A Descriptive Study of Nurses' Happiness at Shahid Sadoughi Hospital, Iran

Despite the importance of the issue, limited amount of studies have investigated nurses' happiness. Most studies have measured the level of mental health, anxiety and depression of nurses which has traditionally been focused by clinical psychology. The new branch of psychology focuses on study of human strength and happiness instead of psychological deficits and disability [12]. Therefore, this study was conducted to determine the happiness of nurses working at Shahid Sadoughi Hospital in Yazd.


Introduction
Happiness is the most basic human issue and the most central stimulus for human purposes [1]. Happiness is not the opposite of depression or lack of it [2], rather lack of depression is a necessary condition for reaching happiness [3]. Happiness is an emotional or affective state that is characterized by feelings of enjoyment and satisfaction, which is often equated with morale, contentment, wellbeing, life satisfaction, successful aging, quality of life, and the good life [4].
Researches show that happy people are less emotional and occupational burnout, less absenteeism and unlikely to leave their jobs. Happy employees have more interpersonal communication skills and are committed to the organization [5,6]. Being happy is one of the factors contributing to economic, cultural, social and political development leading to good performance and increased production [7].
Happiness causes environmental stability and reduces tensions and, on the other hand, has a significant impact on staff morale [8]. Positive self-concept, physical and mental health, emotional balance, increased hope for the future, favorable attitudes toward one's self and others, promoting social relationships, more willing to help others, making better decisions, and more creativity are other benefits of happiness [9,10].
One of the professions requiring happiness for greater effectiveness is nursing. Nurses have one of the stressful jobs in healthcare and their mental health is at risk by many occupational stressors. Pedersen suggested that nurses became depressed twice as much as ordinary people. The rate of occupational hazards are high in nurses, especially those in intensive wards because of the nature and difficulties of their job where depression is also more prevalent. Working in intensive wards is Fordyce happiness scale on a four-point Likert scale.
Argil, reported internal consistency of this test in original language as 0.73 to 0.93 with a mean of 0.86. In Persian draft, Oxford Happiness Questionnaire was used to test the validity of happiness measures [13]. Its reliability was calculated as 0.92 [14].
The questionnaire score was divided into five levels: weak (35-20), moderate (50-36), good (65-51), very good (80-66), and great happiness (81 and above). Informed consent was obtained from the volunteers while some information regarding the aims, procedures of the study, and participants' rights were clearly explained to them individually before the initiation of interviews. For the characterization of the study population, a descriptive analysis was done. All analyses were conducted using SPSS 15.0. Data were statistically analyzed by descriptive statistics, mean, standard deviation and t-test.

Results
In this study, 73 nurses were investigated, of whom 84% were married, and more than three quarters were women. More than 90% of the subjects had a bachelor's degree. Nurses were in the age range of 22-47 years with a mean age of 33.16 ± 6.5 years. The average work experience was 10 ± 7.2 years (Table 1).
According to the results of this study, mean value of happiness was calculated as 68 ± 0.37 that was equivalent to very good happiness status ( Table 2).
There was no significant difference between happiness and other demographic variables such as age, gender, education, and work experience, however, happiness was considerably related to workplace (P<0.04). In this study, 30.1% of the subjects worked in intensive wards and 69.9% in other wards. Only 4.5% of the intensive units were very happy. Average happiness in other wards was 78.75% while the average happiness of the nurses in intensive units was 65.75% (Table 3).
A question that the majority of nurses (42%) had complete agreement with it was "I have friendly relationship with God.", and the question that the majority of nurses (42%) disagreed with was "I have a lot entertainment and recreational activities".

Conclusion
The results of this study showed no relationship between happiness and age, sex, and marital status that is consistent with the findings of Sametyan and Sharifi. Hee in a study, found a relationship between happiness and work experience and education of nurses which is not in agreement with the results of this study. The reason might be due to the fact that most of the nurses in this study had a bachelor's degree. In this study happiness had a significant association with the workplace which is consistent with Hee's results. This could explain more pressure and stress on the nurses in intensive wards.
In the current study nurses happiness was measured as very good that was consistent with previous studies in this field [15]. Schwartz tried to compare happiness in nurses and other people in Iceland concluding that nurses were happy, like other individuals of the society. Hee et al. assessed happiness of the nurses in 10 general hospitals in Thailand. Mean value of happiness was 3.03 out of 5 equal to 60% [16]. In a study, Sharifi assessed the happiness of medical sciences students of Kashan. The mean happiness of nursing students was moderate; lower than happiness of nurses in this study. This difference is probably due to more independence in work, more skill and experience of the nurses.
Another finding of the study was that nurses of intensive units were less happy, that represents a possible impact of working place on the morale of nurses. Kushali believed that working conditions and workplace could affect nurses' mental health and well-being. According to the studies in relation to depression, regarding higher prevalence of burnout and stress among the nurses of intensive units [17][18][19] low average of the happiness is not unexpected Although the level of happiness of the nurses was measured as very good, there is still a distance to great score. Since happy nurses can do their jobs better, reduce stress of work environment and improve the quality of nursing care, it is important to promote levels of happiness.
On the other hand, the nurse happiness is worth more than other   jobs for happiness is contagious [20] and thus transmitted to the patient leading to increased patient satisfaction.
According to the results of this study, happiness of the nurses should be seriously taken into account because happiness affects their performance including quality of care and communication with the patient.
Authorities are, therefore, recommended to enhance happiness of the nurses by applying principled and expert interventions, such as providing a happy environment and welfare facilities particularly for intensive units personnel. Further studies are suggested in field of happiness of the nurses and the related factors with the aim of more precise access to the rate and promotion factors of happiness. Also stressful situations at work should be identified and reduced. A consultation center for the personnel at hospital could also be beneficial.