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Relationship of Quality of Life, Resilience, and Associated Factors Among Nursing Faculty During COVID-19

Keener, Tina Antill PhD, MBA, MSN, RN, CPNP; Hall, Katherine MSN, RN, ONC; Wang, Kesheng PhD, MA, BS; Hulsey, Tara PhD, RN, CNE, FAAN; Piamjariyakul, Ubolrat PhD, RN

Author Information
doi: 10.1097/NNE.0000000000000926

Abstract

On March 11, the World Health Organization (WHO) formally declared COVID-19 a pandemic1; recommendations for social distancing to slow the spread and protect the health of the public population quickly followed.2 As of June 25, 2020, there were more than 9.2 million confirmed cases across the globe, with more than 479 000 deaths.3 The United States reported the highest prevalence, with more than 2.3 million confirmed cases and more than 121 000 deaths at the time this article was written.4

Within days, schools of nursing across the country addressed the unprecedented threat of COVID-19 and transitioned from face-to-face learning to online classes.5 Nursing faculty were faced with the responsibility of quickly redesigning courses and developing new learning opportunities while maintaining communication and support with their students. These challenges impacted not only the delivery and environment of nursing education, but also the quality of life (QoL) of the faculty. The WHO defined QoL as “an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns.”6(p1)

Nursing faculty working at our school of nursing faced many pressures from different demands such as teaching, research, clinical practice and precepting, community outreach programs, administration, serving on multiple campus-wide and professional committees, and scholarship commitment and expectations.7 The expectations and pressing job demands were risk factors to QoL of university faculty, which were associated with burnout and the intent of faculty to leave academia.8-10 However, the studies on QoL and associated factors among nursing faculty are scarce.

Changes in personal and professional life norms have the potential to impact one's perceived QoL. To maintain a healthy QoL, faculty need to be able to adapt to change and bounce back after hardships or stressful events. Resilience is defined as “the ability to recover from perceived adverse or changing situations, through a dynamic process of adaptation, influenced by personal characteristics, family and social resources, and manifested by positive coping, control, and integration.”11(p194) There are growing numbers of resilience studies conducted in various stressful work conditions.12-15 A national survey among nurses working in the ICU reported that nurses who had lower resilience scores were likely to have higher scores on anxiety, depression, and post-traumatic stress disorder.16 One recent study in Taiwan reported that nurses who were able to adapt and balance their daily work life around the pressing job demands and high-intensity work environments during the color dust explosion could maintain a good QoL.17 Thus, there was an urgent need for school administrators to evaluate and identify strategies to assist faculty in maintaining a healthy QoL as faculty faced the emergent challenges of education demand, supporting students and their learning needs during the unprecedented COVID-19 pandemic and social distancing requirements.

Purpose

The purpose of this cross-sectional survey study was to examine the relationship of QoL, resilience, and associated factors among nursing faculty during the unprecedented COVID-19 pandemic and subsequent social distancing requirements. The research questions of this study were as follows: (1) Do resilience and selected variables (work-related and demographic) predict QoL among nursing faculty? (2) What are the relationships among QoL, resilience, and demographic characteristics?

Methods

Design, Settings, and Sample

This study used a cross-sectional, descriptive survey design. The study was conducted during late April 2020 at a school of nursing at a public university in rural Appalachia (West Virginia). The school of nursing has a main campus in a large health sciences center and 3 satellite campuses throughout the state. The school of nursing at the health sciences center offers baccalaureate, master, and doctoral programs.

Measures

The questionnaire included the following: (1) WHO Quality of Life–BREF (WHOQOL-BREF),18 (2) Connor-Davidson Resilience Scale 10 (CD-RISC-10),19 (3) 12 work-related and demographics questions, and (4) 1 open-ended question. Cronbach's α scores for each QoL domain and resilience scale were calculated for this study.

The 26-item WHOQOL-BREF is a shorter version of the original 100-item WHOQOL scale. Two general items addressed self-perception of QoL and satisfaction with health, whereas 24 items were grouped into the following 4 domains: (1) physical health (7 items), (2) psychological (6 items), (3) social relationship (3 items), and (4) environment (8 items). The response options were rated on a 5-point Likert scale; scores were transferred to a 100-point scale, with a higher score indicating better QoL.18

The CD-RISC-10 is a self-reported shorter version of the original CD-RISC-25 questionnaire measuring one's perception of resilience.19,20 The response options were rated on a 5-point Likert scale, on a scale of 0 (not true at all) to 4 (true nearly all the time), with a higher score indicating better resilience.

Demographic data and other work-related independent variables selected were age, years of teaching experience, level of teaching, online teaching experience, perception of preparedness to work online, home workspace, current work as an RN, primary caregiver for a child or family member, and assisting a child or children with school work (Supplemental Digital Content, Table 1, http://links.lww.com/NE/A838). Additionally, the following open-ended question was posted: “Please briefly share any concerns and insights regarding your experience during COVID-19 social distancing and stay-at-home guidelines.” This open-ended question allowed participants to address other concerns in their own words.

Procedure

The institutional review board of the university approved the study. Anonymous data were collected via an electronic survey sent to all school of nursing faculty. The survey took approximately 15 to 30 minutes to complete.

Data Analysis

Data were entered into the IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, New York), for analysis. The categorical variables were presented in their raw values along with the proportions, and continuous variables were presented in the form of the mean (M) ± SD. The bivariate linear regression for each independent variable with each of the 4 QoL domains was conducted; variables with P < .20 were selected and entered in the multiple regression model to predict each QoL domain.21 The R2 indicated the proportion of variance in the dependent variable (each QoL domain) that was explained by the independent variables. The F ratio and P < .05 in the analysis of variance indicated the regression model was a good fit for the data. The β indicated the direction of the relationship and how much Y (dependent variable) would change as X (predicted variable) increased 1 unit. Cronbach's α scores for each QoL domain and CD-RISC-10 were calculated. Content analysis was used to analyze the open-ended questions. Two nurse researchers coded initial data independently then met to verify and select final categories.

Results

Demographics

Descriptive statistics of independent variables are listed in Supplemental Digital Content, Table 1, http://links.lww.com/NE/A838. Fifty-two nursing faculty completed the survey with a response rate of 52%. The majority (n = 27, 52%) were 40 to 54 years old, average years of teaching experience was 11.87 (SD, 8.57; range, 1-40). There were only a few male faculty (n = 5) respondents; therefore, gender was omitted from the analysis to protect anonymity. Of the 52 respondents, 28.8% (n = 15) taught at the graduate level only, and 71.2% (n = 37) taught at undergraduate levels or both levels. The majority of participants were a course or clinical coordinator (n = 30) or clinical faculty (n = 22); some faculty had more than one role (eg, teaching and clinical).

The M, SD, reliability (α), and frequency of poor scores for physical health, psychological, social relationship, environment QoL domains, and resilience are reported in the Table. Faculty reported highest scores in the physical (M, 81.5) and environment (M, 85.25) QoL domains. The social domain (M, 79.12) and psychological (M, 71.92) were the lowest QoL domains among faculty. Notably, 10% to 19% of faculty had scores below 60, indicating poor QoL on physical, psychological, and social relationship domains, and 17% of faculty reported poor resilience.

Table - Scores on Quality of Life Scale and Resilience Scale
Scale/Subscales (Domains) M (SD) Range Reliability (α) Poor Score a,b
n %
Quality of Life Scale (WHOQOL-BREF)
Physical health (7 items) 81.50 (15.44) 31-100 .83 5 9.62
Psychological (6 items) 71.92 (16.86) 31-100 .89 10 19.23
Social relationship (3 items) 79.11 (16.47) 44-100 .71 8 15.38
Environment (8 items) 85.25 (13.11) 38-100 .82 1 1.92
Resilience Scale (CD-RISC-10)
Resilience (10 items) 32.02 (5.34) 14-40 .90 9 17.30
aScores below 60 indicate poor QoL on each domain.
bScores below 27 indicate poor resilience.

Bivariate and Multiple Linear Regression Analyses

The bivariate linear regression was conducted for each independent variable with each of the 4 QoL domains. The independent variables with P < .20 were entered in the multiple regression model to predict each QoL domain. There was a high correlation between workspace and resilience score (r = 0.63, P < .001); thus, workspace was removed from multiple regression analyses. There were significant correlations among each of the 4 QoL domains: social, physical, psychological, and environmental. Supplemental Digital Content, Table 2, http://links.lww.com/NE/A839, presents the multiple regression model summary for the 4 QoL domains:

  • Domain 1: Physical health. Three variables (well-prepared, caregiver, and resilience) were entered in the final multiple regression model. Resilience was the only significant variable associated with physical health QoL domain.
  • Domain 2: Psychological. Five variables (year teaching, caregiver, RN/advanced practice RN [APRN], workspace, and resilience) were entered in the final multiple regression model. Resilience was the only significant variable associated with psychological QoL domain.
  • Domain 3: Social relationship. Two variables (well-prepared and resilience) were entered in the final multiple regression model. Resilience was the only significant variable associated with social relationship QoL domain.
  • Domain 4: Environment. Six variables (well-prepared, caregiver, RN/APRN, level teaching, year teaching, and resilience) were entered in the final multiple regression model. Years of teaching, level of teaching (at graduate or both graduate and undergraduate level), and resilience were significant variables associated with environment QoL domain.

Open-Ended Question Analysis

Supplemental Digital Content, Table 3, http://links.lww.com/NE/A840, provides a summary of comments and insights regarding faculty experience with social distancing and stay-at-home guidelines. Overall, comments were positive, and faculty were well-adapted to social distancing and supported stay-at-home guidelines. Seven participants described the struggle with balancing work and family life. Faculty identified challenges in working and caring for small children, assisting in home schooling older children, and setting boundaries. A faculty member stated, “I have a hard time setting work and home responsibilities, child care, and school work boundaries.” The third most frequent comment was related to the home office. A faculty noted, “I have to use my mobile hotspot for my laptop because our internet service is unreliable. I do not have a dedicated workspace… No access to scanner.” Other faculty commented that they lacked space, hardware, or connectivity to create a productive home workspace.

Discussion

The results of this study revealed multiple factors associated with QoL among faculty at a school of nursing during the COVID-19 pandemic. The mean resilience score for the nurse faculty in our study was 32.0 (SD, 5.3), which was similar to a large study with adults (n = 764) of the United States (M, 31.8 [SD, 5.4]).22 Resilience was the strongest variable predicting physical health, psychological, social relationship, and environment QoL domains. The results indicated that nursing faculty who reported better QoL across 4 domains were those who were able to adapt to changes and challenges mandated during the COVID-19 pandemic. Significant correlations among physical health, psychological, social relationship, and environment QoL domains demonstrated that higher QoL on one domain was associated with higher QoL in other domains. These findings concurred with a study by Tseng and colleagues17 that resilience was a protective factor for QoL when nurses encountered a mass casualty incident. Our findings demonstrated the overlap and complexity of QoL and underscored the importance of holistic care of individuals.

In addition, years of teaching, level of teaching (at graduate or both graduate and undergraduate level), and working as an RN or APRN were variables associated with the environment QoL domain. This domain was the perception of aspects related to the environment where the individual lived and included safety, home, finances, services, information, leisure, environment, and transportation.23 Nursing faculty with greater years of teaching might have gained more teaching skills over time, potentially adapted to new teaching technology, and found support when needed. Faculty with an active practice (as an RN/APRN) earned additional income, which may explain the report of higher QoL in the environmental domain. Financial stability supported many aspects of the environmental domain, including acceptable living conditions and adequate transportation. Additionally, faculty with an active practice may have perceived greater access to health services and obtained new clinical skills, which was essential for clinical nursing faculty.

Lower scores on the environment QoL domain were reported by faculty who taught only at the undergraduate level, which was a sizeable proportion (57.7%) of this sample. Nursing faculty who taught at the undergraduate level were not accustomed to delivering online courses. They may have perceived they were less prepared to teach in the new online environment during social distancing requirements compared with graduate-level faculty whose courses were already delivered online. Under normal circumstances, undergraduate classes at this school of nursing were conducted in the classroom, simulation center, hospital, or community settings. Thus, due to the unprecedented changes during COVID-19, our undergraduate faculty were faced with daunting tasks of quickly redesigning courses to be delivered online, finding and utilizing new technology to enhance student learning experiences, developing novel virtual clinical experiences matching course objectives, and developing new grading rubrics while supporting and reassuring students. Social distancing also changed the way faculty and students communicated and interacted, potentially negatively affecting the relationships between students and faculty. Many students may have had more learning challenges, requiring more attention from faculty.

Notably, there was high correlation between resilience and workspace. The open-ended responses of faculty supported the muliple linear rergression results. Faculty commented on not having a designated space; lack of necessary hardware, such as dual computer screens, scanners, and printers; and unreliable internet as challenges for online teaching. Social distancing guidelines required nursing faculty to quickly adapt to working in the home environment. Working from home is not inherently effective for everyone and is increasingly difficult during this time. Shuttered schools, child care services, and nonessential businesses changed household routines and obliterated all personal and professional boundaries. Nursing faculty who reported having a designated location for home workspace had higher resiliency and better perceived environment QoL domain. Nursing faculty reported that their physical environment, described as adequate office space and a quiet area to reflect, was imperative to producing quality work.24 Thus, having a private, designated workspace at home was essential to managing the new challenge of online teaching during social distancing and may improve the QoL of the nursing faculty in the future.8

The results highlighted the importance of cultivating skills of resiliency among nursing faculty. Programs developed to enhance resilient behaviors among nursing faculty may be a viable option for supporting nursing faculty and providing protection during stressful events. For instance, Stress Management and Resiliency Training was designed to heighten resilience and improve overall QoL among health care providers25 and public-school teachers.14 Resiliency training may be especially beneficial when offered thorough new faculty orientation, incorporated into faculty mentoring programs, and integrated into employee wellness programs. Furthermore, all nursing faculty and administrations may benefit from resiliency training in an effort to recognize and support students and colleagues during stressful situations.26 Developing resilience programs may encourage a healthy nursing faculty workforce, improve overall job satisfaction, and diminish nurse faculty intent to leave.

Limitations

The study was conducted in a school of nursing in a rural geographic area, which limited the generalizability of the findings. Internet instability or inadequate workspace issues may have prevented some faculty from accessing or completing the survey. Additionally, competing demands, feeling overwhelmed, and considering the survey too time consuming may have prevented faculty from responding. Although this study did not address other measures such as fear, coping, stress, and anxiety, the open-ended question allowed faculty to share unique and personal concerns that aligned with majority of the selected independent variables in this study.

Implications

Our findings support the idea that cultivating resilience may improve QoL. More resilient individuals reported higher job satisfaction, work happiness, and commitment to the organization.27 Further research is needed to evaluate programs aimed at strengthening and building resilience among nursing faculty.

Our findings are important in evaluating the impact of the system change due to COVID-19 and social distancing on nursing faculty. Workspace was an important variable of QoL and indicated a designated quiet workspace is needed. Faculty should be encouraged to maintain open communication with other household members, designate work hours, and recognize useful mobile applications to improve office functionality, including scanners and Wi-Fi signal detectors. Nursing leaders may consider collaborating with retailers to offer discounts to employees and encouraging all faculty to establish a functioning home workspace. Alternately, schools of nursing may establish a loaner program to assist faculty in creating a functioning home workspace if social distancing is required for future COVID-19 outbreaks or other public health threats. Regardless, administration should regularly assess the comfort level and needs of nursing faculty related to working with technology and establish refresher courses for nursing faculty not accustomed to online teaching.

The challenges of the COVID-19 pandemic required schools of nursing to foster communication and transparency among nursing administration, faculty, and students. Nurse leaders may consider offering several communication methods to mitigate these challenges that impacted nurse faculty QoL while transitioning to a “new normal.”

Conclusion

The COVID-19 pandemic and subsequent social distancing guidelines caused a major upheaval in schools of nursing. This study discussed the multiple factors associated with QoL among faculty at a school of nursing during the COVID-19 pandemic. Resilience was the strongest predicting variable across all 4 QoL domains and the only significant variable associated with physical health, psychological, and social relationship QoL domains. Notably, a high correlation was found between resilience and faculty home workspace and indicated a quiet, designated workspace may help to improve QoL of nurse faculty. These findings illustrate the importance of resiliency among nursing faculty and support the development of evidence-based programs to build resiliency that may improve QoL among nursing faculty.

Acknowledgment

The authors thank Renee Pforr, assistant to the dean, for distributing the anonymous survey and sending follow-up emails.

References

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Keywords:

COVID-19; cross-sectional survey; nursing faculty; quality of life; resilience; workspace

Supplemental Digital Content

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