The relationship between psychological well-being, helpfulness, and tolerance tendency in nursing students

Abstract

Background

Psychological well-being, helpfulness, and tolerance are fundamental concepts for nursing students’ professional identity development, human-centered care approach, and quality healthcare.

Objective

This study was conducted to examine the relationship between psychological well-being, helpfulness and tolerance tendency in nursing students.

Methods

The descriptive and correlational study was conducted between April and July 2022 with the voluntary participation of 753 students studying in the nursing departments of three public and one private universities in Türkiye. The data were collected with the Information Form, Psychological Well-Being Scale, Helpfulness Scale, Tolerance Tendency Scale Form for Adults and tested with t-test, Kruskal Wallis H, ANOVA, Pearson Correlation, Multiple Linear Regression Analyses.

Results

The psychological well-being scale score of the students was 5.31 ± 0.94, the helpfulness scale score was 4.26 ± 0.51 and the tolerance tendency scale score was 3.62 ± 0.65. While students’ tolerance tendency (β = 0.389), psychological well-being (β = 0.240), being female (β = 0.114), liking the nursing department (β = 0.077) and having good relationships with their friends (β = 0.113) significantly positively affected their helpfulness scale scores, having a nuclear family structure negatively affected them (β=-0.068) (p < 0.05).

Conclusion

Students had high levels of psychological well-being and helpfulness and moderate levels of tolerance tendency. There is a significant relationship between these three concepts, and tolerance tendency has had the greatest impact on helpfulness. For the sustainability of students’ helpfulness, simulation and group trainings and games can be planned to improve their tolerance tendencies.

Introduction

One of the main goals and duties of nursing from past to present is to help the individual/patient [1]. Nurses help to protect and improve health, meet the basic needs of sick individuals and help the individual to become able to meet their own needs independently [2]. Therefore, it is important that nursing is chosen by individuals who love people and have the understanding of being able to help [2–4]. In some studies supporting this statement, it has been determined that students prefer nursing to help people [5, 6] and are impressed by friendly nurses who help people [6]. Because the help provided is satisfying and meaningful when it is presented with caring, supportive or sincere/sincere behaviors or tolerance [7]. In this sense, the combination of the service provided in nursing with love and care reveals the meaning and value of the service and that it is an effort on behalf of humanity [8]. Therefore, the effort to protect and strengthen the well-being of one’s immediate environment [9], a multidimensional value encompassing positive attitudes and behaviors such as generosity, cooperation, compassion, hospitality, and sharing, known as “helpfulness” [10] which is an altruistic behavior [11], is one of the fundamental values that student nurses should possess.

Tolerance, which is a universal value such as helpfulness [12] and also one of the principles of managerial ethics [13], is that enables individuals to live in harmony with their differences [14], a moral principle as well as a political and legal requirement [15]. The essence of tolerance is respect; it means understanding different thoughts, beliefs and identities. It does not require consensus or compromise on beliefs, but rather recognizing diversity and being sincerely open to different points of view. It involves a form of acceptance and understanding that comes from the heart rather than a forced endurance [14]. Individuals’ tolerance in their relationships with both themselves and their environment supports their personal happiness, social harmony and success [15]. It is also a virtue that enhances an individual’s worth, facilitates acceptance by others, encourages sharing, and encompasses showing understanding and responding with understanding. It prevents the emergence of negative emotions that adversely affect individual and social life and cause irreversible damage in physical and psychological terms. By fostering positive emotions and thoughts, it enables a humane way of living and renders life meaningful [16]; therefore, it preserves psychological well-being [17]. In this respect, it is necessary for student nurses to be tolerant in terms of their happiness, social cohesion and success in the field of education/practice. Students’ focus on positive experiences is key to overcoming obstacles and difficulties and is associated with better psychological well-being [18].

Psychological well-being refers to an individual’s experiencing positive emotions more frequently than negative ones, feeling satisfied with life, and having a high quality of life [19]. It also entails being at peace with oneself, accepting one’s strengths and weaknesses, maintaining emotional balance, acting in line with one’s goals, and coping effectively with life’s stressors [20]. Psychological well-being is addressed within the complementary frameworks of hedonism (subjective well-being) and eudaimonia (psychological well-being) [21]. While the hedonic approach emphasizes life satisfaction and the balance between positive and negative emotions [22], the eudaimonic approach encompasses self-realization, effective functioning, and perceived ability to cope with life’s challenges [19]. Psychological well-being emerges from the coexistence of the components of these two approaches [21, 22]. In this context, Bradburn’s Affect Balance Model posits that positive affect must be predominant for psychological well-being and that this balance is influenced by social, economic, and political factors. Seligman’s PERMA model integrates hedonic and eudaimonic approaches and explains psychological well-being through the dimensions of positive emotions, engagement, relationships, meaning, and accomplishment. Ryff’s six-dimensional model, on the other hand, conceptualizes psychological well-being in terms of self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth [19].

Psychological well-being encompasses individuals’ ability to maintain their physical and mental health and to use their potential consciously [23], as well as to establish positive relationships characterized by empathy, love, and compassion and to reflect these in their behaviors. Individuals with high levels of positive relationships and subjective well-being form meaningful bonds, are sensitive to their environment, and feel a sense of responsibility toward the needs of others [17]. Moreover, they participate more frequently in volunteer activities, display altruistic, trustworthy, and cooperative behaviors, and exhibit lower levels of intolerance [24, 25]. Some studies have also found that nursing students’ participation in voluntary clinical services/activities increases psychological well-being [22]; that helping or providing care to patients evokes positive emotions (e.g., happiness, empathy, optimism) [26, 27]; that increases in the tendency to help positively affect caring behaviors [26]; and that such experiences contribute to coping with negative emotions. In summary, it has been reported that the caregiving process generates psychological satisfaction [27]. However, studies indicate that nursing students experience greater psychological distress than students in other disciplines due to difficulties in adapting to university life, economic problems, academic and clinical experiences/stressors, interpersonal relationships, and insufficient support systems [23, 28]. They experience stress/academic stress, anxiety, and depression, which negatively affect their psychological well-being [22, 23, 29–36]. During the COVID-19 period, students experienced fear and sleep disturbances in addition to these problems [37]. Inability to cope with these challenges may lead to feelings of powerlessness and helplessness among students, as well as physical and psychological problems [23] and the emergence of negative emotions [38]. These difficulties may adversely affect learning processes, academic and clinical performance, and nurse–patient relationships [28]. Furthermore, they may result in increased tension, decreased levels of tolerance, and negative impacts on caregiving practices and quality of care [38]. Conversely, maintaining psychological well-being among students is vital for completing their education [28], adapting to university life and the profession, and remaining in the profession [18].

When the literature was examined, it was seen that there were a limited number of studies on directly the tolerance [38] and the helpfulness levels of nursing students [2], and their psychological well-being was studied with topics such as social support [39, 40], empathy and professional motivation [41], happiness [42], stress [35, 40] and resilience [33, 43], psychological distress, depression, anxiety [35], burnout or academic burnout [43, 44], emotional intelligence [21]. However, a study was unavailable in which psychological well-being, helpfulness and tolerance were examined together. In this context, examining the relationships among the three concepts and the associated factors may fill an important gap in the literature and contribute to identifying protective factors that support students’ psychological well-being and reduce stress, anxiety, and burnout. It may guide the development of student-centered educational and psychosocial practices/activities, as well as guidance and counseling services, and raise awareness among educators and faculty administrators regarding this issue. Moreover, it may help strengthen the professional values of future nurses—such as person-centered care, empathy, and ethical sensitivity—support their successful continuation of education, promote retention in the profession, and enhance their professional productivity. This study examines the relationship between psychological well-being, helpfulness and tolerance tendency in nursing students.

Research questions:

1. What are the psychological well-being, helpfulness and tolerance tendency levels of nursing students?

2. Is there a relationship between psychological well-being, helpfulness and tolerance tendency in nursing students?

3. What are the factors affecting the helpfulness of nursing students?

Methods

The design of the study

It is a descriptive and correlational study.

Population and sample

The population of the study consisted of 2334 students studying in the 1st, 2nd, 3rd and 4th grades of the nursing department of three state universities and one foundation university located in the Marmara and Eastern Black Sea regions of Türkiye in the Spring Semester of the 2021–2022 Academic Year. The sample selection formula (95% confidence interval, 5% margin of error) was used for the known population sample calculation. The minimum sample size for the study was found to be 330. The study was conducted 753 students. Students who were actively enrolled in the nursing departments of the specified universities and who volunteered to participate in the study were included.

Data collection tools

Data were collected between April and July 2022, using the Information Form, Psychological Well-Being Scale, Helpfulness Scale, Tolerance Tendency Scale Form for Adults and Informed Consent Form, which were prepared as an online Google form. This online form was sent to all students via WhatsApp application. Students were able to answer this online form after reading the information text and consenting that they voluntarily agreed to participate in the study on the first page.

Information form

It was developed by the researchers in line with the relevant literature [2, 23]. It consists of 11 questions about students’ demographic (e.g. age, gender), academic (e.g. grade, liking the nursing department) and family (e.g. family structure, family relations) characteristics.

Psychological Well-Being scale (PWBS)

Developed by Diener et al. (2010) [45], PWBS was adapted into Turkish by Telef (2013) [46]. It consists of 8 items and a single dimension and is a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). Scores range from 8 to 56. A high score indicates that the person has many psychological resources and strengths. In Telef’s study [46], the Cronbach alpha coefficient of the scale was 0.80, while in this study it was 0.88.

Helpfulness Scale (HS): The scale was developed by Demirci and Ekşi (2018) [47]. Consisting of 7 items and a single dimension, the scale is in 5-point Likert type (1 = Not at all suitable for me to 5 = Completely suitable for me). The second item in the scale is reverse coded. As the scores obtained from the scale increase, the level of helpfulness increases accordingly. The Cronbach alpha coefficient of the scale was 0.76 in Demirci and Ekşi’s [47] study and 0.83 in this study.

Tolerance Tendency Scale Form for Adults (TTS): The scale was developed by Çalışkan and Çavuş (2020) [48]. The 10-item scale consists of 2 sub-dimensions: Respect for Differences (items 1,3,5,7,9 and 10) and Acceptance (items 2,4,6 and 8). There are no reverse items in the scale, which is a 5-point Likert type (1 = Not at all appropriate to 5 = Completely appropriate). Cronbach alpha coefficient of the scale was found to be 0.82. If the score obtained from the total and sub-dimensions of the scale is high, the characteristic of the dimension evaluated and the tendency towards tolerance in total is high [48] In this study, the total Cronbach alpha coefficient of the scale was found to be 0.86, and the Cronbach alpha coefficients of the Respect for Differences and Acceptance sub-dimensions were 0.88 and 0.70, respectively.

Data analysis

Data were analyzed with SPSS 17 program. Frequency, percentage and mean were used to determine the demographic, academic and family characteristics of the students. The normal distribution of the data was evaluated with skewness and kurtosis (± 1) and it was determined that the data showed normal distribution [49]. In the study, the skewness and kurtosis values of the scales were, respectively, − 0.584 and 0.213 for HS, − 0.792 and 0.910 for PWBS, and − 0.058 and − 0.480 for TTS. Descriptive statistics and Pearson Correlation Analysis were used to determine the psychological well-being, helpfulness, and tolerance tendency levels of the students and to determine the relationship between them. In the study, the independent variables were identified as age, gender, grade, liking the nursing department, family structure, income level, family attitude, family relationships, relationships with friend, effectively coping with problems, taking values and ethics in nursing course, PWBS points, TTS points, while the dependent variable was identified as HS scores. T-test, one-way ANOVA and Kruskal Wallis H test were used to compare the demographic, academic and family characteristics of the students with their helpfulness scale scores. Variables found to be significant as a result of the difference tests were included in Model 2. Multiple Linear Regression Analysis using the Enter method was conducted to determine the effect of some independent variables on students’ helpfulness. The findings were evaluated at a 95% confidence interval with a 5% level of significance.

Ethical considerations

Approval dated 25.03.2022 and numbered 2022/03 was obtained from the ethics committee of a university in Istanbul. Permission was obtained from the institutions (07.04.2022–262064, 13.04.2022-2512) where the study was conducted and scale use permissions were obtained from the authors. In addition, voluntary informed consent was obtained from the students participating in the study.

Results

The mean age of the students was 21.06 ± 1.80, 79.4% were female and 31.9% were 2nd year students. 85.1% of the students stated that they liked the nursing department, 83% stated that they had a nuclear family structure, 66.7% described their family relations and 68.8% described their friend relations as good. 77.7% of the students stated that they could cope with problems effectively, and 88.7% stated that they had taken a course on values and ethics in nursing (Table 1).

Table 1.

Demographic, family and academic characteristics of nursing students (n = 753)

Variable		Mean ± SD
Age (Year)		21.06 ± 1.80
		n	%
Gender	Female	598	79.4
	Male	155	20.6
Grade	1st grade	144	19.1
	2nd grade	240	31.9
	3rd grade	159	21.1
	4th grade	210	27.9
Liking the nursing department	Yes	641	85.1
	No	112	14.9
Family Structure	Nuclear family	625	83
	Extended family	128	17
Income level	Low	106	14.1
	Medium	622	82.6
	High	25	3.3
Family attitude	Democratic	500	66.4
	Authoritarian	219	29.1
	Indifferent/Uninterested	34	4.5
Family relationships	Good	502	66.7
	Medium	220	29.2
	Weak	31	4.1
Relationships with friends	Good	518	68.8
	Medium	214	28.4
	Weak	21	2.8
Effectively coping with problems	Yes	585	77.7
	No	168	22.3
Taking values and ethics in nursing course	Yes	668	88.7
	No	85	11.3
Total		753	100

SD: Standard deviations

The students’ PWBS mean score was 5.31 ± 0.94 and their HS mean score was 4.26 ± 0.51. The students’ total TTS score average is 3.62 ± 0.65, the respect for differences sub-dimension is 4.02 ± 0.69, and the acceptance sub-dimension is 3.02 ± 0.79. There is a moderate positive and statistically significant correlation (p < 0.001) between the students’ HS and TTS total scores (r = 0.488), respect for differences (r = 0.513) and acceptance (r = 0.332) sub-dimensions, as well as the PWBS score (r = 0.438). There is a moderate correlation between the PWBS and TTS total scores (r = 0.339) and respect for differences sub-dimension (r = 0.327), and a weak but positive significant correlation between the scores of the acceptance sub-dimension (r = 0.270) (p < 0.001) (Table 2).

Table 2.

Means, standard deviations and correlations of all measures (n = 753)

Scales	Mean ± SD	In study Min.-Max.	Scale Min.-Max.	1	2	3	4	5
1. HS	4.26 ± 0.51	2.29-5	1–5	1
2. PWBS	5.31 ± 0.94	2–7	1–7	0.438*	1
3. Respect for Differences Subscale	4.02 ± 0.69	2–5	1–5	0.513*	0.327*	1
4. Acceptance Subscale	3.02 ± 0.79	1–5	1–5	0.332*	0.270*	0.578*	1
5. TTTS	3.62 ± 0.65	1.90-5	1–5	0.488*	0.339*	0.918*	0.854*	1

***p < 0.001, HS: Helpfulness Scale, TTTS: Tolerance Tendency Total Scale, PWBS: Psychological Well Being Scale, SD: Standard deviations, Min.: Minimum, Max.: Maximum

The results of the regression analysis indicated that Model 1, assessing the effects of TTS and PWBS scores on HS scores, was statistically significant (F(2,750) = 178.414; p < 0.001). A statistically significant difference was found between the Helpfulness Scale (HS) scores and gender (t(751) = 3.695; p < 0.001), liking the nursing department (t(136.712) = 5.226; p < 0.001), coping with problems (t(751) = 5.038; p < 0.001), family structure (t(751)=-2.022; p < 0.05), family relationships (F(2,750) = 19.857; p < 0.001), and relationships with friend (Kruskal–Wallis χ² (2) = 47.149; p < 0.001) (p < 0.05). In this context, the Model 2 created for the effect of students’ significant demographic, academic and family characteristics, TTS and PWBS scores on HS scores was significant (F(8, 744) = 53.256, p < 0.001). The variables in the model explained 35.7% of the HS score (R² = 0.364; Adj R² = 0.357). While the students’ tolerance tendency (β = 0.389), psychological well-being (β = 0.240), being female (β = 0.114), liking the nursing department (β = 0.077) and having a good relationship with their friends (β = 0.113) positively affected the helpfulness scale scores, having a nuclear family structure negatively affected them (β=-0.068). These findings were statistically significant (p < 0.05) (Table 3).

Table 3.

Factors affecting on helpfulness of nurse students (n = 753)

	Variables	Unstandardized Coefficients					%95 Confidence Interval
		B	SE	β	t	p	Lower limit	Upper limit
Model 1	Constant	2.271	0.107	-	21.298	0.000***	2.062	2.481
	TTS	0.301	0.025	0.383	12.002	0.000***	0.252	0.351
	PWBS	0.168	0.017	0.308	9.650	0.000***	0.134	0.203
F(2,750) = 178.414, p < 0.001; R2 = 0.322; Adj R2 = 0.321
Model 2	Constant	2.252	0.113	-	19.870	0.000***	2.030	2.475
	TTS	0.306	0.024	0.389	12.505	0.000***	0.258	0.354
	PWBS	0.131	0.020	0.240	6.428	0.000***	0.091	0.172
	Gender (Female)	0.145	0.037	0.114	3.884	0.000***	0.072	0.218
	Liking the department (Yes)	0.112	0.045	0.077	2.475	0.014*	0.023	0.200
	Coping with problems (Yes)	− 0.073	0.042	− 0.059	-1.755	0.080	− 0.155	0.009
	Family Structure (Nuclear)	− 0.093	0.040	− 0.068	-2.309	0.021*	− 0.171	− 0.014
	Family relationships (Good)	0.057	0.037	0.053	1.555	0.120	− 0.015	0.129
	Relationships with friends (Good)	0.124	0.039	0.113	3.204	0.001**	0.048	0.201
F(8, 744) = 53.256, p < 0.001; R2 = 0.364; Adj R2 = 0.357

Dependent variable: Helpfulness Scale Score *p < 0.05 **p < 0.01 ***p < 0.001

TTS: Tolerance Tendency Scale, PWBS: Psychological Well-Being Scale, B = unstandardized regression coefficient, SE = standard error, β = standardized regression coefficient, t = t value, p = significance level, F = overall model test statistic, R²= coefficient of determination, Adj R² = adjusted coefficient of determination

Discussion

Psychological well-being is a fundamental component of the educational and professional development processes of nursing students who will be the nurses of the future [33]. During these processes, students are influenced by their positive experiences and derive pleasure from them. This situation can strengthen students’ psychological well-being and health, as well as increase their psychological resilience, levels of self-acceptance, and efforts toward their responsibilities [22]. In addition, as stated in the definition of nursing, students, as future nurses, should be able to perform or learn to perform these duties and care practices with respect for human dignity, based on ethical principles and an understanding of social justice, and in a human-centered and culturally competent manner [50]. In this context, addressing psychological well-being, helpfulness, and tolerance tendencies together among nursing students is important in terms of academic success, the internalization of professional values, and the development of professional identity. However, in the literature, no study has been found that directly addresses these three fundamental components together from a nursing perspective.

In this study on psychological well-being, helpfulness and tolerance tendency, the helpfulness levels of student nurses, most of whom were female, liked the nursing department, had good family and friend relations, had nuclear families and one third of them were second year students, were high. It is a pleasing finding that nursing students, who are the candidates of the nursing profession, which is centered on the understanding of helping, have high levels of helpfulness. High levels of helpfulness of nursing students indicate that they have a strong capacity to fulfill professional responsibilities and empathize. This finding reveals that students have the ethical values required by the nursing profession and provide an important advantage in the process of preparation for the profession. This situation may be related to students’ internalization of professional values during their education and to the supportive role of positive family and peer relationships. Similarly, in some studies, student nurses have high levels of helpfulness [2] and altruism [11]. In a study on the personal values of nursing students, it was observed that the benevolence sub-dimension ranked first with the highest score [51], and in another study, it was observed that students received the highest score from benevolence, one of the sub-dimensions of moral sensitivity [52]. In line with these results, it is reported in the literature that professionalism requires the ability to be motivated by the desire to help others as well as having many characteristics [53]. In a study conducted in the Philippines, it was reported that nurses experience the joy of helping when they perform benevolent action. In addition, in the same study, it was stated that nursing students should be the first to understand the concept of benevolence in order to appreciate goodness and beauty, and educators should emphasize the value of benevolence to their students in the classroom or clinical environment [54].

Helpfulness, which is a moral virtue that develops feelings of love and brotherhood among people and is necessary for the peace of humanity, also enables individuals to feel a sense of satisfaction due to their duties towards others, improves self-esteem and contributes positively to mental health [55]. In one study, it is stated that helpfulness is a source of human welfare [56]. In support of this finding, in our study, it was observed that as the helpfulness of the students increased, their psychological well-being increased and the psychological well-being levels of the students were high. While some studies indicate that nursing students have high psychological well-being [32, 42], one study found that the psychological well-being of nursing students in upper grades was better [39], while another study found that it was lower [32]. Students taking their first steps into nursing were reported to be at a moderate level [57]. It is desirable that psychological well-being is high in nursing students. Because psychological well-being of students is highly and positively correlated with their happiness [42]. It is necessary for students to lead a healthy life and have a high quality of life for the functions they perform for patient care and problem solving [58].

Students’ psychological well-being is also related to their tolerance. Tolerance is a fundamental element for healthy individuals and a peaceful society [59]. In this study, it was determined that as student nurses became more tolerant, their psychological well-being levels increased. In addition, it was seen that the tolerance tendencies of the students in general were at a moderate level, and they received the highest score from the “respect for differences” sub-dimension. In studies, it is stated that being tolerant is among the behaviors that patients expect from nurses [60] and also among the characteristics that nurses think make them a good nurse [61]. In some study conducted with nursing students, they had a moderate level of tolerance [38] and expressed tolerance among the characteristics of a good nurse [62, 63]. While these findings reveal that tolerance is accepted as an important professional value and professional attitude in the nursing profession, the fact that patients and nurses emphasize tolerance shows that the concept of tolerance is directly related to the human-oriented and ethical dimension of the profession. In addition, the fact that nursing students also mentioned tolerance among the characteristics that a good nurse should have suggests that this value is internalized by students during the professional socialization process. In this context, supporting tolerance skills in the nursing education process and empowering students in this direction are important in terms of both professional identity development and improving the quality of patient care.

In addition to these, in the study, while tolerance tendencies, psychological well-being, being female, having good friend relationships, and liking the nursing department positively affected the helpfulness levels of student nurses, having a nuclear family negatively affected them. An individual’s psychological and emotional balance is reflected in their social behaviors. It is thought that individuals who feel good about themselves tend to be more understanding and empathetic towards others, and individuals with high levels of tolerance show more social behaviors by exhibiting more accepting and supportive attitudes towards differences. In this framework, it can be said that students’ establishing healthy relationships with themselves and their environment is an important psychosocial factor that encourages helpfulness.

However, although female students had higher levels of helpfulness in the study, different results were obtained in the literature. In one study, it was reported that there was no difference between the helpfulness levels of nursing students according to their gender [2], while in another study, female students’ benevolence scores were found to be higher [51]. In another study, it was reported that women had higher helpfulness than men [55]. The fact that female students are more helpful may be related to the traditional roles attributed to them by society, such as attributing characteristics such as helpfulness, sensitivity and sacrifice more to women, and encouraging girls to be more empathetic, sensitive and helpful to others from an early age.

In addition to social and cultural influences, helpfulness may also be related to students’ career choices and social relationships. In this respect, the fact that nursing is mostly chosen with the feeling of helping [3, 64, 65] and the need for sharing and helping to maintain friendships is manifested in the high level of helpfulness of students who like the nursing department and have good friendships as seen in this study. Supporting these results, in a study conducted with university students, it was found that students who had seven or more friends that they could ask for help had higher helpfulness scores [66]. Good friend relationships can contribute to the reinforcement of behaviors such as sharing, cooperation, and empathy. Therefore, students with strong social ties may increase their helpfulness tendencies by participating more in social support processes.

In the study, the helpfulness scores of students with nuclear family structure were found to be lower than those of students with extended family structure which includes many family members such as mother, father, grandfather, grandmother, and where strong relationships and solidarity between relatives come to mind [67]. This may be associated with the existence of a social structure based on sharing and solidarity in extended families. In such family environments, individuals gain experience in taking responsibility, cooperating and being sensitive to the needs of others at an early age due to living together with different generations. Therefore, it can be said that family structure is an important socialization factor that shapes individuals’ tendency to be helpful.

Limitations of the study

This study is limited to the opinions/self-reports of student nurses studying in three public and one private universities, who volunteered to participate in the study and who are mostly studying in the second year among the first, second, third and fourth years.

Conclusion and recommendations

This study is the first to examine the relationship between psychological well-being, helpfulness, and tolerance in nursing services. The results indicate that student nurses exhibit high levels of psychological well-being and helpfulness, while their tolerance tendencies are moderate. As students’ tolerance tendencies and psychological well-being increased, their levels of helpfulness also increased. Being tolerant and psychologically well, as well as being female, having positive friendships, and liking the nursing department, were found to positively influence helpfulness. In this context, the implementation of social-emotional learning activities, including group work, simulation-based training, games, volunteering-based projects, and empathy workshops, may contribute to strengthening students’ tolerance tendencies and sustaining their helpfulness behaviors. Psychological counseling and guidance services offered to students, along with stress coping, resilience, self-awareness programs, and peer mentoring practices, can contribute to maintaining students’ psychological well-being and supporting the continuity of helpfulness behaviors. Willingly choosing to study nursing and having positive peer relationships also positively affect students’ levels of helpfulness; therefore, learning environments that support teamwork, collaboration, and professional motivation can be created. Through group work, community service activities, and educational programs that emphasize the humanistic and ethical aspects of nursing, interaction among students can be increased, and sharing and helping behaviors can be strengthened.

Author contributions

Study design: SKÖ. Data collection: SKÖ, HÖ, NB, ZÖ, BD. Data analysis: SKÖ, HÖ, ZÖ. Study supervision: SKÖ, HÖ, NB, ZÖ, BD. Manuscript writing: SKÖ, HÖ, NB, ZÖ, BD. Critical revisions for important intellectual content: SKÖ, HÖ, NB. All authors have read and approved the final manuscript.

Funding

No funding or any financial support.

Data availability

The datasets used and analyzed during this study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Approval dated 25.03.2022 and numbered 2022/03 was obtained from the Istanbul Sabahattin Zaim University Ethics Committee. Permission was obtained from the institutions where the study was conducted and scale use permissions were obtained from the authors. In addition, voluntary informed consent was obtained from the students participating in the study. The Declaration of Helsinki was followed throughout the research.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.