INTRODUCTION
Happiness is a fundamental goal of human life and a key determinant of quality of life [1]. However, South Korea consistently ranks among the lowest in happiness among OECD countries, reflecting challenges in economic stability and life satisfaction [2]. Because individuals spend most of their waking hours at work, workplace happiness plays a key influence on overall well-being [3]. In healthcare settings, nurses' happiness not only affects their personal health and job satisfaction but also influences turnover, work performance, and the quality of patient care [4]. Excessive workload, emotional labor, and occupational stress have been identified as major threats to nurses' well-being [5]. Understanding the determinants of nurses' happiness is therefore essential for promoting both staff retention and the quality of healthcare delivery [6].
Previous studies have identified several factors influencing nurses' happiness, including social support, job satisfaction, gratitude, and resilience. Social support from colleagues and organizations provides emotional stability and buffers against work-related stress [7]. Job satisfaction enhances motivation, commitment, and professional fulfillment [8]. Gratitude helps individuals reinterpret challenges positively, fostering emotional balance and positive affect [9]. Resilience enables nurses to recover from adversity and maintain psychological well-being in demanding clinical environments [10]. The Integrated Model of Happiness [9] conceptualizes happiness as a multidimensional construct resulting from interactions among environmental, dispositional, and psychological factors. In this framework, social support and job satisfaction represent environmental influences, gratitude reflects a dispositional trait, and resilience serves as a psychological mediator integrating these effects.
Accordingly, the present study differs from previous research by reorganizing commonly examined variables within a theoretically grounded structure based on the Integrated Model of Happiness. Specifically, social support and job satisfaction were conceptualized as environmental factors, gratitude as an enduring personal disposition and resilience as a dynamic psychological process mediating the effects of environmental and dispositional components on happiness. By applying this integrative perspective, this study moves beyond a simple categorical classification of determinants and clarifies the structural and psychological mechanisms underlying nurses' happiness.
Based on this theoretical foundation, a structural equation model was constructed and empirically tested to explain the factors influencing nurses' happiness according to the Integrated Model of Happiness [9]. Specifically, happiness was analyzed in relation to social support, job satisfaction, and gratitude through resilience as a mediating mechanism. By identifying these mechanisms, the study seeks to provide empirical evidence for developing effective interventions to support nurses' psychological and professional well-being while contributing to higher standards of care.
METHODS
1. Study Design
This study applied a model-building method grounded in the Integrated Model of Happiness to identify factors influencing nurses' happiness. A hypothetical structural equation model was developed to capture the complex interrelationships among these factors, and its fit and theoretical assumptions were tested using empirical data.
2. Participants
Participants were 250 registered nurses employed in E University Hospital in U City, Gyeonggi Province, South Korea. Clinical nurses with a minimum of one year of professional experience were recruited after receiving detailed information about the study and providing voluntary written consent. Nurse managers, administrative staff, and nurses with less than one year of experience were excluded due to differences in job characteristics. For structural equation modeling using maximum likelihood estimation, a sample size of 200~300 is considered appropriate; therefore, 250 participants were deemed sufficient [11].
3. Instruments
1) Social support
Jeong's social support scale [12] was used to assess perceived social support. The instrument includes nine items across three domains: supervisor, colleague, and organizational support. Items are rated on a five-point response scale, with higher scores representing greater perceived support. In the present sample, Cronbach's ⍺ values indicated high reliability (.91~.92 for subscales; .92 overall).
2) Job satisfaction
Job satisfaction was measured using Lee's [13] 33-item scale encompassing six domains: The scale comprises six subdimensions: organizational support and recognition (9 items), personal growth (6 items), interpersonal respect (8 items), professional responsibility (4 items), job stability and reward (3 items), and professional competence (3 items). Responses were recorded on a 5-point Likert scale, with higher scores indicating greater levels of satisfaction. Cronbach's ⍺ in this study ranged from .80 to .90 across domains and .96 overall.
3) Gratitude
Gratitude was assessed with the Korean adaptation of the Gratitude Questionnaire-6 (K-GQ-6), initially developed by McCullough et al. [14] and later validated by Kwon et al. [15]. The instrument consists of six items, including two reverse-worded statements. Responses were recorded on a seven-point scale ranging from "strongly disagree" to "strongly agree," with higher composite scores representing greater gratitude. In the present sample, the scale exhibited acceptable internal consistency (Cronbach's ⍺=.82).
4) Resilience
Resilience was assessed with the Korean version of the Connor-Davidson Resilience Scale (K-CD-RISC) [10]. The scale comprises 25 items representing five dimensions: tenacity, persistence, optimism, support, and spirituality. Items were rated on a five-point response format from 0 ("not at all") to 4 ("very much"), with higher scores indicating greater resilience. In the present study, the instrument demonstrated high internal consistency, with Cronbach's ⍺ values ranging from .60 to .91 for the subscales and .95 for the total scale.
5) Happiness
Happiness was assessed using the Korean adaptation of the Oxford Happiness Questionnaire, initially developed by Argyle et al. [16], later refined by Hills and Argyle, and subsequently translated by Heo [17]. The instrument consists of 29 items comprising three sub-domains: self-confidence (12 items), self-control (11 items), and positive emotion (6 items; 12 items were reverse-coded). In the present study, happiness was modeled as a single latent variable in the structural equation model, with the three sub-domains specified as observed indicators representing the underlying construct of happiness, rather than as separate latent variables.
All measurement tools employed in the present research had been validated for use in Korea, and authorization to use each instrument was obtained from the respective developers.
4. Data Collection and Ethical Considerations
Following the Institutional Review Board approval at E University (IRB No. EU24-39), data were gathered from October 21 to November 30, 2024. Following approval from the hospital Nursing Department, self-administered questionnaires were provided to nurses who consented to participate on a voluntary basis. Prior to data collection, participants received information regarding the study objectives, confidentiality of their responses, and the freedom to withdraw from the study at any point without any adverse consequences. Written informed consent was obtained. Completion of the questionnaire required approximately 15~20 minutes, and a small incentive was offered upon completion. All completed questionnaires were sealed, anonymized, and coded prior to data entry. Data were securely stored on password-protected devices and will be retained for three years before being permanently destroyed.
5. Data Analysis
Statistical analyses were performed with SPSS (version 27.0) and AMOS (version 26.0). Descriptive statistics (frequency, percentage, mean, SD) were used to summarize general characteristics. Reliability was assessed using Cronbach's ⍺, and confirmatory factor analysis verified construct validity. Normality was evaluated via skewness and kurtosis. Pearson's correlation coefficients examined relationships among variables and assessed multicollinearity. To evaluate the proposed model, structural equation modeling was employed with maximum likelihood estimation. Model adequacy was assessed using multiple fit indices, including x2, x2/df, GFI, AGFI, CFI, IFI, SRMR, and RMSEA. To evaluate the statistical significance of the estimated pathways, bootstrapping procedures were employed to examine direct, indirect, and overall effects.
RESULTS
1. Participants' Characteristics and Differences in Happiness
The sample comprised 250 registered nurses, with women accounting for 84.0% of participants and those in their twenties representing the largest age group (84.0%). Most were unmarried (92.4%) and reported no religious affiliation (70.8%). Regarding education, 213 participants (85.2%) held a bachelor's degree. More than half had less than three years of total work experience (54.8%), and nearly half were assigned to specialized units (48.4%). Most nurses worked in three rotating shifts (89.6%) and held staff nurse positions (95.2%). More than half expressed satisfaction with their current department (57.2%) (Table 1).
Significant differences in happiness were identified according to sex, religious affiliation, work schedule, and departmental satisfaction. Male nurses reported higher happiness than females (t=2.40, p=.020). A trend toward higher happiness was observed among participants with a religious affiliation compared to those without; the observed difference was not statistically significant (t=1.97, p=.051). Nurses working fixed day/evening shifts exhibited higher happiness scores compared with those working rotating shifts (F=4.85, p=.003). Participants who were highly satisfied with their current department showed the highest levels of happiness (F=13.55, p<.001). No significant differences were found according to age, marital status, and level of education, clinical experience, department type, or position (Table 2).
2. Descriptive Statistics and Validity of Measurement Variables
The mean scores of the study variables were as follows: social support, 4.07; job satisfaction, 3.66; gratitude, 5.31; resilience, 3.57; and happiness, 4.16. All variables satisfied the assumptions of normality (skewness <2, kurtosis <7), and multicollinearity was not detected (tolerance >.20, VIF <4) [11].
Construct validity was examined through confirmatory factor analysis, and the measurement model met established standards for convergent validity (standardized factor loading ≥.50, AVE >.50, CR >.70).
Discriminant validity was established, as the AVE of each construct exceeded the squared inter-construct correlations, and none of the 95% confidence intervals for the correlations encompassed the value of 1.0. These findings indicate the soundness of the measurement model in terms of reliability as well as convergent and discriminant validity (Table 3).
3. Verification of the Structural and Modified Model
The hypothesized structural model demonstrated an acceptable but partially suboptimal fit (x2/dF=3.07, GFI=.84, AGFI=.78, CFI=.92, IFI=.92, SRMR=.06, RMSEA=.09). Of the seven hypothesized paths, five were statistically significant. Job satisfaction (β=.74, p<.001) and gratitude (β=.17, p=.006) exerted positive effects on resilience, whereas social support was not significant. Resilience (β=.60, p<.001), job satisfaction (β=.26, p=.005), and gratitude (β=.15, p=.002) positively influenced happiness. The model explained 55.1% of the variance in resilience and 75.1% of the variance in happiness. To improve model fit and theoretical coherence, modification indices (MI) and parameter change (Par Change) values were reviewed. Based on theoretical justification, two covariances were added: (1) between personal growth through work and respectful interpersonal relationships (MI=10.81, Par Change=-0.03), and (2) between professional responsibility and job stability and reward (MI=18.96, Par Change=0.05). These modifications were conceptually justified, as interpersonal respect facilitates personal growth, and professional responsibility is inherently related to job stability and fulfillment.
The modified model demonstrated improved goodness-of-fit indices (x2/dF=2.79, GFI=.86, AGFI=.81, CFI=.93, IFI=.93, SRMR=.06, RMSEA=.09). The x2 difference test demonstrated that the revised model showed a statistically significant improvement in fit relative to the initial model (Δx2=40.30, dF=2, p<.05).
In the final model, job satisfaction (β=.67, p<.001) and gratitude (β=.21, p=.006) remained significant predictors of resilience, while social support was not significant. Happiness was significantly predicted by job satisfaction (β=.23, p=.009), gratitude (β=.16, p<.001), and resilience (β=.62, p<.001). The modified model accounted for 53.1% of the variance in resilience and 74.7% in happiness, demonstrating robust explanatory power (Table 4, Figure 1).
DISCUSSION
This study verified a structural model explaining factors influencing nurses' happiness based on the Integrated Model of Happiness. The model included social support, job satisfaction, and gratitude as exogenous variables, and resilience and happiness as endogenous variables. The overall model demonstrated acceptable fit indices (x2/dF =2.79, GFI=.86, AGFI=.81, CFI=.93, IFI=.93, SRMR=.06, RMSEA=.09), confirming its adequacy for explaining the mechanisms underlying nurses' happiness. The explanatory power was 53.1% for resilience and 74.7% for happiness, indicating strong predictive validity.
Job satisfaction, gratitude, and resilience were significant positive predictors of happiness, whereas social support showed no significant effect. Among these, job satisfaction had the strongest influence. Nurses with higher job satisfaction showed greater levels of life satisfaction and psychological well-being, aligning with prior research indicating that job satisfaction strengthens organizational commitment and mitigates emotional exhaustion. Job satisfaction is a multidimensional construct encompassing recognition, autonomy, professional growth, and collegial support [18]. The findings reaffirm that positive job-related experiences, including greater job autonomy, opportunities for professional development, and supportive collegial relationships, are directly associated with higher levels of happiness among nurses.
Gratitude also had a positive effect on happiness. Nur-ses with higher gratitude levels experienced greater psychological stability and positive affect, consistent with studies showing that gratitude enhances well-being and mitigates stress [19]. Gratitude enables individuals to reinterpret stressful situations constructively, promoting resilience and happiness [20]. Organizational programs such as gratitude journaling and appreciation training may be effective interventions to improve emotional well-being and professional satisfaction.
Resilience demonstrated a strong positive relationship with happiness, suggesting that the ability to recover from stress and maintain emotional balance is crucial to nurses' well-being [21]. This finding aligns with previous evidence that resilience protects against burnout and supports adaptive coping in high-stress work environments [22]. Interventions that enhance resilience-through education, mindfulness, or emotional regulation programs-may help sustain happiness and professional engagement.
In contrast, social support did not show a significant direct effect on resilience or happiness in the present study. Although earlier research has reported positive associations between social support and psychological well-being [23], its influence may depend less on the perceived quantity of support and more on the quality, authenticity, and contextual relevance of that support. In high-stress clinical environments, such as hospital settings, routinely available or formally structured support may be perceived as insufficiently responsive to nurses' emotional and psychological needs, thereby limiting its direct association with happiness. In demanding clinical settings, social support may therefore operate indirectly through psychological resources rather than exerting a direct influence on happiness [24].
Overall, these findings support the Integrated Model of Happiness [9], which conceptualizes happiness as an outcome of dynamic interactions among environmental, dispositional, and psychological components. Social support and job satisfaction represent environmental resources, gratitude reflects a personal trait, and resilience serves as a psychological mechanism integrating these influences. This theoretical alignment confirms the model's validity and applicability in understanding nurses' happiness within organizational contexts.
This study provides theoretical and practical implications for nursing. The findings extend the theoretical understanding of happiness in nurses and offer empirical evidence for developing interventions aimed at enhancing job satisfaction, gratitude, and resilience. Leadership that values recognition, fairness, and emotional support may effectively improve nurses' well-being and retention. Nevertheless, this study was limited to nurses from a single university hospital, and most participants were young, unmarried women, which restricts generalizability. Selfreported data may also be affected by response bias. In addition, because the final model incorporated post-hoc covariance paths based on modification indices, there is a potential risk of overfitting. Although these adjustments improved model fit, the revised model may reflect sample-specific characteristics rather than fully generalizable relationships, and caution is warranted regarding this limitation when considering the study outcomes. Future research should incorporate more heterogeneous samples and a broader range of variables to expand the model's explanatory scope.
CONCLUSION
This study proposed and empirically validated a structural model explaining nurses' happiness based on the Integrated Model of Happiness. The model included social support, job satisfaction, and gratitude as exogenous variables, and resilience and happiness as endogenous variables. The model demonstrated good fit, confirming that job satisfaction, gratitude, and resilience are key factors influencing nurses' happiness, while social support did not significantly predict the outcome.
Among these, job satisfaction exerted the strongest effect, indicating that positive perceptions of work and organizational culture directly enhance nurses' well-being. Gratitude and resilience also contributed significantly, highlighting the role of positive psychological resources in maintaining emotional stability and promoting happiness in high-stress nursing environments. These findings emphasize that nurses' happiness results from the interaction of occupational, emotional, and personal factors rather than from a single element.
This study provides an empirical foundation for developing interventions to promote nurses' happiness. Strategies that enhance job satisfaction, foster gratitude, and strengthen resilience may improve both individual wellbeing and retention within healthcare organizations. Given the possibility of overfitting associated with model modifications, further studies are needed to replicate the model across diverse samples and settings to verify its stability and generalizability. Future research should expand the model by including additional psychological and environmental variables, recruit more diverse participants, and employ longitudinal or experimental designs to confirm causal relationships.
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