Student Nurses' Quality of Life in Majmaah University: A Cross-Sectional Study

Introduction

In Saudi Arabia, student nurses have experienced a high level of stress during their academic and clinical preparation that could influence their quality of life (QoL) [1-4]. The identified primary sources of their stress were the huge number of assignments and workloads [4-7], and perceived lack of professional nursing knowledge and skills resulting to poor QoL specifically on their physical health, social functioning, and vitality [4,8-10]. Single students as compared to married have experienced the worse quality of life and poorer health [11-12]. Also, the distance of students going to school either by driving or commuting has been reported to affect the QoL as manifested by their lower attendance [13]. Despite this scenario, they conveyed to be more empowered to establish a good social relationship [14]. On the other hand, students who are receiving less allowance have frequently visited their school clinic that offers free health services, or they just tolerate minor illnesses to save time and avoid difficulty [15]. These pressing problems and challenges to the QoL of students imply that the schools particularly in the nursing field have the responsibilities to initiate specific curriculum change. This would ensure that the students’ QoL is at its optimal level so that their academic and clinical performance will not be affected.

Based on the knowledge of the researchers, despite the vast number of studies related to the student's QoL only a few were explicitly conducted in the nursing academe. Also, limited studies have particularly examined the association of demographic variables to the student’s QoL. Therefore, this study aimed to determine the correlation of social factors such as gender, marital status, distance from school, and monthly allowance to the physical, psychological, social, and environment domains of student nurses’ QoL. Results of the study are deemed opportunity for educators to consider factors that have an impact on students’ QoL in planning extra-curricular and academic requirements particularly in the nursing academe in Saudi Arabia.

Objective

This study aimed to determine the correlation of demographic factors and QoL of student nurses enrolled in the baccalaureate degree program at Majmaah University in Saudi Arabia.

Methods

Research design and participants

This study used a correlational design to determine the relationship of demographic factors and QoL among 100 nursing students in both male and female sections at Majmaah University using purposive sampling. A priori power analysis was utilized with medium effect size (0.15), significance level of 0.05, and statistical power of 0.80 using the G*Power version 3.17 software to determine the sample size in this study which required to have at least 100 participants. Those who are Saudi nationals, presently registered in the nursing program, and able to read and write in Arabic were qualified to participate in this study.

Instruments

A demographic questionnaire, and adopted Arabic version of the World Health Organization Quality of Life (WHOQOL-BREF) were used in this study. The WHOQOL-BREF is a cross-culturally accepted instrument to assess the quality of life. The students independently answered the printed copies of the questionnaires in their classrooms for about 15-20 minutes between October to November 2016. It consists of 26 items that are offered in various languages for developed and developing countries. It has four domains, such as: the physical health, the psychological health, the social relationship and the environment. Physical health includes “dependence on medicinal substances and medical aids, activities of daily living, mobility, fatigue, pain and discomfort, sleep and rest, and work capacity while psychological health includes bodily image and appearance, negative feelings, positive feelings, self-esteem, spirituality, thinking, learning, memory, and concentration” [16]. The social relationship domain involves “the personal relationship, social support, and sexual activity” [16]. Furthermore, the environment domain involves “financial resources, freedom, physical safety, and security, health and social care, opportunities for acquiring new information and skills, home environment, participation in and opportunities for recreation, physical environment, and transport” [16]. Responses will be according to 5-point Likert scale. Also, raw scores on each domain can be converted from 0 being the least favorable to 100 being the most favorable using the established transmutation table, and higher scores denote higher level of QoL [16].

Ethical Considerations

The study was approved by the dean of the College of Applied Medical Sciences, and the Ethics Review Board at Majmaah University, Saudi Arabia. Informed consent was obtained from the students with the guarantee of anonymity and confidentiality.

Data Analysis

The descriptive statistics were used to describe the demographics of the participants. To establish the demographic predictors of the QoL in nursing students, multiple regression analyses were used using SPSS Statistics version 23.0 for Mac OS X.

Results

Demographics

Of the 105 distributed questionnaires to the nursing students in the male and female sections, 100 were successfully answered and retrieved with a response rate of 95.24%. The mean age of the nursing students was 21.36 ± 2.01 years, and the majority of them were male (66%). Almost all of them were single (90%), and only 10% were married. Furthermore, most of the respondents live >51 km from school (74%). Regarding monthly allowance, 40% received 1,000-1,500 SAR, whereas only 27% obtained 501-999 SAR, 24% acquired >2,000 SAR, and only a minority (9%) have received <500 SAR.

>>> insert table 1

Table 1. Socio-demographics of nursing students (n=100)
Variables	Mean (SD/%)
Age	21.36 ± 2.01
Gender
Male	66 (66)
Female	34 (34)
Marital Status
Single	90 (90)
Married	10 (10)
Distance from School
<50 km	26 (26)
>51km	74 (74)
Monthly Allowance
<500 SAR	9 (9)
501-999 SAR	27 (27)
1,000-1,500 SAR	40 (40)
>2,000 SAR	24 (24)

The QoL scores in the four domains

The QoL scores has four domains such as physical health, psychological, social relationship, and environment as shown in table 2. Firstly, the mean psychological score was 20.55 (±3.77), while the environment mean score was 26. 99 (±5.17), and both of these acquired an equivalent score of 63 in a 100 scale transmutation which can be interpreted as an above average score. Secondly, social relationship obtained a mean score of 10.28 (±2.85) which has an equivalence of 56 and can be interpreted as an average score. Lastly, physical health attained 20.54 (±3.32) which has an equivalence of 50 and can be inferred as average.

Table 2. The mean scores in the four domains of quality of life among nursing students (n=100)
Domains	Mean	SD
Physical Health	20.54	3.32
Psychological	20.55	3.77
Social Relationship	10.28	2.85
Environment	26.99	5.17

>>> insert table 2

The correlation between demographic factors and student nurses’ QoL

As specified in table 2, it is noteworthy that gender (p >0.05), marital status (p >0.05), distance from school (p >0.05), and monthly allowance (p >0.05) were found to have no significant relationship to the physical, psychological and social domains of QoL. On the other hand, only marital status (p <0.05) was established to have a significant relationship to the environment domain of QoL. Specifically, being married decreases the environment domain by 11.21 compared to being single. However, gender (p >0.05), distance from school (p >0.05), and monthly allowance (p >0.05) attained no significant relationship to the environment domain.

>>> insert table 3

Table 3. The relationship of the social factors and quality of life among nursing students using multiple linear regression (n=100)
Variables	Quality of Life
Physical domain	Psychological domain	Social domain	Environment domain
β (SE)	P	β (SE)	p	β (SE)	p	β (SE)	p
Gender (Male)	2.52 (2.61)	0.34	2.41 (3.45)	0.49	4.06 (5.21)	0.44	1.63 (3.50)	0.64
Marital Status (Single)	-5.62 (4.31)	0.20	-1.73 (5.70)	0.76	-4.76 (8.60)	0.58	-11.21 (5.77)	<0.05
Distance from school (<50 km)	-1.19 (2.82)	0.68	-3.60 (3.72)	0.34	-6.83 (5.62)	0.23	-2.09 (3.77)	0.58
Monthly Allowance (<500 SAR)	-1.15 (1.43)	0.42	0.49 (1.88)	0.80	0.98 (2.84)	0.73	1.20 (1.91)	0.53
R2	0.05	0.02	0.03	0.05

Discussion

This study established the QoL scores and its relationship to the select demographic factors among the nursing students at Majmaah University. It is noteworthy that the nursing students obtained the highest score on both psychological and environment domain, while physical health was found to be the lowest among the four domains. This study supported the result conducted in the Philippines [17] where nursing students acquired a high score in the environment domain. However, the result in this study about the physical domain was contrary to the results conducted in Poland [18], Brazil [19], and others (Chile, Egypt, Greece, Hong Kong, India, Kenya, Oman, Saudi Arabia and United States of America) [20] where it was found that nursing students have a high score in physical domain. Thus, it is important to take note of the cultural, geographical, and educational system aspects with regards to the relationship of demographic factors in the QoL of the students.

Further, it is remarkable that no significant relationships were found in gender, distance from school, and the monthly allowance to the four domains of QoL. However, only the marital status obtained a significant association with the environment domain of QoL. There is a limited number of literature about student’s quality of life and its association with gender. However, this study supports some published studies that claim to have no significant association between gender and QoL [21-25]. There is a notable difference on how people responds to their social or cultural roles. This finding indicates the cultural acceptance of Saudi nationalities in their patriarchal society regardless of the privileges they possess regarding their gender. The school location away from home has been reported as a contributing factor to empower students and their social relationships [14]. The increased distance to the university, and the students living out of commuting distance is associated with lower attendance going to school [13,26]. However, it is interesting to note that although the majority of the students live far away from the university, this study established that distance has no significant association with their QoL. Due to the high prevalence of dangerous driving behaviors among Saudi Youths [27], it is vital that the safety concerns in the traffic danger must always be considered most especially to those who drive by themselves. Some studies revealed that students who have higher monthly allowance from their parents have reported a higher level of quality of life [14,28]. In this study, it is noteworthy that although the students are receiving the monthly allowance from the government aside from their parents, it attained no significant relationship to the QoL. This signifies that the students have the same level of quality of life regardless of the amount of money they received.

On the other hand, although a study found that married individuals had a greater satisfaction with life [28], this study established that marital status has no significant association to physical, psychological, and social domains of QoL. However, it acquired a significant relationship to the environment domain. Specifically, this study found that being married decreases the environment domain of QoL in nursing students. It is noteworthy that this finding is contrary to some studies that claim that single individuals are at risk for worse quality of life and poorer health [11-12]. Moreover, this study implies that married individuals have lesser advantages in terms of “financial resources, independence, safety and security, health and social care, home environment, opportunities for acquiring new information and skills, physical environment, and transport” [11] than single individuals, participation in and opportunities for recreation. Abundant considerations must be given to the married students in the universities in Saudi Arabia to encourage them to finish their degree despite the challenges they encounter in their married life.

The study was conducted in one university in Saudi Arabia using a purposive sampling and with a smaller sample size, thus, caution must be highly considered in the generalizability of its results with other universities. It is recommended that more studies must be accomplished in other universities to support the claims in this study.

Conclusion

In conclusion, gender, distance from school, and monthly allowance were found to have no significant association to the four domains of QoL. However, marital status was found to have a significant relationship to the QoL, but only with the environment domain. Those who are married have a decreased environment QoL than the single individuals.

The findings suggest that the administrators and faculty members should consider the various dimensions of quality of life of nursing students most especially in planning their extra-curricular and academic requirements to help them maximize their learning as well as to enhance their satisfaction. Moreover, the academic requirements must not overburden the students which can lead to lack of sleep and too much stress most especially for those who are married.

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