INTRODUCTION:

Background / rationale

Research on student–teacher relationships suggests nursing education is humanising. In humanistic student–teacher relationships, emancipatory curricula, and nursing education metasynthesises of care, connection is defined¹. In higher education, educator-student relationships generate a sense of belonging and collaborative drive. Kids are confident enough to try new things and succeed in a fear-free atmosphere. Instructors can help students set goals and motivate themselves, and students can ask for their help.²

Friendly teachers enhance nursing students' academic achievement and satisfaction, encouraging participation in extracurricular activities and positive relationships with peers^3. According to Harter (1999), people develop a self-concept with four domains: physical, academic, social, and self-esteem^4.

These data suggest that student-teacher relationships affect many aspects of children's development and outcomes. Nurse self-concept pertains to the knowledge and convictions that nurses possess regarding their responsibilities, principles, and conduct.^5.

Nursing self-concept will enable them give excellent care⁹. A strong professional self-concept leads to self-esteem, confidence, and patient care knowledge.^6.

Student nurses are role models, educators, and carers in underdeveloped countries like India. College students make health decisions as adults. Thus, they commonly engage in unhealthy behaviours such inactivity, poor diets, and risky drinking, drug, and sexual practices^7. Instead of food and exercise, college students' health is centred on risky habits including drinking, drugs, and sexual activity. All affect long-term health, especially since diet and exercise prevent diabetes, hypertension, heart disease, and obesity⁸. Fewer studies link student nurses' professional relationships, self-concept, and healthy lifestyle practices. As a result, the purpose of this research was to establish a correlation between these variables and to compare them across various classes of undergraduate nursing students.

OBJECTIVES:

The initial goal was to compare nursing students' professional relationships, self-concept, and health-promoting lifestyles. The second and third goals of this study were to determine the correlation between nursing students' professional relationships, self-concept, and health-promoting life-style behaviours, and to determine the association between nursing students' socio-demographic variables and these factors.

METHODS:

Ethics Statement:

The researcher detailed the study's goals and assured participants of their privacy and data protection. Participants were notified that data would only be used for study and could opt out at any moment. Participating pupils gave consent. The Ethics Committee of DRIEMS University (Ref. ID: DRIEMS.SON.REC.101.23) has approved this study with full confidence.

Study Design:

This study used a correlational design to explore the relationships between Professional Relationships, Self-Concept, and Health-Promoting Lifestyle Behaviours.

Setting:

This study was conducted among nursing students at DRIEMS University School of Nursing in Cuttack, Odisha. The survey was conducted from October 1st to 30th October 2023.

Participants:

The study included baccalaureate nursing students from the first to the fourth year, with a total of 250 participants. Of these participants, 90 were third-year BSc (N) students, 58 were first-year students, 56 were third-year students, and 46 were fourth-year students. The study used convenience sampling to recruit participants.

Variables:

The research variables were Professional Relationships, Self-Concept, and Health-Promoting Lifestyle Behaviours.

Data sources/measurements:

The researcher utilized both standardized and non-standardized tools to gather data. The tool employed was structured and comprised of four parts. The first part was designed to elicit socio-demographic characteristics of the study participants. The second part comprised a self-structured rating scale consisting of 14 items, which measured the professional relationship that students had with their nursing lecturers. The rating scale was a three-point system that included options such as always, sometimes, and never. The tool was validated by five experts in the field of nursing research and tested for reliability using a split-half technique. The results indicated that the tool was reliable, with a Karl Pearson correlation coefficient value of 0.83, suggesting strong reliability.

The Nurses Self-Concept Instrument (NSCI) is a comprehensive tool specifically designed for nurses to assess their self-concept, job satisfaction, and retention in the nursing profession. Created by Leanne S. Cowin in 2002, NSCI underwent rigorous testing and has since been used in various studies. In this particular study, NSCI was utilized to evaluate nursing students' self-concept across four domains: care, knowledge, staff relations, and leadership, with a total of 14 positively worded items randomly assigned throughout the questionnaire. Each item was rated on an 8-point Likert scale, with higher scores indicating a stronger endorsement of the statement^10.

The standardized 52-item Health-Promoting Lifestyle Profile II (HPLP II) assesses adults' healthy lifestyle activities^11. The instrument measures health responsibility, physical activity, nutrition, spiritual growth, interpersonal interactions, and stress management using a total scale and six subscales. Subscale values range from 1 to 4, with higher scores suggesting more health-promoting behaviours. Total scores are the sum of subscale values, ranging from 52 to 208. Healthcare practitioners and researchers can utilise the HPLP II to measure health-promoting behaviours and build effective intervention programmes to promote healthy lifestyles^12.

Bias of the total of 450 students, a mere 250 students provided responses to the survey form. There may have been bias caused by a disproportionate percentage of non-responding students.

Study Size:

Despite estimating the target population at 452, Based on this population size, 207 samples were calculated for 95% confidence and 5% confidence intervals. The researcher chose 250 samples from 253 survey respondents for the current investigation.

Statistical Methods:

All data were analyzed using IBM SPSS version 20.0 (IBM Corp.). For statistical analysis, both descriptive and inferential statistics were employed. Descriptive statistics, including frequency distribution, measures of central tendency, and measures of dispersion, were used to summarize the data. F test was used to examine the association between the variables in the study. Furthermore, Karl Pearson correlation coefficient test was conducted to determine the strength of correlation between the variables.

RESULTS:

Table I shows the distribution of study samples based on socio-demographic characteristics. (N = 250)

Socio-Demographic Characteristics		Percentage (%)	Frequency (f)
Age	20 Years	48%	120
	21 Years	43%	108
	22 Years	0%	0
	23 Years	6%	14
	24 Years	3%	8
Gender	Male	17%	43
Gender	Female	83%	207
Class of Study	B. Sc I year	23%	58
	B. Sc II Year	22%	56
	B. Sc III Year	36%	90
	B. Sc IV Year	18%	46
Place of Residence	Urban	38%	94
	Rural	43%	108
	Semi-Urban	18%	45
	Tribal area	1%	3
Type of Family	Joint Family	44%	111
Type of Family	Nuclear Family	56%	139
Socio-Economic Class	Upper Class	4%	9
	Upper Middle Class	57%	142
	Lower Middle Class	36%	89
	Lower Upper Class	3%	8
	Lower Class	1%	2
Mother's Educational Status	No Formal Education	1%	3
	Primary	4%	9
	Secondary	9%	23
	Higher Secondary	28%	71
	Senior Secondary	3%	7
	Diploma	2%	4
	Graduate	48%	119
	Post Graduate	6%	14
Father's Educational Status	No Formal Education	3%	7
	Primary	4%	9
	Secondary	9%	22
	Higher Secondary	18%	44
	Senior Secondary	4%	10
	Diploma	1%	3
	Graduate	48%	120
	Post Graduate	14%	35
Participation in Social Activities	Yes	82%	204
Participation in Social Activities	No	18%	46
Relationship with Friends	Good	85%	213
	Average	13%	33
	Poor	2%	4
Relationship with Parents	Good	98%	245
	Average	2%	4
	Poor	0%	1
Father's Parenting Style	Permissive	76%	191
	Authoritative	22%	56
	Uninvolved	1%	3
Mother's Parenting Style	Permissive	77%	193
	Authoritative	21%	53
	Uninvolved	2%	4
Class Teacher Administration Style	Permissive	56%	140
	Authoritative	38%	96
	Uninvolved	6%	14

Table I shows that 48.0% of 120 were 20. The majority (83.0%) were women. Most participants, 90(36.0%), were in their third year of B.Sc. (N). Rural participants numbered 108(43%). More than half of the samples—139(56.0%)—were in joint families. Of the samples, 142 (57.0%) are upper middle class. The majority of the samples' mothers (119/48.0%) and fathers (120/48.0%) were graduates. Most of 204(82.0%) of 250 samples were socially active. Most students report good relationships with their parents 245(98.0%) and friends (213(85.0%). It was revealed that most fathers mothers and class teachers had a permissive style of parenting and administration style.

Table – II Frequency and Percentage Distribution of Samples According to Level of Professional Relationship (n = 250)

Level of Professional Relationship

Level

I Year

II Year

III Year

IV Year

Good

(46.6 %)

(39.3 %)

(38.9 %)

(56.5 %)

Average

(53.4 %)

(57.1 %)

(57.8 %)

(43.5 %)

Poor

(0.0 %)

(3.6 %)

(3.3 %)

(0.0 %)

Level of Nurses Self - Concept

Good

(100.0 %)

(96.4 %)

(98.9 %)

(100.0 %)

Average

(0.0 %)

(3.6 %)

(1.1 %)

(0.0 %)

Poor

(0.0 %)

Level of Health Promoting Life – Style Behaviour

Good

(0.0 %)

Average

58 (100.0 %)

(100.0 %)

(97.8 %)

(100.0 %)

Poor

(0.0 %)

(2.2 %)

(0.0 %)

Table II shows the frequency and percentage of samples by professional relationship.

The majority of first-year B.Sc(N) students, 31(53.4%), had average professional relationships. Most second-year B. Sc (N) participants 32(57.1%) and third-year B. Sc (N) participants 52(57.8%) had average professional relationships. B.Sc(N) Majority 26(56.5%) had solid professional relationships in fourth year.

All B.Sc. (N)-I- and IV-year participants, 58(100.0%) and 46(100.0%), had good nurse self-concepts. A good nurse self-concept was found in 54(96.4%) and 89 (98.9%) B.Sc. (N) II- and III-year respondents.

Out of all B. Sc (N) I, II, and IV-year participants, 58 (100.0%), 56(100.0%), and 46(100.0%) had an average level of healthy life style behaviour. In B. Sc (N) III-year, 88(97.8%) had an average level, while only 2 (2.2%) had poor behaviour.

Table – III: Association Between Class of Study and Professional Relationship, Nurses Self – Concept and Health Promoting Life – Style Behaviour (n = 250)

Class	Count	Mean ± SD	F Value	P value
Professional Relationship
B.Sc. I year	58	32.57 ± 5.11	0.652	0.05*
B.Sc. II Year	56	32.00 ± 5.70
B.Sc. III Year	90	31.29 ± 5.76
B.Sc. IV Year	46	34.02 ± 5.64
Nurses Self - Concept
B.Sc. I year	58	25.50 ± 2.46	0.615	0.60^NS
B.Sc. II Year	56	25.45 ± 2.97
B.Sc. III Year	90	25.52 ± 2.54
B.Sc. IV Year	46	26.09 ± 2.89
Health Promoting Life – Style Behaviour
B.Sc. I year	58	21.69 ± 2.92	0.772	0.511^NS
B.Sc. II Year	56	21.71 ± 1.91
B.Sc. III Year	90	21.26 ± 2.49
B.Sc. IV Year	46	21.83 ± 2.31

Level of Significant at p-value <0.05, NS – Not Significant, * Significant

Concerning the professional relationship and class of study of the samples in this study, there was a significant association between class professional relationship and class of study with the F value as 0.652 at p-value < 0.05. there was no significant association between the class of study and nurses’ self–concept (F = 0.615, p < 0.60) and health-promoting lifestyle behavior (F = 0.772. p<0.511)

Table – IV Level of Association Between Professional Relationship and Socio-Demographic Variables of the Samples (n = 250)

Class	Socio-Demographic Variables		Professional Relationship			ꭓ² Value	P value
Class	Socio-Demographic Variables		Good	Average	Poor	ꭓ² Value	P value
B. Sc (N) I Year	Socio-Economic Class	Upper Class	5	0	0	12.47	0.014*
		Upper Middle Class	16	14	0
		Lower Middle Class	4	14	0
		Lower Upper Class	1	3	0
		Lower Class	1	0	0
	Class Teacher Administration Style	Permissive	20	6	0	18.61	0.001*
		Authoritative	7	20	0
		Uninvolved	0	5	0
B. Sc (N) II Year	Father's Educational Status	No Formal Education	2	0	0	8.099	0.017*
		Primary	0	2	0
		Secondary	1	3	0
		Higher Secondary	3	3	0
		Senior Secondary	1	1	0
		Diploma	0	0	0
		Graduate	12	15	0
		Post Graduate	3	8	0
	Mother's Parenting Style	Permissive	18	27	0	12.89	0.012*
		Authoritative	4	3	0
		Uninvolved	0	2	0
B. Sc (N) III Year	Gender	Male	15	6	0	12.41	0.002*
	Gender	Female	20	46	3	12.41	0.002*
	Place of Residence	Urban	9	29	1	10.471	0.033*
		Rural	22	16	1
		Semi-Urban	4	7	1
		Tribal area	0	0	0
	Father's Educational Status	No Formal Education	1	1	0	12.33	0.002*
		Primary	1	2	0
		Secondary	3	7	0
		Higher Secondary	3	8	1
		Senior Secondary	0	3	1
		Diploma	2	1	0
		Graduate	21	25	1
		Post Graduate	4	5	0
B. Sc (N) IV Year	Father's Educational Status	No Formal Education	0	0	0	9.220	0.002*
		Primary	0	2	0
		Secondary	4	1	0
		Higher Secondary	3	6	0
		Senior Secondary	0	0	0
		Diploma	0	0	0
		Graduate	16	6	0
		Post Graduate	3	5	0

Level of significance at p-value < than 0.05, * Significant

Table V presents the correlation analysis between professional relationships, nurses' self-concepts, and healthy lifestyle behaviors. The study found that the correlation between professional relationships and nurses' self-concepts was mildly positive (0.03(p< 0.55)). However, a negative correlation was observed between professional relationships and healthy lifestyle behavior (r = -.102 (p<1.08)). Moreover, the study also discovered a negative correlation between nurses' self-concept and healthy lifestyle behavior (r = -.010 (p < 0.87)). These findings suggest that there is a need for further exploration and intervention in promoting healthy lifestyle behaviors among nurses while improving their professional relationships and self-concepts.

DISCUSSION:

Key results:

The objective of this study was to compare the self-concept, health-promoting lifestyles, and professional relationships of nursing students. Furthermore, the study aimed to determine the correlation between these factors and the socio-demographic variables of the students. The majority of the nursing students who were selected for the study actively participated and completed the survey form. The findings revealed that the nursing students had average professional relationships with their clinical instructors. Although most of the students believed that their teachers trusted them, a large number of participants expressed a lack of support and guidance from their clinical instructors. The majority of the students reported that their clinical instructors utilized group work for academic purposes. The study also found that the clinical instructors-maintained order and discipline in class without being excessively strict. Moreover, it was observed that the teachers had a good sense of humour, but many students felt that their clinical instructors did not communicate with them regularly.

Professional self-concept is an individual's perception of their profession. The study participants' self-concept as nurses indicated that all class students possessed a positive level of self-concept in their nursing role. A detailed analysis of the nurse self-concept across different areas showed that the mean and standard deviation score for care was 25.60±2.68, for knowledge it was 19.02+2.43, for staff relations it was 19.48±2.06, and for leadership, it was 25.72±2.13.

A study was conducted on the health-promoting lifestyle practices of nursing students in selected institutions. The majority of students, across all classes, had an average level of health-promoting lifestyle practices. The scores for various areas of health-promoting lifestyle practices are as follows: health responsibility scores were 21.56± 2.44, physical activity scores were 17.30±2.07, nutrition scores were 16.98±2.29, spiritual growth scores were 24.96±2.46, interpersonal relationship scores were 23.45 ±3.194, and stress management component scores were 20.94±2.36.

INTERPRETATIONS:

The current study conducted in selected nursing institutions in the state of Odisha, India, has yielded some interesting results and key findings. It has been observed that a vast majority of the study participants had established good professional relationships, and had a positive self-concept of being a nurse. Additionally, an average level of health-promoting life style practices were commonly followed by a majority of the study participants. These findings shed light on the overall health and wellbeing of nurses in the state of Odisha, and emphasize the importance of maintaining good professional relationships and adopting healthy lifestyle practices.

According to a recent study, there exists a mild positive correlation between professional relationships among nurses and their self-concepts. However, the study also revealed that there is a negative correlation between professional relationships and healthy lifestyle behavior. In addition, it was observed that nurses who have a negative self-concept tend to exhibit unhealthy lifestyle behaviors. These findings highlight the importance of promoting healthy lifestyle behaviors and fostering positive professional relationships among nurses in healthcare settings.

COMPARISON WITH PREVIOUS STUDIES:

Due to the specificity of the measurement devices that were utilized, it is difficult to compare the results of our investigation with those of other studies.

Clinical instructors' attitudes affect students' learning, especially in clinical practice. The study found that students appreciated clinical instructors' teaching abilities most, followed by nursing competence and evaluation. Teaching ability was students' top choice for clinical teachers, followed by nursing competence and evaluation. Nursing students' personality and interpersonal interactions affect clinical learning fourth and fifth ^(13). Many studies have shown that clinical learning based on a positive caring interaction between faculty and nursing students helps students develop caring traits. A study of nursing students' perceptions of instructors' caring behaviours in India, Greece, Nigeria, and the Philippines found that nursing students valued caring, but the number was lower than expected (14). A cross-sectional study was conducted on 124 B.J. Government Medical College and Sassoon General Hospitals, Pune, nursing students. The study found that nursing students had strong health behaviour orientations. Poor eating and exercise habits were noted ^15.

LIMITATIONS:

A few study limitations existed. The disproportionate sample size in each class was a major restriction. The researcher did not randomise the sample. The study was done in one institution, therefore the results can be extended to other contexts and samples with caution. There were few reviews, which supports the present study findings.

SUGGESTIONS FOR FURTHER STUDIES:

The study's conclusions have multiple ramifications. The results of this study will stimulate more exploration into doing comparable studies involving several institutions. Researchers can then design diverse programmes aimed at enhancing nursing students' professional relationships, self-concept, and health-promoting behaviours. In the future, longitudinal studies can be conducted to assess the efficacy of these interventions on nursing students' self-concept and the impact of health-promoting practices.

CONCLUSION:

The research reveals that nursing students need to establish a strong relationship with their clinical teachers to improve their knowledge and develop a caring attitude. This will enable them to become compassionate nurses who can provide quality care to patients in all areas. As students gain experience, their self-concept should improve, allowing them to excel as caring and competent nurses. Nurses must adopt healthy behaviors to maintain their well-being and create a professional image that reflects the contemporary nursing standards.

AUTHORS CONTRIBUTIONS:

CONFLICT OF INTEREST:

We assert that there are no potential conflicts of interest that could have any impact on the findings or interpretation of this article. We assure you that the information provided is unbiased and reliable.

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Received on 21.02.2025 Revised on 12.04.2025

Accepted on 23.05.2025 Published on 16.08.2025

Available online from August 25, 2025

Int. J. Nursing Education and Research. 2025;13(3):151-157.

DOI: 10.52711/2454-2660.2025.00032

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Variables	Professional Relationship	Nurses Self - Concept	Healthy Life-Style Behaviour
Professional Relationship	-	0.03 (p < 0.55)	-.102 (p < 1.08)
Nurses Self - Concept	0.03 (p < 0.55)	-	-.010 (p < 0.87)
Healthy Life-Style Behaviour	-.102 (p < 1.08)	-.010 (p < 0.87)	-