Quality of life of undergraduate nursing students

Objective: to evaluate the quality of life of nursing students of a public university in Pará. Method: exploratory, descriptive, quantitative study carried out with 159 students. A questionnaire was applied with questions from the World Health Organization Quality Of Life-Bref form. Exploratory data analysis and descriptive statistics methods were carried out. Results: regarding the general quality of life, 76 (47.80%) evaluated it as average. As for the domains, the worst average score was in the environment, 2.69. Other statements: 83 (52.19%) said they had little money; 35 (22.64%), little opportunity for leisure activities, 47 (29.56%), dissatisfaction with access to health services; 59 (37.11%), very dissatisfied with transportation. In the physical domain, 67 (42.14%) were dissatisfied with sleep/rest. In the psychological one, 66 (41.51%) had negative thoughts at times. Conclusion: nursing students rated their general quality of life as average, but there is dissatisfaction with sleep/rest, access to health services and transportation. Descriptors: Nursing students. Public health. Quality of life. RESUMO Objetivo: avaliar a qualidade de vida dos estudantes de enfermagem de uma universidade pública do Pará. Método: estudo exploratório, descritivo, quantitativo, realizado com 159 alunos. Aplicado questionário com perguntas do formulário World Health Organization Quality Of Life-Bref. Realizada análise exploratória dos dados e métodos de estatística descritiva. Resultados: quanto à qualidade de vida geral, 76 (47,80%) avaliaram como média. Quanto aos domínios, o pior escore médio foi no meio ambiente, 2,69. Outras afirmações: 83 (52,19%) disseram ter pouco dinheiro; 35 (22,64%), pouca oportunidade para atividades de lazer, 47 (29,56%), insatisfação com o acesso aos serviços de saúde; 59 (37,11%), muita insatisfação com o meio de transporte. No domínio físico, insatisfação de 67 (42,14%) com o sono/repouso. No psicológico, 66 (41,51%) apresentaram pensamentos negativos algumas vezes. Conclusão: os estudantes de enfermagem avaliaram sua qualidade de vida geral como média, porém há insatisfação no sono/repouso, acesso aos serviços de saúde e transporte. Descritores: Estudantes de enfermagem. Saúde coletiva. Qualidade de vida. RESUMÉN Objetivo: evaluar la calidad de vida de estudiantes de enfermería de una universidad pública de Pará. Método: estudio exploratorio, descriptivo, cuantitativo, realizado con 159 estudiantes. Aplicado cuestionario con preguntas del formulario World Health Organization Quality Of Life-Bref. Realizado análisis exploratorio de datos y métodos de estadística descriptiva. Resultados: evaluaron la calidad de vida general como media, 76 (47,80%). En los dominios, el peor puntaje promedio fue en medio ambiente, 2.69. Otras afirmaciones: 83 (52,19%) dijeron tener poco dinero; 35 (22,64%), poca oportunidad de ocio, 47 (29,56%), insatisfacción con el acceso a los servicios de salud; 59 (37,11%), mucha insatisfacción con el transporte. En dominio físico, 67 (42,14%) estaban insatisfechos con el sueño/descanso. En el psicológico, 66 (41,51%) tuvieron pensamientos negativos en algún momento. Conclusión: los estudiantes de enfermería calificaron su calidad de vida general como media, pero existe insatisfacción con el sueño/descanso, acceso a servicios de salud y transporte. Descriptores: Estudiantes de enfermería. Salud pública. Calidad de vida. ISSN: 2238-7234 Souza JG; Margotti E. Qualidade de vida durante a graduação.. 2 English Rev Enferm UFPI. 2021 10:e858. DOI: 10.26694/reufpi.v10i1.858 INTRODUCTION The World Health Organization Quality Of Life (WHOQOL) group, of the World Health Organization (WHO), defines quality of life (QOL) as “the individual’s perception of their position in life, in the context culture and value system in which they live and in relation to their goals, expectations, standards and concerns”. Lack in relation to recreation and leisure, extensive workloads proposed by the course, required demands for dedication to classes, fatigue and mental/physical stress due to past experiences and lived events in the academic environment are intervening factors in the QOL of the nursing student. Monitoring the QOL of the population, especially students, is a pressing need due to individual socioeconomic conditions, as well as daily curricular and life activities. In the case of courses in the health area, other factors – such as the level of demand regarding theoretical content, completion of end-of-course activities, in addition to experience in hospital environments – can be elements that trigger changes in the social life and health of these students who, in addition to tolerating emotional problems due to the overload of activities, may also undergo changes in the body, causing negative results for QOL. It is, therefore, a broad concept, which involves physical and psychological aspects, in addition to social relationships and the environment. Another important factor to be emphasized is the academic experience as a determining factor in the QOL of students, as it is known that the Nursing course, due to the level of demand, becomes a stressor and, consequently, can act as a determinant to reduce the QOL. We noticed that there are few studies related to the QOL of professional nurses and, even less, of students of Nursing courses. The study of the QOL of this population in particular is essential to identify possible comorbidities caused by academic experience. Thus, based on knowledge of QOL by domains (physical, psychological, social relationships and environments), it will be possible to plan preventive and effective actions for the well-being of the student during the undergraduate course. Promoting a healthy environment at the undergraduate course allows a healthy environment for teaching and learning and, consequently, for the training of quality professionals. Based on the gap that was listed, the question is: how is the QOL of nursing students of higher education, in the periods in which they begin their experiences and live events in the different practice scenarios? In this sense, the concern with analyzing QOL is associated with the growing number of chronic and psychological diseases among university students, given that there are not many studies on the subject when it comes to nursing students. Therefore, based on this assumption, the study aims to evaluate the QOL of nursing students at a public university in


INTRODUCTION
The World Health Organization Quality Of Life (WHOQOL) group, of the World Health Organization (WHO), defines quality of life (QOL) as "the individual's perception of their position in life, in the context culture and value system in which they live and in relation to their goals, expectations, standards and concerns". (1:1405) Lack in relation to recreation and leisure, extensive workloads proposed by the course, required demands for dedication to classes, fatigue and mental/physical stress due to past experiences and lived events in the academic environment are intervening factors in the QOL of the nursing student. (2) Monitoring the QOL of the population, especially students, is a pressing need due to individual socioeconomic conditions, as well as daily curricular and life activities. (3) In the case of courses in the health area, other factors -such as the level of demand regarding theoretical content, completion of end-of-course activities, in addition to experience in hospital environments -can be elements that trigger changes in the social life and health of these students who, in addition to tolerating emotional problems due to the overload of activities, may also undergo changes in the body, causing negative results for QOL. (4,5) It is, therefore, a broad concept, which involves physical and psychological aspects, in addition to social relationships and the environment. Another important factor to be emphasized is the academic experience as a determining factor in the QOL of students, as it is known that the Nursing course, due to the level of demand, becomes a stressor and, consequently, can act as a determinant to reduce the QOL. (6) We noticed that there are few studies related to the QOL of professional nurses and, even less, of students of Nursing courses. The study of the QOL of this population in particular is essential to identify possible comorbidities caused by academic experience. Thus, based on knowledge of QOL by domains (physical, psychological, social relationships and environments), it will be possible to plan preventive and effective actions for the well-being of the student during the undergraduate course. Promoting a healthy environment at the undergraduate course allows a healthy environment for teaching and learning and, consequently, for the training of quality professionals.
Based on the gap that was listed, the question is: how is the QOL of nursing students of higher education, in the periods in which they begin their experiences and live events in the different practice scenarios?
In this sense, the concern with analyzing QOL is associated with the growing number of chronic and psychological diseases among university students, given that there are not many studies on the subject when it comes to nursing students. Therefore, based on this assumption, the study aims to evaluate the QOL of nursing students at a public university in Pará.

METHOD
This is an exploratory, descriptive study with a quantitative approach, carried out in a nursing faculty of a public university in Belém -Pará, between July and September 2019.
To calculate the stratified sample, the following formula was used, in which " " represents the size of the sample stratum, that is, the number of participants per class, and " " the population size, that is, the number of students enrolled per class .
The study sample consisted of 159 students, among the 259 enrolled at the Faculty of Nursing, in the 2019.4 period. Data collection occurred in proportion to the number of students enrolled per class.
Students regularly enrolled in the nursing course at a public university in Pará in the 2019.4 period, from the 3 rd to the 9 th semester were included in the research, as it is understood that these semesters cover theoretical-practical disciplines, making it possible to establish solid relationships between theory and the practice of caring. Students who requested to withdraw their enrollment, visiting students, or absent from the course for any particular reason or not were excluded from the research.
Data collection took place through a questionnaire containing questions from the WHOQOL-Bref form, prepared by the WHO. The WHOQOL-Bref is an abbreviated version of the instrument developed to assess the QOL of individuals in their physical, psychological, social and environmental aspects. Its composition is made up of 26 questions, two of which refer to the individual's general QOL and 24 questions are divided into four domains. The evaluation method is based on the Likert psychometric model, which has a numerical scale from 1 to 5 points, in which the level of intensity, capacity, frequency or satisfaction follows the model of an increasing scale. (1) The four domains covered by the instrument and their respective facets were: physical (pain or tiredness, medical treatment, energy for everyday life, locomotion on campus, sleep and rest, ability to perform activities, ability in mandatory internships and in performing teamwork); psychological (enjoyment of life, life has meaning, concentration, to accept physical appearance, self-satisfied, negative feelings), social relationships (personal relationships, sex life, support from friends) and environment (security in the academic environment routine, physical academic environment, money to meet your needs, available for academic information, opportunities for leisure activities in the academic environment, conditions of the place where you live, access to health services, means of transportation). The average score is obtained from the sum of all the multiplications of the scale value, divided by the number of responses. It was necessary to decode questions 3, 4 and 26, as the Likert scale followed the reverse order, that is, from 5 to 1.
Initially, exploratory analysis of the collected data and descriptive statistics calculations (frequency,

RESULTS
Of the 159 nursing students who participated in the survey, most (76; 47.80%) assessed their general quality of life as being average (Graph 1). In graph 2, we can see the low QOL of students in the Physical and Environment domains.

DISCUSSION
Regarding the general QOL, having an average score in our work, some researchers from other regions showed different results from this research. A study carried out in Piauí with 206 nursing students from a public university showed good QOL (3) ; a survey carried out with 14 students from the last period of nursing at a university in Bahia, showed dissatisfaction with QOL (4) ; a study with 60 students from the last period of a private university in Rio de Janeiro showed a QOL between low and medium. (2) However, in a study carried out at a public university in Cartagena, Colombia, with dental students, there were positive results. As in this work, in the research carried out in Colombia, 55.3% of the students perceived a good state of health and a very good health-related QOL, even though was collected the information that 35.4% of the students were sick and 61.8% with gastrointestinal diseases. (7) Other findings show that students of the nursing course are prone to develop psychosomatic diseases and, consequently, to decrease their QOL. (8) This leads to the belief that QOL is still widely discussed due to its complexity, regardless of the degree in which the student is. It is a subjective condition in which sociodemographic, cultural and academic characteristics of students from different regions can influence.
In the research carried out in Piauí, (3) with nursing students from a Higher Education Institution, the worst scores were for the Environment domain (54.2%) and the best scores were for the Social Relationships domain, with 74.3%. The findings of the work carried out with nursing students from Amazonas pointed to higher average scores in the Social Relationships domain, with 71.26%, and 57.4% representing the worst scores for the Physical domain. (9) In the study with students from Rio de Janeiro, in the last period of the nursing undergraduate course, the lowest average was 3.99% in the physical well-being dimension, when compared to the average of the social relationships dimension, which was 4.35.
(2) All the data shown above are in line with our findings, where the average scores related to the social relationships domain were higher. Regarding the students' QOL in the physical domain, Energy and Fatigue facet, the results of this study showed an average satisfaction of 55.98%, contrary to the findings of a study carried out with 189 students at the University of São Paulo, (11) where the nursing students interviewed reported not performing all their tasks and activities, due to the moderate/extreme level of tiredness (83.5%).
Regarding the Sleep and Rest facet, in which the question was "having enough energy for your day to day in the course", 55.98% reported being in the average category. Going against the data of the work carried out at the University of São Paulo, with 189 nursing students, where sleep disturbance as a cause of fatigue presented a much lower percentage, being 26.4% among nursing students. (11) Regarding the percentage of assessment of the QOL of our nursing students in the physical domain, specifically in the Work Capacity -how satisfied are you with your ability in the mandatory internships and in carrying out teamwork -, it showed that 42.76% were satisfied on an average way, going in the opposite direction of the results of some authors, (3,7,9) who demonstrate that the extensive course load, the time spent to fulfill demands and extracurricular activities are factors that ratify the students' discontent and dissatisfaction, related to the absence and/or decrease in QOL in the academic environment.
Other studies also mention that: the demand that exists to dedicate oneself in classes, assignments and tests, if not balanced with leisure activities that serve as a distraction, significantly declines QOL (2) ; the overload of classes, assignments, tests, participation in events, excessive number of subjects and extensive classes cause 44.40% of students' fatigue (11) ; due to the particular factors of the nursing course -workload, full-time work, extracurricular activities -the dimensions of the demands of the training environment regarding the level of knowledge required, added to constant dissatisfaction -such as the perception of low acquired knowledge -, causes students to perceive their practices as insufficient, subjecting them daily to stressful situations that affect their academic performance and QOL during the course. (4,5) Regarding the evaluation of the facets: transportation, health and social care, participation and opportunities for recreation and leisure, and financial resources, all the answers given to these facets certainly demonstrate negative feelings, such as anger, stress, anguish, anxiety and even states of depression in relation to these items, which somehow influence the student's QOL. This is worrying, given that students have all these negative feelings during their academic life.
Thus, collaborating with these premises, a study conducted with 1,182 men and women, followed up for 29 years later, showed that individuals with a low level of neuroticism (tendency to easily experience negative emotions in the face of common life events, such as depression, stress, anger, anxiety and anguish, among others) may have reduced QOL and reduced subjective well-being throughout life. (12) In a study carried out in Curitiba with 78 students from the eighth period of nursing in the morning shift, 53.85% reported that they received one to two minimum wages, demonstrating dissatisfaction. (10) Therefore, in other studies, not only this one, there is dissatisfaction with financial resources.
Regarding the Environment domain -how satisfied you are with access to health services -the findings of the present study showed dissatisfaction. Regarding participation and opportunities for recreation and leisure, opportunities for leisure activities in the academic environment, little satisfaction was found on the part of students. Similar data were obtained in a study in Colombia, with 192 nursing students, which showed that students are not concerned with the development of healthy lifestyle habits, do not attend health services and recreational environments, do not maintain adequate food habits during the periods they attend classes, in addition to dedicating most of their time only to their academic activities, negatively affecting their health. (13) The existence of the problem involving QOL, both of students and of professional nurses, is characterized by the lack of skill and willingness of managers, administrators and directors regarding their relationship with the absence of QOL in the academic environment, on the perception and intervention in the same (14). In this sense, it is necessary that institutions, both of teaching and assistance, have an adequate learning infrastructure, with a pleasant and humanized environment, adequate dimensioning of space, of safety, leisure and health, access to clear communication, (14) in addition to organizational and educational policies that address QOL, both at work and in teaching.
The limitations that can be registered in this work are the fact that the information about the response of the satisfaction categories may, at some point, have been distorted by the students, culminating in the classification in altered categories. This fact can occur even if clear rules have been defined for the classification of the category. In addition to false response or non-acceptance bias, a situation where students may not report situations of dissatisfaction and discontent, as this can bring personal embarrassment and discomfort to respondents.

CONCLUSION
Nursing students rated their overall QOL as average. The domain of social relationships obtained the best scores -most students are satisfied with their personal relationships, sex life and with a supportive relationship with friends -, but there is dissatisfaction with sleep and rest and access to health services, a lot of dissatisfaction with the transportation and the majority reported having little money and having little opportunity for leisure on campus.
Based on this study, it will be possible to establish concrete parameters regarding the absence of QOL in the academic environment and, later, to enable managers, administrators and directors responsible for the subject, to then formulate effective interventions to improve the QOL of nursing students. With this, the academic experience will be healthy, providing good performance coefficients and, consequently, resulting in outstanding health professionals.
The findings of this research may contribute to reflection in other institutions, since the methodology used is common to other studies. Future studies are needed to generate reflections that can build ways to overcome the difficulties encountered by students in academic life and for a better understanding and assessment of their QOL.