Abstract
Objectives
Studies on quality of life (QoL) and academic resilience among nursing students during the Coronavirus disease (COVID-19) pandemic remain underreported. This study investigated the relationship between nursing students’ QoL and academic resilience and their predictors during the COVID-19 pandemic.
Methods
A descriptive survey, cross-sectional study that used two self-reported questionnaire scales to evaluate the QoL and academic resilience of Filipino nursing students (n=924). Chi-squared test and multiple regression were used to analyze the data.
Results
There was no significant association between the QoL and academic resilience to participants’ profile variables. Gender and year level of nursing students were significant predictors of QoL and academic resilience.
Conclusions
Our study concludes that a better understanding of the QoL and academic resilience, which are two distinct concepts critical in developing a student’s mental well-being, will help stakeholders in nursing education establish effective psychoeducation programs for nursing students.
Introduction
After the first outbreak in Wuhan, Hubei Province, China, in January 2020, the Coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020 (WHO, 2021). After that, the pandemic negatively impacted people’s lives worldwide. The pandemic’s virulence and pace of transmission, especially to the most vulnerable segment of the global population, have been catastrophic worldwide (Kumar et al., 2021). The Philippines recorded 1,530,266 COVID-19 cases as of July 23, 2021, with 26,891 deaths (WHO, 2021). There has been an average of 5,000 COVID infections daily since May 2021 (Department of Health [DOH], 2021). Due to this sharp rise of COVID-19, the Philippine government has decided to suspend plans to reopen a limited number of face-to-face higher education classes while continuing to provide online courses (Commission on Higher Education [CHED], 2021).
Quality of life (QoL) and resilience have been associated with a sense of well-being (Bermejo-Toro, Sánchez-Izquierdo, Calvete, & Roldán, 2020). According to the WHO QoL Assessment Group, QoL is a multidimensional subjective and analytical interpretation and evaluation of a person’s characteristics (The World Health Organization Quality of Life [WHOQOL]-BREF, 2004). On the other hand, resilience pertains to the individual’s capacity to recover, adjust, or thrive to adversity (Hegney, Rees, Eley, Osseiran-Moisson, & Francis, 2015). Individual adjustment or transition to different environments is supported by resilience, which helps individuals cope with trauma or maintain their QoL (Stainton et al., 2019).
Background
Several factors influence nursing students’ QoL. Nursing students identified psychological fatigue, depression, and anxiety as factors impacting their QoL during the COVID-19 pandemic (Savitsky, Findling, Ereli, & Hendel, 2020). Students who encountered these signs reported having a low QoL. As a result, being able to manage depression and retain a sense of well-being are essential factors in improving QoL (Khodami, Seif, Koochakzadeh, Fathi, & Kaur, 2021).
There is limited research on Filipino nursing students’ QoL. Torres and Paragas (2019) found that certain social determinants of health are related to Filipino nursing students’ QoL. Guillasper, Oducado, and Soriano (2021) also explored the relationship of QoL to resilience during the COVID-19 pandemic. However, the limitation in Guillasper et al.’s (2021) study was that during the period of the study, the number of cases was still under 200,000, no new COVID-19 variant was reported, and the Philippines had no vaccine rolled out yet (WHO, 2021). Nevertheless, in April 2021, significant developments have occurred in the Philippines that have altered the overall situation of the COVID-19 pandemic. The vaccination of frontline Filipino healthcare providers and the elderly population, new COVID-19 variants (e.g., UK, South African, and Delta), and the exponential trend of COVID-19 cases in the Philippines (WHO, 2021), were significant events that necessitated revisiting and investigating QoL and academic resilience among Filipino nursing students. The preceding justifications are enough compelling reasons to examine the QoL of Filipino nursing students during the COVID-19 pandemic and conduct this research in response to crucial pandemic-related developments affecting nursing students deliberately or not inadvertently. These significant developments include the emergence of new COVID-19 variants, the vaccination rate of Filipinos, and the impact of nursing students transitioning from face-to-face instruction to virtual learning and then returning to face-to-face instruction when health authorities deem it safe.
One factor affecting nursing students’ QoL is the way they exemplify and maximize resilience. Resilience among nursing students, particularly during pandemics, takes many forms and manifests itself in several ways. It can operate as a regulating, protecting, or enhancing component. A longitudinal analysis of nursing students’ resilience showed to moderate the effect of emotional exhaustion on their psychological well-being (Ríos-Risquez, García-Izquierdo, Sabuco-Tebar, Carrillo-Garcia, & Solano-Ruiz, 2018). Also, nursing students’ resilience helps them prepare and work adequately for the complex demands of clinical practice before the pandemic (Ríos-Risquez et al., 2018). Taylor, Thomas-Gregory, and Hofmeyer (2020) argued that building nursing students’ resilience in the face of a global pandemic leads to improved working capabilities and high-quality patient care provision. Thus, nursing schools should be committed to establishing programs that promote resilience of students to better equip them during their education and for their future careers (Ríos-Risquez et al., 2018).
Academic resilience, a type of resilience developed among students, is defined as the ability to endure and accomplish academic tasks despite being exposed to a multitude of stressors and risk factors (Rudd, Meissel, & Meyer, 2021), and that a resilient student may overcome academic challenges and achieve success in the face of difficulties during their studies (Cassidy, 2016). Thus, academic resilience has a beneficial impact on students’ learning outcomes and may avoid absenteeism and poor academic performance (Rudd et al., 2021). For example, students from low-income families are more likely to drop out and perform poorly on standardized tests (Morales, 2014). However, students with high levels of academic resilience seem to be impervious to risk factors and excel academically (Liu & Platow, 2020; Morales 2014). Academic resilience was measured in a study of Taiwanese nursing students by their ability to maintain optimism in the face of adversity while performing clinical duties, as well as their use of practical learning methods to overcome challenges with understanding nursing concepts (Wang et al., 2021).
Reported studies investigated college students’ academic resilience before the COVID-19 pandemic (Calo, Peiris, Chipchase, Blackstock, & Judd, 2019; Cassidy, 2016; Mendez & Bauman, 2018; Meneghel, Martínez, Salanova, & De Witte, 2019), but not correlated to QoL. However, one study on resilience and QoL conducted during the pandemic among Filipino nursing students (Guillasper, Oducado, & Soriano, 2021) did not focus explicitly on academic resilience. Instead, it used a resilience scale to assess how people recover from stress and provided information about their health concerns (Smith et al., 2008). Additionally, we conducted this study at a period of significant COVID-19 events, including an increase in reported cases and mortality, the imposition of lockdowns across the Philippines, and COVID vaccine rollouts (Berdida, Grande, & Lopez, 2021). These developments may affect nursing students’ QoL and resilience, as they are caught between a positive development (e.g., public availability of COVID-19 vaccine) and a negative situation (e.g., continued increase in positive cases, hospitals’ COVID-19 facilities at full capacity) (DOH, 2021). These new pandemic-related developments were the considerations we included in our study in order to understand better the relationship between academic resilience and nursing students’ QoL in the context of the COVID-19 pandemic. To the best of our knowledge, no accessible studies have previously examined the relationship between QoL and academic resilience among Filipino nursing students, particularly during the COVID-19 pandemic, necessitating the pressing need to investigate this topic during this pivotal time.
Theoretical underpinning
Our research is guided by Norman Garmezy’s (1987) three models of resilience. The first model is the compensatory model, in which stressors impair competence but personal characteristics assist in adjustment. The second model is the protective-vs.-vulnerability model, also known as the immunity-vs.-vulnerability model, which illustrates the interactive link between stressors and individual characteristics and the relationship between stress and outcome varies according to individual traits. The challenge model is the third of Garmezy’s three models of resilience, in which he explained the curvilinear relationship between stressors and resilience. According to the third model, stressors facilitate adjustment, but not at extremely low or extremely high levels, and extremely high levels of stress impair competence (Garmezy, 1987).
Garmezy’s models of resilience describe the various protective factors that exist at the individual and familial levels and those that live beyond the family, all of which affect one’s level of resilience (Garmezy, 1991). The individual characteristics Garmezy’s (1991) model include temperament, ability to respond positively to people, and cognitive abilities. On the other hand, familial and support factors refer to the parent’s role in their children’s welfare and the availability of social support, respectively (Garmezy, 1991).
During this pandemic, it is critical to pay close attention to the factors in Garmezy’s (1991) models of resilience to fully comprehend nursing students’ QoL and academic resilience and how these circumstances affect their overall well-being. Therefore, the purpose of our study was to determine: (a) the association between QoL and academic resilience; and (b) the predictive effect of demographic variables such gender, year level, number of units enrolled in the current semester, and GPA on the QoL and academic resilience of Filipino nursing students during the COVID-19 pandemic.
Methods
Research design
A descriptive survey, cross-sectional design guided this study. We used this design to determine the association between the participants’ QoL and academic resilience and their predictor profile variables. This study was conducted during the COVID-19 pandemic, which may significantly impact the QoL and academic resilience of the participant nursing students. Additionally, we used Garmezy’s (1987) three models of resilience to better understand nursing students’ academic resilience and to explain our study’s findings.
Study setting
This research was carried out in two state universities with baccalaureate nursing programs. One university was in Manila, the Philippines’ capital city. The other university was in the Bicol region, situated in the southeastern part of Luzon (one of the main islands of the Philippines).
Sampling and participants
Convenience sampling was used in this study. The inclusion criteria were: (1) enrolled in the study setting’s nursing program for the academic year 2020–2021, and (2) consented to participate in the study. A total of 1,339 nursing students were eligible to participate in this study. About 134 (10%) students took part in the instrument’s pilot test. After excluding the participants from the pilot test, 1,205 survey questionnaires were distributed. Subsequently, 982 filled-out survey forms were retrieved. After carefully checking the data for errors and clarity by following the prescribed protocol for data cleaning and thorough checking of surveys for completeness and accuracy (Polit & Beck, 2018), a total of 924 usable survey forms were fit for analysis. This research used the original English version of the instruments during the pilot test and actual data gathering. Translating the instruments to the Filipino language, such as Tagalog, one of the official languages of the Philippines, was not necessary because English is used as the medium of instruction at all levels of education in the Philippines, and college students are generally proficient in English. The purpose of the pilot test was to ascertain whether there were any issues with interpreting the statements and if any items were deemed to be inappropriate for Filipino nursing students.
Ethical considerations
The ethics review committee of Universidad de Manila approved this study after all the required documents were submitted. Permission to proceed was granted with the Ethics Review Committee reference number ERC-UdM-2021-007 (approved on January 8, 2021). We collected data using online survey forms because of the COVID-19 safety protocols on face-to-face contact. The first portion of the survey form asked for their permission to participate in the study. This included the study’s details, intent, benefits, and potential risks. The form also had a disclaimer that should they choose to take part, they can fill out the form and return it to the sender, or they can disregard the email with the documents sent to them. When we received the completed forms, we regarded them as their implied consent to participate in the research voluntarily and willingly.
Instruments
This study used two psychometrically validated instruments to assess nursing students’ QoL and academic resilience. The original authors of both instruments gave their permission to use in this study. Questions about the participants’ demographic and academic characteristics, gender, year level, percentage of enrolled units, and grade point average (GPA) in the previous semester preceded the two instruments.
Lindner et al. (2016) developed and published the Brunnsviken Brief Quality of Life Scale (BBQ) to assess QoL. This short QoL test was created to assess overall QoL using 12 elements that equate to happiness in six life areas (recreation, philosophy of life, self-esteem, creativity, learning, and friendship). This single-factor scale is scored on a scale of 0–4, with zero indicating “heavy disagreement” and four indicating “strong agreement.” To know the overall life score, multiply the satisfaction (items 1, 3, 5, 7, 9, and 11) and importance (items 2, 4, 6, 8, 10, and 12) ratings for each life sector, then add the six items (leisure time, view my life, artistic, studying, friends and friendly, and myself as a person). The possible score ranges from 0 to 96 points. Higher scores on the BBQ indicated better QoL. The BBQ has a Cronbach’s alpha of 0.76 and an intra-class correlation coefficient of 0.82, indicating high test-retest reliability (Lindner et al., 2016).
We used the BBQ scale as the outcome measure instead of other instruments that measure QoL. These include the subjective QoL scale (Berzon, Donnelly, Simpson, Simeon, & Tilson, 1995), WHOQoL-BREF (2004), EuroQoL (1990), RAND-36 (Hays, Sherbourne, & Mazel, 1993), Satisfaction with Life Scale (Sheehan, Harnett-Sheehan, & Raj, 1996), and other existing QoL scales for a variety of important reasons. Aside from being brief and accessible given our large number of participants, the BBQ also explicitly assesses the importance of overall life satisfaction, is sensitive to determining QoL impairments, and has been tested in clinical and non-clinical samples. Furthermore, BBQ is not difficult to understand when compared to other QoL instruments, and the items are novel in terms of phrasing and response format, as well as the fact that it is unidirectional, with no negative items influencing the derivation of the total score (Lindner et al., 2016).
Academic Resilience Scale (ARS-30) was used to evaluate the participants’ academic resilience (Cassidy, 2016). This 30-item questionnaire evaluated students’ academic resilience based on how they handle academic challenges. The scale’s elements reflect emotional, affective, and behavioral reactions to academic stress. The three components of the ARS-30 are “perseverance,” “reflecting and adaptive-help-seeking,” and “negative effect and emotional reaction.” The ARS-30 is scored on a scale of 5–1, with five being the “most likely” and one as “least probable.” Before summing the scores in each factor, the positively worded items (2, 4, 5, 8, 9, 10, 11, 13, 16, 17, 18, 20, 21, 22, 23, 24, 25, 26, and 27) were reverse-coded. High scores indicate high academic resilience. A mean result is determined with a range of 30–150. The overall Cronbach’s alpha score is 0.90, with the three factors showing a range of alpha scores from 0.78 to 0.83 (Cassidy, 2016).
In the current study, we conducted a pilot test of the instruments (i.e., the BBQ and the ARS-30) to assess the reliability and relevance of the instruments among Filipino nursing students; 134 nursing students participated in the pilot. The pilot test yielded Cronbach’s alpha scores of 0.87 for BBQ and 0.92 for ARS-30, showing high reliability and consistency for both instruments.
Data collection
The data was collected using an online Google survey from April 7, 2021, to August 8, 2021. Online data collecting was the safest way of collecting data since face-to-face contact was not allowed in the research setting. These procedures complied with the government’s COVID-19 prevention policy. Participants’ full names and other personally identifying details were not included in the survey forms. The survey forms were sent to their registered email addresses. Thereafter, follow-up notifications via text message were sent to participants’ WhatsApp or Messenger apps on their smartphones to ensure that the participants successfully obtained the survey forms. We verified the returned survey forms for outliers and wild codes to ensure that only error-free data is subjected to statistical analysis. Additionally, we verified the consistency of the data returned by participants (Polit & Beck, 2018).
Statistical analysis
This study used IBM Statistical Package for Social Sciences (SPSS) version 23.0 for the statistical analysis of our study. The demographic profiles of the participants were computed using frequency and percentage distribution. To determine the correlation between the responses of the participants to the BBQ and the ARS-30 when grouped according to their profile variables, we used Chi-squared test. Finally, the predictor variables of the participants’ QoL and academic resilience were identified utilizing multiple regression analysis.
Results
A total of 924 participants took part in the study (response rate: 75.68%). Table 1 shows the distribution of participants based on demographic profiles. In terms of gender, about 57.8% were females and 42.2% were males. About 80% of those who partake in this study were in their second or third year. Most of the participants (83.8%) enrolled in all the units available during the semester. As indicated in Table 1, none of the students had an average GPA (below 76%), but 7.7% had an excellent GPA.
Demographic profile of the participants (n=924).
| Profile variable | n | % | |
|---|---|---|---|
| Gender | Male | 390 | 42.2 |
| Female | 534 | 57.8 | |
| Year level | First | 129 | 14.0 |
| Second | 421 | 45.5 | |
| Third | 374 | 40.5 | |
| Units enrolled | Less than 50% of offered units | 19 | 2.1 |
| 50% of offered units | 131 | 14.2 | |
| 100% of offered units | 774 | 83.8 | |
| GPA | Excellent (95–100% or 10 and 9) | 71 | 7.7 |
| Superior (89–94% or 8 and 7) | 453 | 49.0 | |
| Very good (83–88% or 5 and 6) | 363 | 39.3 | |
| Above average (77–88% or 3 and 4) | 37 | 4.0 | |
| Average (below 76% or 2 and 1) | 0 | 0 |
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GPA, grade point average.
Table 2 shows the association between the BBQ and the ARS-30 when the participants’ profile variables were grouped. As indicated, there were no significant associations between BBQ and ARS-30 in terms of gender, year level, units enrolled in the current semester, or GPA, as shown by all p values >0.05.
Association between QoL and academic resilience of the participants to their demographic profiles (n=924).
| Profile variables | Chi-square | df | p-Value | |
|---|---|---|---|---|
| Gender | Male | 7.76 | 6 | 0.26 (NS) |
| Female | 5.09 | 6 | 0.53 (NS) | |
| Year level | First | 0.53 | 3 | 0.91 (NS) |
| Second | 3.46 | 6 | 0.75 (NS) | |
| Third | 11.12 | 6 | 0.07 (NS) | |
| Units enrolled | Less than 50% of offered units | 6.55 | 4 | 0.16 (NS) |
| 50% of offered units | 4.04 | 4 | 0.40 (NS) | |
| 100% of offered units | 7.79 | 6 | 0.25 (NS) | |
| GPA | Excellent (95–100% or 10 and 9) | 3.62 | 6 | 0.72 (NS) |
| Superior (89–94% or 8 and 7) | 3.60 | 6 | 0.73 (NS) | |
| Very good (83–88% or 5 and 6) | 4.25 | 6 | 0.64 (NS) | |
| Above average (77–88% or 3 and 4) | 10.34 | 4 | 0.06 (NS) | |
| Average (below 76% or 2 and 1) | – | – | – | |
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p>0.05 – not significant (NS); p≤0.05 – significant (S). GPA, grade point average; QoL, quality of life.
A multivariate regression analysis was used to identify QoL and academic resilience predictors, as shown in Table 3. Gender and year level were significant predictors of both QoL and academic resilience. The participants’ gender and year level were found significant predictors of QoL, as revealed by both p values of 0.0001. Accordingly, gender (p=0.02) and year level (p=0.001) were significant predictors of academic resilience.
Predictors of QoL and academic resilience (n=924).
| Variable | BBQ | ARS-30 | ||||||
|---|---|---|---|---|---|---|---|---|
| β | SE | 95% CI | p-Value | β | SE | 95% CI | p-Value | |
| Gender | −0.143 | 0.034 | From −0.210 to −0.075 | <0.0001 (S)a | 0.065 | 0.028 | 0.009–0.121 | 0.02 (S)a |
| Year level | −0.133 | 0.025 | From −0.182 to −0.084 | <0.0001 (S)a | 0.066 | 0.020 | 0.025–0.106 | 0.001 (S)a |
| Units enrolled in the current semester | −0.024 | 0.037 | From −0.097 to 0.050 | 0.53 (NS) | 0.003 | 0.031 | From −0.058 to 0.063 | 0.93 (NS) |
| GPA | −0.023 | 0.024 | From −0.070 to 0.024 | 0.34 (NS) | −0.031 | 0.020 | From −0.069 to 0.008 | 0.12 (NS) |
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R 2=0.017 adjusted R 2=0.013. Linear Regression Analysis. aS, significant; NS, not significant; BBQ, Brunnsviken Brief Quality of Life Scale; ARS-30, Academic Resilience Scale; GPA, grade point average; QoL, quality of life.
Discussion
Our study described the dynamic character of nursing students’ academic resilience during the pandemic, including their coping during the transition from face-to-face to online learning. To the best of our knowledge, this level of academic resilience among Filipino nursing students and its influence on their QoL has never been reported during the most critical phases of the COVID-19 pandemic. Therefore, it is essential to report and disseminate these developments to establish the next course of action and inform policymakers about the required measures and assistance for specific population groups, such as nursing students, during this pandemic. The findings of our study showed that most of the participants were female. Nursing is a female-dominated higher education program in the Philippines. The nursing profession is traditionally regarded as the care work performed by females, and male nursing students and nurses are significantly fewer than their female counterparts (Mao, Lu, Lin, & He, 2021). Additionally, there were no fourth year nursing students in the study setting because in 2012 Philippines shifted to a kindergarten-to-12-year primary education curriculum (K-to-12). In 2016, a two year extension to the existing ten year basic education curriculum prior to college was implemented (CHED, 2021). Therefore, rather than proceeding directly to college, students spend an additional two years in high school. The first graduates of the K-to-12 program will be in 2022. Consequently, during the academic year 2020–2021, nursing students are still enrolled in their third year of the K-to-12 program. Nursing students enrolled in the two study settings (i.e., the two universities where the surveys were administered) must maintain a good standing GPA (equivalent to 85–88% or better) to be retained in the program.
Our study revealed no associations between QoL and academic resilience of nursing students. Several studies support these findings (Chow, Tang, Tang, & Leung, 2020; Spurr, Walker, Squires, & Redl, 2021; Teixeira, Martins, Celeste, Hugo, & Hilgert, 2015). In other studies, psychological and social domains of nursing students’ QoL were more important than environmental and physical domains, reflecting a more focused cognitive aspect of life (Grande, Butcon, Indonto, Villacorte, & Berdida, 2021). Also, fostering resilience in nursing students has shown to improve nursing students’ QoL (Keener, Hall, Wang, Hulsey, & Piamjariyakul, 2021). Furthermore, since resilience implies stability and adaptation, its facets vary from vulnerability to protective factors, depending on the presence and the strength of conditioning factors (Teixeira et al., 2015). Spurr, Walker, Squires, and Redl (2021) reported no connection between gender, QoL, and academic resilience among Canadian nursing students. While Chow, Tang, Tang, and Leung (2020) discovered a negative relationship between resilience and well-being as a measure of QoL using a mixed-method design compared to positive relationships found in previous studies on nursing students. Hongkongese nursing students showed a positive relationship between resilience and perceived well-being (Chow et al., 2020). Additionally, proper rest periods and prioritizing basic needs are also predictors of an optimum level of well-being. Nursing students can organize their daily activities and, above all, sustain their rest periods during the COVID-19 pandemic. Roca et al. (2021) emphasized the importance of nursing students prioritizing their well-being and QoL. Further, nursing students can achieve a balanced QoL by ensuring they meet their essential human needs to survive. This finding is corroborated by Garmezy’s second model of resilience, which states that stressors and individual qualities (e.g., resilient traits, individual coping mechanisms, and past experiences) can be balanced so that the impact of stress on an individual is reduced. As a result, their resilience will improve to an acceptable degree (Garmezy, 1987).
Our findings revealed that nursing students’ gender and year level were significant predictors of academic resilience and QoL. A survey among Filipino nursing students showed that gender was a significant indicator of QoL during the COVID-19 pandemic and female nursing students had slightly higher QoL (Guillasper et al., 2021). As mentioned in their study, Turkish, Saudi, and Australian nursing students also had the same results (Guillasper et al., 2021). Correspondingly, a survey of Filipino college students, including nursing students, reported that psychological well-being and anxiety are positively and negatively associated with youth QoL (Cleofas, 2020). The fact that 89% of the participants in the sample were females suggests that the results link to the female gender. However, Yang, Wang, Liu, Li, and Jiang (2021) reported that gender and other demographic profiles had no effect on depression and anxiety levels among Chinese students and COVID-19 anxiety among Saudi nursing students (Grande, Berdida, Paulino, et al., 2021). Additionally, our findings show that the year level has a clear association with students’ life satisfaction. Third year students reported the highest levels of life satisfaction, while first year students reported the lowest. Since the first year of university education is a time of adjustment to university life and a new reality, first year students have the lowest level of life satisfaction (Cleofas 2020). Also, we did not find any significant difference in resilience between junior and senior nursing students in Hong Kong (Chow et al. 2020). Resilience did not substantially improve over the year. As the student progresses into the nursing program, there is a noticeable decline in resilience along the spectrum (Fowler, Goldsberry, & Handwerker, 2020). Given the conflicting findings of these studies on QoL and resilience among nursing students, this strengthens our findings that year level is a significant predictor. The severity of the stressors affecting nursing students over the years complimenting their year level in the nursing program is supported by Garmezy’s (1987) third model (i.e., the challenge model) of resilience. The model underscores that stressors facilitate adjustment but not at extremely low or high levels when students receive more stress as they go higher in the program, which may impair their competence.
Our findings indicate that the COVID-19 pandemic has had a greater impact on the academic resilience and QoL of upper-year nursing students than on lower-year nursing students. Similarly, Reverté-Villarroya et al. (2021) found that students who did not adapt successfully to the pandemic’s negative effects were more likely to have mental health issues than those who did. The sense of coherence (SOC), which evaluates a person’s ability to deal with challenging and traumatic circumstances, serves as a calming factor, notwithstanding the reality that cognitive fatigue negatively impacts well-being (Reverté-Villarroya et al., 2021). Contrarily, younger undergraduate students, medical students, students with general health, and those who closely followed the COVID-19 pandemic reports were more vulnerable to the pandemic’s harmful effects than those in higher year groups (Yang et al., 2021). Lifestyle is a subjective and quantitative indicator of QoL. Nursing students with GPAs below the 50th percentile had poorer lifestyles. In contrast, those with GPAs in the upper 50th percentile had a better lifestyle, while those with almost perfect GPAs (above the 90th percentile) had an ideal lifestyle (Heidari, Borujeni, Borujeni, & Shirvani, 2017). Corollary to this, Saudi nursing students who excel academically are more resilient (Grande, Berdida, Villagracia, et al., 2021). Similarly, Tope-Banjoko et al. (2020) found that students who scored higher on subscales of the Patterns of Adaptive Learning Scale (PALS) correlated with constructive coping were thought to be more resilient and have a significantly higher GPA. According to their findings, students who scored higher on the PALS subscales showed more constructive coping skills, contributing to a higher overall GPA. In another study, the results showed that most students’ overall academic achievement levels were often associated with moderate levels of academic resilience (Mwangi & Okatcha, 2015).
Overall, the findings support the theory that there is a strong connection between robust behavior and academic success. Nursing students have been acutely mindful of the importance of maintaining resilience coping behaviors despite the challenges and hardships during the pandemic. More particularly, throughout the COVID-19 pandemic, nursing students developed a variety of coping mechanisms, which can be explained by Garmezy’s (1987) first model of resilience. Garmezy’s (1987) first model of resilience established unequivocally that personal characteristics, particularly inherent protective characteristics such as effective coping skills, become more apparent during moments of stress and contribute to the adjustment process despite the presence of significant stressors. Several personal beliefs and cultural values are among the unique attributes of Filipinos identified among our study’s nursing students. One example is the Filipino value of “madiskarte,” or ingenuity, which reflects the Filipinos’ will and resolve to see the positive side of every situation (Pe-Pua & Protacio-Marcelino, 2000). Despite being amid a pandemic, nursing students continued learning from home despite difficulties with resources such as internet connections, particularly those in remote places where they would go to the top of a mountain to secure better internet connectivity. Another trait is “masayahin” or joyousness (Pe-Pua & Protacio-Marcelino, 2000). Even during the pandemic, Filipinos retain the ability to smile and laugh. Filipinos possess the unique ability to find happiness even in challenging situations, demonstrating the Filipino spirit of resilience, which was reflected among the nursing student participants. Finally, Filipino nurses are highly sought after in most developed economies globally, such as in the Middle East countries, the United States of America, and the United Kingdom. Filipino nurses’ sacrifices being away from home for years and not seeing their family for a long time exemplify the trait of “matapang” or bravery (Pe-Pua & Protacio-Marcelino, 2000).
Limitations
Our study used a descriptive survey with a cross-sectional design, which can only infer findings from when the study was carried out. Cross-sectional studies are useful for describing the status of phenomena or the relationships between phenomena at a specific point in time; however, they cannot infer changes over time (Polit & Beck, 2018). Another limitation of the study was that we only used two government nursing colleges, albeit these schools had large nursing student enrollment. If we had employed a national sample of Filipino nursing students, our findings would have been more generalizable.
Recommendations
We recommend involving larger samples and multi-settings to provide more generalizable findings on nursing students’ QoL and academic resilience. A more sophisticated research design, such as an experimental study comparing before and aftereffects, may have yielded different results. Additionally, a triangulation method can be used to help assess the nursing students’ answers to the questions in the instruments.
Conclusions
This research reveals no strong correlation between QoL and academic resilience during the COVID-19 pandemic among Filipino nursing students. They may have associations before or after the pandemic, but our investigation cannot determine that. However, our results indicate that nursing students’ gender and year level can predict academic resilience level and intensity and the possibility of a stable and good QoL during the current pandemic. At the same time, other factors such as GPA and the units enrolled are not significant predictors of the investigated concepts in our study.
Considering the peculiarities of our results and the noticeable impact of the pandemic on the general well-being of nursing students, educators, and administrators should be mindful that nursing students, like any other cohort of university students, are vulnerable to the harmful effects of the COVID-19 pandemic. Our research advances the field by exploring the relationship between QoL and academic resilience in the context of the COVID-19 pandemic, which has not been explored previously, as explained by the three resilience models that guided our study. While QoL and academic resilience are two distinct concepts, research shows that they are important indicators of a student’s holistic well-being.
Acknowledgments
The authors are indebted to nursing students, faculty members, and administrators of the two participating universities in the Philippines. We also like to thank Ma. Grace C. Rosales, MSPH of Manila Central University-FDTMF, Inc., our statistician.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The Ethics Review Committee of Universidad de Manila approved this study (Reference Number: UdM-ERC-2021-007; approved on January 8, 2021).
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