Health behaviour, nursing self-efficacy and engagement among nursing students : a longitudinal cohort study

Abstract

Nursing students represent one of the largest groups of students in higher education in Sweden. Their future occupation as registered nurses requires professional competencies including working on health promotion. However, nurses are frequently recognised as an occupational group with a high risk of impaired health due to stress in the working environment. Therefore, the higher educational institutions providing nursing education have an important role to play in the health and health resources of nursing students during the academic years preparing them for working life.

The overall aim of the thesis was to describe and investigate the health behaviour, nursing self-efficacy and student engagement during higher education and in subgroups of nursing students, and further to elucidate health resources important to positive health development. The four papers included in this thesis are based on selected quantitative data from the prospective longitudinal cohort study, the Longitudinal Analyses of Nursing Education (the LANE study) collected by annual questionnaires. In Study I the aim was to examine the psychometric properties of the Nursing Self-Efficacy scale (NSE) (n= 1,314). The NSE scale showed various problems with targeting and lack of invariance according to the underlying dimension. The model fit was, however, acceptable after removing two items and rescoring into fewer response categories. In Study II the aim was to investigate prospectively the levels of engagement of nursing students during education and to determine whether there are differences between subgroups of students.

The student engagement, both active (AE) and emotional engagement (EE), was followed during the years of education and studied in subgroups of students (n= 1,334). The AE increased and EE decreased (marginally) during nursing studies and differences were to be found regarding age, gender, prior assistant nurse education or not, self rated health (SRH) and higher educational organisation. In Study III the aim was to investigate the SRH and health behaviour in a nationwide sample of first year nursing students (n= 1,622) and to investigate whether these differ according to subgroups of students. The SRH was good or somewhat good for most first year nursing students, but their health behaviour differed according to the studied subgroups. In Study IV the aim was to describe prospectively the SRH and health behaviour of nursing students (n= 1,291) in a nationwide sample, and to examine variables associated with a good SRH during the final year of education. The self-rated health was good or somewhat good for the majority, but the mean value decreased slightly among nursing students over the course of time. Health behaviour showed diverse trends during the years of study (better, worse and stable). Good SRH (the highest response category) in the final year was associated with high level of EE, high level of NSE, good sleep quality and not having problems with study stress, headache and backache.

This thesis demonstrates that the levels of SRH, health behaviour and student engagement of nursing students change during the years of higher education and that there are differences to be found in subgroups of students. Improvements in nursing education could already be made, during the first year of education, to obtain a healthy student environment, as well as the students positive health resources, i.e. their emotional engagement and nursing self-efficacy.