Research Article

Relationship between life satisfaction and quality of life in

Turkish nursing school students
Yasemin Yildirim, PhD, RN,
1
Serap Parlar Kilic, PhD, RN
2
and Asiye Durmaz Akyol, PhD, RN
1
1
Department of Internal Medicine Nursing, Ege University of Nursing Faculty, Izmir, Bornova, and
2
Department of
Internal Medicine Nursing, Gaziantep University of Health Sciences, Gaziantep, Turkey
Abstract The aim of this study was to evaluate the relationship between life satisfaction and quality of life of nursing
students. This descriptive and cross-sectional study was conducted with a research population of 396 nursing
students who received education at a school of nursing. The research data were collected between May and
June of the 20072008 academic year. The data collection tools included Student Description Form,
Life Satisfaction Scale, and WHOQOL-BREF (TR) Quality of Life (QOL) Scale. The mean score of life
satisfaction was 22.90 5.74. Participants QOL mean scores were 67.16 15.29 in the physical domain,
64.33 14.72 in the psychological domain, 62.81 19.12 in the social relationships domain, and 60.59 12.59
in the environmental domain. There was a signicant correlation between life satisfaction and the four main
domains of quality of life scores (P < 0.05) and that there was a signicant positive correlation between life
satisfaction and quality of life among nursing students. In addition, it was determined that being a nursing
student had a positive effect on students life satisfaction and quality of life. Therefore, the education system
is recommended to be redesigned in such a way as to make students more active and to improve their life
satisfaction and quality of life.
Key words life satisfaction, nursing education, nursing student, quality of life, Turkey.
INTRODUCTION
Being successful at the university entrance exam one of the
most crucial steps in students lives in Turkey is getting
more and more difcult every year, and the more difcult it
becomes, the higher its economic cost is. Yet, once students
start their university education, they mostly feel unsatised
regarding their expectations about university life or their
department (Tmkaya et al., 2008). One of most the critical
periods in youth is the university period, which is known to
be a dynamic transition period that functions as a bridge
between childhood and adulthood. In this period of physical,
psychological, social and sexual development, young people
gradually assume responsibility for their own health (Lee &
Loke, 2005). In addition to these developmental changes and
new-found responsibilities, university students have greater
autonomy and control over their lifestyles than other adoles-
cents (Dinger & Waigandt, 1997; Can et al., 2008). Starting
higher education gives an individual condence and respon-
sibility. In this transition period, a young individual takes
more responsibility in controlling his/her own life and
making effective decisions about his/her future, improves his/
her ability to think independently, and gains condence in
solving his/her problems (Sertbas et al., 2004). In this transi-
tion period, academic pressures, peer pressure, challenges in
relationships, being away from home, cultural differences in
malefemale relationships and nancial concerns have been
identied as common stressors among university students
(Bhandari, 2012). All these problems pose a threat for stu-
dents in fullling their needs, such as belonging to a group,
receiving respect and love, and recognizing their identity and
self value.
Nursing students face some other stressors that affect
their quality of life (Chan et al., 2011): (i) feeling unpre-
pared for clinical practice; and (ii) feeling incompetent
regarding clinical skills. Main sources of stress are related to
placement. Some of these are common to those reported by
practicing nurses, such as the challenge of working with
dying patients, conicts with other staff members, feelings of
insecurity about clinical competence, interpersonal prob-
lems with patients, and work overload (Gibbons et al.,
2011). They go through clinical practice, regular clinical and
educational assessment, and have to work in frequently
changing clinical environments (Watson et al., 2008).
Nursing students are also supposed to handle dispensing
and drug administration, and take responsibilities for
patients health and safety (Muro et al., 2002). With respect
to the workload, nursing students also experience longer
hours of study and lack of free time (Gibbons et al., 2011).
Correspondence address: Serap Parlar Klc, Department of Internal Medicine
Nursing Sehitkamil, Faculty of Health Sciences, Gaziantep University, Gaziantep,
Turkey. Email: serap.parlar@mynet.com
Received 27 February 2012; revision received 27 November 2012; accepted 6 Decem-
ber 2012.
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Nursing and Health Sciences (2013), 15, 415422
2013 Wiley Publishing Asia Pty Ltd. doi: 10.1111/nhs.12029
Since nursing is a health-oriented profession, life satisfac-
tion and quality of life (QOL) levels of the individuals who
perform this profession should be high.
Quality of life and life satisfaction are considered to be
related to attaining a healthy and productive lifestyle (Anand
& Arora, 2009). Quality of life is often equated with life
satisfaction in psychology and psychiatry and to a lesser
extent in general medicine (Zullig et al., 2001). Satisfaction
with ones life implies contentment or acceptance of ones
life circumstances or the fulllment of ones wants and needs
for ones life as a whole. Life satisfaction is a subjective and
cognitive assessment of the quality of ones life and has been
conceptualized as a key indicator of well-being (Anand &
Arora, 2009; Paschali & Tsitsas, 2010). Life satisfaction is
described as a cognitively oriented, subjective judgment of
ones current life situation in relation to ones own expecta-
tions (Anand & Arora, 2009). A single measure of happiness
or life satisfaction could describe, in general, how life is
good for an individual (Veenhoven, 1995; Suhonen, 2005).
Life satisfaction involves an aspect of judgement, whereby
individuals evaluate the quality of their lives based on par-
ticular criteria (Pavot & Diener, 1993).
Quality of life, a concept related to life satisfaction, is simi-
larly regarded as a general and constant state of well-being
(Zullig et al., 2005). Dened as a persons perception of his/
her physical and mental health, QOL covers broad domains
including physical, psychological, economical, spiritual, and
social well-being (Wong et al., 2001). A group of researchers
from the World Health Organization dened the quality of
life as the individuals perception of his/her position in life
within his/her cultural context and value systems, related to
his/her objectives, expectations, standards and social relation-
ships (World Health Organization, 1998, pp. 551558).
Research shows that subjective well-being and quality of
life are positively related to mental and physical health, job
performance, school life, interpersonal relationships and mar-
riage (Sirgy et al., 2006). It is reported in many studies that
several factors such as age, gender, religion, stress, physical
health status, parents behavior, availability of social support,
cultural background, character properties, and education-
related variables have a role in life satisfaction and QOL
(Seibel & Johnson, 2001; Tulsky & Rosenthal, 2003; Chow,
2005; S ener et al., 2007; Bhandari, 2012). Knowing these
factors and improving life satisfaction and QOL are impor-
tant for students to exhibit behavior to protect and improve
their health (Ozer & Karabulut, 2003).
In recent years, studies have been performed in our
country on life satisfaction and QOL of students. While some
of these studies have evaluated life satisfaction of university
students (Baykal et al., 2005; Deniz, 2006; Kaynar et al., 2006;
Gndog ar et al., 2007; Dilma & Eksi, 2008), others have
focused on their QOL (Dall et al., 2000; Akakanat et al.,
2011). Although there are a few studies on life satisfaction
and QOL of university students, no studies have been con-
ducted to examine the interrelationship between the life sat-
isfaction and QOL among nursing students, particularly in
Turkey. It is expected that this study will provide some ben-
ets in order to take measures to increase life satisfaction and
QOL of nursing students.
Therefore, the aim of this study was to evaluate the rela-
tionship between life satisfaction and QOL of the nursing
students in Turkey.
MATERIALS AND METHODS
Design and sample
A descriptive design was used in this study, which was carried
out at Ege University School of Nursing (EUSN) in Izmir,
Turkey. Ege University, the largest university in western
Turkey, was founded in 1955 and the rst faculties under the
umbrella of Ege University were the Faculty of Medicine,
School of Nursing and the Faculty of Agriculture. The EUSN
was the rst nursing school founded in Turkey. Every year,
180200 students are admitted to the school based on the
scores that students obtain from the University Entrance
Exam organized by the Higher Education Council.
The total number of students who registered for the EUSN
in the year of this research was 610. The EUSN had pursued
a conventional education program since its foundation, but
adopted an integrated educational approach only in the
20052006 academic year. Therefore, at the time when the
research was conducted, of the nursing students included in
the study, some received education in the conventional
system while others received it in the integrated system. The
rst, second, and third-year students were receiving inte-
grated education, while the fourth year students were receiv-
ing education in the conventional system. At the end of their
four years of education the students graduate with a bacca-
laureate degree.
The research data were collected in May and June of the
20072008 academic year. In this study, sampling was not
used and the research population comprised of all students.
However, 64 students were absent, 67 did not want to partici-
pate in the study, and 83 did not complete the study forms.
Thus, the study was completed with 396 students.
Instruments
In the research, a Student Description Form, Life Satisfac-
tion Scale, and WHOQOL-BREF (TR) Quality of Life Scale
(World Health Organization, 1998) were used to collect data.
Student description form
The form was prepared by the researchers at the end of the
required literature survey in order to evaluate the sociode-
mographic data of students and students opinions on QOL.
It included 16 questions (Ayaz et al., 2005; Kaynar et al., 2006;
Gndog ar et al., 2007).
The Satisfaction with Life Scale (SWLS)
The SWLS (Diener et al., 1985) is a ve-item self-report
measure of satisfaction with ones life (i.e. a measure of
global life satisfaction). Each item was scored from 1 (totally
disagree) to 7 (totally agree), so that the scores ranged from
5 (low satisfaction) to 35 (high satisfaction). The coefcient a
416 Y. Yildirim et al.
2013 Wiley Publishing Asia Pty Ltd.
of the scale was 0.87 and the testretest reliability conducted
during a two month period was 0.82 (Diener et al., 1985). The
Turkish validity and reliability study of the scale was carried
out by Yetim (1993).
WHOQOL-BREF (TR) Quality of Life Scale
The WHOQOL-BREF has been used widely in many coun-
tries to assess QOL. The WHOQO-BREF is a shortened
version (26 items) of the WHOQOL-100, developed by the
WHOQOL Group (World Health Organization, 1998). The
WHOQOL-BREF consists of four domains: physical
(Domain 1), psychological (Domain 2), social relationships
(Domain 3), and environmental (Domain 4). Each domain
includes three to eight items. Furthermore, two overall ques-
tions were included to yield information on overall QOL
(Q1) and health satisfaction (Q2). All items on the
WHOQOL-BREF are scored on a ve-point Likert Scale
with total scores ranging from 25 to 125 points and where
higher scores indicate a better QOL (World Health Organi-
zation, 1998). The WHOQOL-BREF has been translated and
adapted into Turkish by Fidaner et al. (1999) and is consid-
ered to be highly reliable (Cronbachs a = 0.82).
Data collection
Before the questionnaires were administered, the purpose of
the study was explained to the students and their consent was
obtained. The questionnaires to be lled out anonymously
were distributed in the classrooms by two researchers to the
students who wanted to participate in the research. The stu-
dents were asked not to write their names on the question-
naires and were told to answer all the questions. In order to
maximize response rate, students were verbally requested,
both at the beginning and end of the lecture, to complete the
questionnaire. The questionnaires were collected the same
day at the end of the lecture. All participants completed the
forms within approximately 15 minutes.
Ethical considerations
Ethical approval of the study was obtained from the Ethics
Committees of Ege University Faculty of Nursing. Written
permission to execute the research was obtained from the
institution. All the students were informed about the aim of
the study and were assured of condentiality and anonymity.
Participants were also assured of their right to refuse partici-
pation and that all the information obtained would be used
for research purposes only.
Data analyses
Statistical analysis for data evaluation was performed by
using Statistical Package for Social Sciences (SPSS Version
15.0) (SPSSi Inc., Chicago, IL, USA). Sociodemographical
data were expressed as numbers and percentage. The Mann
Whitney U-test, KruskalWallis test and analysis of variance
(anova) were used to assess the effect of certain student
characteristics on life satisfaction and quality of life. The
relationship between life satisfaction and quality of life was
evaluated by Pearson correlation. When the P-value was less
than 0.05, the results were considered signicant.
RESULTS
Student characteristics
The mean age of the participants was 21.54 1.76 years.
Most students (98.5%) were female and 36.6% of the stu-
dents stayed at the dormitory. Of the students, 24%, 26.5%,
23.7%, and 25.8% were rst, second, third, and fourth-year
students, respectively. It was determined that mothers of
most of the students (83.2%) were unemployed, fathers of
42.2% were retired, parents of a majority of students (95.7%)
lived together, and 96.2% of the students did not have a job
(Table 1). Seventy-two percent of mothers and 55.1% of
fathers were primary school graduates.
According to the students who participated in this study,
QOL means living with peace of mind and being healthy
(34.8%). Students described QOL as well-being related to
social, economical, and cultural domains (26.0%), as leading
a good life (24.2%), and as being happy (14.9%). Of the
students, 49.7% perceived their QOL as moderate, 44.4%
as good, and 5.8% as bad.
Table 1. Distribution of students according to their
sociodemographic characteristics
Sociodemographic characteristic Frequency %
Gender Female 390 98.5
Male 6 1.5
Graduated
high school
High school 339 85.6
Health vocational school 9 2.3
Private high school 48 12.1
Residing With family 121 30.6
With friends at home 11 2.8
With a relative 113 28.5
At dormitory 145 36.6
Others 6 1.5
Year First year 95 24.0
Second year 105 26.5
Third year 94 23.7
Fourth year 102 25.8
Mothers job House wife 332 83.2
Worker 16 4.0
Employer 8 2.0
Free job 3 0.8
Retiree 37 9.3
Fathers job Farmer 29 7.3
Worker 63 15.9
Employer 70 17.7
Free job 67 16.9
Retiree 167 42.2
Status with
living parents
Yes 379 95.7
No 17 4.3
Working status Yes 15 3.8
No 381 96.2
Total 396 100.0
Nursing student quality of life 417
2013 Wiley Publishing Asia Pty Ltd.
When the effect of being a nursing student on QOL was
examined, it was found that almost half the students (40.7%)
reported a positive effect and 32.1% reported a negative
effect, while 23.7% stated that their QOL was not affected at
all. Thirty-seven percent of the students expressed that their
QOL was affected positively because nursing education pro-
vided them with a model of healthy life, whereas 64.6% men-
tioned a negative effect due to the busy schedule of nursing
education. Furthermore, the students emphasized that a
higher QOL required some changes, such as a higher level of
economic income (35.1%), a healthier life (28.3), and a stress-
free lifestyle (24.5%) (Table 2).
Mean scores of life satisfaction and QOL and the
relationship between mean scores and various
characteristics of the sample
The mean score of life satisfaction was 22.90 5.74. The
QOL mean scores obtained by the participants for physical,
psychological, social relationships, and environmental
domains were 67.16 15.29, 64.33 14.72, 62.81 19.12,
and 60.59 12.59, respectively.
The relationship between the mean scores of life satisfac-
tion and of QOL subscales and various characteristics is
presented in Table 3. As shown, no signicant difference
was detected between life satisfaction and variables such as
age, graduated high school, place of residence, and parents
educational level (P > 0.05). In the advanced analysis, a sig-
nicant difference was found between a students grade and
his/her mean score of life satisfaction (P < 0.05), especially
among the rst- and third-grade students. Life satisfaction
of working students was found to be signicantly higher
than that of nonworking students (P < 0.05). Students with
a family income of 2500 Turkish Liras ( ) (approximately
1380 $) and above had higher life satisfaction score
(P < 0.05).
No signicant difference was detected between the sub-
domains of QOL and variables such as age, graduated high
school, place of residence, fathers education level, parents
status of living together, and working status (P > 0.05). Edu-
cational level of mothers signicantly affected the scores of
the environmental domain (P < 0.05). The mean scores of
students for the psychological and environmental domains
differed signicantly in the advanced analysis with respect to
the family income. Students with a family income of 2500
(Turkish liras; approximately $1380) and above had higher
QOL scores in the psychological and environmental elds
(Table 3).
Comparison of QOL subdomains and life satisfaction
with students opinions about QOL
When life satisfaction and the subdomains of QOL were
compared with students opinions about QOL, a statistical
difference was found between students denitions of QOL
and their life satisfaction (P < 0.05). It was determined that
the mean life satisfaction scores of the students who dened
QOL as healthy life were higher, while the mean life satis-
faction scores of the students who dened it as economic
well-being were lower. However, no statistical difference
was detected between the students denitions of QOL and
their QOL subscore averages (P > 0.05) (Table 4).
There was a signicant relationship among students QOL
levels, their life satisfaction, and QOL subscores (P < 0.05). It
was observed that life satisfaction and mean QOL scores
were higher among students who expressed their QOL level
as good (Table 4).
Life satisfaction was found to be the highest among the
students who stated that being a nursing student had a posi-
tive effect on their QOL (P < 0.001). The students who
stated that being a nursing student did not affect their
QOL, had higher QOL scores in the physical and environ-
mental domains (P < 0.05) (Table 4).
The relationship between life satisfaction and QOL
There was a signicant correlation between life satisfaction
and the four main domains of QOL (P < 0.05). Life satisfac-
tion of the students improved with increasing QOL (Table 5).
Table 2. Evaluation of the effect of being a nursing student on the
quality of life (QOL)
Opinion Frequency %
The effect of being a nursing student on
the QOL
n = 396
Positive 161 40.7
Negative 127 32.1
Not affected 108 23.7
The reason of the positive effect of
being a nursing student on the QOL
n = 161
Learning a healthy life model 60 37.3
Being happy by helping people 19 11.8
Helping to improve health by the
received information
47 29.2
Development of self-respect 22 13.7
High possibility of nding a job after
graduation
13 8.1
The reason of the negative effect of
being a nursing student on the QOL
n = 127
Difculties of nursing as a profession 24 18.9
Busy schedule of nursing education 82 64.6
Negative image of nursing in society 21 16.5
Necessary changes to increase your
QOL
n = 96
Staying away from stress 97 24.5
Having a good job 71 17.9
Having a high level of income 139 35.1
Having regular working conditions 81 20.5
A good education 69 17.4
A comfortable living environment 75 18.9
A good circle of friends 53 13.4
A healthy life 112 28.3
Students mentioned more than one change for the increase in
their QOL.
418 Y. Yildirim et al.
2013 Wiley Publishing Asia Pty Ltd.
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Nursing student quality of life 419
2013 Wiley Publishing Asia Pty Ltd.
DISCUSSION
This study aimed to investigate the relationship between life
satisfaction and QOL in nursing school students. At the end
of this research, a signicant positive correlation was found
between life satisfaction and QOL among nursing students. It
is possible to say that nursing students satisfaction with life
increased as their QOL increased. Bailey and Miller (1998)
reported that students with higher life satisfaction and expec-
tations were less stressed compared to other students with
lower level of life satisfaction. In another study carried out in
Turkey by Deniz (2006), it was observed that students could
cope with stress better as their satisfaction with life increased.
Moreover, in our study it was also observed that both life
satisfaction and QOL scores of the students, who described
their QOL level as good, were signicantly higher.
Almost half the students stated that being a nursing
student had a positive effect on their QOL, and most of
them associated this positive effect with the model of
healthy life provided by their nursing education. Further-
more, life satisfaction was observed to be signicantly
higher among the students who dened QOL as a healthy
life. In addition to this nding, the majority of the students
reported that a higher level of income and a healthy life
were necessary to increase their QOL. It was also observed
that a healthy life was emphasized more. These results are
in fact not surprising for nursing students, because the
nursing education program includes lessons that highlight
the importance of health, protection and improvement of
health, and healthy life behavior, all of which might lead
nursing students to emphasize their opinions about health
more than others. Ayaz et al. (2005) stated that such lessons
included in the university curriculum have a positive effect
on students behavior towards a healthy life, leading stu-
dents to associate quality of life with a healthy life.
There was a signicant difference between students life
satisfaction and in which grade they were at the university. It
was observed that life satisfaction of the third-year students
was the highest, while it was the lowest among the rst-year
students. The lowest level of life satisfaction observed in the
rst-year students may be associated with the fact that the
rst year of university education is a transition period of
adjusting to university life and to a foreign environment.
Additionally, in Turkish culture young individuals are usually
dependent on their families about the decisions of their own
life. Many young people experience the rst separation from
their families when they start university. Before university
life, young people have, directly or indirectly, a strong T
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Table 5. Evaluation of the relationship between students
satisfaction with life and their quality of life subdomains
Life
satisfaction
Quality of life subdomain
Physical Psychological Social Environmental
0.388* 0.603* 0.425* 0.494*
*P < 0.05.
420 Y. Yildirim et al.
2013 Wiley Publishing Asia Pty Ltd.
interaction and relationship with their relatives and neigh-
bors. Once they become a university student, this strong
support decreases and the responsibility of making inde-
pendent decisions for their own life increases, which can
negatively affect the life satisfaction of students especially in
the rst years of their education. In another study, it was also
reported that life satisfaction of students in their rst years
were lower, since they became to know their profession in
their rst years before they internalize it (Kaynar et al., 2006).
Life satisfaction was the highest among the third-year stu-
dents, who had left behind the rst years of their education
and began to take an active role in their career with an
awareness of the responsibilities as well as the difculties of
their profession. Thus, life satisfaction was observed to be
higher in the third-year students compared to the students in
other years. Murphy et al. (2009) reported in his study that
the rst-year students experienced more difculties in their
school life, whereas third-year students were confronted with
lesser problems compared to other students. In Turkey,
Baykal et al. (2005) also obtained results similar to ours and
determined that life satisfaction scores were lower in the
rst-year and fourth-year students.
Life satisfaction scores were detected to be higher in the
students with a monthly income of 2500 and above. Similar
results supporting this nding were obtained in different
studies (Gndog ar et al., 2007; Dilmac & Eksi, 2008). Stu-
dents with a monthly family income of 2500 and above had
a higher level of life satisfaction, yet a signicant difference
was detected in the psychological and environmental
domains. This nding may be associated with the anxieties of
students who come from different cities and try to adapt to a
new environment. In our study it was also found that life
satisfaction was signicantly higher in working students com-
pared to nonworking students. Similar results were obtained
from the study carried out by Chow (2005) who reported that
life satisfaction increased with increase in socioeconomic
level. Xiao et al. (2009) investigated the effects of students
economic status on their satisfaction with life, and good eco-
nomic status was found to have a positive effect on both the
QOL and life satisfaction of students. Moreover, cross-
national studies suggest that university students in Western
and economically afuent societies have higher levels of life
satisfaction (Veenhoven, 1995; Dorahy et al., 2000). In our
study, the comparison of life satisfaction and QOL with other
variables revealed no signicant difference.
Limitations of the Study
This study does have some limitations. The research was con-
ducted only with university students, and research sampling
included nursing students only from a single university. Life
satisfaction and QOL of students from different universities,
different departments, and different cultures may be tested in
further studies with different sampling groups (adolescents,
adults, or gender).
CONCLUSION AND RECOMMENDATIONS
In this study, a positive relationship was observed between
students satisfaction with life and their QOL. In addition, it
was determined that being a nursing student had a positive
effect on students life satisfaction and QOL.
In line with our ndings, it is recommended that the edu-
cation system is redesigned in a way to make students more
active and to improve their life satisfaction and QOL. Factors
that affect students academic success should be investigated
in more detail, and especially psychological counseling
centers in the universities can carry out some studies to
increase students success levels. Teachers should not lose
sight of the fact that changes, especially small changes, in how
they interact with students can affect their teaching. In the
rst years of education, students should be provided with
orientation to adapt to the education program and university
life; they should be informed in their nal years about how to
resolve their anxieties about starting their career; and educa-
tion strategies should be applied in courses to increase
students life satisfaction and quality of life. In addition,
cultural-specic counseling and orientation programs also
should be planned at each university.
ACKNOWLEDGMENTS
We would like to thank all of the students who willingly
contributed to this research.
CONTRIBUTIONS
Study Design: YY, SP, ADA.
Data Collection: YY, SP, ADA.
Data Analysis: YY, SP.
Manuscript Writing: YY, SP, ADA.
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