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. 2024 Mar 1;11(3):e2119. doi: 10.1002/nop2.2119

Flourishing among undergraduate nursing students: Insights from a cross‐sectional study in Saudi Arabia

Emad Shdaifat 1,✉, Amira Alshowkan 1, Amna Omer 1, Friyal Alqahtani 1, Mona AL‐Qahtani 1, Nagla Alsaleh 1, Neama Kamel 1, Nora Alotaibi 1
PMCID: PMC10907610  PMID: 38429881

Abstract

Aim

This study aimed to examine the factors that influence the level of flourishing among nursing students.

Design

Cross‐sectional study.

Methods

A multistage sampling technique was used to recruit 328 undergraduate nursing students from a nursing college. Data were collected from February to June 2023 using the Global Flourishing Study (GFS) questionnaire, which assesses six domains of flourishing and their determinants. To ensure reliability and validity, a pilot study was conducted and a thorough validation process was employed.

Results

The Flourishing Index ranged from 24.0 to 100.0, with an average score of 74.2 (SD = 14.8). Well‐being, disposition and behaviour, as well as external factors, correlated strongly positively with the Flourishing Index (r = 0.741, r = 0.565, r = 0.596, all p < 0.001). The Flourishing level was significantly negatively correlated with religion (r = −0.381, p < 0.001). Married participants had a significantly negative association with flourishing (p = 0.009). Disposition and behaviour were significantly and positively associated with flourishing (p = 0.017). The regression model had goodness of fit (R 2 = 0.628) and was significant overall (F = 108.703, p = 0.001). The Flourishing model was established based on well‐being, external factors, religion, disposition and behaviour, and marital status.

Conclusion

Positive correlations between flourishing and well‐being, disposition and external factors suggest areas of improvement. Conversely, the negative association with religion emphasizes the necessity of culturally sensitive approaches. Future studies with larger and more diverse samples, as well as additional variables, are crucial to obtain a deeper understanding of the factors that influence flourishing among nursing students in Saudi Arabia.

Keywords: flourishing, happiness, life satisfaction, meaning and purpose, mental health, Saudi Arabia, social relationships, undergraduate nursing students, well‐being

1. INTRODUCTION

The nursing profession in Saudi Arabia is advancing with increasing opportunities to enter various training programs. Along with these advancements, responsibilities and role refinement changes are increasing; however, it is challenging to guarantee clarity in the scope of nursing practice and the scope of practice and sustainability of the profession (AL‐Dossary, 2018). Nursing education in Saudi Arabia passes through different stages, and there are still some challenges in the form of a lack of national scope of nursing guidelines and gender‐related issues, as male nursing is prohibited from practicing in female wards, which puts a burden on the educational institution to offer simulation labs for education (Aljohani, 2020). Consequently, nursing students experience considerable stress during the training. Stress is defined as a state of unease that affects an individual's life. Stress among nursing students is viewed as a universal experience (Alghamdi et al., 2019). Examining nursing students' stress from a cultural perspective is recommended to establish definite support strategies. A recent study among 500 nursing students in Jeddah, Saudi Arabia reported high levels of stressors related to nursing students who were single and aged <25 years. In addition, stress was highly related to lack of free time, lack of entertainment, fear of low grades, and course failure. In addition, age and marital status are significantly related to stress in nursing students (Aljohani et al., 2021). Therefore, the demand for mental health services has increased (Lipson et al., 2019). Therefore, it is important to study the factors that affect flourishing levels among nursing students in Saudi Arabia.

Well‐being and flourishing, which are often used interchangeably, refer to an optimal state of functioning across all aspects of life (Gostin et al., 2023). The PERMA™ theory developed by Martin Seligman identifies positive emotions, engagement, relationships, meaning, and accomplishment as the fundamental elements for flourishing (Seligman, 2018). Research suggests that well‐being measures evaluate psychological flourishing (Diener et al., 2010), and a study of first‐year residents established a significant correlation between flourishing, resilience, and risk factors (Lebares et al., 2021).

2. BACKGROUND

Flourishing is viewed as an utterance of emotional condition, psychosocial functioning, and social welfare and is seen as a single continuum from mental illness (Agenor et al., 2017). There is a positive relationship between psychological state and physical health; as stated, psychological well‐being alone does not capture the meaning and understanding of flourishing. Therefore, flourishing occurs when all aspects of life are good (Vanderweele, 2017). While flourishing covers both the absence of mental illness and positive well‐being, quality of life has been defined as a concept that refers only to the feeling of positive well‐being (Burns et al., 2022). Therefore, quality of life may be considered a cornerstone of flourishing, in addition to other personality aspects that promise a bright future. The positive mental health of college students is linked to a range of academic accomplishments, optimum health, and positive social outcomes (Antaramian, 2015). However, there are few publications on the flourishing levels and predictors among college students.

Flourishing has been found to benefit college students with and without symptoms of disease. For symptomatic college students, flourishing can help to prevent mental disorders (Schotanus‐Dijkstra et al., 2017). In addition, it enhances positive outcomes, such as academic assertion and engagement with the community (Antaramian, 2015). Helping students flourish also helps them pursue professional academic goals without interruption (Van Zyl & Stander, 2019). Likewise, positive psychological interventions are worthwhile and help student retention (Schotanus‐Dijkstra et al., 2018). Ahlstedt et al. (2020) confirmed that providing support to employees in their respective work areas enhances their satisfaction and performance. Supporting employees in their working areas increases their satisfaction and performance. Consequently, employees can flourish in their jobs. In addition, they explored whether nurses' motivation through daily communication positively influences the flourishing of their work. A study conducted in Cyprus (Sürücü et al., 2021) highlighted that fear can negatively affect flourishing. This is clear during the COVID‐19 pandemic, when people were isolated and felt fear and anxiety that impacted their mental health. Social relationships are an important domain in human flourishing and have been limited during pandemics. In addition, financial instability is negatively influenced.

Based on an extensive literature review on the topic of human flourishing, few studies have been conducted in this field. Further studies are required to examine the relationship between socio‐demographic factors and flourishing levels. Therefore, this study aimed to examine the level of flourishing and its predictors among nursing students based on Figure 1. While this research demonstrates the characteristics of college students that are associated with lower levels of flourishing, mental health promotion strategies to enhance students' levels of flourishing are suggested. Investigating the dynamics between the six domains concurrently within a comprehensive framework of combined flourishing concepts can provide an effective understanding of the role of each domain in influencing overall flourishing and well‐being across other domains (Crabtree et al., 2021). This evidence may be important for implementing public health recommendations to promote overall well‐being at a population level. Therefore, this study aimed to examine the levels of flourishing among undergraduate nursing students in Saudi Arabia, assess the various domains and determinants of flourishing and identify predictors of flourishing.

FIGURE 1.

FIGURE 1

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Framework of the Global Flourishing Scale: Domains and Determinant Influences. Adapted from (Crabtree et al., 2021).

3. METHODS

3.1. Setting and design

This study was conducted at Imam Abdulrahman Bin Faisal University (IAU) (REDACTED), Saudi Arabia. This study had a cross‐sectional design. The use of a cross‐sectional design implied that data were collected from different participants at a single point in time.

3.2. Sampling and sample size

Nursing students in their first to fourth year of nursing school participated in this study. Data were collected using a self‐reported questionnaire from February 2023 to June 2023. The inclusion criteria required students to be enrolled in the nursing program and willing to participate in the study. Students who did not meet these criteria or met any of the following exclusion criteria were excluded: currently on academic probation, on leave of absence from the program, or unwilling to participate in the study. Using the formula of Krejcie and Morgan (1970) to determine the sample size with a population (N) of 1000, the calculated sample size (n) was approximately 346. Considering possible missing data, it is advisable to increase the sample size by 10%, resulting in an adjusted sample size of approximately 380. The formula is expressed as follows:

s=X2NP1−P÷d2N−1+X2P1−P.

where s represents the required sample size, X 2 is the chi‐square table value for one degree of freedom at the desired confidence level, N is the population size, P is the assumed population proportion (typically set at 0.50 the maximum sample size), and d is the degree of accuracy expressed as a proportion (e.g., 0.05).

Using a multi‐stage sampling technique, we meticulously designed a process to improve the representativeness of the sample. First, we stratified the population based on educational level, ensuring proportional representation among different educational levels. Within each stratum, participants were selected based on their gender, using a systematic approach to ensure a balanced representation of both genders. This multistep approach was chosen to comprehensively address the population diversity, thereby increasing the validity and generalizability of our results. The rationale for this meticulous procedure was to find a sample that accurately reflects the demographic characteristics of the entire population, thereby enhancing the validity of our findings.

3.3. Survey instrument

3.3.1. Description of the instrument

Data were collected using the Global Flourishing Study Questionnaire (GFS), which included 61 questions, 12 of which were dedicated to assessing flourishing in six domains: happiness and life satisfaction, mental and physical health, meaning and purpose, character and virtue, close social relationships, and financial and material stability. Participants responded on a 0–10 Likert scale, and the flourish measure was derived by summing the scores for each domain. The total points were capped at 120, with each domain contributing up to 20 points. Higher values indicated greater flourishing. Each domain includes two questions. For example, in area 1 (happiness and satisfaction), participants were asked: “How satisfied are you with life as a whole these days?” For each area, similar representative questions capture different aspects of well‐being. In the mental and physical health assessment (Domain 2), participants were asked to rate their overall physical health to provide insight into their perceived well‐being. Exploring meaning and purpose in life (Domain 3) included an assessment of participants' understanding of their life's purpose. Domain 4 focused on character and virtue, with participants reflecting on their ability to sacrifice immediate happiness for greater future well‐being. Close social relationships (Domain 5) were examined through participants' satisfaction with their friendships and relationships. Finally, financial and material stability (Domain 6) were assessed by assessing participants' concerns about covering normal monthly living expenses. This structured approach enabled a comprehensive examination of flourishing across different areas of life and contributed to a nuanced understanding of participants' overall well‐being (Vanderweele, 2017).

The other questions covered various determinants of flourishing, including self‐reported well‐being, determinants related to disposition and behaviour, determinants related to external factors, religion/spirituality, and demographic variables. Self‐reported well‐being indicators encompass different aspects of an individual's subjective well‐being, such as life satisfaction ratings, contentment, and a sense of balance or harmony. They reflect a person's overall happiness and self‐assessment of their mental and physical health. Evaluating these dimensions provides insights into an individual's level of life satisfaction, contentment, and overall well‐being as well as their perception of happiness, contentment, inner harmony, and mental and physical health. Individual scores for the questions within each determinant were summed to determine the score for each determinant associated with flourishing.

Determinants related to dispositions and behaviours include character traits, the ability to forgive others, self‐confidence, optimism, lifestyle choices such as alcohol and tobacco consumption, and engagement in physical exercise. Determinants related to external factors encompass aspects such as the level of satisfaction with friendships and relationships, degree of trust among people in their country, availability of reliable social networks for support during difficult times, sense of belonging within a community, confidence in the government, and experiences of discrimination. These determinants shed light on individuals' social interactions and relationships, the level of trust within society, the presence of supportive networks, a sense of belonging, perceptions of the government, and encounters with discrimination. Religion and spirituality involve connecting to higher powers or spiritual beliefs and participating in communal practices, such as attending worship. They provide meaning, guidance, and a sense of belonging, shaping values and well‐being (Vanderweele, 2017), and there are nine questions about the demographic profile. The determinant questions have different formats, including a scale from 1 to 10, a Likert scale with four levels (from “always” to “never”), yes/no questions, and scales ranging from “many times” to “never” and “a lot” to “never.” Examples of these questions include “freedom in life,” “remaining hopeful about the future,” “expectation of more happiness in the future,” and “connection to religion.” The determinants of flourishing are systematically presented, accompanied by clear questions. Well‐being (Determinant 1) includes life satisfaction, contentment, sense of balance, happiness, and self‐assessment of mental and physical health. It broadly refers to a positive state of human existence, encompassing both physical and mental health, as well as subjective qualities, such as happiness and a sense of security. These subjective aspects are evaluated based on the individual's own perception and not on external judgements; 18 questions were used to determine this determinant. Disposition and behaviour (Determinant 2) were examined through questions that addressed sustained hope in the face of challenges and gratitude for the positive aspects of life; six questions were used to determine this determinant. External factors (Determinant 3) were assessed by asking about feelings of loneliness and participation in group activities such as book clubs or sports, and 10 questions were used to determine this determinant. Religion (Determinant 4) was examined through questions that assessed participants' connection to a religious or spiritual framework and the influence of these beliefs on their outlook on life. Six questions were used to determine this determinant. Demographic factors, including sex, age, marital status, employment status, income, and education were considered, with questions covering these aspects. The source used to decide the questions according to their references was the GFS link (Crabtree et al., 2021).

3.3.2. Linguistic and cultural adaptation

To ensure the precision and reliability of the scales used in this study, careful validation was performed. Although they received the translated version of the Global Flourishing Scale (GFS) from members involved in the global study, a panel of four doctoral nurses and two psychologists carefully evaluated the content of the scale using a variety of techniques. The Arabic version of the GFS was adopted to determine the flourishing level and its determinants among the university students. The flourishing scale, as indicated by Weziak‐Bialowolska et al. (2019), demonstrates acceptable psychometric properties with good indices (CFI = 0.978, TLI = 0.971, RMSEA = 0.041, SRMR = 0.026) and an internal consistency of 0.86. In the Arabic language, Confirmatory Factor Analysis (CFA) using AMOS was conducted to assess the measurement model. Model‐fit measures, including CMIN/df, GFI, CFI, SRMR, and RMSEA, were employed to evaluate the overall goodness of fit. The obtained values (CMIN/df = 2.138, GFI = 0.960, CFI = 0.962, SRMR = 0.040, and RMSEA = 0.059) indicated a satisfactory fit, consistent with established standards (Byrne, 1994; Hair et al., 2006, 2010; Hu & Bentler, 1998). This indicates its robust psychometric properties and confirms its validity and reliability in assessing flourishing levels. The surveys were distributed via the online survey platform QuestionPro (www.questionpro.com) and permission to use the questionnaire was obtained from the original authors. While considering cultural and religious considerations, certain questions were either revised or deleted based on feedback from the study team to address the comprehension issues.

3.3.3. Pilot study

Content validity was assessed through expert opinions, and pilot testing was conducted with 23 students who exhibited characteristics similar to those of the study sample. For this reason, some questions were reworded to improve participants' understanding. Expert ratings confirmed the content validity, whereas construct validity was consistent with the research topic. Overall, “flourishing” showed significance, with item correlations ranging from 0.519 to 0.756, with the exception of two items (f7 and f8) related to the areas of character and virtue, which were excluded due to their importance in examining participant characteristics in the final study were retained. The panel recommended changes to certain questions to ensure cultural fit in Saudi Arabia.

To assess construct validity, Pearson's correlation analysis was used to compare item scores with the critical and total scores. Items with an R‐value >0.4132 were considered valid based on a correlation analysis table. The instruments showed construct validity and Cronbach's alpha coefficients showed good internal consistency, ensuring reliability. Reliability analysis of the scale items revealed high internal consistency for the measure of flourishing, with Cronbach's alpha of 82.3%. The determinants of external factors showed good internal consistency (Cronbach's alpha = 0.731), whereas those of well‐being, disposition, and behaviour showed moderate internal consistency (Cronbach's alpha = 0.607 and 0.588, respectively). However, the religion determinant showed less internal consistency (Cronbach's alpha = 0.433) (Bagus Laksita et al., 2021).

3.3.4. Validity and reliability

The construct validity of each item was assessed using Pearson's correlation analysis. The results were compared with the critical values obtained from the correlation analysis and total values. Items were considered valid if the correlation coefficient (r‐value) exceeded 0.1083, a cutoff value determined from the table. Cronbach's alpha coefficient was used to evaluate the reliability of the GFS and determinants of flourishing. The findings showed a satisfactory level of internal consistency (Table 1) (Bagus Laksita et al., 2021).

TABLE 1.

Person correlation analysis results between flourishing scale and the determinants.

Scale & determinants r value Cronbach's alpha Critical value
Flourishing scale 0.399–0.714 0.806 0.1083
Well‐being 0.215–0.708 0.779 0.1083
Disposition and behaviour 0167–0.821 0.477 0.1083
External factors 0.142–0.707 0.547 0.1083
Religion 0.507–0.695 0.647 0.1083
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3.4. Data collection procedure

After obtaining ethical approval, the principal investigator collaborated with the course coordinators to collect data. Detailed communication was ensured with the nursing students regarding the study's goals, methods, and procedures, with a strong emphasis on voluntary participation and anonymity. WhatsApp was used as a platform for students to receive an invitation letter containing a survey link and a barcode. Recruitment through WhatsApp, facilitated by team leaders, reduces direct contact between coordinators and students, thus improving safeguards against undue influence. Transparent communication regarding voluntariness and confidentiality upholds ethical standards, and participant anonymity is maintained by excluding identifying information. This recruitment method strengthens protective measures and ensures the maintenance of ethical standards. A response rate of 61.7% was achieved for the survey, which took approximately 15–20 min to complete.

3.5. Statistical analysis

Statistical Package for Social Sciences (version 22) was used to store and analyse the data. Categorical data are presented as frequencies and percentages. Continuous data are presented as the mean, SD, minimum, maximum, and range. A comparative analysis of students' scores on Flourishing's six domains by demographic variables and other related data was conducted using both the t‐test and the One‐way ANOVA test. The Cronbach's alpha was used to evaluate the internal consistency of the items. The correlation coefficient was computed to evaluate correlations between the study variables. Regression analysis was performed to identify the predictors of flourishing along with related factors. Statistical significance was set at p < 0.05.

Several important steps were taken to ensure the reliability and validity of the results. Missing data were construed using the means for continuous variables and medians for categorical variables. The response rate was 61.8%, indicating satisfactory participation in the study. After reviewing and cleaning the data, 11 participants were excluded from the analysis as their responses did not vary. A Mahalanobis distance threshold of 24.322 (p‐value = 0.001, df = 7, CV = 24.322) was used to detect and remove outliers. This value corresponds to a critical point in the chi‐square distribution, which is consistent with the established statistical significance and ensures the reliable identification of potential outliers in our analysis. Stepwise regression analysis identified predictors of student flourishing by considering demographic variables (gender, age, marital status, employment status, income, education) and determinants (well‐being, external factors, religion, disposition, and behaviour). The analysis aimed to identify significant variables for predicting student flourishing. Additionally, flourishing levels were categorized using a visual binary approach with a 33.3% percentile cut‐off using SPSS (Table 6).

TABLE 6.

Category levels of flourishing.

Categories Frequency Per cent
<94.0 109 33.2
94.0–106.0 106 32.3
≥107.0 113 34.5
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4. RESULTS

Table 2 presents the demographic characteristics of the 328 participants who participated in the study. It is interesting to note that most participants reported having one to three children in their households; 62.5% were female, and 68.0% were 20 years or younger. Furthermore, 92.7% were single and 90.9% were in the unemployment category.

TABLE 2.

Demographic characteristic (N = 328).

Variables Categories Frequency Per cent
Children <18 years in household <1 59 18.0
1–3 217 66.2
>3 52 15.9
Gender Male 123 37.5
Female 205 62.5
Age ≤20 223 68.0
>20 105 32.0
Marital status Single 304 92.7
Married 24 7.3
Employment Private sector 17 5.2
Personal job 13 4.0
Unemployment 298 90.9
Family income <3000 SAR 54 16.5
3000–12,000 SAR 136 41.5
>12,000 SAR 138 42.1
Income perception Financially stable 166 50.6
Financially constrained 121 36.9
Financial difficulty 41 12.5
Residence status Own 244 74.4
Rent 52 15.9
Student housing 32 9.8
Education level First year 132 40.2
Second year 70 21.3
Third year 90 27.4
Fourth year 36 11.0
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Table 3 presents the significant differences between the groups for the various variables and total flourishing levels and their domains. In terms of gender, males had significantly higher scores than females on the Flourishing. Regarding income, participants earning between 3000 and 12,000 SAR showed significantly lower scores than those earning over 12,000 SAR on total flourishing level. Analysing the Income perception, participants who reported “Financially constrained” had significantly lower scores than those who reported “Financially stable” on the total Flourishing level. Finally, housing status played a role in flourishing as participants who rented had significantly lower scores than those who owned the total flourishing level.

TABLE 3.

Differences in Flourishing Levels and its domains among Different Groups (N = 328).

Variables/domains Total flourishing Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Domain 6
Variable Category Mean t/F stat. p Value Mean t/F stat. p Value Mean t/F stat. p Value Mean t/F stat. p Value Mean t/F stat. p Value Mean t/F stat. p Value Mean t/F stat. p Value
Gender Male 101.67 2.556 0.011 16.21 2.849 0.005 16.97 1.413 0.159 18.73 1.267 0.206 17.14 −0.670 0.503 17.77 3.887 0.001 14.82 1.182 0.238
Female 96.75 14.80 16.37 18.28 17.43 15.73 14.11
Age ≤20 98.68 0.130 0.897 15.28 −0.320 0.750 16.60 0.086 0.931 18.39 −0.490 0.624 17.27 −0.353 0.724 16.40 −0.472 0.637 14.70 1.605 0.109
>20 98.41 15.44 16.57 18.58 17.43 16.68 13.69
Marital status Single 99.04 1.702 0.090 15.40 0.975 0.330 16.68 1.489 0.138 18.47 0.269 0.788 17.36 0.548 0.584 16.50 0.082 0.934 14.62 2.989 0.003
Married 92.91 14.50 15.50 18.29 16.91 16.41 11.29
Employment Private sector 103.88 0.864 0.423 15.76 0.094 0.910 17.58 0.624 0.536 18.64 0.143 0.867 18.35 1.138 0.322 17.70 0.582 0.559 15.82 0.827 0.438
Personal job 98.53 15.46 16.46 18.84 18.30 16.00 13.46
Unemployment 98.29 15.30 16.54 18.42 17.22 16.44 14.33
Income <3000 SAR 96.85 3.774 0.024 a 14.81 0.974 0.379 16.44 0.937 0.393 17.87 2.468 0.086 17.77 0.978 0.377 16.37 2.501 0.084 13.57 4.711 0.010 b
3000–12,000 SAR 96.25 15.16 16.32 18.26 17.00 15.85 13.63
>12,000 SAR 101.59 15.70 16.92 18.87 17.47 17.18 15.42
Income perception Financially stable 102.33 11.561 0.001 c 16.21 7.192 0.001 d 17.30 7.681 0.001 e 18.98 4.982 0.007 f 17.50 1.362 0.257 17.07 3.871 0.022 g 15.25 12.567 0.001 h
Financially constrained 96.59 14.36 16.15 17.95 17.40 16.30 14.41
Financial difficulty 89.36 14.63 15.02 17.80 16.41 14.73 10.75
Children <18 in household <1 99.28 0.064 0.938 15.67 0.435 0.648 16.83 0.567 0.568 18.69 0.236 0.790 16.64 1.449 0.236 17.22 0.765 0.466 14.22 0.149 0.862
1–3 98.39 15.17 16.44 18.38 17.56 16.33 14.49
>3 98.67 15.61 16.98 18.50 17.11 16.36 14.09
Residence status Own 100.20 4.352 0.014 i 15.63 2.430 0.090 17.06 7.740 0.001 j 18.63 1.761 0.174 17.50 1.145 0.320 16.59 0.200 0.818 14.78 2.755 0.065
Rent 93.96 14.23 15.05 18.11 17.03 16.23 13.28
Student housing 93.84 14.87 15.56 17.65 16.50 16.15 13.09
Education level First year 100.85 1.620 0.184 15.67 3.309 0.020 k 16.75 0.435 0.728 18.96 2.259 0.081 17.07 0.726 0.537 17.07 2.161 0.093 15.31 2.583 0.053
Second year 97.35 15.27 16.78 17.98 17.90 15.24 14.17
Third year 96.00 14.31 16.22 18.34 17.24 16.50 13.37
Fourth year 99.22 16.77 16.58 17.80 17.36 16.80 13.88
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Note: Domain 1: Happiness and life satisfaction; Domain 2: Mental and physical health; Domain 3: Meaning and purpose; Domain 4: Character and virtue; Domain 5: Close social relationship; Domain 6: Financial and material stability.

a

Income perception with Total flourishing: Tukey HSD test: 3000–12,000 versus >12,000 (p = 0.025).

b

Income perception with Domain 6: Tukey HSD test: 3000–12,000 versus >12,000 (p = 0.014).

c

Income perception with total flourishing: Tukey HSD test: Financially stable versus Financially constrained (p = 0.011), Financial difficulty (p = 0.001) and financially constrained versus financial difficulty (p = 0.042).

d

Income perception with Domain 1: Tukey HSD test: Financially stable versus Financially constrained (p = 0.01).

e

Income perception with Domain 2: Tukey HSD test: Financially stable versus Financially constrained (p = 0.025), Financial difficulty (p < 0.001) and financially constrained versus financial difficulty (p = 0.025).

f

Income perception with Domain 3: Tukey HSD test: Financially stable versus financially constrained (p = 0.015).

g

Income perception with Domain 5: Tukey HSD test: Financially stable versus financial difficulty (p = 0.018).

h

Income perception with Domain 6: Tukey HSD test: Financially stable versus financial difficulty (p < 0.001), and financially constrained versus financial difficulty (p < 0.001).

i

Residence with Total flourishing: Tukey HSD test: owns versus rent (p = 0.042).

j

Residence with Domain 2: Tukey HSD test: own versus rent (p < 0.001).

k

Education level with Domain 2: Tukey HSD test: 3rd year versus 4th year (p = 0.021).

Table 4 provides a summary of the scores for different flourishing dimensions including range, minimum, maximum, and mean scores. The total flourishing level ranged from 24.0 to 100.0, with an average score of 74.2. Specific dimensions, such as “Meaning and Purpose”, ranged from 6.0 to 22.0, with a mean of 18.5.

TABLE 4.

Range of flourishing level and domains.

Scale & domains Range Minimum Maximum Mean (SD)
Total flourishing level 76.0 24.0 100.0 74.2 (14.8)
Meaning and purpose 16.0 6.0 22.0 18.5 (3.1)
Character and virtue 20.0 2.0 22.0 17.3 (3.8)
Mental and physical health 20.0 2.0 22.0 16.6 (3.8)
Close social relationship 20.0 2.0 22.0 16.5 (5.0)
Happiness and life satisfaction 20.0 2.0 22.0 15.3 (4.4)
Financial and material stability 20.0 2.0 22.0 14.4 (5.3)
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Table 5 displays the correlations between the flourishing level and its determinants: well‐being, disposition and behaviour, external factors, and religion. The flourishing index exhibited strong positive correlations with well‐being, disposition, behaviour, and external factors. However, flourishing levels showed a significantly negative correlation with religion.

TABLE 5.

The correlations between flourishing level and determinants.

Scale & determinants 1 2 3 4
Total flourishing level 0.741* 0.565* 0.596* −0.381*
1. Well‐being 0.606* 0.544* −0.309*
2. Disposition and behaviour 0.470* −0.365*
3. External factor −0.346*
4. Religion 1
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*

p < 0.001.

Table 6 demonstrates how the participants were distributed among the different levels of flourishing. These categories signify different levels of positive psychological functioning and well‐being, with a substantial number of participants falling into higher flourishing levels.

Table 7 presents the results of the multiple regression analysis examining the predictors of the flourishing level. Well‐being, external factors, religion, and disposition/behaviour play a significant role in determining flourishing levels. Among these factors, well‐being had the strongest positive impact, while being married was associated with a significant negative impact. The model explained 62.2% of the variance, indicating substantial explanatory power. The regression equation is as follows: Flourishing Level = 17.96 + 0.76 (well‐being) + 0.50 (External Factors) − 0.60 (religion) + 0.43 (disposition and behaviour) − 5.86 (Marital Status).

TABLE 7.

Multiple regression analysis of predictors of flourishing level.

Predictor B 95% CI β Sig. R 2 F Adj R 2
(Constant) 17.96 [6.71, 29.22] 0.002 0.628 108.703 0.622
Well‐being 0.76 [0.62, 0.89] 0.52 0.001
External factors 0.50 [0.33, 0.68] 0.24 0.001
Religion −0.60 [−1.06, −0.14] −0.10 0.010
Disposition and behaviour 0.43 [0.08, 0.77] 0.11 0.017
Marital status (ref: single)
Married −5.86 [−10.25, −1.47] −0.09 0.009
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5. DISCUSSION

This study aimed to examine the factors that influence students' level of flourishing. The study found that males showed higher levels of overall flourishing than females. Income was another factor, as participants with a higher income and those who reported living comfortably exhibited higher levels of overall flourishing. Housing status also influenced flourishing, with homeowners displaying higher levels of flourishing than renters did. The Flourishing Index shows positive correlations with predictors such as well‐being, disposition, and behaviour, as well as external factors that contribute to well‐being. However, it has a negative association with predictors such as religion and marital status.

We found that male students showed higher levels of overall flourishing than female students. The findings of the current study are consistent with the research conducted by Pandey et al. (2020), which demonstrated that males with higher levels of flourishing exhibit several indicators of adjustment. These indicators included increased productivity, decreased resentment, and heightened levels of forgiveness. Such attributes contribute to the enhancement of self‐ and interpersonal relationships and are positively correlated with all dimensions of flourishing. However, some studies have reported inconsistent results, indicating that females flourish more than males (De La Fuente et al., 2019; Deb, 2017; Schotanus‐Dijkstra et al., 2017). The observed differences in flourishing rates between men and women in the current study may be due to variations in the research methods and environmental contexts. The unique phase in which Saudi women currently live, characterized by significant societal contributions and achievements, as well as their multiple roles in social work, may expose them to prolonged stress. Cultural factors, including historical gender norms and leadership opportunities, also contribute to higher flourishing rates in men than in women in Arab cultures.

Income was another factor, whereby participants who had higher incomes and reported living comfortably exhibited higher levels of overall flourishing. Housing status also influenced flourishing, with participants who owned their houses displaying higher levels of flourishing than renters. According to a large body of research, socio‐demographic factors, such as higher national and personal income, higher education, living with a partner, and paid employment, are all positively connected to subjective well‐being (Cicognani et al., 2008; Demır & Weitekamp, 2007). More money can promote happiness by increasing access to needs, wants, problem resolution, social support, self‐esteem, and opportunities to participate in favourite activities.

The findings of the current study revealed a negative correlation between flourishing levels and religion among students. Perhaps, this is because most of the study sample had a good spiritual perception of life. This differs from religious beliefs, which are collective matters inherited from the previous generations. Therefore, the findings showed a weak relationship between religious beliefs and emotional well‐being. However, this result is inconsistent with numerous studies reporting that attendance at religious services strongly improves health and several aspects of flourishing, such as relationships, meaning in life, and character (Li et al., 2016; Vanderweele, 2017; VanderWeele et al., 2016). Moreover, the findings of this study are in contrast with those of Rizvi and Hossain (2017), who conducted a comprehensive systematic review covering the past two decades to examine the correlation between religiousness and happiness. However, there are indications that Muslims seem to be the most content with respect to cultural variation. In addition, previous studies insist that the relationship between flourishing and religion should be interpreted with caution, as there is a need to differentiate between religious identity, attendance, and participation in religious practices. Therefore, a future longitudinal study with a larger sample size could offer more extensive insights into the correlation between flourishing and religion among nursing students.

Determinants related to dispositions and behaviours include individuals' character traits, ability to forgive others, self‐confidence, optimism, and lifestyle choices. In this study, these factors were positively correlated with the flourishing index and well‐being. Our results can be rationalized by the fact that high levels of flourishing may be linked to these factors because they are essential elements of a healthy lifestyle, leading to high productivity, improved physical health, and healthy life adjustment, and they are positively correlated with all dimensions of flourishing. This study is very similar to one that was conducted to evaluate the prevalence and associations of flourishing in a large sample of New Zealand employees (Hone et al., 2015). Another study has investigated the influence of self‐forgiveness on adult human flourishing. The study findings indicated that realization and reparation are positively associated with well‐being and human flourishing (Pandey et al., 2020).

Our study uncovered a positive correlation between well‐being and the level of flourishing, which is in line with the findings of Gostin et al. (2023), who established well‐being as a reliable predictor of future health. Moreover, Lebares et al. (2021) identified positive links between flourishing and individual mindfulness, workplace support, and resilience factors such as high emotional intelligence. To summarize, well‐being emerged as a significant predictor of flourishing, encompassing emotional, psychological, and social well‐being, and exhibiting positive associations with mindfulness, workplace support, and resilience. Consequently, it has emerged as a robust predictor of health. Furthermore, a randomized controlled trial showed that promoting well‐being and flourishing at an early stage can reduce anxiety and depression, thus reinforcing the interconnectedness of these two concepts (Schotanus‐Dijkstra et al., 2017).

Our study provides evidence supporting the positive relationship between external factors and flourishing. This aligns with previous research, which has established that flourishing is closely connected to emotional, psychological, and social well‐being (Eraslan‐Capan, 2016). Moreover, flourishing is associated with positive relationships, life purposes, personal growth, and authentic leadership styles (Fowers et al., 2016; Kleynhans et al., 2022). Additionally, research has shown that social media use can have a positive impact on flourishing, particularly when individuals have positive experiences and draw inspiration from others on social media (Marciano & Viswanath, 2023). Various factors influence social connectedness, such as friendship satisfaction, community trust, reliable social networks, belongingness, and discrimination experiences. Social connectedness is a crucial factor in flourishing and is closely linked to psychological and social well‐being, as noted in previous research. Quality friendships, characterized by stimulating companionship and trust, significantly contribute to flourishing by enhancing happiness and overall well‐being (Anderson & Fowers, 2020; Eraslan‐Capan, 2016; Pezirkianidis et al., 2022; Wissing et al., 2019).

This study revealed that marital status also played a role as married individuals displayed lower levels of flourishing than single individuals. This result is inconsistent with other studies that found high flourishing and general well‐being among married persons compared with other marital status groups (Tao, 2019; Vanderweele, 2017, 2020; VanderWeele et al., 2016). In addition, a study conducted by Adamczyk and Segrin (2015) contradicted our results, as it indicated that single individuals reported lower emotional well‐being than partnered individuals. The higher levels of flourishing among single nursing students can be attributed to the potential challenges faced by married individuals in balancing family and academic responsibilities, further compounded by social obligations in the Arab world. Furthermore, limited life experiences during this young age may have contributed to these differences. The results of the present study, influenced by a predominantly young and single group of participants, warrant cautious interpretation. It is advisable to conduct further research with larger and more diverse samples across various age groups and marital statuses.

5.1. Limitation

This study has several limitations that should be considered. First, the reliance on self‐reported measures has the potential for response and measurement errors. Second, this study focused on a limited number of variables and may have overlooked other important factors that could influence successful outcomes. There may also be unmeasured confounding variables that were not considered in this study related to nursing students, such as study load and clinical training factors, which might affect the flourishing level of students in different academic years. Additionally, non‐random sampling methods may have introduced a selection bias. Finally, the study was conducted at a single site, which raises questions regarding its generalizability to other environments or populations. Therefore, Strategies to enhance the diversity and representativeness of the sample for future research in the form of larger samples, multi‐university nursing students, and country‐level studies would enhance the diversity of the study sample and generalizability of the study results. Furthermore, addressing these limitations through longitudinal or experimental designs, objective measurements, and the inclusion of a wider range of variables would improve the validity and generalizability of future studies in this area.

5.2. Implication

This study of flourishing among undergraduate nursing students in Saudi Arabia provides valuable theoretical and practical insights. The findings highlight the importance of demographics, such as gender, income, and housing status, in understanding and promoting overall well‐being and positive psychological functioning. The complex connections found between dimensions of flourishing, such as well‐being, disposition, and behaviour, and external factors, shed light on the intricate nature of flourishing and its underlying mechanisms. From a practical perspective, interventions aimed at increasing levels of flourishing can concentrate on specific factors, such as gender, income, and housing arrangements. Recommendations include early counselling for female and married students, support through academic social groups for the latter, and prioritized financial aid and housing services for students with low income. Furthermore, the study identifies well‐being, external factors, and disposition and behaviour as important predictors of flourishing, proposing targeted interventions to enhance these aspects. In conclusion, this research emphasizes the multifaceted nature of flourishing and provides actionable recommendations for educational institutions, policymakers, and counselling services to promote flourishing among nursing students.

6. CONCLUSION

The level of flourishing among nursing students was related to gender, income, and housing conditions. Flourishing levels were reported to be low among nursing students who were female, reported low‐income status, and lived in rental housing. These findings highlight the complex nature of flourishing and emphasize the importance of considering various factors to understand and promote overall well‐being and positive psychological functioning. Therefore, academic institution decision‐makers are encouraged to enhance supportive services that focus on enhancing the well‐being of female, and low‐income nursing students. This can be achieved by early assessment of students' conditions since university enrollment, by providing psychological, social, financial, and living support for the above‐mentioned students. Therefore, future research is encouraged to perform cross‐cultural studies to examine the level of flourishing among nursing students. In addition, longitudinal studies would help explore the causal effects of the relationship between the study variables. Most importantly, exploring the teaching and acidic factors related to the nursing curriculum and flourishing of students would provide an insightful general perspective of this topic and, thus, intervention studies will be the next step in planning different flourishing enhancement programs among nursing students. Therefore, the results of the current study and recommended future studies would provide comprehensive theoretical knowledge and practical interventions targeting the enhancement of individuals' well‐being, specifically within the academic context.

AUTHOR CONTRIBUTIONS

The research project involved the collaboration of a team of dedicated professionals, each bringing their expertise to different aspects of the study. Dr. Emad played a key role in designing the project and was also involved in preparing the tools and managing the IRB application process. The pilot study was co‐authored by Dr. Emad, Dr. Amira, and Ms. Nora. Dr. Nagla carefully conducted the literature review and wrote the introduction to provide a solid foundation for the study. The methodological design was the responsibility of Dr. Mona and ensured a robust and well‐structured research approach. Dr. Amna took on the crucial task of data collection, while the data analysis and interpretation of the results were carried out by Dr Emad. Dr Neama and Dr Friyal led the discussion portion and provided insightful interpretations and conclusions from the results. Eventually, the entire team came together to collaboratively author and format the research. In the last step, Dr Emad and Dr Amira led the journal submission process and sought to share their collaborative efforts with the wider academic community.

FUNDING INFORMATION

This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.

CONFLICT OF INTEREST STATEMENT

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

ETHICS STATEMENT

Ethics approval for the study was obtained from the ethical committee of Imam Abdulrahman Bin Faisal University, Saudi Arabia (IRB‐2022‐04‐531) on 19 December 2022. The study adherence to the ethical standards of the Helsinki Declaration, and implied consent was obtained from all participants.

ACKNOWLEDGEMENTS

The authors would like to thank Prof. Tyler J. VanderWeele for providing the scale used in this research. In addition, the authors would like to thank Prof. Suliman Bah and Dr. Khaldun Aldababi for their invaluable scientific and statistical advice, which greatly contributed to the quality and accuracy of this study.

Shdaifat, E. , Alshowkan, A. , Omer, A. , Alqahtani, F. , AL‐Qahtani, M. , Alsaleh, N. , Kamel, N. , & Alotaibi, N. (2024). Flourishing among undergraduate nursing students: Insights from a cross‐sectional study in Saudi Arabia. Nursing Open, 11, e2119. 10.1002/nop2.2119

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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