A Survey of Mental Health in Graduate Nursing Students during the COVID-19 Pandemic

Help-seeking in nursing and medical students: a concept analysis

Background

The prevalence of mental health issues in healthcare students is a growing concern. However, many healthcare students do not seek help because of the strong stigma attached to mental illness. This reluctance has been extensively researched, but a clear understanding of help-seeking behaviour among healthcare students remains elusive.

Aims

To clarify the concept of help-seeking in order to develop effective strategies aimed at encouraging help-seeking behaviour in students.

Method

Concept analysis of help-seeking behaviour among nursing and medical students in the context of mental health, based on Rodgers' evolutionary model.

Results

Attributes: (a) consulting a healthcare professional, (b) talking to family/peers/friends and (c) self-treatment. Antecedents: (a) self-awareness, (b) relationship and previous experiences with a help-provider, (c) social perception and (d) availability of university-offered help services. Barriers: (a) barriers specific to healthcare students, (b) misconceptions about mental healthcare services, (c) negative social perception, (d) cost and (e) culture. Consequences included: positive and negative consequences.

Conclusion

This concept analysis aimed to fill in the gap in concept-analysis research and to provide a new conceptualisation of help-seeking by examining subjective reports. The findings of this study will contribute to implementing effective incentives aimed at encouraging help-seeking behaviour in nursing and medical students.

The relationship between interpersonal emotional regulation and psychological resilience in nursing undergraduates: a cross-sectional study and network analysis

Background and purpose

Nursing students are more likely to have mental health problems due to the influence of many social environment factors, such as busy professional courses, difficult balance of learning and practice and complex and changeable clinical work environment. Psychological resilience, as a well-known protective factor, plays an important role in maintaining students' mental health. At the same time, from the perspective of social interaction, the particularity of close interpersonal contact (including colleague relationship, nurse-patient relationship, etc.) in clinical practice makes interpersonal emotion regulation ability of nursing students have great significance. The emotion-regulation framework suggests a strong link between psychological resilience and emotional regulation. However, the correlation and function between the various components of psychological resilience and interpersonal emotional regulation are still unclear. Network analysis can realize the objective analysis and prediction of complex symptoms. This study investigated the network structure of interpersonal emotional regulation ability and psychological resilience in nursing undergraduates, aiming to identify central and bridge nodes and provide suggestions for precise intervention of interpersonal emotional regulation ability and psychological resilience in nursing undergraduates.

Methods

A total of 1,948 nursing undergraduates were included in our study. Interpersonal Regulation Questionnaire (IRQ) was used to assess interpersonal emotional regulation. Psychological Resilience levels were assessed using The Connor-Davidson Resilience Scale (CD-RISC). Network analysis is used for statistical analysis.

Results

Network analysis revealed that IRQ14 (Enjoy being with friends), IRQ11 (Like to share), and CD-RISC11 (Believe in achieving goals) are core nodes of the interpersonal Emotional regulation-psychological resilience network. IRQ14 (Enjoy being with friends), CD-RISC2 (intimate relationship), and CD-RISC3 (The help of fate) are bridging nodes linking interpersonal emotional regulation and psychological resilience. In addition, the network structure is slightly different between different grades (upper and lower grades).

Conclusion

The relationship between core nodes and bridge nodes revealed in this study (including interpersonal relationship, positive emotion, optimistic personality and self-efficacy, etc.) may provide help for the accurate intervention of students' interpersonal emotion regulation ability and psychological resilience level.

Graduate public health student learning experiences, social connectedness, and mental health during COVID-19: pedagogical implications for public health academic departments

Introduction

The COVID-19 pandemic impacted college student learning both globally and nationally. Current literature points to decreases in social connectedness, adverse mental health outcomes, and decreased overall learning outcomes; however, there are limited findings from higher education institutions within the Bay Area, California. There are also limited studies that examine the COVID-19 impact among public health graduate students, especially to understand how the pandemic renewed their interest in the field. The purpose of this study was to investigate the effects of COVID-19 on graduate student learning experiences, social connectedness and mental health within the Master of Public Health program at San José State University in San Jose, California.

Methods

We employed a convergent mixed-methods design using a survey that quantitatively assessed student learning experiences through a retrospective pre-and post-design, and a semi-structured interview guide that qualitatively assessed student learning experiences and its relationship with mental health and social connectedness using a phenomenological design. Data were collected between September 2022 and June 2023 and analysis was performed using descriptive statistics and thematic analysis.

Results

A total of 22 students completed the survey and four participated in follow-up semi-structured interviews. Of the 22, 12(54%) were among the 18-29-year age group, 9(41%) identified as Asian, 21(95%) identified as female, and 9(41%) identified as a first-generation college student. When comparing survey responses, the median change in learning experiences pre and during-pandemic were statistically significant across several areas such as student ability to stay organized (p < 0.0001), participate actively in class (p < 0.001), retain course material (p < 0.0001), collaborate with peers (p < 0.0001), and maintain a sense of connection with their cohort (p = 0.0001) and broader campus community (p < 0.0001). Semi-structured interviews further revealed the following six themes: (1) Consistent faculty support; (2) Sense of community; (3) Reduced social connectedness; (4) Impact on mental health; (5) Deeper public health understanding; and (6) Facilitators and barriers.

Conclusion

Educational practitioners are encouraged to offer hybrid academic programs and establish resource infrastructures that provide students with social and mental wellness support when transitioning to different learning modalities.

Depression in nursing students during the COVID-19 pandemic: Systematic review and meta-analysis

The pandemic meant a change in academic approach. This had an impact on the mental health of students, leading to, among other problems, depressive disorders. The aim of this study was to find out the prevalence and factors that favoured the development of depression in nursing students during the COVID-19 pandemic. A systematic review with meta-analysis of prevalence was conducted in October 2023, using Pubmed, CINAHL and Scopus as the data sources used for the search. This review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Search equation was: "(undergraduate nurses OR nursing students) AND depression AND (COVID-19 OR Sars-CoV-2)". The final set of articles was N = 12. Quantitative primary studies using anonymous scales and surveys to assess the prevalence of depression in nursing students in the last 3 years were included. Studies show a high prevalence of depression among young university students with figures above 50%. The total sample of students in the meta-analysis was n = 4,479 with a prevalence value of 32% (CI95% 22%-42%). Affected students are characterised by young, female students. Concerns included generalised academic uncertainty, social isolation, work overload, fear of contagion and concern about teaching delivery. Coping mechanisms were generally resilience, spiritual support, laughter therapy, seeking information about COVID-19 and eating food. In conclusion, students, especially female students, are at high risk of depression due to social isolation. In addition, coping techniques were inadequate and future strategies to prevent this situation should be considered.

Comparing factors related to perceived control and preventive behaviors from COVID-19 between Japanese and American nursing students: A cross-sectional study

AIM

Higher levels of perceived control are important to maintain health. The difference in factors related to perceived control and preventive behaviors during the COVID-19 pandemic between Japanese and American nursing students remains unknown. This study aimed to compare factors related to perceived control and infection preventive behaviors between the two countries.

METHODS

This cross-sectional study included nursing students attending four universities in Japan and one in the United States. Using Google Forms, the participants answered a survey comprising sociodemographic data, the Perceived Control and Self-Efficacy Scale, the Perceived Health Competence Scale, and a preventive behavior questionnaire. The data were collected from November 2020 to May 2021. Linear and logistic regressions were used to analyze the factors related to perceived control and preventive behaviors, respectively.

RESULTS

Data from 878 students were analyzed. University/campus emerged as a strong predictor for perceived control and preventive behaviors in both countries, with a positive correlation between perceived control and preventive behaviors. Older age, less frequent alcohol consumption, higher perceived health competence, less frequent work in Japan; and chronic conditions in the United States were associated with frequent preventive behaviors. Younger age was correlated with higher perceived control in Japan, while religion and increased workload were potential factors for American students.

CONCLUSION

Individual factors were pivotal in Japan, whereas interpersonal factors were more likely related to perceived control in the United States. Additionally, in both countries, policy or organizational factors significantly influenced students' preventive behaviors.

COVID-19 Experiences and Mental Health Among Graduate and Undergraduate Nursing Students in Los Angeles

BACKGROUND

Nurses and nursing students are at risk for negative mental health as a result of significant work stressors from the COVID-19 pandemic.

AIMS

The purpose of this study was to (1) describe the mental health of nursing students during the COVID-19 pandemic, (2) investigate relationships between stressful COVID-19 experiences and mental health, and (3) examine correlates of mental health service use.

METHOD

This observational study used a web-based survey to assess COVID-19 experiences, self-reported mental health, and mental health service utilization among nursing students in Los Angeles in spring 2021 (N = 174, 30.1% response rate). The survey used measures of stressful COVID-19 experiences (personal COVID-19 illness, hospitalization of close friends or family, and death of close friends or family), loneliness, resilience, depression, anxiety, COVID-19-related traumatic stress, and utilization of campus and noncampus mental health services.

RESULTS

Students had high levels of depression (30%), anxiety (38%), and traumatic stress (30%). There was no relationship between stressful COVID-19 experiences and mental health, but loneliness was associated with higher odds of mental health problems and resilience with lower odds. Mental health problems were not associated with use of campus or noncampus mental health services. Students with primary caregiving responsibilities (OR = 0.22, 95% CI [0.05, 0.87]) and students who identified as Asian/Pacific Islander (OR = 0.24, 95% CI [0.09, 0.70]) had lower odds of mental health service utilization.

CONCLUSIONS

Resilience and loneliness affect nursing student risk for negative mental health as a result of the COVID-19 pandemic. Targeted, accessible mental health support within nursing education programs may be warranted.

Student-Led Stress Reduction Support Groups: A Qualitative Program Evaluation

BACKGROUND

Burnout and attrition in nursing have been accelerated by the coronavirus disease 2019 (COVID-19) pandemic. Nursing students experience greater stress than non-nursing students but often lack adequate institutional support to build resiliency. Support groups are an effective strategy for processing stress that are underused in nursing education. An innovative online stress impact course was developed at a college of nursing to address students' stress during the pandemic. The course culminated in a voluntary virtual support group led by a Psychiatric Mental Health Nurse Practitioner graduate student. The aim of this qualitative program evaluation was to determine how graduate nursing students experienced the stress support group.

METHOD

This study used qualitative exploratory analysis of support group reflections from 47 graduate nursing students.

RESULTS

Four themes emerged: (1) Making Positive Connections; (2) Leveraging Skills to Manage Stress; (3) Beneficial; and (4) Facing Trauma.

CONCLUSION

Graduate student-led support groups are a feasible and effective strategy to mitigate stress and improve nursing student resiliency. [J Nurs Educ. 2023;62(12):711-715.].

Leveraging twitter data to understand nurses' emotion dynamics during the COVID-19 pandemic

The nursing workforce is the largest discipline in healthcare and has been at the forefront of the COVID-19 pandemic response since the outbreak of COVID-19. However, the impact of COVID-19 on the nursing workforce is largely unknown as is the emotional burden experienced by nurses throughout the different waves of the pandemic. Conventional approaches often use survey question-based instruments to learn nurses' emotions, and may not reflect actual everyday emotions but the beliefs specific to survey questions. Social media has been increasingly used to express people's thoughts and feelings. This paper uses Twitter data to describe the emotional dynamics of registered nurse and student nurse groups residing in New South Wales in Australia during the COVID-19 pandemic. A novel analysis framework that considered emotions, talking topics, the unfolding development of COVID-19, as well as government public health actions and significant events was utilised to detect the emotion dynamics of nurses and student nurses. The results found that the emotional dynamics of registered and student nurses were significantly correlated with the development of COVID-19 at different waves. Both groups also showed various emotional changes parallel to the scale of pandemic waves and corresponding public health responses. The results have potential applications such as to adjust the psychological and/or physical support extended to the nursing workforce. However, this study has several limitations that will be considered in the future study such as not validated in a healthcare professional group, small sample size, and possible bias in tweets.

Public Health Graduate Students' Longitudinal Perceptions of Remote Learning Challenges and Career Goals During an Ongoing Public Health Crisis

The ongoing COVID-19 pandemic created a shift from traditional face-to-face learning toward remote learning, resulting in students experiencing unforeseen challenges and benefits through participation in a non-traditional mode of education. Little is known regarding the impact that a shift to remote learning may have had on the learning experiences and the career goals of Master of Public Health (MPH) students. A qualitative study was conducted among a convenience sample of MPH students in the US from January to April 2021. The primary aims were (1) to describe salient challenges or benefits of learning that persisted throughout a semester of remote learning and (2) to describe how being in graduate school during the pandemic impacted students' career goals in public health. A secondary aim was to describe students' general feelings regarding their public health education, given their lived experience of remote learning during the COVID-19 pandemic. Study findings demonstrated that MPH students had mixed perceptions of how a shift to remote learning during a public health crisis impacted their learning experiences and career goals in public health over one semester. Understanding students' responses can guide public health instructors to best prepare trainees to join the workforce during ongoing and future unforeseen public health crises that continue or have the potential to disrupt learning modalities.

Stress Impact and Care for COVID-19: Pilot Education and Support Course Decreases Burnout Among Nursing Students

BACKGROUND

Nurses and nursing students have been at the forefront of the fight against COVID-19, often working in conditions that produce stress injuries and burnout. Early recognition and mitigation of stress and emotional trauma help prevent burnout.

AIMS

To evaluate the effectiveness of an online 8-hour stress awareness course and associated 1-hour support group in reducing stress and burnout among nursing students.

METHODS

We conducted a program evaluation for an online stress awareness pilot course offered to nursing students. The course, and associated support groups led by trained psychiatric mental health nurse practitioner students, included a common language for talking about stress, screening tools for recognizing stress injuries, and strategies for improving self-care. Students completed pre- and post-course surveys. Outcome measures included changes on course learning objectives, level of burnout, health-related locus of control, and experiences of stress and coping.

RESULTS

Nursing students (n = 360) enrolled in the course, and 224 (62%) completed pre- and post-course surveys. Sixty percent rated the course excellent or very good. Depression Anxiety and Stress Scales and Impact of Event Scale Revised scores were within established normal ranges. There was a significant increase in all nine course learning objectives (p < .001) and decreased signs of stress (p < .001). Students' level of burnout decreased by odds ratio = 0.58 (95% CI: [0.4, 0.9], p < .006).

CONCLUSIONS

Nursing leaders can use psychoeducational strategies to mitigate the impact of stress, build confidence, and support nursing students entering the workforce during these unprecedented times.

Mental Health-Related Barriers and Facilitators to PhD Program Retention among Underrepresented Racial and Ethnic Minoritized (UREM) Nursing Students: A Qualitative Inquiry

Mental health concerns among doctorate (PhD) nursing students may impact program retention, especially among underrepresented racial-/ethnic-minoritized (UREM) students. Understanding mental health concerns among UREM PhD students is necessary to develop retention strategies. We conducted a qualitative secondary data analysis of a descriptive study with focus groups and individual semi-structured interviews. Participants identified as actively enrolled UREM in PhD nursing programs. Conventional content analysis was utilized. Mental health informed retention through the following themes: PhD program pressure and expectations, help-seeking barriers, personal motivations to succeed, and it takes a village: fostering peer support. Implications for nursing faculty are discussed.

Perceived Nexus Between Non-Invigilated Summative Assessment and Mental Health Difficulties: A Cross Sectional Studies

The COVID-19 pandemic rapidly led to changes in the mode of teaching, learning and assessments in most tertiary institutions worldwide. Notably, non-invigilated summative assessments became predominant. These changes heightened anxiety and depression, especially among individuals with less resilient coping mechanism. We explored the perceptions and experiences of mental health difficulties of students in tertiary education regarding non-invigilated alternative assessments in comparison to invigilated assessments. A pragmatic, mixed method cross sectional design was conducted online via Qualtrics. Thematic analysis of text was carried out using NVivo 12. In the quantitative analysis, univariable and multivariable ordinal logistic models were used to examine the potential factors for preference among students in higher education. A total of 380 Nursing and Social Science students responded to the survey. Approximately 77% of students perceived non-invigilated assessments to be less stressful compared to invigilated exams. Age, course of study, stage of studies, and number of units enrolled per semester were identified as significant drivers for students' perceived preference for non-invigilated assessments. There was an inverse relationship between the perception of stress associated with invigilated exams and the age of students. For instance, students aged between 18-24 were 5 times more likely to prefer non-invigilated exams compared to those aged 55 or more. Comparatively, students in early stages of studies had higher preference for non-invigilated assessments. However, there was a preference reversal for students enrolled in 2 or less units per semester. Social sciences students were two times more likely to prefer non-invigilated examinations to invigilated examinations compared to nursing students. The findings reinforce the use of alternative assessments in higher education as a mitigating agency to lessen the mental health burden of tertiary students in post COVID-19 era.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10805-023-09472-w.

Emotional Freedom Technique (EFT): Tap to relieve stress and burnout

The effects of the COVID-19 pandemic have exponentially increased stress, anxiety and burnout levels for all healthcare professionals and students. The psychological effects of working with COVID-19 patients and the physical stress of working under distressing conditions exacerbate an already stressed workforce. Working long hours, shift work, short staffing, demanding workloads, dealing with death and dying and conflicts with management, other staff and disciplines and poor communication between disciplines are among the issues that can lead to burnout, anxiety and depression. Emotional Freedom Technique (EFT) or tapping is a holistic practice that is easy to learn and apply to self and produces relief from stress, anxiety and the symptoms of burnout within in minutes. There are many websites, videos, and tutorials which can teach and support the healthcare practitioner in the practice of EFT.

Nursing students' perceptions of how the COVID-19 pandemic impacts mental well-being and educational environment

Background

Challenging work conditions put over 20 million U.S. health workers, including nurses, at risk for mental health problems. Mental health concerns among nurses and nursing students include anxiety, burnout, and stress which can lead to substance abuse and suicidal behavior. Nursing students practice in environments where they are exposed to complex challenges and high-stress situations that can lead to a higher prevalence of psychiatric disorders. As nursing students attempt to adapt to a post-pandemic educational environment, it is important to identify perceptions of nursing students' mental well-being.

Methods

A qualitative design was utilized using a descriptive method. Semi-structured interviews were conducted with a purposeful sample of BSN students (n = 11) from the southeastern U.S. Content analysis and coding were utilized in the study.

Results

Coping strategies and coping skills are imperative for nursing students to thrive in the educational environment, which includes a multitude of stressors that can negatively impact academic success. The rigorous workload of nursing schools, lack of support, financial challenges, and lack of experience are contributing factors that lead to decreased mental well-being among nursing students.

Conclusion

Interventions that aid in recognizing students at high risk for negative mental health outcomes must be implemented to ensure academic success. Implementing interventions to support healthy mental well-being among nursing students can also create an educational environment that prepares students to provide high-quality, safe, and effective patient care.

Global prevalence and trend of anxiety among graduate students: A systematic review and meta-analysis

OBJECTIVE

To evaluate the comprehensive prevalence of anxiety among postgraduates and estimate its changes with a meta-analysis.

METHOD

Systematic retrieval to SAGE, ERIC, EBSCO, Wiley, ScienceDirect, ProQuest, PubMed, EMBASE, and Web of Science database was performed for quantitative studies on the prevalence of anxiety among graduate students published before November 22, 2022. The prevalence of anxiety synthesized with random-effects model, and subgroup analysis was conducted by study characteristics (publication year, sampling method, and measurements) and subjects' characteristics (gender, region, and educational level).

RESULT

Fifty studies were included in the meta-analysis, totaling 39,668 graduate students. The result revealed that 34.8% of graduates suffered from the anxiety (95% CI: 29.5%-40.5%). Specifically, 19.1% (95% CI: 15.4%-23.5%) had mild anxiety, 15.1% (95% C: 11.6%-19.6%) had moderate anxiety, and 10.3% (95% CI: 7.2%-14.6%) had severe anxiety. And this prevalence showed a upward trend since 2005. Besides, master students suffered slightly less than doctoral students (29.2% vs. 34.3%), and female had similar anxiety to male (26.4% vs. 24.9%). Due to the COVID-19, the prevalence of anxiety is higher after the pandemic than that before (any anxiety: 34.3% vs. 24.8%). Compared with other countries, students from Saudi Arabia, India, and Nepal were more vulnerable. The results of quality assessment showed that, 5 (10%) were in high quality, 21 (42%) were in moderate to high quality, 21 (42%) were in low to moderate quality, and 3 (6%) were in low quality. But, the studies with low quality tend to report a higher prevalence than that with high quality (40.3% vs. 13.0%), studies with nonrandom sampling tend to report a higher prevalence than that with random sampling (33.6% vs. 20.7%). Although we included the data collected based on the standard scales, there were higher heterogeneity among the measure (Q = 253.1, df = 12, p < .00).

CONCLUSION

More than one-third postgraduates suffered from anxiety disorder, and this prevalence had a slight upward trend since 2005, school administrators, teachers and students should take joint actions to prevent mental disorder of graduates for deteriorating.

Factors related to mental health effect among nursing students in Japan and the United States during the coronavirus pandemic: A cross-sectional study

In the context of mental health, university students have been considered a vulnerable population. However, limited studies have underscored the association between preventive health behaviour levels and mental health effects among nursing students. The current cross-sectional study provides a comparative analysis of the impact of mental health factors on nursing students in Japan and the United States (US) in the context of the coronavirus disease 2019 (COVID-19) pandemic. The study consisted of 878 participants, comprising both undergraduate and graduate nursing students from four universities in Japan, and one from the US. Hierarchical logistic regression was used to analyse the participant data in this study. In contrast to the American students, the Japanese students demonstrated significantly lower levels of perceived control and significantly higher levels of preventive health behaviours. Furthermore, Japanese students exhibited significantly higher levels of stress and/or symptoms of depression induced by the social distancing orders compared to the American students (z = -4.218, P < 0.001). However, no difference was observed after adjusting for perceived control, individual factors, socio-economic factors, and preventive behaviours. During the pandemic, risk factors that can worsen mental health among the nursing students included younger age [odds ratio (95%CI) = 0.62 (0.48-0.81)], women [OR = 2.17 (1.02-4.61)], higher preventive health behaviour [OR = 1.05 (1.02-1.08)], lower perceived control [OR = 0.97 (0.94-0.99)], and lower perceived health competence [OR = 0.93 (0.90-0.96)]. Thus, this study recommends establishing training programmes that enhance perceived control and perceived health competence while encouraging preventive behaviour to support the mental health of nursing students, particularly young female students.

The Experience of Working Nurses Attending Graduate School During COVID-19: A Hermeneutic Phenomenology Study

Introduction

There has been unprecedented uncertainty involved in the COVID-19 pandemic, especially for working nurses. Nurses working while attending graduate school faced additional unique challenges including working extended hours while also home-schooling young children, managing a family life while also navigating pandemic-related changes affecting students' educational paths.

Objectives

The purpose of this study was to explore the lived experiences of working nurses attending graduate school during the COVID-19 pandemic. The central research question was: What is the lived experience of working nurses attending graduate school during COVID-19?

Methods

The exploration of the lived experience of working nurses attending graduate school during a pandemic required a research methodology delving into the meaning of lived experience as it has been lived, temporally, and contextually (during a pandemic). Qualitative hermeneutic phenomenology was used to explore the meaning of lived experience from an interpretational stance.

Results

The overall meaning of the experience was a paradigm shift of existence across the three realms of work, home, and school. The themes associated with the shift were rapid change, uncertainty, fear, and support persons. Stress was a resulting overarching theme.

Conclusions

To support working nurses further their education during times of crisis, nurse leaders and educators should put processes in place to mitigate change and stress through strategic communication and supportive work environments.

Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

The SARS-CoV-2 (COVID-19) pandemic has increased healthcare worker (HCW) susceptibility to mental illness. We conducted a meta-analysis to investigate the prevalence and possible factors associated with post-traumatic stress disorder (PTSD) symptoms among HCW during the COVID-19 pandemic. We searched PubMed, SCOPUS and EMBASE databases up to May 4th, 2022. We performed random effects meta-analysis and moderator analyses for the prevalence of PTSD-relevant symptoms and severe PTSD symptoms. We identified 1276 studies, reviewed 209 full-text articles, and included 119 studies (117,143 participants) with a total of 121 data points in our final analysis. 34 studies (24,541 participants) reported prevalence of severe PTSD symptoms. Approximately 25.2% of participants were physicians, 42.8% nurses, 12.4% allied health professionals, 8.9% auxiliary health professionals, and 10.8% "other". The pooled prevalence of PTSD symptoms among HCWs was 34% (95% CI, 0.30-0.39, I² >90%), and 14% for severe PTSD (95% CI, 0.11 - 0.17, I² >90%). The introduction of COVID vaccines was associated with a sharp decline in the prevalence of PTSD, and new virus variants were associated with small increases in PTSD rates. It is important that policies work towards allocating adequate resources towards protecting the well-being of healthcare workers to minimize adverse consequences of PTSD.

Emotional State of Teachers and University Administrative Staff in the Return to Face-to-Face Mode

Social distancing and security measures have contained the spread of the COVID-19 pandemic. Despite this, the return to face-to-face activities is necessary for specific companies, and some higher education institutions have already done so. The various disorders that this new reality could generate have motivated the present study, which aims to analyze the emotional state of teachers and administrative staff. The instrument used was the abbreviated depression, anxiety, and stress scale (DASS-21), with an internal consistency index of 0.87. The methodology was based on applying a survey to 202 participants from Quito, Ecuador. The sample consisted of 97 men and 105 women aged between 23 and 59 years. A quantitative and cross-sectional design was used in this research. The results show that 40.1% of the respondents presented anxiety, 36.63% depression, and 38.61% stress between mild and highly severe categories. Additionally, when analyzing the depression, anxiety, and stress levels compared to productivity variables, we found that five disorders, i.e., fear, anxiety, over reactivity, skeletal muscle effects, and dysphoria, directly affect productivity variables, such as performing simple tasks, performing difficult tasks, the number of products made, and the number of products rejected. Thus, returning to face-to-face mode has affected the emotional state of many people, showing differences according to the job position, with anxiety being the highest self-identified incidence rate.

I Get by With a Little Help From My Peers: Mindfulness and Peer Support for Doctor of Nursing Practice Students

ABSTRACT

Graduate nursing students faced numerous stressors while pursuing their education during the COVID-19 pandemic, with many working clinically while studying. The purpose of this pilot was to explore support strategies and decrease stress in first-year students enrolled in a doctor of nursing practice program during a time of uncertainty and crisis. Graduate students were assigned to practice a three-minute mindfulness activity and connect with a fellow student for a month. Students reported mindfulness benefits and social support. Modeling healthy practices is critical to support mastery of skills that will promote positive reactions to challenges in their future practice settings.

Prelicensure Nursing Students’ Reflections on Institutional Response to the 2020 COVID-19 Crisis

The study aimed to describe how prelicensure student nurses perceive academic support and their institutions’ response during the 2020 COVID-19 crisis. The shift to online learning caused by the COVID-19 pandemic disrupted every aspect of higher education, including pre-licensure nursing students. Prelicensure nursing education is one of the most stressful programs in higher education. In a period of great uncertainty, it becomes essential to explore how prelicensure nursing students perceive academic support from their institutions. A qualitative descriptive design was employed for the study. Thematic analysis was used to analyze data obtained from 16 semi-structured interviews. Six themes resulted from the data: Disorganization leading to chaos; technology and technical challenges; stress and frustration; am I prepared to be a nurse?; not having money; mental health matters. This study validates the experiences of nursing students. Students’ obstacles during the pandemic should be identified and mitigated to promote learning and academic success.

Trauma-Informed Education in Nursing: A Concept Analysis

BACKGROUND

Trauma-informed education provides a framework for a collaborative, relational trauma awareness model when working with nursing students. This concept analysis provides clarification, explicates the conceptual meaning of trauma-informed education, and lays a foundation for nurse educators navigating the challenge of meeting student needs during and after the coronavirus disease 2019 (COVID-19) pandemic.

METHOD

Using Walker and Avant's concept analysis method, exhaustive multi-disciplinary and ancestry searches conducted in PubMed, CINAHL, ERIC, and PsychINFO identified 31 relevant article that were evaluated for relevance to the concept analysis as it relates to the context of nursing education.

RESULTS

This analysis proposes a new definition of trauma-informed education to support future practice and research endeavors, providing a framework for transforming the nurse educator-student dyadic relationship.

CONCLUSION

Trauma-informed education can provide a collaborative relational model with students based on trauma awareness as affecting one's being and self. [J Nurs Educ. 2022;61(6):296-302.].

Stress and depression in undergraduate students during the COVID-19 pandemic: Nursing students compared to undergraduate students in non-nursing majors

Background

The COVID-19 pandemic exacerbated an already alarming mental health crisis on college campuses. Nursing students were uniquely impacted through the loss of clinical practicum experiences.

Purpose

The purpose of this study was to explore relationships between student perceptions of life-stress and depressive symptoms during the COVID-19 pandemic in nursing students compared to students in other academic disciplines. A secondary purpose of this study was to understand nursing student perceptions of how the COVID-19 pandemic impacted their educational experience.

Methods

School-related life stress and depression measures were studied in a cross-section of 2326 undergraduate students using an anonymous online survey. Follow-up qualitative data were collected (N = 12) to further explore relationships between school-related life stress and depression in nursing students.

Results

Nursing students had higher levels of student-life stress but fewer depressive symptoms than students in any other academic major. Students related that social support and belongingness were critical to their academic perseverance.

Conclusions

Differences between nursing and non-nursing students are likely due to a multifactorial combination of social support, resilience, and posttraumatic growth.

THE IMPACT OF MENTAL HEALTH, SUBJECTIVE HAPPINESS AND RELIGIOUS COPING ON THE QUALITY OF LIFE OF NURSING STUDENTS DURING THE COVID-19 PANDEMIC

OBJECTIVE

The aim of this study is to examine the effect of psychological distress and religious coping in quality of life of nursing students during the second wave of the pandemic in Greece.

PATIENTS AND METHODS

Materials and methods: A cross-sectional online survey was conducted among nursing students. Data were collected via an e-survey consisting of five parts including HADS Questionary, SF-36, B-RCOPE and Subjective Happiness scale.

RESULTS

Results: From the total of 200 nursing students the 86.5% were female, 35.5% were in their first year of study, 54% were single and 65.5 were urban residents. 51.9% of the students were experiencing anxiety and 31,5% were depressed. In regard to subjective happiness, the mean value was 4.51±1.27. In addition, the majority of the students consider themselves unhappy (67.5%). Finally, in regard to SF-36 scores, we observed that PCS mean score was 68.49±13.19, MCS56.12±24.23. Depression, as well as negative religious coping, can have a negative effect on both physical and mental health components of quality of life.

CONCLUSION

Conclusions: Nursing students experience very high levels of stress and anxiety during the COVID-19 pandemic and need support and guidance to better manage stress and fear in this unusual situation.

Student Interviews Exploring the Influence of the Coronavirus Pandemic on Graduate Nursing Education

Introduction

Advanced practice nurses are needed to fill the primary healthcare gap in the United States. Advanced practice/graduate nursing students were profoundly affected by the coronavirus pandemic in ways that may impact their educational experience.

Objective

The objective of this study was to explore the influence of the coronavirus pandemic on the educational experience of graduate nursing students.

Methods

An exploratory descriptive qualitative study using semistructured video conferencing interviews of 11 graduate nursing students at one university in the United States was conducted during July 2020. Data were explored using theme analysis.

Results

Four themes expressing the pandemic's impact on graduate student experience were identified: Alteration in human connections; Agility in action; Collaborative construction of change; and Metamorphosis emerging from disruption. The pandemic brought an alteration in how students connected with faculty, other students, and family. Many faculty and students responded with agility to the new mandates for social distancing. The students and faculty worked together to construct changes needed to provide the students with the required components of graduate education. These factors together created a metamorphosis in the functioning of the institution, breaking through hierarchical barriers in academia.

Conclusion

The disruption in graduate nursing education due to the pandemic led to opportunities, including swift faculty innovation, a collaborative spirit between faculty and students, and new appreciation for connections with faculty and fellow students. Continuing intentional implementation of these opportunities would benefit students' experiences moving forward.

Post-secondary Student Mental Health During COVID-19: A Meta-Analysis

The COVID-19 pandemic has posed notable challenges to post-secondary students, causing concern for their psychological well-being. In the face of school closures, academic disruptions, and constraints on social gatherings, it is crucial to understand the extent to which mental health among post-secondary students has been impacted in order to inform support implementation for this population. The present meta-analysis examines the global prevalence of clinically significant depression and anxiety among post-secondary students during the COVID-19 pandemic. Several moderator analyses were also performed to examine sources of variability in depression and anxiety prevalence rates. A systematic search was conducted across six databases on May 3, 2021, yielding a total of 176 studies (1,732,456 participants) which met inclusion criteria. Random-effects meta-analyses of 126 studies assessing depression symptoms and 144 studies assessing anxiety symptoms were conducted. The pooled prevalence estimates of clinically elevated depressive and anxiety symptoms for post-secondary students during the COVID-19 pandemic was 30.6% (95% CI: 0.274, 0.340) and 28.2% (CI: 0.246, 0.321), respectively. The month of data collection and geographical region were determined to be significant moderators. However, student age, sex, type (i.e., healthcare student vs. non-healthcare student), and level of training (i.e., undergraduate, university or college generally; graduate, medical, post-doctorate, fellow, trainee), were not sources of variability in pooled rates of depression and anxiety symptoms during the pandemic. The current study indicates a call for continued access to mental health services to ensure post-secondary students receive adequate support during and after the COVID-19 pandemic. Systematic Review Registration: PROSPERO website: https://www.crd.york.ac.uk/prospero/, identifier: CRD42021253547.

Nursing students' experience of providing frontline COVID-19 support: A qualitative study

Understanding the unique experience of nursing students providing frontline support in COVID-19 hospital wards is crucial for the design of strategies to improve crisis management and mitigate future pandemic outbreaks. Limited research concerning this phenomenon has been published. This qualitative study aimed to understand the experience of providing support from COVID-19 frontline nursing students' perspective. Online interviews were conducted with nine nursing students from April to May 2020; interview data were analyzed by content analysis using Burnard's method. Six main categories emerged from the data analysis: "experiencing a rapid transition from student to professional," "fear and uncertainty of the unknown," "resilience throughout the crisis," "sense of belonging to a team," "shared responsibility," and "importance of the profession." Based on these findings, multicomponent strategies that function in parallel with practical contexts should be developed to enable students to diligently adapt their abilities to their new role and cope with health crises.

Nursing student experiences in turmoil: A year of the pandemic and social strife during final clinical rotations

Background

The duration and magnitude of the coronavirus (COVID-19) posed unique challenges for nursing students, whose education was altered because of the pandemic.

Purpose

To explore the perceptions and experiences of nursing students whose clinical rotations were abruptly interrupted by COVID-19's initial surge in the United States.

Methods

This qualitative study was conducted at a midwestern, academic medical center to elicit senior nursing students' experiences. An online survey was administered with eight open-ended questions asking about: initial impressions of the pandemic; experiences of being a senior nursing student; sources of stress and coping mechanisms; preparing to work as a registered nurse; and views on the nursing profession.

Results

Among the 26 students who completed the survey, the majority were female (92%), aged 28 ∓ 4.1 years. A total of 18 subcategories emerged with four main themes identified as: a) breakdown of normal systems, b) feeling alone and the inability to escape, c) protective factors/adaptability, and d) role identify and formation.

Conclusions

Findings indicate students implemented a variety of strategies while adapting to the abrupt interruption of in-person clinical rotations, mandated restrictions, and social unrest. The cascading themes illustrate the enormity of sudden changes and their significant impact on daily life.

Prevalence of mental health problems and sleep disturbances in nursing students during the COVID-19 pandemic: A systematic review and meta-analysis

AIM

To identify the prevalence of mental health problems and sleep disturbances among nursing students during the COVID-19 pandemic.

BACKGROUND

As a future professional workforce, nursing students are expected to play a role in controlling the COVID-19 pandemic; however, physical and mental health problems may hinder their willingness to stay in the nursing profession. Evidence of the prevalence of the health problems among nursing students related to COVID-19 may allow educators to manage their students' health problems and make them feel more positive about their future careers.

DESIGN

Systematic review and meta-analysis. This study was prospectively registered with PROSPERO.

DATA SOURCES

Databases, including CINAHL, Embase, PubMed and Web of Science, were searched for all related journal articles, from database inception to June 29, 2021, published between 2020 and 2021.

METHODS

This review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using a PICOS search strategy. A DerSimonian-Laird random-effects model was used to estimate the prevalence and potential heterogeneity among the selected studies using the Cochran Q statistic and I-square test. Publication bias was assessed using the Egger intercept test.

RESULTS

Seventeen studies were included in the meta-analysis, representing 13,247 nursing students. During the COVID-19 pandemic, the prevalence of four health problems and sleep disturbances were identified. The health problem with the highest prevalence in nursing students was depression (52%). Other COVID-19-related health problems were fear (41%), anxiety (32%) and stress (30%) and sleep disturbances (27%).

CONCLUSIONS

The findings from this study showed that strategies are necessary to manage nursing students' teaching and learning during the COVID-19 pandemic or similar future situations. Our results suggest that preparing modified distance learning might reduce the prevalence of health problems related to the educational process. In addition, providing regular mental health assessments or online mental health services to students may improve their mental health and increase their well-being. Nursing education policies regarding clinical practice remain to be formulated to ensure the achievement of competencies to support future careers while considering the mental readiness and safety of students.

Graduate nursing student stressors during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic profoundly impacted graduate nursing students at work, home, and school. Stress can influence the ability to focus, study, and may delay continuation in graduate school.

PURPOSE

The purpose of this study was to identify the stressors of graduate nursing students during the pandemic.

METHOD

A prospective, descriptive, online survey design was used to identify graduate nursing student stressors during the pandemic at one educational institution in the United States. Questions related to employment, COVID-19 exposure, institutional support, future graduate plans were summarized for the total sample and stratified by program (MS, DNP, PhD). Changes in a total stress score were evaluated pre and post onset of the COVID-19 pandemic.

RESULTS

A total of 222 graduate nursing students completed the survey. The vast majority of students were employed before the pandemic and a significant decrease in employment occurred during the pandemic (97.3% to 90.1%, p < .001). Overall stress increased (p < .001). The increased total stress was associated with students participating in clinical rotations (q = 0.024) and having a change in work hours (q = 0.022).

CONCLUSIONS

Nursing schools need to address graduate student concerns during the pandemic, including having clear communication platforms and offering support services.