Evaluation of quality of life of undergraduate nursing students from first and fourth years: the influence of sociodemographic variables

Abstracts

INTRODUÇÃO: O objetivo deste artigo foi avaliar a qualidade de vida de acadêmicos de graduação em Enfermagem de uma universidade pública do Estado do Paraná, correlacionar com variáveis sociodemográficas, e comparar os acadêmicos do primeiro e quarto anos do curso. MÉTODO: Estudo descritivo, transversal e com abordagem quantitativa. Participaram 34 acadêmicos do primeiro ano (89,5%) e 33 acadêmicos do quarto ano (100%), que responderam ao questionário WHOQOL-bref da Organização Mundial da Saúde, além de informações complementares. RESULTADOS: Os acadêmicos pesquisados eram predominantemente mulheres, jovens, solteiras, com renda per capita média familiar mensal de mais de um salário mínimo, procedentes de outras cidades e residiam com a família ou em república/pensionato. Considerando todos os acadêmicos, o maior escore médio de qualidade de vida foi para o domínio físico (72,7 + 13,1), e o menor para o domínio meio ambiente (60,7 + 12,7). Na correlação com variáveis sociodemográficas, apenas o sexo apresentou correlação com a qualidade de vida, com maiores escores médios para os acadêmicos do sexo masculino nos domínios físico (79,9 + 9,8) e psicológico (77,6 + 6,3). Na análise comparativa entre os acadêmicos do primeiro e quarto anos, apesar das diferenças significativas para idade e renda, com o primeiro ano apresentando alunos mais jovens e com menor renda média familiar mensal em relação ao quarto ano, não houve diferença significativa nos domínios da qualidade de vida. CONCLUSÃO: Os resultados deste estudo sugerem que os acadêmicos de Enfermagem merecem atenção quanto à qualidade de vida, principalmente as mulheres nos aspectos físico e psicológico.

Qualidade de vida; estudantes de enfermagem; Organização Mundial da Saúde; estudos transversais


INTRODUCTION: The aim of this study was to evaluate the quality of life of undergraduate students from a nursing course in a public university in the State of Paraná, Brazil, correlating with sociodemographic variables, and to compare undergraduate students from first and fourth years. METHOD: This is a descriptive and cross-sectional study with a quantitative approach. Thirty-four students (89.5%) from the first year and 33 (100%) from the fourth year participated. They answered the WHOQOL-bref, a questionnaire designed by the World Health Organization, in addition to some additional information. RESULTS: The students were predominantly female, young and single, with per capita family income up to one minimum wage, coming from other cities and living with the family or with housemates. Considering the entire sample, the highest quality of life mean score was for the physical domain (72.7 + 13.1), and the lowest for the environment domain (60.7 + 12.7). Correlation with sociodemographic variables showed that only gender had significant correlation with quality of life. The highest mean scores were for male students in the physical (79.9 + 9.8) and psychological (77.6 + 6.3) domains. There was significant difference between age and income in the comparison between students from first and fourth years, the profile of first-year students being younger and with low income than students from the fourth year. In spite of this, no significant difference in quality of life domains was found. CONCLUSION: The results of this study suggest that nursing students need attention in relation to the quality of life, especially women in the physical and psychological aspects.

Quality of life; nursing students; World Health Organization; cross-sectional studies


ORIGINAL ARTICLE

Evaluation of quality of life of undergraduate nursing students from first and fourth years: the influence of sociodemographic variables

Rosane Bueno EurichI; Ana Cláudia G. C. KluthcovskyII

INurse, Unidade Mista de Humaitá, Humaitá, AM, Brazil.

IIMaster's Degree. MD, Assistant professor, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil.

Correspondence

ABSTRACT

INTRODUCTION: The aim of this study was to evaluate the quality of life of undergraduate students from a nursing course in a public university in the State of Paraná, Brazil, correlating with sociodemographic variables, and to compare undergraduate students from first and fourth years.

METHOD: This is a descriptive and cross-sectional study with a quantitative approach. Thirty-four students (89.5%) from the first year and 33 (100%) from the fourth year participated. They answered the WHOQOL-bref, a questionnaire designed by the World Health Organization, in addition to some additional information.

RESULTS: The students were predominantly female, young and single, with per capita family income up to one minimum wage, coming from other cities and living with the family or with housemates. Considering the entire sample, the highest quality of life mean score was for the physical domain (72.7 + 13.1), and the lowest for the environment domain (60.7 + 12.7). Correlation with sociodemographic variables showed that only gender had significant correlation with quality of life. The highest mean scores were for male students in the physical (79.9 + 9.8) and psychological (77.6 + 6.3) domains. There was significant difference between age and income in the comparison between students from first and fourth years, the profile of first-year students being younger and with low income than students from the fourth year. In spite of this, no significant difference in quality of life domains was found.

CONCLUSION: The results of this study suggest that nursing students need attention in relation to the quality of life, especially women in the physical and psychological aspects.

Keywords: Quality of life, nursing students, World Health Organization, cross-sectional studies.

Introduction

Individuals find a favorable environment for self development and improvement of values related to their future professional and personal lives at universities. Through the search for scientific knowledge, people must find good conditions to develop critical consciousness and to perform their roles as citizens. Such conditions are crucial so that they can have a professional education committed to society.1

According to Saupe et al.,2 an undergraduate nursing student is "a human being that chose to take care of and help other human beings: to be born and live in a healthy manner, to overcome health problems, to deal with disabilities and to find a meaning in this experience, and to die with dignity. And during the process of preparation to perform these different activities that are part of their job taking into consideration technical knowledge, communication skills and political matters, these students have to face suffering situations that can contribute either to make them more or less sensitive.

During the nurses' educational process, more emphasis is given to the technical dimension, which allows for little internal growth of the professional, in spite of the attempt to consider the human being as a whole.3 The support provided to students is usually aimed only at the pedagogical aspects and the urgent and curative care. There is little concern about mental health aspects, which help us to develop consciousness and the ability to analyze the situations. Such abilities would be useful to create learning opportunities and solve difficult problems in the students' routines and in their future professional lives.4

Undergraduate nursing students are going through a phase of life that offers possibilities of changes and new expectations. This can generate deep impact on their current and future quality of life.5 Therefore, the discussion about the education of professional caregivers in the universities is highly important, especially taking into consideration the Guidelines for Nursing Education in Brazil. In this context, there is a need for projects that involve the educational system as an environment where the quality of life of the future professional is discussed.6

The term quality of life is a complex concept, and, in spite of the debates that have been taking place in the last decades, consensus has not been reached.7-10 In spite of the conceptual difficulties, many authors have increasing interest on it and they emphasize the necessity and the relevance of evaluating quality of life, even in the health care field.9,10

The concept has been extended throughout the years, and it slowly encompassed the socioeconomic and human development, or the objective aspect, and the individual perception, or the subjective aspect.9 Furthermore, the perception of quality of life can be different according to different people, and it is a dynamic concept for each individual.11

With regards to the several different approaches to quality of life, Holmes & Dickerson12 reported that the factors that contribute to the quality of life as a whole are: personal satisfaction, self-esteem, performance ability, comparison with others, previous knowledge/experience, economic status, general health and emotional status.

Regarding the definitions of quality of life, there are many different definitions in the literature, and, according to Meeberg,8 some of these definitions are focused on subjective aspects, others are focused on objective aspects, and others use both types of aspects, in a unidimensional or multidimensional manner. Some authors define quality of life in terms of satisfaction with life or satisfaction of needs.

According to the World Health Organization (WHO),13 quality of life is defined as: "the individuals' 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."

In the present study, we emphasize the importance of evaluating the quality of life of undergraduate nursing students due to the special characteristics of this phase of life.

During their training at the university, the students go through processes of adaptation that can generate crisis, such as depression, alcoholism, school dropout, learning difficulties, problems with personal relationships and social withdrawn.4

In addition to their routine as university students, other aspects of their lives can also have an impact on their quality of life and professional future. Saupe et al.2 reported some professors' concerns regarding the students, such as learning, interest, motivation, suffering related to financial problems, family difficulties, health problems and worries related to the specific routine of the future profession, which were made worse due to their familiarity with the pain and death of the patients who seek health care services, in addition to the type of system that is prevalent in the undergraduate teaching institutions, "whose humanistic speech is not always present in the classrooms."

Another aspect that reinforces the importance of this study is the scarcity of publications on this topic. Therefore, the objectives of the present study were to evaluate the quality of life of undergraduate nursing students from a public university of the State of Paraná, correlating with sociodemographic variables and comparing the results from first-year and fourth-year students.

Method

This is a descriptive, cross-sectional study with a quantitative approach. The participants are undergraduate nursing students from a public university of the State of Paraná. Students have a full-time schedule and they attend classes for four years.

Despite the limitations of a cross-sectional study, since it is not possible to define cause and effect, this is a widely used method in studies with the purpose of assessing the relationship between events. In addition, it is a fast, simple, inexpensive and objective method of data collection.14

The university where the study was carried out is located in a medium size city in the State of Paraná, in the South Region of Brazil. The city is a regional center, and it is a benchmark in the region in terms of health care and learning, since it offers several majors either in public or private universities, being an attractive choice for students from other cities, even from other Brazilian States.

The coordination of the Nursing School authorized this investigation, and the study was analyzed and approved by the Research Ethics Committee of the university.

A pilot study was performed involving eight undergraduate nursing students. All of them attended the same university where the study was carried out. The objective of the pilot study was to test the acceptance of the study and to check how well the participants understood the questionnaire. Since there were no difficulties during data collection, data obtained with the pilot study were included in the final results.

All participants and their guardians, including those who participated in the pilot study, signed the written consent form in compliance with the Resolution 196/96 of the National Council of Ethics in Research.15

Data collection was performed during class breaks, within a period of time aimed at this investigation, in April, May and June 2007.

The group of participants comprised students enrolled in the first and fourth years of the undergraduate nursing school who accepted to answer the questionnaire for data collection. Thus, of the 38 students enrolled in the first year, 34 (89.5%) participated in the study and four (10.5%) refuse to participate. Of the 33 students enrolled in the fourth year, all (100%) took part in the study.

We decided to investigate the first and fourth years because of the specific differences between these two periods of the students' life regarding their respective academic curriculums. During the first year, the students take mandatory courses concerning their basic education. The students from the fourth year take mandatory courses concerning their professional education, including supervised internships in health care services having direct contact with patients.

The information obtained through the questionnaire was filled out by the subjects during one meeting, and the questionnaires were handed out and collected by the authors of the study.

The instrument used for data collection was the generic quality of life questionnaire developed by the WHO, the WHOQOL-bref, which is the brief version of the WHOQOL-100. Both were designed by the WHOQOL Group.16 The WHOQOL-100 resulted from a multicentric collaborative project with the purpose of developing an instrument to evaluate quality of life from an international point of view.17

The Portuguese version of the WHOQOL-bref was developed by the WHOQOL Center for Brazil.16 It includes 26 questions: two general questions, which are not taken into consideration to calculate the scores of the domains, and 24 questions distributed among four domains: physical, psychological, social relationships and environment.

The final scores for each domain consider the answers of each question belonging to that domain, resulting in final scores in a scale from 4 to 20, which can be transformed in a scale from 0 to 100, scaled in a positive direction. Higher scores denote higher quality of life.

We chose to use the WHOQOL-bref because it was developed and validated showing good psychometric characteristics,16 which are very important when choosing an instrument to evaluate quality of life.9,18,19 Furthermore, this instrument can be used either to evaluate healthy populations or patients with chronic diseases.20

We also collected supplemental information about the academic year the student was attending, gender, age, marital status, family income and number of people supported by that income, city of origin and familial relationships.

Variables were analyzed using absolute and relative frequencies and descriptive statistical measures. After checking the variables normality using the Kolmogorov-Smirnov test, we used Student's t test to compare the means. Fisher's exact test was used to compare proportions. The statistical significance level was set at 5%.

Results

The results are related to the evaluation of the quality of life of 67 undergraduate nursing students; 34 students from the first year and 33 from the fourth year.

The mean time the participants needed to fill out the questionnaires was 7 minutes (SD ±3.1).

To be used in the present study, the WHOQOL-bref underwent a reliability assessment considering its internal consistency. The assessment was carried out using Cronbach's alpha coefficient with scores of 0.90 (for the 26 items), 0.89 (for the domains), 0.77 (physical domain), 0.68 (psychological domain) and 0.77 (environment domain). The social relationships domain had a Cronbach's alpha coefficient of 0.51; in spite of that, we decided to include this domain in the calculation of the results because it is a more instable domain in terms of psychometric characteristics according to what was demonstrated by a field test.16

Table 1 shows the total distribution of the students according to sociodemographic variables.

In terms of gender, most students were women (80.6%). Other studies have demonstrated the prevalence of women in Nursing Schools, with percentages ranging from 89% to 97.8%.21-27 This profile was also confirmed in a study about the students who took the National Exam of Students' Performance in 2004, which reinforced two trends previously identified in the literature regarding the historically established relationships between women and the task of providing health care, and the socially established relationships between women and the choice to attend nursing schools.28

Students' mean age was 21.2 years (SD ±4.3), the youngest participant was 17 and the oldest was 44 years old. According to the data shown in Table 1, most students (53.7%) were younger than or 20 years old.

A similar mean age (20 years) was found in a study about depression involving 99 nursing students from the first to the fourth years from the Medical School of Botucatu - UNESP, São Paulo.26

Among undergraduate nursing students who participated in a study about their knowledge on alternative/supplemental therapies from public and private universities, the mean age was 24.3 years old.23

A study about the sociodemographic profile of students who enrolled in the Nursing School of Ribeirão Preto - USP, from 1999 to 2003, found ages ranging from 16 to 45 years old, and the age group between 17 and 21 years old accounted for 92.04% of the students. In both studies, the reason for the enrollment of young students might be the fact that universities require full-time availability, what makes it difficult or even impossible for the students to have a job.21

In an evaluation of the quality of life of 264 nursing students in a city of the State of São Paulo, the age ranged from 17 to 40 years old, also showing a prevalence of young people, from 17 to 20 years old, in 65.5% of the sample.22

A recent study involving 224 undergraduate nursing students from the first, second and third years found that the age ranged from 17 to 44 years; however, there was a prevalence of the age group between 21 and 25 years (60.3%).24

Regarding marital status, most students were single (91.0%). Mostly single individuals were found in a study carried out among students who had just enrolled in the nursing school (96.8%), 21 among all the students enrolled in this major (88.6%),22 among students from the first, second and fourth years (95.6%),24 and among the students enrolled in the last year (91.3%).25

Most students (76.6%) had a mean family income of more than one minimum salary per month. Considering the income as the number of minimum salaries received by each student's family, most families (45.5%) had an income between 6 and 10 minimum salaries per month.

In a previously mentioned study that evaluated the quality of life involving undergraduate nursing students from the Estabelecimento de Ensino Superior Integrado da Fundação Educacional de Fernandópolis, State of São Paulo, there was a prevalence of income between 6 and 10 minimum salaries, 43.9% of the respondents, followed by 28.4% with an income of 11 or more minimum salaries. Most students owned their house and used a car as the family's main mean of transportation, which suggested the students' families had high purchase power.22

Also among 99 nursing students from the first to the fourth years from the Medical School of Botucatu - UNESP, São Paulo, the family monthly income was similar to that, ranging from 5 to 10 minimum salaries.26

Most students (61.2%) came from other cities and, in terms of familial relationships, 86.6% lived with relatives or in dorms, and only 13.4% lived alone. In a previously mentioned study, most students (95.96%) also came from other cities, and most of them lived in dorms (65.7%).26 On the other hand, among 33 students who had just enrolled in the nursing school of a private university in the city of São Paulo, more than half of them (52.0%) lived in the South Region of the city, where the school was located, suggesting the institution was deeply integrated in the community with support from the local means of public transportation.27

With regards to the mean scores of quality of life domains (Table 2), the highest mean score was for the physical domain 72.7 (SD ±13.1), and the lowest mean score was for the environment domain (SD ±12.7).

In a study carried out by Saupe et al.2 that evaluated the quality of life of 825 students in six nursing schools in the South Region of Brazil, the highest mean score was for the social relationships domain (70), and the lowest mean score for the environment domain (55). The authors considered that the low score of the environment domain might be related to the lack of self-confidence and the uncertainty currently experienced by the Brazilian population.

Table 3 shows the mean scores of quality of life for all nursing students participating in this study according to the associations among sociodemographic characteristics. We found significant associations between gender and the physical and psychological domains, with the highest mean scores for male students in the physical domain (79.9±9.8) and in the psychological domain (77.6±6.3) in comparison with the female students (physical domain = 71.0±13.2 and psychological domain = 67.3±12.7).

Table 3 - Click to enlarge

In the physical domain, the instrument used for data collection in this study includes aspects related to pain and discomfort, dependence on medication or treatments, energy and fatigue, mobility, sleep and rest, activities of daily living and work capacity. The psychological domain includes positive feelings, spirituality/religion/personal beliefs, thinking, learning, memory and concentration, body image and appearance, self-esteem and negative feelings.16

With regards to the aspects related to reports of diseases, in a study about quality of life, 39% of the nursing students reported they had a disease, especially chronic nervous or emotional problems, depression and skin disease.2

The measurement of the most frequent symptoms of depression among 99 nursing students from the first to the fourth year resulted in 41.41% of the students with mild to severe depression. The most frequent symptoms were self-blame, irritability and fatigue. The study tried to link the gender issue, which is present in the nursing professional activity, to depression, since this disorder more often affects women, mainly those who work full-time. Regarding the undergraduate nursing students, who are mostly women, the curriculum requires them to spend around 9 hours a day performing learning activities, which is similar to a full-time job.26

Telles Filho et al.,25 while studying stress in nursing students, reported that the most often mentioned expectations regarding the future among students from the last year were related to job, work, salary, urgent employment relationship and professional satisfaction. When analyzing the characteristics of stress in these students, the authors found that 39.1% of the individuals reported they always felt tired at the end of the day, 34.8% always had thoughts that caused anxiety and 30.4% always had emotional exhaustion.

The differences found in this study, with lower mean scores of quality of life for women in the physical and psychological domains, and the fact that health care services are quite stressful since they deal with suffering, suggest that more attention should be given to the process of education of nursing students, especially when they are women.

Since, within the context of nursing, the process of taking care can cause anxiety, it is important to favor the process of self-knowledge and provide students with support about issues such as fears and anxieties, which are inherent to the task of taking care of oneself and others.6

Actually, according to a report by Esperidião and Munari,3 "the process of academic education has not focused on aspects that allow for the emotional strengthening of future health professionals, revealing clear disregard for the problems caused by the stressing situation the students have to deal with on a daily basis."

The process of taking care of people exposes the professor and the student to direct contact with people who are suffering. Therefore, professors play an important role in counseling and listening to the students, so that they can experience transference and countertransference, and elaborate their experiences during the process of taking care of themselves and others.6

Table 4 shows the associations among the sociodemographic variables of students from the first and fourth years. There are differences in terms of age and income, since the first year has younger students (up to 20 years old) and lower mean monthly family income (up to one minimum salary) in comparison with the fourth year.

For most young people, entering the university takes place during a phase of transition between adolescence and adulthood. This phase is usually full of doubts and uncertainties. The academic environment also requires a period of adaptation from the students because it represents a change in their life styles.29 Students usually enter the academic environment under high stress and pressure because of the entrance examination. They are also full of expectations and desires typical of that phase of their lives. However, they often have to face situations that are different from what they expected regarding the major and the teaching conditions. Then they realize they are in a new phase of their lives, a phase during which they have to take responsibility.3

Table 5 shows the comparison of the mean scores of quality of life domains between students from the first and fourth years. No significant difference was found.

The significant difference found for age and mean income between the two groups of students could have an influence on the evaluations of the quality of life domains. But such an influence was not seen in the present study. This finding reinforces the idea of understanding quality of life as a subjective and personal concept, increasing the relevance of the individual's opinion.9

In a study with a qualitative approach about the perception of quality of life involving undergraduate nursing students, the authors found that the main situations promoting quality of life were the extracurricular experiences, the relationship professor-student and the relationships among students. On the other hand, the situations that did not promote quality of life were lack of support from professors and nurses, lack of integration with the team and with students from other majors and excessive class hours for those students who had a job.6

Still considering the data shown in Table 5, the highest mean scores were for the social relationships domain (72.06±16.52) for the students from the first year, and for the physical domain (73.60±13.09) for the students of the fourth year. The lowest mean scores were for the environment domain in both groups, with mean score of 60.40 (SD±11.46) for the first year and 61 (SD±13.97) for the fourth year.

Beuter et al.5 studied leisure in the life of undergraduate nursing students, since, in addition to the academic activities, how students use their free time can have an impact on their future choices. Therefore, if the nursing students understand and value leisure in a more encompassing dimension during different phases of their lives, such as taking care of themselves, they can bring comfort, well-being, relieve and calmness to their lives, providing humanized care to other people.

The low mean scores in the environment domain for the students who participated in the present study are a reason for concern, since the rhythm of capitalism imposes a stressful routine to people, only valuing the future. And an increasingly demanding labor market make people devote themselves exclusively to activities related to the professional future, what can make them stop practicing pleasant activities.5

Either the economic scenario of the country, such as lack of work opportunities, or the experience of the students with internships in a health system that is not focused on fulfilling the real needs of the population, are not motivating factors for an optimistic performance and do not reinforce the self-esteem of young people who are about to enter the labor market.24

In addition, aspects related to the physical environment need to be considered. In a study involving 2,613 respondents, including professors, employees and students, aspects of the physical environment of the campus of Universidade de Brasília were assessed. In the global assessment, negative aspects mentioned by the respondents were paper, glass and plastic recycling, external lighting and protection against theft. The priorities for improvement mentioned by the respondents were aspects related to security, such as external lighting, protection against theft, personal security, in addition to collective transportation, traffic safety and quality of water.30

Conclusions

The group of students included in this study had a prevalence of young, single women, with mean family income of more than one minimum salary, who came from other cities and lived with their families or in dorms. The highest mean score of quality of life was for the physical domain and the lowest mean score was for the environment domain. In the correlation with sociodemographic variables, only gender had a correlation with quality of life, with higher mean scores for male students in the physical and psychological domains.

In the comparative analysis between the students from the first and fourth years, in spite of the significant differences for age and income, with students from the first year being younger and having lower mean monthly family income in comparison with those from the fourth year, there was no significant difference in the quality of life domains.

The results of the present study suggest that nursing students should receive more attention with regards to quality of life, especially women in terms of physical and psychological aspects.

Nursing plays a very important role either in the maintenance or promotion of health. Furthermore, nursing leads its professionals to put into practice a thought guided by the activities of caring and teaching because it is a profession with peculiarities in terms of knowledge.31

Therefore, the education of nursing professionals focused only in specific technical performance cannot be accepted by the universities. Their training must be aimed at the education of citizens, leading them to achieve technical and scientific competence and, above all, to have a broad vision of the human dimension.32

Teaching focused on the person must get more attention, considering the student's technical and rational competence, but also the student as a whole person, understanding that he/she is someone with personal characteristics who experiences several different feelings during his/her professional activities.3

The importance of professors for students also cannot be disregarded, either in terms of professional or personal performance. After all, professors follow the students most of the time since they enter the university until their graduation in order to ensure that negative aspects of their quality of life experienced during their academic education do not have a negative impact on their professional career.

We hope that this study serves as a motivation for other studies evaluating the quality of life of nursing students, with comparison between different groups and use of different methodological approaches. These results can serve as sources of information for the design of supporting and coping strategies for students, as well as for the implementation and maintenance of formal environments focused on their real needs. These environments must be free, easy to access and they must respect ethical aspects.

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Publication Dates

  • Publication in this collection
    17 Mar 2009
  • Date of issue
    Dec 2008

History

  • Accepted
    08 July 2008
  • Received
    14 Mar 2008
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