Exploring the Relationship Between Life Meaning and Occupational Identity Among Nursing Students in China: A Cross-Sectional Study

Introduction

Since the emergence of the Coronavirus disease 2019 (COVID-19) in China in 2020, the nation’s public health system has undergone immense strain, particularly among nurses who served on the front lines. These professionals faced both a high risk of infection and intense psychological pressure. The combination of viral exposure and heavy workloads resulted in increased rates of anxiety, depression, and sleep problems among nurses [1, 2], which negatively affected their personal well-being and job performance. Previous research suggests that a strong sense of life meaning can buffer against emotional distress, such as depression, and promote psychological health [3]. A well-developed sense of meaning helps nurses value life, understand its deeper significance, respond to patients’ spiritual needs, and provide compassionate, holistic care. At the same time, it strengthens their professional identity. Therefore, nurturing nurses’ sense of life meaning not only supports their mental health but also enhances their professional commitment and improves the quality of patient care. Work itself is a major avenue for discovering personal meaning. Understanding how one finds purpose through work is therefore essential [4].

According to Frankl [5], the type of work is less important than the attitude and mindset one brings to it. A positive, creative, and responsible approach gives work its meaning—an idea closely linked to the concept of occupational or professional identity.

Professional identity [6] involves internalizing one’s professional role, embracing it sincerely, and forming a positive evaluation of that role. In China, however, nursing has long been perceived as a field with low academic prestige, low social status, and high workload [7]. Because of this negative public image, Chinese nurses have historically reported low levels of professional identity [8]. At the same time, because nurses often work in close proximity to illness and death, these experiences prompt deeper reflection on the meaning of life, with previous studies showing moderately high levels of life meaning among Chinese nurses [9].

During the three years of battling COVID-19, media portrayals of nurses as dedicated heroes helped improve the public’s view of the profession, which in turn enhanced nurses’ professional identity compared to pre-pandemic levels [10, 11]. However, nurses remained among the groups most vulnerable to infection, with a reported mortality rate of 54.2% among Chinese healthcare workers early in the pandemic [12]. The threat of contracting the virus, as well as the risk posed to their families [13], contributed to heightened fear and stress, potentially undermining nurses’ psychological well-being and sense of life meaning.

Nursing students, as the future core of the nursing workforce, face the task of understanding life, death, and suffering on a profound level. They must develop resilience to cope with the emotional impact of illness and death on themselves, their peers, and patients’ families. Their social and educational environments require them to cultivate this understanding early on. Moreover, nursing students’ level of professional identity directly affects workforce stability—those who lack a strong sense of professional belonging may experience low job satisfaction and leave the profession prematurely [14]. In China, few students intentionally choose nursing after the National College Entrance Examination [15]; many enter the field only after failing to qualify for higher-ranked majors. Additionally, Chinese nursing education traditionally emphasizes theory and technical skills, with limited focus on fostering life meaning or developing professional identity [16].

Earlier research has shown that nursing students’ professional identity correlates with traits such as psychological resilience [17], empathy fatigue [18], and attitudes toward death [19]. A positive sense of life meaning can help students form a healthy perspective on death and accept it more openly. However, the COVID-19 pandemic has not only reshaped individuals’ understanding of life and mortality but has also influenced nursing students’ professional identity. Based on this, the present study proposes two hypotheses:

(1) Following the COVID-19 pandemic, nursing students’ professional identity has increased, whereas their sense of life meaning has decreased.

(2) Nursing students’ sense of life meaning is positively associated with their professional identity, and strengthening their life meaning can enhance their professional identity.

Materials and Methods

Study design, participants, and data collection

Following the adjustment of China’s infectious disease management policy on January 8, 2023, the State Council reclassified COVID-19 from a Class A to a Class B infectious disease [20]. As a result, the disease was managed with less restrictive public health measures. Mandatory quarantine, close-contact tracing, and the classification of high- and low-risk zones were all discontinued.

Between March and April 2023, this study applied a convenience sampling technique to recruit 418 nursing students from Hangzhou, Zhejiang Province. The purpose and procedures of the study were explained clearly to all participants, who agreed to take part on a voluntary basis.

Ethical approval

The study protocol was reviewed and approved by the university’s institutional ethics committee (Approval No. 2022045). Participants were informed that their involvement was voluntary and that they could withdraw from the study at any time during the survey process without any consequences.

Instruments

General information form

This cross-sectional study utilized a structured questionnaire composed of three main sections. The first section gathered participants’ demographic data, including gender, level of education, clinical practice experience, and history of COVID-19 infection.

Chinese meaning in life questionnaire (C-MLQ)

The second section assessed the participants’ sense of life meaning using the Chinese adaptation of the Meaning in Life Questionnaire (C-MLQ). Originally developed by Steger et al.  [21] and later translated and validated in Chinese by Liu et al.  [22], the scale includes nine items grouped into two subscales: Presence of Meaning and Search for Meaning. Each item is rated on a 7-point Likert scale. Scores below 38 indicate a low sense of life meaning, 38–51 represent a moderate level, and scores above 51 indicate a high level of meaning. The Presence subscale measures how much individuals perceive their lives as meaningful, while the Search subscale reflects their ongoing efforts to find meaning. This questionnaire has been widely applied in psychological and nursing studies [23–25]. In this research, the internal consistency coefficient (Cronbach’s α) for the C-MLQ was 0.729.

Occupational identity scale

The third section of the survey used Hao Yufang’s Occupational Identity Scale [26] to measure nursing students’ identification with their professional role. The tool consists of 17 items divided into five components: career self-concept, perceived benefits of remaining and risks of leaving, social reflection and comparison, career choice autonomy, and social persuasion. Each item is scored on a 5-point Likert scale (total range: 17–85), with item 12 being reverse-scored. Higher total scores represent a stronger professional identity. The Chinese version of the scale has demonstrated solid psychometric properties and has been applied in multiple nursing education studies [11, 27, 28]. In Hao’s original study, the Cronbach’s alpha was 0.827; in this study, the reliability was 0.967.

Data analysis

Data were analyzed using SPSS version 25.0. Descriptive statistics were used to summarize the sample, with categorical variables presented as frequencies and percentages, and continuous variables as mean ± standard deviation (SD). Data normality was verified using skewness and kurtosis values, where absolute values ≤ 3 were considered acceptable for normal distribution [29]. Independent samples t-tests and one-way ANOVA were applied for group comparisons, while Pearson correlation analysis examined the relationship between professional identity and life meaning. A significance level of p < 0.05 was adopted. Participants were grouped into low, moderate, and high life meaning categories based on their C-MLQ scores, and t-tests were used to assess differences in professional identity between the high and low groups.

Results and Discussion

Assessment of common method bias

Since all variables were measured using self-reported questionnaires, potential common method bias was examined. To reduce this risk, participants responded anonymously, and some reverse-scored items were included. Harman’s single-factor test was conducted through confirmatory factor analysis to check for bias across all measurement items. The model fit indices indicated poor fit (χ²/df = 14.545, CFI = 0.717, GFI = 0.418, AGFI = 0.317, NFI = 0.703, RMSEA = 0.180), suggesting that no significant common method bias was present in the data. Career identity and sense of life meaning scores (Table 1)

Table 1. Total score of professional identity and sense of life meaning and scores of each dimension

Correlation between demographic characteristics of nursing students and sense of life meaning

Table 2 summarizes the demographic data of the 418 nursing students and outlines differences in their life meaning scores across various characteristics. Statistical analysis revealed that gender, educational background, and clinical practice experience were significantly related to students’ sense of life meaning. Male participants reported higher life meaning scores than female students (p<0.001). Regarding education, undergraduates achieved the highest mean scores, followed by postgraduates and junior college students, showing a significant variation among the three groups (p<0.001). Students who had not yet engaged in clinical training also demonstrated a higher perceived life meaning compared to those with such experience (p = 0.006). In contrast, whether students had been infected with COVID-19 did not lead to a statistically significant difference (p = 0.207).

Table 2. Correlation between demographic characteristics of nursing students and sense of life meaning (n = 418)

Relationship between sense of life meaning and professional identity

As indicated in Table 3, the results of the Pearson correlation test revealed a strong and positive association between professional identity and the overall sense of life meaning (r = 0.703, p < 0.01). Professional identity was also positively linked with both subdimensions of life meaning — the presence of meaning (r = 0.649, p < 0.01) and the search for meaning (r = 0.709, p < 0.01).

To further examine group differences, participants were classified into three categories — low, medium, and high — according to their total life meaning scores. The one-way ANOVA results (Table 4) demonstrated that students with a high level of life meaning scored significantly higher in professional identity than those with moderate (p < 0.01) or low (p < 0.01) levels.

Table 3. Correlation between nursing students’ sense of professional identity and sense of life meaning

(**: P<0.01)

Table 4. Comparison of professional identity scores and differences among nursing students with low, medium and high levels of sense of life meaning

This study examined the association between life meaning and professional identity among nursing students in China following the COVID-19 pandemic. The findings indicated that students reported a moderate level of life meaning. Additionally, both the presence and search dimensions of life meaning were positively correlated with professional identity, suggesting a close link between these constructs.

Historical experience with epidemics, such as SARS in 2003, has previously highlighted the public’s understanding of nursing work and the role of nurses [30], which aligns with the current findings. In this study, the average professional identity score among the 418 nursing students was 61.58 ± 16.16, indicating a moderate level, comparable to the 62.02 ± 12.02 reported by Zhang et al.  during the 2021 pandemic [7]. When compared with pre-pandemic studies, these results suggest an improvement in professional identity among nursing undergraduates [31, 32], indicating that the COVID-19 pandemic may have reinforced students’ commitment to and recognition of the nursing profession. Supporting this, a prior cross-sectional study reported that 90% of nursing students believed the pandemic positively influenced the public image of nursing [7]. The relatively higher scores in social persuasion (3.78 ± 1.04) and social comparison and reflection (3.76 ± 0.93) compared to pre-pandemic studies [31–35] suggest that increased societal appreciation of nurses during COVID-19 may have strengthened students’ professional identity. By reflecting on themselves and comparing their career paths with other professions, students can reinforce their professional beliefs and clarify their future direction in nursing. Although the pandemic has had far-reaching effects on medical, social, and economic systems, the associated improvement in public perception of nursing appears to provide more benefits than drawbacks in fostering professional identity. Consistent with the study’s hypothesis, nursing students’ professional identity seems to have strengthened after the pandemic.

Life meaning reflects an individual’s sense of purpose and the significance they attribute to their existence [5]. Nursing students, in particular, must learn to understand and confront the realities of life and death due to the nature of their future careers. Compared to pre-pandemic studies on life meaning among nursing students [36–38], the average score in this study was lower (45.29 ± 12.65). Notably, the search for meaning dimension scored lower than the presence dimension, likely due to the uncertainty and ongoing changes associated with COVID-19, which affected students’ academic performance, life goals, and career planning [39]. As a result, students may have experienced heightened difficulties in finding personal purpose, leading to frustration and a diminished sense of life meaning. Prior research has shown that having a clear sense of life purpose during the pandemic can enhance engagement and provide psychological protection against fear and stress [40–42]. A strong life meaning is associated with well-being and life satisfaction, whereas a lower sense of meaning can contribute to negative emotions and decreased mental health [43].

Gender and clinical experience were also significant factors. Male students reported higher life meaning scores than female students, potentially due to greater emotional regulation and more proactive coping strategies. Female students, conversely, may experience higher levels of anxiety or depressive symptoms during stressful events, reducing motivation for self-development and, consequently, life meaning. Similarly, students without clinical experience scored higher than those with such experience, which may reflect the idealized perception of the profession prior to hands-on practice. Exposure to real-world clinical challenges, complex patient interactions, and the gap between theory and practice may contribute to uncertainty, making it more difficult for students to find a clear sense of purpose [38].

The study also confirmed a significant positive correlation between life meaning and professional identity. ANOVA results showed that students in the high life meaning group had markedly higher professional identity scores than those in the intermediate or low groups (p<0.001). These findings highlight the influence of life meaning on professional identity. From the perspective of positive psychology, pursuing life meaning is a key motivator for human behavior. Frankl’s existential theory posits that the primary drive of humans is to find meaning and purpose in life [44]. A strong sense of life meaning enhances motivation, resilience, and goal-directed behavior, which positively influences professional development. Conversely, a weak sense of meaning can impair decision-making, reduce career engagement, and undermine professional identity.

Furthermore, the increased societal recognition of nurses during the COVID-19 pandemic may have reinforced nursing students’ sense of life purpose. Observing the value and respect attributed to nursing work likely strengthened students’ perception of the profession as honorable, enhancing professional pride and further solidifying their professional identity.

There is growing agreement [40, 45] that crises such as the COVID-19 pandemic can profoundly affect individuals’ lives. However, guiding people to actively seek meaning and purpose can help them interpret life events and integrate these experiences with their professional responsibilities. Individuals with a strong sense of life meaning often experience a sense of transcendence, which encourages attentiveness to others and promotes altruistic behaviors [46]. Therefore, fostering awareness of life’s purpose may enhance overall quality of life and increase willingness to engage in social service.

In China, the traditional education system has largely emphasized exam-oriented learning, and life education remains in its early stages [47]. Nursing students often receive little structured guidance on exploring life meaning, with some undergraduate programs offering life education only as elective courses, while some junior colleges do not provide such courses at all. This contributes to lower life meaning scores among junior college nursing students. Conversely, undergraduate programs frequently incorporate practical activities, such as voluntary organ donation initiatives or hospice care experiences, which can foster reflection on life and enhance life meaning. In this study, undergraduate students reported significantly higher life meaning scores (52.01 ± 12.18) than junior college students (40.25 ± 10.73). These findings suggest that nursing schools should develop dedicated curricula for life education and expand opportunities for social practice, aiming to cultivate students’ psychological resilience, humanistic qualities, and professional identity. By doing so, nursing programs can build a competent and socially responsive workforce capable of meeting evolving societal needs.

This study has several limitations. First, the sample was drawn from a specific region, which may limit the generalizability of the results. Future research could include larger and more geographically diverse samples to strengthen external validity. Second, the cross-sectional design precludes causal inferences and does not account for potential mediating or moderating variables in the relationship between life meaning and professional identity. Lastly, this study focused solely on the influence of life meaning on professional identity; future research could examine additional factors that may contribute to the development of professional identity among nursing students.

Conclusion

In conclusion, the COVID-19 pandemic appears to have enhanced the professional identity of nursing students in China, even as their overall sense of life meaning decreased. Students with higher life meaning scores demonstrated stronger professional identity compared to those with lower scores. These findings underscore the importance of supporting nursing students in exploring and reflecting on life’s meaning, which can strengthen their professional identity and prepare them for future roles in the healthcare profession.

Acknowledgments: None

Conflict of interest: None

Financial support: None

Ethics statement: None