Psychological distress, self-efficacy, and academic advising among Saudi nursing students during academic reform: a mixed-methods study

Abstract Background: Changes in academic structure—such as the implementation of a trimester system—can impose considerable psychological strain on students. In nursing education, such reforms may elevate stress, anxiety, and depression while undermining self-efficacy. Academic advising can potentially buffer these effects, yet its role during transitional periods remains underexplored in the Saudi context. Purpose: This study investigates the levels of stress, anxiety, depression, and self-efficacy among nursing students following the adoption of a trimester academic system at King Saud bin Abdulaziz