Factors that influence happiness among nursing students: a cross-sectional study in South Korea

Abstract

Objectives

This study aims to provide guidance for nursing college students to enhance their overall happiness and to support the development of internal resources that contribute to improved physical and psychological health as they progress in their nursing careers.

Design

A descriptive survey design was employed.

Setting

The study was conducted among nursing students enrolled at four nursing colleges in South Korea.

Participants

The final sample comprised 302 nursing students who met the following criteria: (1) enrolled in their third or fourth year of study, (2) engaged in club activities for more than 6 months within the previous year—considering the period during which face-to-face classes resumed following the COVID-19 pandemic— and (3) voluntarily consented to participate after receiving detailed information about the study.

Intervention

The dependent variable was happiness. Candidate explanatory variables included college life adaptation, leisure satisfaction from club activities and family strengths. Data were collected between 5 and 30 June 2023, and analysed using SPSS/WIN V.22.0 software in accordance with the study objectives.

Results

The multiple regression model was statistically significant (F=28.60, p<0.001), with college life adaptation (β=0.45, p<0.001), family strengths (β=0.15, p=0.002), number of siblings (β=0.12, p=0.008) and perceived physical health status (β=0.11, p=0.023) identified as significant predictors of happiness.

Conclusions

These variables collectively explained 42.0% of the variance in happiness. Future interventions aiming to enhance mental health and happiness among nursing students should consider these key influencing factors.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• The strength of this study lies in its bottom-up approach to happiness, which identifies psychological factors. We investigated a wide range of psychological factors, assuming that overall well-being is formed by cumulative satisfaction across various life domains, including income, leisure activities, family relationships and work.

• The study was limited to third-year and fourth-year nursing students; future research should include students across all academic years to enhance generalisability.

• To gain a deeper understanding of nursing students’ experiences of happiness, future research should complement quantitative findings with qualitative approaches.

Introduction

Happiness is widely recognised as a fundamental human need and a positive emotional state that facilitates the formation of meaningful social relationships and the pursuit of personal and societal goals.^{1 2} It is also a core determinant of health, exerting a significant influence on daily functioning, particularly in relation to mental well-being.³ In South Korea, the national happiness score is 5.95 out of 10, ranking 57th among 146 countries, 1.85 points lower than the highest-ranking country, Finland.⁴ In 2021, the happiness index for Korean adolescents was 79.5, reflecting a 9-point decline from 2019 and a 35.7-point gap compared with the Netherlands, the top-ranked country.⁵

The happiness of nursing students plays a pivotal role in shaping their ability to enhance both physical and mental health outcomes, which in turn influences their capacity to care for and support others.⁶ As nursing is a profession inherently centred on the care of human life, a core mission of nursing education is to cultivate students who are equipped with not only the requisite knowledge and skills, but also the emotional and physical resilience necessary for clinical practice.⁷ As part of their education, nursing students participate in clinical practicums, where they must navigate both the emotional and academic demands of patient care and adjust to the complexities of the clinical environment.

Nursing students often face heightened academic stress compared with peers in other academic disciplines due to the intensity of both theoretical coursework and hands-on clinical training. This increased stress can contribute to psychological distress, commonly manifesting as avoidance, social withdrawal and emotional exhaustion, all of which can diminish overall happiness.⁸ Accordingly, nursing colleges represent a critical setting for promoting happiness among students before they enter the workforce.⁹

Adaptation to college life refers to the array of coping strategies and behavioural adjustments students employ to manage the diverse demands of university life. This process reflects an active effort to meet personal needs across multiple domains, including academics, career development, interpersonal relationships, emotional regulation and satisfaction with one’s major, all within the broader sociocultural context of the college environment.^{10 11} Nursing curricula span foundational health sciences to complex clinical challenges, often placing considerable psychological and emotional demands on students.^{12 13} Additional challenges frequently emerge in the clinical setting, particularly in communication and collaboration with healthcare professionals.¹⁴ Students who successfully adapt to college life tend to perceive greater social support and demonstrate stronger independent stress management skills.¹⁵ This adaptive capacity positively impacts academic performance, major satisfaction, overall educational experience and future employment prospects, which together contribute significantly to students’ overall happiness.¹⁶

Leisure satisfaction refers to the positive perceptions or emotional responses that arise from engaging in leisure activities that fulfil personal needs.¹⁷ Such activities promote happiness by fostering intrinsic motivation, reinforcing a positive self-identity, strengthening social relationships and encouraging lifelong learning, thereby contributing to a sense of purpose and meaningful living.¹⁸ Empirical evidence suggests that structured leisure activities yield greater satisfaction than unstructured ones,¹⁹ and that voluntary participation in leisure activities has a more immediate and pronounced positive effect on happiness compared with involuntary engagement.^{20 21} Structured activities, such as club participation organised around defined social or behavioural goals, have been shown to enhance happiness by cultivating personal challenge, focused attention and intrinsic motivation.²²

Family strength is defined as a family’s capacity to maintain appropriate emotional bonds and carry out functional processes and interactions that support the well-being of each member. When effectively operating as a system, a strong family adapts its roles and dynamics according to the family’s developmental stage and circumstances, thereby fostering happiness among its members.²³ The family serves as a primary agent of socialisation during late adolescence²⁴ and is a critical determinant of happiness among nursing students, regardless of their cultural, social or economic context.²⁵ While economic resources, such as income and wealth, enable individuals to meet basic needs and pursue personal goals,^{26 27} non-economic factors, such as quality of familial relationships, are strongly associated with happiness due to their role in providing emotional support and facilitating social connectedness.²⁸

The bottom-up approach to happiness posits that overall well-being is shaped by cumulative satisfaction across various life domains, including income, leisure activities, family relationships and occupation.²⁹ In contrast, the top-down perspective attributes happiness to inherent personal traits, while the bottom-up approach highlights the influence of external, lived experiences on subjective well-being.³⁰ Previous studies on nursing students’ happiness have predominantly examined psychological variables, including life satisfaction and psychological well-being,³¹ the associations between depression, anxiety and happiness³² and broader psychological contributors to happiness.⁶ Building on this literature, the present study seeks to generate foundational evidence to inform the design of targeted happiness-enhancement programmes for nursing college students. Specifically, the study aims to examine the effects of key subfactors, college life adaptation, leisure satisfaction derived from club activities and family strengths, through the lens of the bottom-up theory of happiness. Based on this theoretical and empirical foundation, the following hypotheses were proposed:

Hypothesis 1: Korean nursing students’ college life adaptation will affect their happiness.

Hypothesis 2: Korean nursing students’ leisure satisfaction from club activities will affect their happiness.

Hypothesis 3: Korean nursing students’ family strengths will affect their happiness.

Methods

Design

This study employed a cross-sectional survey design using self-administered questionnaires to investigate the influence of college life adaptation, leisure satisfaction derived from club activities and family strengths on the happiness of Korean nursing students.

Participants

Participants were selected through convenience sampling and consisted of nursing students who met the following inclusion criteria: (1) enrolled in the third or fourth year of their undergraduate nursing programme, (2) had participated in club activities for more than 6 months within the past year, considering the timeline during which face-to-face classes resumed following the COVID-19 pandemic and (3) voluntarily agreed to participate after receiving detailed information about the study.

Sample size estimation was performed using G*Power 3.1 to ensure adequate statistical power. Based on a significance level (α) of 0.05, power (1−β) of 0.95, an effect size of 0.10 and 11 independent variables, the required sample size was calculated to be 262. To account for potential non-responses and a 20% exclusion rate due to insincere responses, a total of 320 questionnaires were distributed. Of these, 18 responses (5.63%) were excluded due to non-completion or insincerity, resulting in a final sample of 302 participants (94.38%) (figure 1).

Figure 1. Subject selection procedure.

Research tools with measurements

College life adaptation

College life adaptation was assessed using an instrument specifically developed for nursing students by Park and Kim.³³ The scale includes six subscales: interpersonal relationships (9 items), satisfaction with major (9 items), ease with major (5 items), coping skills (5 items), job preparation (3 items) and academic diligence (3 items), comprising a total of 34 items. Each item is rated on a 5-point Likert scale ranging from 1 (not at all) to 5 (very much so), with higher scores indicating greater adaptation to college life. In the present study, the Cronbach’s alpha was 0.93.

Leisure satisfaction from club activities

Leisure satisfaction was measured using the Leisure Satisfaction Scale, originally developed by Beard and Ragheb¹⁷ and subsequently validated in a Korean context by Kim et al³⁴ The instrument includes six subscales—psychological, educational, social, relaxation, physical and aesthetic satisfaction—comprising a total of 24 items. Responses are rated on a 5-point Likert scale from 1 (not at all) to 5 (very much so), where higher scores reflect greater satisfaction with leisure activities. The Cronbach’s alpha in this study was 0.97.

Family strengths

Family strengths were evaluated using the Korea Family Strengths Scale, developed by Yoo et al.²³ This instrument includes five subdomains: family resilience, mutual respect and acceptance, qualitative bonding, economic stability and cooperation and family culture and social participation, comprising 22 items. Each item is rated on a 5-point Likert scale from 1 (not at all) to 5 (very much so), with higher scores indicating stronger family functioning. The Cronbach’s alpha for this scale in the current study was 0.96.

Happiness

Happiness was measured using the shortened Korean version of the happiness scale developed by Suh and Koo.³⁵ The scale consists of 9 items representing three key dimensions of happiness: life satisfaction, positive emotions and negative emotions. Life satisfaction assesses contentment with personal life, interpersonal relationships and group affiliations, while emotional subscales evaluate the frequency of positive and negative emotions. Items 7, 8 and 9, which assess negative emotions, were reverse-scored. All items are rated on a 7-point Likert scale ranging from 1 (not at all) to 7 (very much so), with higher total scores indicating greater levels of happiness. In this study, the Cronbach’s alpha was 0.90.

Data collection

This study was conducted among nursing students from four nursing colleges in South Korea: Daegu Catholic University, Kyungbuk College, Kwangju Women’s University and Suseong University. From 10 to 21 April 2023, the researchers visited each institution in person to explain the purpose and methodology of the study to the respective department heads and obtained permission to proceed with data collection. Participant recruitment was conducted between 1 and 26 May 2023, through postings on departmental bulletin boards. From 5 to 30 June 2023, the research team met with eligible students who met the inclusion criteria, provided a detailed explanation of the study’s purpose and the questionnaire procedure, and obtained their cooperation. Completion of the survey required approximately 20 min. Participants who completed the questionnaire received a small token of appreciation (a pen valued at US$5).

Data analysis

Data were analysed using the SPSS/WIN V.22.0 software in accordance with the study’s objectives. Descriptive statistics, including frequency, percentage, mean and SD, were used to summarise the general characteristics of participants. Mean and SD values were calculated for scores on college life adaptation, leisure satisfaction from club activities, family strengths and happiness. Differences in happiness according to participants’ general characteristics were assessed using independent t-tests and one-way analysis of variance, with Scheffé’s test employed for post hoc comparisons. Pearson’s correlation coefficient was used to examine pairwise correlations among the main study variables. Multiple linear regression analysis was performed to identify factors significantly associated with nursing students’ happiness.

Ethical considerations

The questionnaire included comprehensive information about the study’s purpose, procedures, estimated time commitment, voluntary nature of participation, the right to withdraw at any time and the potential risks and benefits of participation. It also outlined how participants’ personal information would be managed to ensure confidentiality. Contact details for the research team were provided for enquiries.

Participation was contingent on informed consent. Only those who fully understood the study information and voluntarily agreed to participate were included in the analysis. All participants were assured that their responses would be anonymised and used solely for research purposes and that non-participation or withdrawal would incur no negative consequences. Written consent was obtained prior to data collection, and completed questionnaires were collected directly by the research team.

Patient and public involvement

Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

Results

General characteristics of participants

Among the 302 participants, 86.8% were female and 62.9% were in their fourth year of study. The majority reported living in nuclear families (87.1%), and 55.0% had one sibling. A total of 69.2% indicated that they had no religious affiliation. Most participants (70.2%) reported membership in one club, 83.1% were from middle-income households and 54.3% perceived their physical health as healthy.

Analysis of differences in happiness according to general characteristics (table 1) revealed statistically significant group differences by gender (males scored higher than females: t=2.46, p=0.015), academic year (third-year students scored higher than fourth-year students: t=2.54, p=0.012), number of siblings (happiness scores in descending order: 1>0>2>3 or more; F=5.58, p=0.001), income bracket (high>middle>low; F=9.03, p<0.001) and perceived physical health status (healthy>average>not healthy; F=22.38, p<0.001).

Table 1. General characteristics (N=302).

Variable	Category	n (%)	Mean	SD	t or F (p) Scheffé’s comparison
Sex	Male	40 (13.2)	5.26	1.14	2.46 (0.015)
	Female	262 (86.8)	4.82	1.02
Grade	Third	112 (37.1)	5.08	1.04	2.54 (0.012)
	Fourth	191 (62.9)	4.76	1.04
Family type	Nuclear	263 (87.1)	4.90	1.05	0.90 (0.441)
	Single parent	21 (7.0)	4.60	1.12
	Extended	13 (4.3)	5.03	0.78
	Other	5 (1.7)	4.47	1.11
Number of siblings	0a	21 (7.0)	4.94	0.96	5.58 (0.001) b>c>d>a*
	1b	166 (55.0)	5.08	0.96
	2c	81 (26.8)	4.61	0.05
	3 or mored	34 (11.3)	4.51	1.26
Religion	Yes	93 (30.8)	4.81	1.11	0.80 (0.427)
	No	209 (69.2)	4.91	1.02
Number of clubs	1	212 (70.2)	4.86	1.00	0.47 (0.624)
	2	77 (25.5)	4.88	1.14
	3	13 (4.3)	5.15	1.15
Income brackets	Higha	39 (12.9)	5.49	1.12	9.03 (<0.001) a>b>c*
	Middleb	251 (83.1)	4.81	0.99
	Lowc	12 (4.0)	4.38	1.35
Perceived physical health	Healthya	164 (54.3)	5.20	0.97	22.38 (<0.001) a>b>c*
	Moderateb	126 (41.7)	4.57	1.01
	Not healthyc	12 (4.0)	3.81	0.76

p<0.05.

b>a>c>d. b, a, c, d in that order mean high happiness averages.

^*Scheffé test.

F, The F value is an indicator that tests whether the entire regression model is statistically significant; N, Number; t, The significance of each independent variable.

College life adaptation, leisure satisfaction from club activities, family strengths and happiness

The mean score for college life adaptation was 3.61±0.54 (on a 5-point Likert scale). Leisure satisfaction from club activities averaged 3.45±0.80, and family strengths averaged 4.03±0.69. The mean score for overall happiness was 4.88±1.44 (on a 7-point Likert scale) (table 2).

Table 2. Descriptive statistics for happiness, college life adaptation, leisure satisfaction from club activities and family strengths (N=302).

Measurement	Mean±SD	Minimum	Maximum
Happiness	4.88±1.05	1.44	7.00
College life adaptation	3.61±0.54	2.06	5.00
Leisure satisfaction from club activities	3.45±0.80	1.25	5.00
Family strengths	4.03±0.69	1.50	5.00

Pairwise correlations among study variables

Happiness was significantly and positively correlated with college life adaptation (r=0.59, p<0.001), leisure satisfaction from club activities (r=0.24, p<0.001) and family strengths (r=0.42, p<0.001). Additionally, college life adaptation was positively correlated with leisure satisfaction (r=0.34, p<0.001) and family strengths (r=0.41, p<0.001). A significant positive correlation was also observed between leisure satisfaction and family strengths (r=0.17, p=0.004) (table 3).

Table 3. Correlations among study variables (N=302).

Measurement	Happiness	College life adaptation	Leisure satisfaction	Family strengths
	r (p)	r (p)	r (p)	r (p)
Happiness	1
College life adaptation	0.59 (<0.001)	1
Leisure satisfaction	0.24 (<0.001)	0.34 (<0.001)	1
Family strengths	0.42 (<0.001)	0.41 (<0.001)	0.17 (0.004)	1

r, correlation coefficient.

Factors influencing happiness

To examine the predictors of happiness, demographic variables that showed significant group differences (ie, gender, academic year, number of siblings, income bracket and perceived physical health status) were included as dummy variables. The main explanatory variables, college life adaptation, leisure satisfaction and family strengths, were entered into a multiple linear regression model. The Durbin-Watson statistic was 1.822, indicating no autocorrelation and confirming the independence of residuals. Multicollinearity diagnostics showed acceptable tolerance values (0.701–0.942) and variance inflation factors (1.062–1.426), confirming the absence of multicollinearity. The regression model was statistically significant (F=28.60, p<0.001). College life adaptation (β=0.45, p<0.001), family strengths (β=0.15, p=0.002), number of siblings (β=0.12, p=0.008) and perceived physical health status (β=0.11, p=0.023) were identified as significant predictors of happiness. However, leisure satisfaction from club activities was not statistically significant (β=0.02, p=0.633). The model accounted for 42.0% of the variance in happiness (table 4).

Table 4. Multiple regression analysis of factors influencing happiness (N=302).

Factors	B	SE	β	t	p
(Constant)	0.29			0.76	0.448
Sex	0.23	0.15	0.07	1.54	0.124
Grade	0.13	0.11	0.06	1.24	0.218
Number of siblings	0.25	0.10	0.12	2.67	0.008
Income brackets	0.23	0.14	0.07	1.60	0.110
Perceived physical health status	0.29	0.10	0.11	2.29	0.023
College life adaptation	0.87	0.10	0.45	8.67	<0.001
Leisure satisfaction	0.03	0.06	0.02	0.48	0.633
Family strengths	0.24	0.08	0.15	3.09	0.002

Durbin-Watson=1.822, tolerance limit=0.701–0.942, VIF=1.062–1.426.

R2=0.44, adjusted R2=0.42, F=28.60, p<0.001.

B, Unstandardized Coefficient; F, The F value is an indicator that tests whether the entire regression model is statistically significant; t, The significance of each independent variable; β, Standardized regression coefficients.

Discussion

This study, grounded in the bottom-up theory of happiness, identified college life adaptation and family strengths as significant predictors of happiness among Korean nursing students. The instrument used to assess college life adaptation encompassed six key domains: satisfaction with one’s major, perceived ease of studying the major, academic commitment, preparation for employment, interpersonal relationships and stress management, all of which reflect essential components of academic life.³³ The finding that college life adaptation influences happiness aligns with previous studies reporting that Korean nursing students who express higher satisfaction with their academic major also exhibit greater happiness and academic achievement compared with those who are less satisfied.⁶ This may be attributed to the fact that students who are satisfied with their major tend to invest more effort in cultivating positive emotions, acquiring knowledge and developing personal values throughout their college years. These results also corroborate earlier research indicating that Korean nursing students view the establishment and attainment of academic goals as a central element of their happiness.³⁶

Successful adaptation to college life fosters a sense of belonging to one’s department and increases engagement with academic pursuits, ultimately contributing to academic success.^{37 38} Furthermore, the process of adapting to college life equips students to meet personal, social, academic and institutional challenges—critical for maintaining physical and mental well-being in future clinical practice.³⁸ Nursing students who possess strong academic motivation, learn in a supportive academic environment and demonstrate high awareness of academic well-being are more likely to exhibit successful adaptation compared with those lacking one or more of these factors.³⁹ Accordingly, adaptation to college life appears to serve as an important external environmental factor by promoting academic motivation, supporting sustained academic achievement and encouraging the pursuit of physical and mental health, all of which are essential for students preparing to enter the nursing workforce. Previous literature suggests that college students’ happiness can be improved through the implementation of structured educational programmes.³⁶ In this context, nursing education curricula should be systematically designed to maintain students’ interest and enthusiasm for the profession, thereby supporting academic persistence and success. In addition, diverse educational initiatives should be developed to assist nursing students in stress management, problem-solving, interpersonal communication, experiential learning and volunteer activities. Such programmes should aim to mitigate negative emotions, cultivate positive emotional experiences and ultimately support students’ adjustment to college life.

Family strengths emerged as a symbolic factor in the happiness of Korean nursing students. This finding is consistent with prior research demonstrating that higher levels of family cohesion and flexibility, along with reduced dysfunctional interactions, are positively associated with happiness among college students.⁴⁰ For example, studies have reported that Chinese college students who frequently interact with family members and maintain harmonious relationships with their parents exhibit greater happiness.⁴¹ Similarly, Indian college students report higher happiness levels when they perceive strong, positive relationships with their parents and an overall supportive family environment.⁴² In the Korean context, previous studies have shown that family strengths positively affect psychological attributes, such as self-esteem and resilience, thereby enhancing overall happiness.⁴³ The family unit plays a central role in individual development and socialisation, particularly during the formative period of college life, which coincides with early adulthood.⁴⁰ In South Korea, family dynamics are typically shaped by collectivist values and a strong emphasis on familial cohesion, which may further amplify the influence of family support on student well-being. Family strengths contribute to the development of positive personal characteristics, such as serenity, integrity, moderation, humanity and sprightliness, by enhancing communication and problem-solving within the family.⁴⁴ These personality traits, in turn, guide how individuals experience, interpret and respond to life circumstances, often resulting in greater subjective happiness.⁴⁵ It is, therefore, reasonable to infer that family strengths among nursing students contribute to the formation of positive personality traits, greater problem-solving capacity and improved communication skills. These qualities may help students more effectively address challenges encountered during their academic journey, thereby modifying the external environment that supports happiness. Accordingly, efforts to improve happiness in this population should include interventions aimed at strengthening family dynamics. These may involve programmes designed to foster family resilience, promote mutual respect and acceptance and enhance qualitative familial bonds.

In contrast, leisure satisfaction derived from club activities did not significantly determine the happiness of nursing students in this study. This finding diverges from earlier research suggesting that leisure activities, particularly those involving physical or social engagement, such as participation in sports clubs, can enhance happiness through improvements in physical and mental health.46,48 Previous studies have also shown that engaging in enjoyable activities is associated with increased pleasure and reduced discomfort, contributing to elevated happiness levels.²⁹ However, contextual factors may explain this discrepancy. For example, a survey of 1866 female college students in India found that 43.6% disagreed with the statement, “I spend a lot of time in sports and leisure activities,” indicating lower engagement in leisure activities among female students compared with their male peers.⁴⁹ Among American college students, active leisure pursuits (eg, hiking, camping or biking) were associated with more positive emotional outcomes than passive leisure activities (eg, indoor or cultural engagements).⁵⁰ Moreover, male students were more likely than female students to prefer active, physically engaging leisure activities.⁵¹ Given that 86.8% of the participants in the present study were female, it is plausible that overall interest in leisure activities was relatively low. Even among those who were interested, the preference may have skewed towards passive rather than active forms of leisure.^{51 52} Additionally, 70.2% of participants reported membership in only one club, and opportunities for diverse engagement may have been limited. These factors likely contributed to the lack of a significant impact of leisure satisfaction on happiness in this sample. To foster increased happiness among nursing students, it may be beneficial to create an environment that actively promotes participation in leisure activities. This could include expanding the variety and accessibility of clubs both within and outside the college setting to accommodate a broader range of interests and encourage more active involvement.

Among the general characteristics examined in this study, a greater number of siblings was associated with higher levels of happiness among Korean nursing students. This finding aligns with previous studies indicating that adolescents without siblings tend to spend more time alone and report lower levels of happiness during solitary periods compared with their peers with siblings.⁵³ Furthermore, adolescents with siblings are more likely to express positive emotions and fewer negative emotions during peer interactions. As the number of siblings increases, the range of interpersonal interactions broadens, not only with siblings themselves but also through enhanced engagement with parents and peers, potentially contributing to greater positive affect and overall happiness. Perceived physical health also emerged as a significant factor associated with happiness. Participants who rated their physical health as better reported higher happiness levels. This finding is consistent with previous research among Chinese university students, which showed that perceived physical health had a significant role in happiness⁵⁴ and that it was more strongly correlated with happiness than objective health indicators.⁵⁵

Perceived physical health likely reflects engagement in physical activity, which can lead to improved endurance, elevated self-esteem and reduced symptoms of stress and anxiety.⁵³ These physiological and psychological benefits may reduce the risk of both physical and mental illness while simultaneously enhancing social relationships, factors that contribute positively to subjective well-being. Therefore, in the development and implementation of interventions aimed at improving happiness among nursing students, it is essential to consider general characteristics, such as perceived physical health and participation in extracurricular activities, including club involvement.

The implications and limitations of this study are as follows. This study identified key factors contributing to the happiness of nursing students through the lens of the bottom-up theory of happiness. The findings provide foundational data for the development of targeted happiness promotion programmes for nursing students. Future studies should incorporate more diverse demographic variables and include students from all academic years to enhance generalisability. Qualitative research is warranted to explore the lived experiences and subjective meanings of happiness among nursing students. Future investigations should examine a broader range of variables that may determine happiness to develop more comprehensive intervention strategies. Finally, this study was conducted using a cross-sectional design, which is useful for identifying relationships at a specific point in time, but has limitations in identifying temporal relationships between variables. Additionally, differences in the social and cultural environment to which each group belongs may affect the results. Furthermore, cross-sectional studies have limitations in that they can show correlations but have difficulty clearly proving causality. For example, it may be difficult to clearly distinguish whether a nursing student’s quality of life is the cause of their happiness or whether their quality of life has changed because of their happiness. Therefore, to overcome these limitations, future research needs to clarify changes and causal relationships over time through longitudinal studies. Additionally, it will be necessary to verify the complex causal relationships among multiple variables through path analysis or structural equation models.

It is important to acknowledge that happiness levels among Korean nursing students vary between individuals and can fluctuate over time. As happiness is shaped by a complex interplay of personal circumstances and external factors, identifying universally applicable determinants can be challenging.⁴⁹ The bottom-up theory of happiness, which emphasises the individual’s experience of the external environment,³⁰ provides a useful framework for understanding these dynamics. The findings of this study confirm that adaptation to college life and family strengths are the most significant external environmental factors contributing to happiness in this population. Accordingly, efforts to enhance happiness in nursing students should prioritise strengthening these external supports. Interventions aimed at improving college life adaptation and bolstering family strengths are likely to be more valuable than those focusing solely on leisure activities. Tailoring happiness promotion programmes to the individual’s background and contextual factors will further support the development of happiness as an internal psychological resource.

Conclusions

Nursing students face a distinct set of psychological stressors and risks for burnout due to the simultaneous demands of clinical training and academic coursework. This study, guided by the bottom-up theory of happiness, examined the influence of college life adaptation, leisure satisfaction from club activities and family strengths on happiness. The results indicated that adaptation to college life and family strengths were statistically significant predictors of happiness, whereas leisure satisfaction was not. These findings suggest that future programmes aiming to promote mental well-being and happiness among nursing students should prioritise strategies that support academic adaptation and enhance family support systems.

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.