Introduction
According to the World Happiness Report 2022, the average happiness index for South Koreans was 5.94, ranking 59th out of 146 countries; it was 1.88 points below the first-ranked country, Finland [1]. However, early stages in the COVID-19 pandemic, the average happiness index for Korean university students was low, at 53.3 out of 100 [2]. Upon questioning about their current happiness, the most frequent response was ‘I don’t know exactly’ at 33.0%, followed by ‘I’m relatively happy’ (29.2%), ‘I’m relatively unhappy ' (22.9%), ‘I’m not at all happy’ (11.0%), and ‘I’m extremely happy’ (3.9%). Only about three in ten Korean university students considered their lives to be happy.
Before the COVID-19 pandemic, university students were already experiencing lower levels of happiness due to various factors such as the pressures of establishing a career path, academic demands, the transition from adolescence to adulthood, and peer pressure [3]. The happiness levels of university students further decreased due to changes in daily life caused by COVID-19, including reduced personal interactions with classmates and friends, and the interruption of academic and professional trajectories [4].
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During the COVID-19 pandemic, many countries around the world implemented various infectious disease prevention measures, such as quarantine, maintaining social distance, working from home, and wearing masks, to reduce stress and anxiety related to COVID-19. These measures aimed to create an environment conducive to economic, social, and political well-being [5], but they had more negative than positive effects on human happiness (e.g., deterioration in health, disruption of social relationships, decreased adaptability, financial worries) [6‐8].
Strong social lockdowns that were implemented beginning in the early 2020s shifted classes in nursing theory from face-to-face to distance learning, and transformed nursing practice fields from clinical and community settings to simulation and online systems [9, 10]. Nursing students, faced with restricted access to university facilities and reduced contact with peers and teachers, were compelled to adopt a remote education system while being granted increased autonomy, necessitating increased control over their learning process. However, the unprecedented and unanticipated shift to a remote education system resulted in a decline in academic adaptation among nursing students, compared to the pre-COVID-19 era, due to a lack of motivation, and decrease in attention, in effort, and in time investment in learning [8, 11, 12]. Nursing students faced problems issues in adapting to university life, including personal emotional adjustment, social adaptation, and institutional attachment. These adaptations are necessary to meet the various educational demands that arise from university expectations [13].
Leisure activities are critically important in protecting against the negative effects of the COVID-19 pandemic [14]. However, due to the continuous remote education system during the pandemic, college students’ leisure activities decreased [14]. Nursing students were more anxious about others becoming infected with COVID-19 than about themselves becoming infected with it, and therefore intentionally chose self-quarantine, avoided direct contact with friends and family, and sometimes sought temporary living arrangements alone, thereby detaching themselves from support systems offered by family, friends, or colleagues [9, 15]. Social lockdowns implemented to prevent COVID-19 further limited nursing students’ the social relationships, which are often cultivated by engaging in leisure activities [16, 17].
During the COVID-19 pandemic, information collected from families was important in collecting knowledge about the disease and its risks [13]. Strong social lockdown measures implemented to prevent the spread of the COVID-19 pandemic forced nursing students to undertake online learning at home and to have limited interpersonal interactions with their family members [5]. In this changed home environment, nursing students often encounter conflicts, such as arguments, in maintaining a balance of power with other family members working online [18]. However, the happiness of nursing students increases as their emotional relationships with their family members improve [19].
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Happiness is conceptualized as an subject’s cognitive and emotional evaluation of their life [20]. People who experience happiness and satisfaction are likely to have greater self-discipline, self-regulation and coping abilities, which empower them to positively navigate their lives, even during crisis situations like the COVID-19 pandemic [19]. Throughout the COVID-19 pandemic, key factors that can reduce happiness have been identified; they include the degree of mobility restriction due to isolation and social-distancing measures, the perceived threat to interpersonal relationships such as love and friendship, concerns regarding educational pursuits and employment, the dynamics of remote work and returning to the office, and overall satisfaction with domestic life [21, 22]. The ‘upward approach’ within happiness diffusion theory posits that overall life satisfaction and happiness are influenced by accumulating satisfaction in subject sub-factors that affect happiness. These sub-factors include health, income, leisure, family, academics, and occupation [20].
This research aims to provide foundational data for developing intervention programs to increase the happiness of Korean nursing students during the COVID-19 endemic era. The first step is to distinguish between nursing students who had been infected with COVID-19 (COVID+ students) or had not been infected by COVID-19 (COVID0 students). The second was to explore how their overall happiness was affected by subject happiness sub-factors, such as college life adaption, leisure satisfaction from club activities, and family strengths. The hypotheses of this study are as follows.
Hypothesis 1
College life adaptation affects the happiness of both COVID+ and COVID0 nursing students.
Hypothesis 2
Leisure satisfaction from club activities affect the happiness of both COVID+ and COVID0 students.
Hypothesis 3
Family strengths affects the happiness of both COVID+ and COVID0 nursing students.
Methods
Research design
This a descriptive survey study that utilized a self-reported questionnaire method. It is based on the upward approach within the theory of happiness diffusion as described by Diener [20]. The aim is to determine the impact of college life adaptation, leisure satisfaction from club activities, and family strengths on the happiness of South Korean nursing students during the COVID-19 endemic era. This study analyzes the differences in college life adaptation, leisure satisfaction, family strengths, and happiness depending on the presence or absence of COVID-19 infection. In addition, this study compares and analyzes how factors affecting happiness differ depending on whether there is infection or not.
Research participants
Participants were convenience sampled from five nursing departments in South Korean cities D, G, K, and Y. To ensure sufficient statistical power, the G*Power 3.1 program was used. The study required a minimum convenience sample size of 152 participants, considering a significance level (α) of 0.05, a power (1-β) of 0.90, an effect size of 0.15, and the incorporation of 11 independent variables. To meet this requirement, 370 questionnaires were distributed, accounting for non-response rates and unreliable responses. Of the responses received, 27 were discarded due to a high number of non-responses or insincere answers, leaving a final sample size of 343 participants (180 COVID+, 163 COVID0).
The specific selection criteria for the study were as follows. (1) Common Criteria: Participants were third and fourth-year nursing students who had experienced more than one year (more than three times per week) of remote learning between March 2020 and December 2022 due to the COVID-19 pandemic, and who had actively participated in club activities for more than six months (at least twice a month) within the past year. (2) COVID+ Participants: Subjects who received a positive COVID-19 diagnosis from a health center or hospital after the outbreak and had an experience of isolation, as well as those whose infection was confirmed by an official notification or message from a health center or hospital. (3) COVID0 Participants: Those who have not received a positive COVID-19 diagnosis from a health center or hospital since the outbreak of COVID-19.
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Research tools
College life adaptation
This study used a tool specifically developed for nursing college students by Park and Kim [23]. It is composed of 34 items in six subscales: nine items for interpersonal relations, nine items for major satisfaction, five items for major ease, five items for coping capacity, three items for job preparation, and three items for academic fidelity. Each item is rated on a 5-point Likert scale, starting from 1 point, where negative items are reverse-scored, so a high score corresponds to good overall adaptation to university life. In this study, the instrument had Cronbach’s α = 0.91.
Leisure satisfaction from club activities
This study used the Leisure Satisfaction Scale (LSS), developed by Beard and Ragheb [24] and validated for reliability and validity by Kim et al. [25]. This scale consists of 24 items in six subscales: psychological, educational, social, relaxation, physical, and aesthetic. Each item is rated on a 5-point Likert scale from 1 = ‘Not at all,’ to 5 = ‘Very much so,’ so a high total score signifies high leisure satisfaction. In this study, the scale had Cronbach’s α = 0.97.
Family strengths
This study used the Korea Family Strengths Scale (KFSS-II), developed by Yoo et al. [26]. This scale consists of five sub-areas: family resilience, mutual respect and acceptance, quality of bonding, economic stability and cooperation, and family culture and social participation, totaling 22 items. Each item is scored on a 5-point Likert scale from 1 = ‘Not at all’ to 5 = ‘Very much so’ 5, so a high total score indicates high family strengths. In this study, the scale had Cronbach’s α = 0.96.
Happiness
This study used the shortened Korean version of the happiness scale developed by Suh and Koo [27]. This scale consists of nine items across three core sub-factors of happiness experience: life satisfaction, positive emotions, and negative emotions. Life satisfaction assesses satisfaction with personal aspects, interpersonal relationships, and group belonging. Positive emotions and negative quantify emotions closely related to happiness. Each item is rated on a 7-point Likert scale, from 1 to 7, with happiness increasing with score. In this study, this scale had Cronbach’s α = 0.90.
Data collection
Data were collected from October 4, 2023, to November 15, 2023, as per approved guidelines. The researchers visited five nursing departments in major South Korean cities (D, G, K, and Y cities). They explained the study’s purpose and methodology to the department heads, secured their permission and cooperation for the research, and posted a recruitment announcement for participants. Subjects selected through the recruitment process were given detailed explanations by the researchers about the study’s purpose, anonymity, and confidentiality. The participants gave written consent for voluntary participation, completed the questionnaire, which the researchers later collected. For participants who reported a history of COVID-19 infection, the notification document or text message received from a health center or hospital was verified.
Data analysis
The collected data were analyzed using the SPSS/WIN 23.0 software program. The distributions of general characteristics of the subjects were presented as frequencies and percentages. Differences in happiness according to the subjects’ general characteristics were compared using t-tests and one-way ANOVA. The levels of college life adaptation, leisure satisfaction from club activities, family strengths, and happiness were reported as average and standard deviation. The correlation between happiness and related variables was examined using Pearson’s correlation coefficients. The assumptions for regression analysis of the independent variables were diagnosed considering multicollinearity, residuals, and singular values. Multiple linear regression analysis was conducted to identify factors that influence happiness.
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Ethical considerations
This study was approved by the Kwangju Women’s University Institutional Review Board (IRB NO.1041465-202308-HR-001-30). The survey questionnaire incorporated detailed explanations about the necessity and purpose of the study, research method, estimated time commitment, the possibility of withdrawal during the study, voluntary participation, potential benefits and disadvantages of participating, as well as the management and confidentiality of personal information. Contact information for the researchers was also provided for any inquiries related to the study. The survey was administered only to those who understood and consented to these terms, and their responses were included in the analysis. Participants were assured that the survey results would be quantified, processed, and used exclusively for the purposes of this research, that their anonymity would be preserved, and that they could opt out of the survey at any point without facing any negative consequences. Following these explanations, written consent was obtained from the students who agreed to participate. They then individually completed the questionnaires, which were collected directly by the research team.
Results
Demographic differences in happiness among participants how had been or had not been infected with COVID-19
Most subjects (291) were women; of them, 159 (88.3%) were COVID+ and 132 (81.0%) were COVID0. The average happiness score was 5.16 (± 1.16) for COVID+ subjects and 5.23 (± 1.10) for COVID0 subjects; both scores were higher among men than among women, but the differences were not statistically significant.
Most of COVID+ subjects (94 subjects, 52.2%) were participants were 4th -year students, whereas most of the COVID0 subjects were 3rd -year students (98 subjects, 60.1%). The average happiness score was higher for 3rd -year students, than for 4th -years students: 5.11 (± 0.99) for COVID+ and 5.06 (± 1.01) for COVID0, but these differences were not statistically significant.
Most participants came from nuclear families: 157 (87.2%) of COVID+ and 142 (87.1%) of COVID0 subjects. The average happiness score was higher for those in nuclear families among the COVID+ (5.02 ± 1.04) and in extended families among the COVID0 (5.42 ± 0.63), but the differences were not statistically significant.
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Most participants had one sibling: 90 (50.0%) of COVID+ and 90 (55.2%) of COVID0 subjects. The highest average happiness scores were for those with no siblings among the COVID+ (5.18 ± 0.97) and those with one sibling among the COVID0 (5.15 ± 0.90), but the differences were not statistically significant.
Most participants reported having no religious affiliation: 120 (66.7%) of COVID+ and 114 (69.9%) of COVID0. The average happiness score was slightly higher among those with no religious affiliation than among those who claimed an affiliation, i.e., 5.00 (± 1.06) for COVID+ and 5.01 (± 0.96) for the COVID0, but the differences were not statistically significant.
Most of both groups were members of one club: 115 (63.9%) of COVID+ and 113 (69.3%) of COVID0. The average happiness score was highest for those in one club among the COVID+, at 5.00 (± 1.02), and in four clubs among the COVID+, at 5.83 (± 0.88), but these differences were not statistically significant.
Most participants belonged to the ‘medium’ economic category: 149 (82.8%) of COVID+ and 130 (79.8%) of COVID0. The average happiness score was highest for those in the ‘high’ economic category; i.e., 5.58 (± 1.01) for the COVID+ and 5.39 (± 1.08) for the COVID0. As a result of One-Way ANOVA verification, there was a statistically significant difference (F = 5.640, p = 0.004).
Most participants self-evaluated their health status, as ‘good’; i.e., 107 (59.4%) of COVID+ and 100 (61.3%) COVID0. The average happiness score was highest among those who rated their health as ‘good’; i.e., 5.24 (± 0.99) for COVID+ and 5.22 (± 0.89) for the COVID0. As a result of One-Way ANOVA verification, there was a statistically significant difference (F = 11.801, p < 0.001) (Table 1).
Table 1
Nursing students’ happiness according to demographic characteristics (N = 343)
Characteristics | Category | Infected (n = 180) | Non-Infected (n = 163) | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | M | SD | t/F | p | n | % | M | SD | t/F | p | |||
Sex | Male | 21 | 11.7 | 5.16 | 1.16 | 0.920 | 0.359 | 31 | 19.0 | 5.23 | 1.10 | 1.524 | 0.129 | |
Female | 159 | 88.3 | 4.94 | 1.05 | 132 | 81.0 | 4.94 | 0.92 | ||||||
College year | 3rd | 86 | 47.8 | 5.11 | 0.99 | 1.808 | 0.072 | 98 | 60.1 | 5.06 | 1.01 | 1.063 | 0.289 | |
4th | 94 | 52.2 | 4.83 | 1.11 | 65 | 39.9 | 4.90 | 0.89 | ||||||
Family type | Nuclear families | 157 | 87.2 | 5.02 | 1.04 | 1.973 | 0.120 | 142 | 87.1 | 4.99 | 0.98 | 0.757 | 0.520 | |
Single-parent families | 13 | 7.2 | 4.40 | 1.24 | 10 | 6.1 | 4.90 | 0.78 | ||||||
Extended families | 8 | 4.4 | 4.96 | 0.91 | 8 | 4.9 | 5.42 | 0.63 | ||||||
Etc | 2 | 1.1 | 4.00 | 1.26 | 3 | 1.8 | 4.56 | 1.53 | ||||||
Number of siblings | None | 17 | 9.4 | 5.18 | 0.97 | 0.842 | 0.472 | 15 | 9.2 | 4.86 | 0.88 | 1.929 | 0.127 | |
One | 90 | 50.0 | 5.03 | 1.01 | 90 | 55.2 | 5.15 | 0.90 | ||||||
Two | 46 | 25.6 | 4.78 | 1.16 | 48 | 29.4 | 4.81 | 1.02 | ||||||
3 or more | 27 | 15.0 | 4.93 | 1.10 | 10 | 6.1 | 4.64 | 1.18 | ||||||
Religion | Yes | 60 | 33.3 | 4.90 | 1.07 | -0.591 | 0.555 | 49 | 30.1 | 4.96 | 0.96 | -0.302 | 0.763 | |
No | 120 | 66.7 | 5.00 | 1.06 | 114 | 69.9 | 5.01 | 0.96 | ||||||
Number of club registrations | One | 115 | 63.9 | 5.00 | 1.02 | 0.213 | 0.808 | 113 | 69.3 | 4.99 | 0.92 | 1.558 | 0.202 | |
Two | 57 | 31.7 | 4.92 | 1.13 | 43 | 26.4 | 4.89 | 1.03 | ||||||
Three | 8 | 4.4 | 4.79 | 1.07 | 4 | 2.5 | 5.83 | 0.88 | ||||||
4 or more | 0 | 0.0 | - | 3 | 1.8 | 5.56 | 1.28 | |||||||
Household economic level | Higha | 23 | 12.8 | 5.58 | 1.01 | 5.862 | 0.003 c < a | 26 | 16.0 | 5.39 | 1.08 | 5.640 | 0.004 c < ba | |
Mediumb | 149 | 82.8 | 4.90 | 1.03 | 130 | 79.8 | 4.96 | 0.87 | ||||||
Lowc | 8 | 4.4 | 4.33 | 1.20 | 7 | 4.3 | 4.10 | 1.40 | ||||||
Subjective health status | Gooda | 107 | 59.4 | 5.24 | 0.99 | 11.097 | < 0.001 c < a | 100 | 61.3 | 5.22 | 0.89 | 11.801 | < 0.001 c < ba | |
Normalb | 65 | 36.1 | 4.62 | 1.06 | 58 | 35.6 | 4.73 | 0.91 | ||||||
Badc | 8 | 4.4 | 4.06 | 0.57 | 5 | 3.1 | 3.58 | 1.01 | ||||||
Adaptation to college life, leisure satisfaction, family strengths, and happiness in relation to COVID-19 infection status
Happiness scores were 3.55 ± 0.52 for the COVID+ group and 3.52 ± 0.47 for the COVID+ group. Regarding adaptation to college life, scores were 3.58 ± 0.67 for the COVID+ and 3.49 ± 0.84 for the COVID0. In terms of leisure satisfaction, the scores were 4.12 ± 0.69 for the COVID+ and 4.06 ± 0.67 for the COVID0. For family strengths, the COVID+ group scored 4.96 ± 1.06, whereas the COVID0 group scored 4.99 ± 0.96. As a result of t-test testing according to the presence or absence of infection, there was no statistically significant difference in all variables (Table 2).
Table 2
Nursing students’ happiness, college life adaption, leisure satisfaction from club activities, family strengths (N = 343)
Variable | Infected (n = 180) | Non-Infected (n = 163) | t | p | ||
|---|---|---|---|---|---|---|
M | SD | M | SD | |||
Nursing student happiness | 3.55 | 0.52 | 3.52 | 0.47 | -0.524 | 0.600 |
College life adaption | 3.58 | 0.67 | 3.49 | 0.84 | -1.099 | 0.272 |
Leisure satisfaction | 4.12 | 0.69 | 4.06 | 0.67 | -0.808 | 0.420 |
Family Strengths | 4.96 | 1.06 | 4.99 | 0.96 | 0.271 | 0.787 |
Correlation among study variables
The results of testing “Pearson Correlation” to determine the correlation between research variables are as follows. Among the COVID+ students, happiness showed a significant positive correlation with college life adaptation (r = 0.598, p < 0.001), leisure satisfaction (r = 0.345, p < 0.001), and family strengths (r = 0.387, p < 0.001). In the COVID0 group, happiness also showed a significant positive correlation with college life adaption (r = 0.568, p < 0.001), leisure satisfaction (r = 0.262, p < 0.001), and family strengths (r = 0.331, p < 0.001) (Table 3).
Table 3
Correlation between study variables (N = 343)
Variable | Nursing student happiness | |||
|---|---|---|---|---|
Infected (n = 180) | Non-Infected (n = 163) | |||
r | p | r | p | |
College life adaption | 0.598 | < 0.001 | 0.568 | < 0.001 |
Leisure satisfaction | 0.345 | < 0.001 | 0.262 | < 0.001 |
Family Strengths | 0.387 | < 0.001 | 0.331 | < 0.001 |
Nursing student happiness | 1 | 1 | ||
Factors that influenced happiness
Multiple linear regression was conducted to identify factors that influenced the happiness of the participants. In order to find out the influencing factors on the subject’s happiness, adaptation to college life, leisure satisfaction, and family strengths were input, and additionally, variables with statistically significant results(subjective health status, household economic level) among general characteristics were input step by step. For COVID+ subjects, the regression model for happiness was significant (F = 24.970, p < 0.001), with college life adaptation (b = 0.462, p = 0.001) and family strengths (b = 0.148, p = 0.025) having significant effects on happiness. These variables explained 40.1% of happiness. For COVID0 subjects, the regression model for happiness was also significant (F = 18.177, p < 0.001), with college life adaptation (b = 0.456, p = 0.001) and subjective health status (b = 0.165, p = 0.016) having significant effects on happiness. These variables explained 34.6% of happiness. Therefore, the research results according to the hypothesis are as follows.
Hypothesis 1
Adaptation to college life affected the happiness of infected nursing students (β = 0.462, p = 0.001) and non-infected nursing students (β = 0.456, p = 0.001), so hypothesis 1 was supported.
Hypothesis 2
Leisure satisfaction from club activities does not affect the happiness of infected nursing students (β = 0.083, p = 0.199) and non-infected nursing students (β = 0.014, p = 0.846), so hypothesis 2 is rejected.
Hypothesis 3
Family strengths only affected the happiness of infected nursing students (β = 0.148, p = 0.025), so hypothesis 3 was partially supported.
Regarding the fit of this regression model, the multicollinearity was checked by referring to tolerance limits, which were between 0.731 and 0.880 for COVID+ subjects and between 0.681 and 0.883 for COVID0 subjects; all of these values exceeded the threshold of 0.1. The Variance Inflation Factors (VIF) for COVID+ subjects ranged from 1.136 to 1.368 and from 1.133 to 1.469 for COVID0 subjects; these values were all below the threshold of 10. The Durbin-Watson test for residual normality in the model yielded values of 1.661 for COVID+ subjects and 2.093 for COVID0 subjects; these results indicate no autocorrelation in the residuals (Table 4).
Table 4
Factors affecting the happiness of nursing students (N = 343)
Variable | B | SE | β | t | p |
|---|---|---|---|---|---|
Infected (n = 180) | |||||
(Constant) | -0.679 | 0.536 | - | -1.267 | 0.207 |
Household economic level | 0.155 | 0.160 | 0.060 | 0.966 | 0.335 |
Subjective health status | 0.222 | 0.114 | 0.122 | 1.940 | 0.054 |
College life adaption | 0.944 | 0.138 | 0.462 | 6.827 | 0.000 |
Leisure satisfaction | 0.130 | 0.101 | 0.083 | 1.290 | 0.199 |
Family Strengths | 0.228 | 0.101 | 0.148 | 2.257 | 0.025 |
Durbin-Watson = 1.661, Tolerance Limit = 0.731 ~ 0.880, VIF = 1.136 ~ 1.368, R²=0.418, Adjusted R²=0.401, F = 24.970, p < 0.001 | |||||
Variable | B | SE | β | t | p |
Non-Infected (n = 163) | |||||
(Constant) | 0.088 | 0.537 | - | 0.165 | 0.869 |
Household economic level | 0.087 | 0.153 | 0.040 | 0.568 | 0.571 |
Subjective health status | 0.286 | 0.117 | 0.165 | 2.436 | 0.016 |
College life adaption | 0.926 | 0.156 | 0.456 | 5.927 | 0.000 |
Leisure satisfaction | 0.016 | 0.081 | 0.014 | 0.194 | 0.846 |
Family Strengths | 0.164 | 0.102 | 0.115 | 1.608 | 0.110 |
Durbin-Watson = 2.093, Tolerance Limit = 0.681 ~ 0.883, VIF = 1.133 ~ 1.469, R²=0.367, Adjusted R²=0.346, F = 18.177, p < 0.001 | |||||
Discussion
COVID-19 has been associated with an increase in negative emotions such as anxiety and depression among college students, particularly during their critical period of transition to adulthood and exploration. This increase in negative emotions contributes to a decrease in their overall happiness levels [6]. This study examined the effect of COVID-19 infection on the happiness of Korean nursing students.
This analysis revealed that college life adaptation had the most significant effect on happiness among both COVID+ and COVID0 nursing students. College life adaptation is a specific form of social adaptation, and involves the process by which students adjust their behaviors and thoughts in response to the new environment of the college campus, encompassing living, studying, and social interactions [28]. The COVID-19 outbreak on university campuses was rapid and extensive, and these factors raised concerns about its potential to quickly spread to other communities [9].
Nationally-implemented social containment policies for intercepting and preventing the spread of COVID-19 necessitated a shift from face-to-face academic classes and nursing practices to remote, online learning environments for nursing students [9, 10]. Even before the COVID-19 pandemic, college students had already embraced a culture in which remote support systems using the internet, computers, and smartphones facilitated convenience in learning and daily life [28]. During the COVID-19 pandemic, most university-life activities shifted to online modes, and this transition to remote learning systems continues even in the era of COVID-19 becoming endemic.
Nursing students, regardless of their COVID-19 infection status, relied on non-face-to-face university activities while adhering to national prevention guidelines such as avoiding direct contact, due to their heightened anxiety about infection among family and friends [9, 15]. Excessive online activity can reduce an subject’s ability to regulate emotions, and may thereby lead to depression, suicidal thoughts, academic failure, and social isolation [29].
Attending university entails an increase in freedom of choice and independence from parental supervision [28]. However, nursing students experienced increased psychological distress due to worries about the duration of the COVID-19 pandemic, the uncertainty of returning to normal life, loneliness from isolation, anxiety about limited clinical practice opportunities, and future uncertainties [30]. All of the subjects, both COVID+ and COVID0 realized the importance and necessity of face-to-face interactions in campus life, learning, and social engagement while adhering to long-term infection prevention lifestyle rules.
During the change of COVID-19 from the epidemic to the endemic phase, the academic classes, clinical practice, and other campus activities of nursing education have changed from remote formats back to in-person formats [31]. All of these nursing students, both COVID+ and COVID0, have reinterpreted the current situation as an opportunity for professional growth as nurses [31, 32]. This reevaluation may explain why adaptation to university life significantly affects their happiness. Therefore, to increase the happiness of nursing students, programs must be developed and implemented that aid in job preparation, improve interpersonal relationships, and enhance problem-solving skills, along with regular academic classes and clinical practices, as part of college life adaption.
For COVID+ students, family strengths also influenced their happiness. During COVID-19, nursing students experienced elevated levels of negative emotions like anxiety and depression, especially when dealing with family illness or death, economic struggles due to the breadwinner’s job loss, or conflicts with parents and siblings while staying at home for extended periods [33]. Specifically, COVID+ nursing students experienced anxiety and depression due to uncertainties about infecting other family members, threats to their own and their family’s health, and fears about the challenges of recovery [7, 34].
Negative emotions persisted among 30–40% of COVID+ students, even more than a month after their recovery [7]. During their COVID-19 infection, the primary source of care and concern often came from their own family, rather than others sources. Although direct contact was not possible, family members frequently visited to check on their condition, prayed for their speedy recovery, and provided food and necessary supplies. This unconditional acceptance and support from family members helped to inspire and motivate the participants to recover from COVID-19. Moreover, active family support also helped COVID+ nursing students to positively embrace the healing process. This support strengthened their immune system and reduced feelings of anxiety and depression, and thus promoted health and wellness [35, 36]. These factors indicate that family involvement in the process of recovery from COVID-19 infection assists the infected in resolving problems, and expedites the treatment process.
For COVID+ nursing students, the support and encouragement received from their families were instrumental in overcoming various discomforts and challenges encountered during the recovery process. Consequently, family strengths emerged as a significant factor influencing their happiness. The family is the most essential source of social support and provides support to its members in forms such as emotional, instrumental, informational, and reward support [36]. Hence, to boost the happiness of COVID+ nursing students, interaction-enhancing programs for their families must be developed. Additionally, health-promotion programs that increase knowledge, attitudes, and practices concerning infectious diseases should be implemented to sustain family strengths consistently.
For COVID0 nursing students, subjective health status was another influential factor on their happiness. Subjective health status is the self-perceived assessment of one’s overall health condition as good [37]. During the COVID-19 pandemic, COVID0 nursing students shared similar fears as their infected peers, including the fear of contracting the virus, the fear of close contacts becoming infected, and uncertainties about the future [34, 38]. Subjective health status helps to alleviate various stresses caused by COVID-19 and to increase a person’s ability to manage personal health threats [39, 40]. Increase in an subject’s subjective health status is correlated with a decrease in their subjective perception the risk of contracting COVID-19. This reduction in perceived risk leads to decreased negative emotions related to COVID-19, such as feelings of isolation, loneliness, fear, anxiety, and depression. In short, a high subjective health status causes reduction in perception of the risk of contracting COVID-19, and helps a person to maintain positive emotions in their daily life. In contrast, subjects with poor subjective evaluation of health may feel threatened by the risk of COVID-19 infection, and therefore adhere more strictly to preventive measures like wearing masks and limiting outdoor activities, than people who have high subjective evaluation of health [39].
During the endemic phase of COVID-19, COVID0 nursing students are concerned about the possibility of eventually contracting COVID-19 as daily life transitions from remote to face-to-face interactions, despite the continued presence of the virus [41]. This concern highlights the importance of subjective health status as an influencing factor on their happiness. Therefore, for to increase the happiness of COVID0 nursing students, health care education programs that are aimed at improving their health status should be developed.
Implications
This research has explored the factors affecting the happiness of nursing students in relation to their COVID-19 infection status. Many studies in social sciences have investigated psychological factors linked to the COVID-19 context [12, 21, 28]. However, this study suggests that infection should precede the development of happiness promotion programs based on college life adaptation, leisure satisfaction from club activities, and family health, which are the upward factors of happiness in the COVID-19 endemics era. This differentiation is crucial because psychological responses vary depending on infection status, a concept supported by previous research [42], which found that sensitivity to COVID-19 as a disease can aid in explaining the assessment of stress overload. Therefore, this study seeks to explore the factors influencing the happiness of nursing students depending on the presence or absence of infection. Unlike previous studies, this study is recommended as a differentiated study in that it contributed to providing basic data for developing a program to improve the happiness of nursing students depending on the presence or absence of infection.
In addition, it is necessary to apply and develop the factors that were found to be significant in the results of this study in various ways in practice to find ways to increase the happiness of nurses and improve their work performance after employment. Furthermore, at a policy level, it will be necessary to provide continuous mentoring and counseling programs centered on university counseling centers to help nursing students maintain a happy college life.
Limitations
Firstly, this research involved convenience sampling from five nursing departments in D, G, K, and Y cities. Consequently, these findings may not be applicable to all nursing students across different regions in Korea. To increase generalizability, future research should consider nursing students in various locations to enhance generalizability population density and urban scale. Secondly, the study focused only on college life adaptation, leisure satisfaction, and family strengths as factors affecting nursing students’ happiness; restriction of the analysis to a few aspects may miss out on a multifaceted examination of happiness. Future studies should explore a wider range of factors that may positively influence nursing students’ happiness, than this study considered. Lastly, the use of quantitative research in this study may not sufficiently examine nursing students’ happiness. Future research should employ qualitative methods to explore the practical significance of happiness in nursing students’ experiences.
Conclusion
As a result of this study, adaptation to college life was confirmed to be a factor that affects happiness in both infected and non-infected people. However, the important difference was that family strengths were confirmed as a factor affecting happiness in the case of infected people, and subjective health status was confirmed as a factor affecting happiness in the case of uninfected people. Various activities (quarantine measures, social distancing, working from home, wearing masks, etc.) to prevent the spread of COVID-19 had a negative effect rather than a positive effect on human happiness, and the intensity of application varied depending on the presence or absence of COVID-19 infection [5‐8]. This research has contributed foundational data for the development of happiness enhancement programs for nursing students in the COVID-19 endemic era, by discerning the factors influencing their happiness relative to their COVID-19 infection status. In developing happiness-enhancement programs for nursing students during the COVID-19 endemic era, focus should be placed on college life adaptation. Additionally, for COVID+ nursing students, the emphasis should be on family strengths, whereas for COVID0 nursing students, the focus should be on their health status. Nursing students must be guided in implementing these aspects into their practices.
Acknowledgements
We extend our gratitude to the nurses students participating in the study for their support and cooperation.
Declarations
Ethics approval and consent to participate
The research proposal was approved by the Ethics Committee of Kwangju Women’s University (code: 1041465-202308-HR-001-30), and informed consent was obtained from participants. All procedures were carried out in accordance with the 1964 Helsinki declaration.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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