy Beliefs . J Genet Psychol . 2018 ;179 (5 ):231 –245 . 10.1080/00221325.2018.1491472 30280983 50 Yao ZY , Enright R . Belief in altruistic human nature and prosocial behavior: a serial mediation analysis . ETHICS & BEHAVIOR . 2020 ;30 (2 ):97 –111 . 10.1080/10508422.2019.1591963