Sleep Quality as a Mediator Between Digital Competence and Online Exam Anxiety Among Nursing Students

BACKGROUND: Nursing students increasingly have online examinations, which can provoke significant anxiety. Digital competence, the ability to confidently and critically use digital technologies for learning and professional practice, has become essential for navigating these digital assessment environments; yet, its relationship with exam anxiety remains underexplored. PURPOSE: This study examined whether sleep quality mediates and/or moderates the relationship between digital competence and online exam anxiety among nursing students. METHODS: A cross-sectional descriptive correlational design was used with 597 undergraduate nursing students. Participants completed the Students' Digital Competence Scale, the Test Anxiety Scale for Online Exams, and the Pittsburgh Sleep Quality Index. Mediation and moderation analyses were conducted using the PROCESS macro for SPSS (models 4 and 1) with bootstrapping. RESULTS: Digital competence showed a significant total effect on online exam anxiety (B = -0.11, P = .004). After including sleep quality, the direct effect became nonsignificant (B = -0.05, P = .188), whereas the indirect effect through sleep quality was significant, confirming full mediation (B = -0.06, 95% CI [-0.093, -0.034]). Sleep quality did not moderate the relationship (interaction B = -0.01, P = .316). CONCLUSIONS: Sleep quality fully mediated but did not moderate the relationship between digital competence and online exam anxiety. Higher digital competence was associated with better sleep quality and lower anxiety. Interventions should integrate digital skills training with sleep hygiene education.