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Happiness and its determinants among nursing students
T K Ajesh Kumar1, Deepika Cecil Khakha1, Poonam Joshi1, Smita Das1, KJ Manu2
1 College of Nursing, All India Institutes of Medicals Sciences, New Delhi, India
2 Community Health Nursing, Koyili College of Nursing, Kannur, Kerala, India
|Date of Submission||01-Jun-2021|
|Date of Acceptance||06-Jan-2022|
|Date of Web Publication||08-Aug-2022|
T K Ajesh Kumar,
College of Nursing, All India Institutes of Medicals Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Being happy in life is very essential to be healthy, which is important for nursing students to grow and adapt well in their professional life. Aim: The aim of this study is to assess the level of happiness and identify the determinants of happiness among nursing students. Materials and Methods: Three hundred and forty-two undergraduate nursing students College of Nursing, All India Institutes of Medicals Sciences, New Delhi, India, enrolled in the study by convenience sampling. Data were collected through demographic information sheets and oxford happiness questionnaires. Frequencies, percentages, mean, standard deviation, Chi-square test, and multiple linear regression were used to analyze the data. Results: The mean happiness score of nursing students was 3.96 ± 0.59 on a scale of 6. The percentage distribution showed that 43.2% of the students responded “not particularly happy,” and 42.1% were “rather happy.” The current year of study, the number of close friends, stress experienced in the past 6 months, and engagement in physical activities contributed 53% of the variance in the happiness score of nursing students (P < 0.001). Further, monthly family income (P = 0.018) and choice of course (P = 0.003) had a significant association with their happiness score. Conclusion: Nursing students had a moderate level of happiness. The study suggests that there is a need to develop strategies to enhance happiness among nursing students in alignment with the identified factors. Educators need to develop a holistic curriculum giving equal importance to academic competencies and personal flourishment.
Keywords: Determinants, happiness, nursing, students
Everyone wants to be happy in their life. Happiness is considered to be one of the ultimate goals of life. It is one of the basic psychological needs of humans. Happiness is a multidimensional construct comprising both emotional and cognitive elements. Gretchen Rubin explained in her book titled “The Happiness Project” that happiness varies from person to person, but approximately 40% of our happiness is determined by thoughts, actions, and behaviors, 50% is generally determined by genetics, and 10% is by our circumstances. Happiness promotes a range of lifestyle habits that are essential for overall health. Being happy keeps the immune system strong. Unhappy people tend to have high blood pressure which is the biggest cause of heart disease. Hence, happiness is considered to be cardioprotective. Further, higher levels of happiness are related to lower physical and mental illness, and better coping ability leading to a well-adjusted personality.
Happiness is an important element in developing and building professionalism. Caring, empathy, confidence, flexibility, and physical endurance are the key skills required in providing quality patient care. These skills development is highly dependent on how happy they are. According to Jun and Jo, happiness is very important in the training and development of nursing students as future nurses. This study indicated grateful disposition and support from intimate people promotes happiness among nursing students. Medical students are less ecstatic compared to other students in university because of concrete inculcation and work conditions. The students' levels of happiness will influence their academic and social performances.
The limited scientific pieces of evidence on happiness among nursing students show that they have low-to-moderate levels of happiness. Nursing students perceived social support, participation in social and cultural activities, good academic performance, and conscious selection of nursing as a career had a positive influence on their subjective well-being. Further, psychologically healthy nursing students perform better in clinical and academics. Nursing students in India have a moderate level of happiness, the main factors determining the happiness were a motivational factor to join nursing, engagement in exercise, use of substances, health status, and their relationship with family members, friends, and teachers. In India, this quantitative study is one of the few investigations conducted among nursing students on happiness. India ranked 139 of 149 countries in the list of United Nations. Hence, it is very important to know the current level of happiness of nursing students and its determinants to develop strategies for their happiness enhancement. Further, the results of this study would add a base of evidence to plan measures to promote happiness among nursing students. The present study aims to assess the level of happiness and identify the determinants of happiness among nursing students.
| Materials and Methods|| |
An exploratory, quantitative research approach was adopted with descriptive survey design. This design describes the research variables without studying the causal effect or other hypotheses. The findings of the descriptive researches can be the base of shreds of evidence for many future kinds of research.
Participants and setting
Participants of this study were students who were enrolled in Bachelor of Nursing 1st year, 2nd year, 3rd year, and 4th-year students in the 2019–2020 academic years at College of Nursing, All India Institutes of Medicals Sciences, New Delhi, India. Convenience sampling was used to recruit nursing students in the study. The sample size was calculated based on the pilot study findings, standard deviation (σ) obtained from the pilot study was 0.45, z value is 1.96 for 5% level of significance and margin of error, and E is taken as 0.05 N = 311, anticipating loss to follow-up, 342 nursing students were included in the study. Inclusion criteria were undergraduate nursing students who had agreed to participate in the study, signed an informed consent after getting an explanation with participants' information sheets and available during the data collection period.
Demographic characteristics and personal factors
The nursing students' demographic and personal factors included were age in years, year of study, monthly family money, choice of course, the percentage of marks obtained in the previous academic year, average hours of daily sleep, experienced any stress in the past 6 months, and frequency of physical exercise.
Oxford happiness questionnaire
to measure the happiness of nursing students, the oxford happiness questionnaire was used. This happiness inventory was developed by Michael Argyle and Peter Hills. The permission to use this instrument was obtained from the Copyright Clearance Center of Elsevier. This is one of the most widely used instruments worldwide to measure happiness which is 29 items rating scale responses ranges from strongly agree to strongly disagree in six points. The happiness score ranges from, where one denotes “not happy” and six is “too happy.” This instrument got high reliability. The Cronbach's alpha of the oxford happiness questionnaire has been reported to be 0.91 among Indian students. The instrument was administered in English.
ethical permission to conduct the study was obtained from the Institute Ethics Committee, All India Institute of Medical Sciences, New Delhi, India (Ref. No: IEC-443/07.06.2019, RP-53/2019). Written informed consent was obtained from nursing students who were willing to participate after explaining about the aim and methods of the study with the help of the participants' information sheet. Further, they were informed about the anonymity and confidentiality of the collected data.
Data collection procedure
Initially, written permission to collect data was obtained from the Principal, College of Nursing, All India Institutes of Medicals Sciences, New Delhi, India. The data were collected in December 2019–February 2020. Each year of students filled data collection instruments separately in their classrooms. Then, the principal investigator introduced himself to students, given the participants' information sheet, and obtained informed consent from the participants. Thereafter students were given demographic characteristics, personal factors sheets, and oxford happiness questionnaires to fill by themselves. Students took around 20–25 min to complete these tools.
IBM SPSS Statistics for Windows, Version 22.0. (Armonk, NY: IBM Corp.) was used to analyze the collected data from nursing students. Appropriate descriptive (frequencies, percentages, mean, and standard deviation) and inferential statistics (Chi-square test) were used for data analysis. Multiple linear regression analysis was used to identify the factors influencing happiness among nursing students. For statistical significance, P < 0.05 was considered.
| Results|| |
Analysis was done for 342 participants who participated in the study. All the participants were females, and their ages ranged from 18 to 25 years with a mean of 21.19 ± 1.30. With regards to the current academic year of study, 98 students from the 1st year, 94 students from the 2nd year, 74 students from the 3rd year, and 76 students from the 4th year were enrolled. Half of the participants (54.7%) entry into nursing was by their choice, whereas parents (26.6%) and others influenced (18.7%) to opt for nursing as a career. More than half of the nursing students (53.8%) scored 50%–60% marks in the previous academic year. The majority of students had two or more close friends. Half of the students (50.0%) felt stress several days during the past 6 months. Data on the physical activity revealed that 17.5% of the students were not engaged in any physical activities, 40.4% did only once or twice in a week in physical activities.
The mean happiness score of nursing students was 3.96 ± 0.59. The percentage distribution showed that 43.2% of the students were “not particularly happy” or “unhappy,” 42.1% of them were rather happy; pretty happy [Figure 1]. Further, academic year (P ≤ 0.001), monthly family income (P = 0.018), choice of course (P = 0.003), number of close friends (P = 0.001), any stress during the past 6 months (P ≤ 0.001), and frequency of engaging into physical exercise (P ≤ 0.001) had a significant association with their happiness score [Table 1].
|Figure 1: Bar diagram representing the percentage distribution of nursing students' level of happiness|
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|Table 1: Frequency, percentage distribution, the mean and standard deviation of happiness score, and its association with sample characteristics (n=342)|
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Multiple linear regression was performed to determine the factors behind the happiness of nursing students. Overall regression model was statistically significant at 0.05 level of significance (R2 = 0.537, F [7, (182)] = 30.197, P < 0.001). The predictors such as “year of study” (P < 0.001), “the number of close friends” (P = 0.002), “experienced stress in the past 6 months” (P < 0.001), and “physical activity” (P = 0.016) were statistically significant with the students' happiness level. This model predicted 53% of the variance in the happiness score of nursing students from the variables year of study, number of close friends, stress experienced in the past 6 months, and engagement in physical activities [Table 2].
|Table 2: Factors determining happiness among nursing students: Multiple regression|
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| Discussion|| |
This study aimed to assess the level of happiness among nursing students and their determinants. The mean happiness score was 3.96 ± 0.59 which denotes not particularly happy or unhappy as per the Oxford Happiness Questionnaire. Similar study found that nursing students had a 4.2 ± 0.6 mean happiness score on the same happiness inventory. A similar study among budding Indian nurses reported a moderate level of happiness. Furthermore, happiness among nursing students was above average at two universities of Iran.
This study result showed that the choice of getting into the nursing profession influenced the students' level of happiness. Findings of a similar research reported that preference of selection motivation to study nursing had influenced nursing students' happiness.,, Further, a conscious choice of selection of nursing as a career increased subjective well-being among nursing students. In this study, nursing students' total monthly family income in Indian rupees had a significant association with happiness score. These findings are consistent with another study reported that high economic level had a high happiness score.
Another factor identified as a predictor of nursing student's happiness is their academic year of study. The happiness score of 4th-year nursing students was higher than that of the 3rd year and 2nd-year students. Significant differences in levels of psychological well-being depend on the grades of nursing students. In contrast, 1st-year nursing students had the highest happiness score than 2nd, 3rd, and 4th-year nursing students in Thailand. In future research, we can include the large size of students to explain this discrepancy.
In the current study, nursing students' frequency of engagement in physical activities had a beneficial impact on happiness. These results are in agreement with a study reported that active participation in physical activity can yield beneficial results in improving the mental well-being of nursing students., A similar study among female medical students in Cyprus found a positive correlation between physical activity and happiness.
The more number of close friends increased happiness among nursing students. This finding concurs with similar researches reported that support from intimate contacts is a significant predictor of happiness of nursing students in Korea. In research conducted among other groups of university students, time spends with family and friends had a significant impact on the happiness among Indian Universities student. Further, this study results reported that the frequency of stress experienced in the past 6 months is a negative covariate of nursing students' happiness. In the same way, another study found that a high level of perceived stress can hurt the subjective well-being of nursing students.
The study found that nursing students' academic performance does not have a significant effect on their happiness. A similar study could not establish a relationship between grade point average and happiness of nursing students., However, nursing students' academic achievement had positive effects on subjective well-being. This difference in the findings may be due to the cultural differences among students and the use of different tools to measure happiness and subjective well-being. The larger samples and more comprehensive multi-centered studies are essential to establish this relationship.
This was a cross-sectional, single-center, and self-reporting survey. Further, convenience sampling was used to select the nursing students which can limit the generalizability of the results. All of the participants were female and were hostellers.
| Conclusion|| |
In short, the study explains that a major portion of nursing students are at “not particularly happy” or “pretty happy” levels of happiness. Factors such as year of study, number of close friends, stress experienced in the past 6 months, and engagement in physical activities are significant in determining their happiness. These factors need to be taken into consideration while planning future studies, and developing strategies to promote nursing students' happiness. Further, there should be a promotion of students' participation in physical and extracurricular activities needs for their active engagement and group cohesiveness. Educators need to develop a holistic curriculum giving equal importance to academic competencies and personal flourishment.
The authors would like to thank all nursing students who participated in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]