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

Stress and Trauma Among Nurses in Development (STAND): A Descriptive Study

BACKGROUND

Mental health conditions related to traumatic stress exposure are common in practicing nurses. Less is known about the impact of trauma on nursing students and how it affects their transition to practice.

OBJECTIVES

The purpose of this study is to understand the experience of trauma exposure and resulting symptoms in undergraduate nursing students.

DESIGN

This is an analysis of baseline data from a longitudinal study. Students in an undergraduate nursing program completed a survey with validated instruments to measure trauma exposure, risk and protective factors, and trauma symptoms.

SETTINGS

The study took place in an undergraduate nursing program in the United States.

PARTICIPANTS

A total of 248 nursing students participated in the study.

RESULTS

The nursing students reported a higher number of adverse childhood experiences and post-traumatic stress disorder (PTSD) symptoms than the general population. Additionally, mental health symptoms and burnout symptoms increased over time.

CONCLUSIONS

Nursing students are at high risk for PTSD and other mental health conditions due to cumulative trauma. Interventions are needed to address trauma in developing nurses.

Final year nursing students' preparedness for medication administration during COVID-19: A multi-site survey study

AIM

To examine final-year undergraduate nursing students' characteristics and their perceived preparedness for medication administration across three universities during COVID-19.

BACKGROUND

Medication administration is a complex process and medication errors can cause harm to the patient. Nurses are at the frontline of medication administration; therefore, nursing students must be well-prepared to administer medicines safely before graduation. Little is known about final-year undergraduate nursing students' perceived medication administration preparedness during COVID-19.

DESIGN

A multi-site study using a cross-sectional survey of student demographics, the 'Preparedness for Medication Administration' (Revised) tool and an open-ended question.

METHODS

The questionnaire was distributed to nursing students in their final semester of the program in 2022 across two universities in Australia and one in New Zealand. Completed surveys n=214. Descriptive statistics were used to analyse the demographic data. Differences in demographic data and preparedness scores between the three universities were analysed using ranked means, correlation coefficient, Chi-Square, Mann- Whitney U and Kruskal- Wallace H. Directed content analysis was used to analyse the data from the open-ended question.

RESULTS

Overall, students reported high preparedness scores for medication. International students reported significantly higher preparedness scores (Md =119, n=29) compared with domestic students (Md=112.00, n=164), U=1759.50, z=-2.231, p=02, r=.16. Mean ranked scores for each item were above average across the three universities. The impact of COVID-19 on curriculum and students' opportunity to practice may be one explanation for the difference in preparedness scores between universities. International participants reported significantly higher scores on the Preparedness for Medication Administration (Revised) tool than domestic participants. Older students were more confident in applying principles of pharmacology to practice. Students' comments generated three major categories and five subcategories indicating preparedness gaps.

CONCLUSION

This study provides insights into students' medication management preparedness during restrictions and before transitioning to the role of Registered Nurse. It highlights the need to provide integrated and comprehensive medication education and assessments throughout the curriculum and the need for additional support for newly graduated nurses in medication management due to the restrictions.

Psychometric properties of the Short-Form Five Facets of Mindfulness Questionnaire among nursing students in China: A confirmatory factor analysis

AIM

To analyse the factorial structure and psychometric properties of the Chinese Short-Form Five Facets of Mindfulness Questionnaire (FFMQ-SF) among nursing students in the Chinese mainland.

DESIGN

A cross-sectional study.

METHODS

A total of 240 undergraduate nursing students were recruited from a school of nursing in Beijing, China from 25 to 30 April 2021. FFMQ-SF and Depression-Anxiety-Stress Scale were used to collect information on the mindfulness level and mental health status of the study participants. Descriptive analyses were performed to examine the demographic characteristics. Confirmatory factor analyses (CFAs) were used to test the structural, convergent and discriminant validity of the scale model. Pearson correlation analysis was used to test the correlation between the variables and the criterion validity.

RESULTS

The overall fit of the scale model is good (Bollen-Stine χ2 = 177.206, df = 142, GFI = 0.923, AGFI = 0.883, TLI = 0.980, CFI = 0.983, RMSEA = 0.032, SRMR = 0.090). One-factor models using CFA demonstrated the overall best fit for four out of five subscales of the FFMQ-SF. In the five-factor CFA of the FFMQ-SF, the composite reliability values of the five factors were from 0.685 to 0.870 and the values of average variance extracted were from 0.426 to 0.627.

PATIENT OR PUBLIC CONTRIBUTION

The students who participated in this study contributed to the advancement of knowledge on mindfulness and mental health among nursing students in China. They voluntarily completed the online questionnaires and provided their honest and valid responses. Their data was used to evaluate the psychometric properties of the FFMQ-SF and to examine the relationship between mindfulness and psychological problems. Their feedback also helped to improve the quality and applicability of the FFMQ-SF instrument for future research and practice.

Depressive symptoms, sleep-wake features, and insomnia among female students: The role of rumination

Depression symptoms are prevalent among nursing students, especially those in Asia. This study assessed the association between rumination and depression symptoms among female nursing students (N = 148) and the chain mediation role of sleep-wake indexes and insomnia symptoms. The data were collected from a battery of questionnaires and consecutive 7-day actigraphy data for analyzing sleep-wake indexes. About 54.1% of the participants had either mild or moderate depression symptoms. Most students (89.2%) had a delayed circadian phase, and circadian activity rhythm (CAR) was not ideal. The path mediation model underwent analysis using the PROCESS macros. The results showed that rumination in students is directly positively correlated with depressive symptoms (b = 4.831). Moreover, the association between rumination and depressive symptoms is sequent (moderating effect = 0.12, 95% CI [0.017, 0.410]). The proposed model in this study provides a foundation for improving educational programs on sleep hygiene and promoting mental wellness.

A Short Form for Measuring Anxiety in Nursing Education

Background and Purpose: Nursing education lacks an easily accessible, valid, and reliable short instrument to support researchers and instructors in quickly assessing student anxiety. The purpose of this research was to respond to this need by assessing the reliability and validity of a short-form anxiety instrument adapted from psychology which could measure state and trait anxiety. Methods: Using a one-group, repeated measures design, 51 sophomore level undergraduate nursing students had their state and trait anxiety levels measured at three time points over the course of a semester. Results: Results showed that the anxiety instrument was valid and reliable for use in nursing education with coefficient α ranging from .65 to .88. Conclusion: Future nurse researchers and educators should consider using the short-form anxiety instrument when a quick differentiation is needed to measure state and trait anxiety.

Prevalence and factors associated with job burnout among nurses in China: A cross-sectional study

AIM

Many people see nursing as a high-pressure, high-risk profession. Therefore, job burnout among nursing staff has become an important topic of study and has received widespread attention worldwide. This research intended to evaluate the frequency of and variables related with work burnout among nurses in public hospitals in China.

DESIGN

Using a multistage random sample procedure, a cross-sectional survey was carried out in the eastern, central and western areas of China.

METHODS

The Maslach Inventory-Human Service Survey and demographic information made up the two sections of the questionnaire. Of the 5250 questionnaires sent, 4865 were deemed legitimate, yielding an effective response rate of 92.67%. A linear regression analysis was performed to investigate the variables linked to nursing work burnout.

RESULTS

Among the 4865 nurses, women accounted for 97.4% of the survey respondents, most of whom were aged 26-35 years. Results showed that the total scores of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA) were 20.02 ± 12.04, 4.78 ± 5.54 and 34.42 ± 10.32 respectively. 50.7% of subjects obtained high or moderated scores on EE, 32.8% of subjects obtained high or moderated scores on DP and 80.4% of subjects obtained low or moderated scores on PA. Age, department, position, post-establishment, work shift type in recent months, overtime times in recent months and night shift frequency in recent months were negatively correlated with EE, and child status, monthly income, working days per week and sleep quality in recent 1 month were positively correlated with it (F = 141.827, P < 0.01, R2 = 0.243). Age, gender, department, post-establishment, overtime hours in recent months and night shift frequency in recent months were negatively correlated with DP, and child status and sleep quality in the last 1 month were positively correlated with it (F = 78.794, p < 0.01, R2 = 0.115). Child status, years of nursing work and sleep quality in the last 1 month were negatively correlated with PA, whereas age, position, work shift type in recent months and night shift frequency in recent months were positively correlated with it (F = 67.981, p < 0.01, R2 = 0.089).

Do academic advising and levels of support affect nursing students' mental health? A cross-sectional study

AIM

The current study aimed to identify the association between social support, academic advising and mental health disorders among nursing students.

BACKGROUND

Stress and workload can trigger multiple mental health disorders, especially for nursing students. Thus, academic advising and counselling help support students with academic and mental health problems.

DESIGN

This cross-sectional study utilized online questionnaires in Egypt and Saudi Arabia.

METHODS

Multidimensional Scale of Perceived Social Support (MSPSS), Patient Health Questionnaire (PHQ-4) and the Student Academic Advising and Counseling Survey (SAACS) were utilized to measure social support, depression and anxiety and evaluation of academic advising and counselling services, respectively.

RESULTS

The study included 1134 nursing students (mean age of 20.3 years). Students with higher academic advising satisfaction were 37% less likely to experience depression (OR 0.63, 95% CI 0.46-0.85) and mental disorders (OR 0.68, 95% CI 0.50-0.94). Moderate family social support was associated with lower depression (OR 0.58, 95% CI 0.37-0.93) and mental disorders (OR 0.55, 95% CI 0.33-0.92).

CONCLUSION

Academic advising and social support can mitigate mental health disorders among nursing students. These findings will help nurses and post-secondary providers develop strategies to support nursing students during difficult times.

Factors Affecting Sleep Quality among University Medical and Nursing Students: A Study in Two Countries in the Mediterranean Region

Poor sleep quality, a global public health concern, poses a significant burden on individuals, particularly health care university students facing intense academic stress. A three-center cross-sectional study was conducted at the Higher Institute of Nursing and Health Sciences in Tetouan (Morocco), Faculty of Medicine in Tangier (Morocco) and Faculty of Nursing in Valencia (Spain). We collected various data using a sociodemographic questionnaire, the Pittsburgh sleep quality questionnaire, the international physical activity questionnaire (IPAQ) and the smartphone addiction questionnaire short-version (SAS-SV). A total of 1210 students were included in our study (mean age 20.4 years, 67.2% female, nursing students (66.2%) and medical students (33.8%), 76.1% students from Morocco and 33.9% from Spain). Analysis revealed a higher prevalence of poor sleep quality among Moroccans students compared to Spanish ones (p < 0.001), that nursing students showed less favorable sleep quality than medical students (p < 0.011) and that living with a chronic disease was linked to less favorable sleep quality (p < 0.001). Lastly, intense or weak physical activity and smartphone addiction were correlated with poor sleep quality (p < 0.001). In the multivariate analysis, an association persisted between poor sleep quality and factors such as the country of study (Odds ratio (OR): 6.25 [95% Confidence Interval (CI): 4.34-9.09]), involvement in nursing studies (OR: 3.50 [95% CI: 2.36-5.27]), and the presence of chronic diseases (OR: 2.70 [95% CI: 1.72-4.16]), (p < 0.01 each). Our findings highlight the multifaceted factors affecting sleep quality in young university students. The implications underscore the imperative of interventions tailored to this demographic group.

Chinese college students' mental health during the first three months of the COVID-19 pandemic: the protective role of family functioning

Background

Various psychological theories suggest that a supportive family environment protects the mental health of young adults during stressful life events. However, evidence is limited regarding the protective role of family support during a major public health crisis.

Objective

To examine the role of family functioning on mental health among Chinese college students during first stage of the COVID-19 pandemic.

Methods

Between January-March 2020, 1,555 college students (44% female, on average 19 years old) from five Chinese universities participated. Participants rated their family functioning on the Family APGAR Index and their mental health on the Psychological Questionnaires for Emergent Events of Public Health, measuring depression, neurasthenia, fear, obsessive-anxiety and hypochondriasis.

Results

Better family functioning was associated with having fewer psychological symptoms. In addition, we identified three mental health profiles related to the severity across the psychological symptoms: Low-level, medium-level and high-level symptom clusters. Latent profile analysis showed that as family function improved, students were, respectively, 16 to 24% more likely to be in the low-level symptom group, compared to being in the medium symptom group or the high-level symptom group.

Conclusion

These results support the notion that family support may act as a psychological buffer for young adults during a large-scale public health crisis like the COVID-19 pandemic.

The effect of sleep problems on core self-evaluations in undergraduate nursing students and the role of emotion regulation and resilience: A cross-sectional study

BACKGROUND

Nursing students are prone to sleep problems that affect their core self-evaluations. However, little attention has been paid to the specific roles of emotion regulation (including cognitive reappraisal and expressive suppression) and resilience in this process.

OBJECTIVES

This study aimed to explore 1) the direct effect of sleep problems on core self-evaluations among nursing students; 2) the chain-mediating effect of cognitive reappraisal and resilience on the relationship between sleep problems and core self-evaluations; 3) the moderating effect of expressive suppression on the direct relationship between sleep problems and core self-evaluations; and 4) the moderating effect of expressive suppression on the indirect relationship between sleep problems affecting core self-evaluations through resilience.

METHODS

A total of 345 nursing students completed a survey conducted between September and October 2022. Data was analyzed using descriptive analysis, Fisher exact test, Kruskal-Wallis H test, Spearman correlation analysis, and hierarchical regression analysis. Additionally, the SPSS PROCESS V4.0 plug-in was used to verify the moderated chain-mediating effect.

RESULTS

Sleep problems directly affected core self-evaluations among nursing students. Cognitive reappraisal and resilience played a partial chain-mediating role in the relationship between sleep problems and core self-evaluations, with expressive suppression having a direct moderating effect.

CONCLUSIONS

Opportunities exist for enhancing the core self-evaluations of nursing students by addressing their sleep problems, promoting cognitive reappraisal strategies, and increasing resilience. Additionally, encouraging expressive suppression can mitigate the negative impact of sleep problems on nursing students' core self-evaluations.

Changes in perceived stress and food or housing insecurity associated with COVID-19 in doctor of pharmacy students: A pre- and current- COVID-19 survey

Background

The novel coronavirus 2019 (COVID-19) pandemic impacted everyday life for most individuals, including students. Unique COVID-19 stressors among students may include virtual learning, mental stress, and being socially distanced from classmates. Studies examining the impact of COVID-19 on stress and lifestyle changes among pharmacy students are limited.

Objective

The primary purpose of this study was to compare stress and food or housing insecurity changes associated with COVID-19 in U.S. Doctor of Pharmacy (PharmD) students pre-COVID vs. during-COVID.

Methods

A 23-item survey was administered via Qualtrics® to multiple PharmD programs across the U.S. in pre-COVID-19 (spring 2019) and during-COVID-19 (spring 2021). Participants were recruited via e-mail. The survey included questions related to demographics, lifestyle (sleep, exercise, work hours, extracurricular activities), and food and housing insecurities. The survey also included a validated instrument to measure stress (Cohen-Perceived Stress Scale). Results from 2021 were compared to a similar national survey serendipitously administered prior to COVID-19 in Spring 2019.

Results

Pre- and COVID-19 analytical cohorts included 278 and 138 participants, respectively. While pre-COVID-19 students were slightly older (29.9 ± 4.7 vs. 27.7 ± 4.2, p ≤0.001), relative to COVID-19 students, other demographic factors were similar. No significant difference was observed in reported stress levels (PSS = 20.0 ± 6.3 vs. 19.7 ± 6.2, p = 0.610) between time periods. Significant differences in food (53.2% vs. 51.4%, p = 0.731) and housing (45.0% vs. 47.1%, p = 0.680) insecurity were also not seen.

Conclusions

These findings highlight that PharmD students' perceived stress and food and housing insecurities due to COVID-19 may have been minimal. Additional studies on pharmacy students should be conducted to validate these results. These results may help inform policymakers and stakeholders during the early stages of any future pandemics.

Sleep disorders and associated factors among medical students in the Middle East and North Africa: a systematic review and meta-analysis

Sleep disturbances like poor and insufficient sleep are common among medical students in the Middle East and North Africa (MENA) countries; however, the extent of medically defined sleep disorders (SDs) remains unclear. This meta-analysis determines SD prevalence and identifies associated factors among medical students in the MENA. PubMed, Web of Science, Google Scholar, and reference lists of included studies were searched (latest search: June 2022). Meta-analyses included 22 studies and were performed using random-effect models. Included studies used self-reported screening tools for assessing SDs and then estimated the proportion of participants at high risk of developing a SD. Central disorders of hypersomnolence were the most prevalent SD [prevalencepooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia disorders [prevalencepooled range: 30.4% (Jordan) to 59.1% (Morocco)], circadian rhythm sleep-wake disorders [prevalencepooled range: 13.5% (Jordan) to 22.4% (Saudi Arabia)], sleep-related breathing disorders [prevalencepooled range: 12.2% (Jordan) to 22.5% (Pakistan)], sleep-related movement disorders [prevalencepooled range: 5.9% (Egypt) to 30.6% (Saudi Arabia)], and parasomnias [prevalencepooled range: 5.6% (Jordan) to 17.4% (Saudi Arabia)]. Female sex, studying in the latter academic years, having anxiety, excessive internet use, and poor academic performance were significantly associated with SDs. SDs are prevalent among MENA medical students. Implementing student-centered interventions targeting high risk groups in medical schools should be considered to improve students' health and wellbeing.

Salivary Brain-Derived Neurotrophic Factor and Cortisol Associated with Psychological Alterations in University Students

INTRODUCTION

Recent evidence reported mental health issues in university students such as anxiety and depressive symptoms and poor sleep quality. Decreased plasma brain-derived neurotrophic factor (BDNF) levels have been proposed as a biomarker of depressive symptoms, whereas cortisol levels are an index of energy mobilization and stress and have been linked to sleep quality. Given that salivary biomarkers represent an interesting new field of research, the aim of this cross-sectional study was to evaluate salivary BDNF and cortisol levels in university students to assess whether they have associations with psychological disturbances such as anxiety and depressive symptoms, sleep quality, and stress level.

METHODS

Salivary BDNF and cortisol levels were measured by specific immunoassays in 70 students whose mental health was also evaluated on the same day through the evaluation of anxiety and depression symptoms (Goldberg scale), sleep quality (Pittsburg Sleep Quality Index and Athens Insomnia Scale), and stress (self-perceived stress scale) and healthy lifestyle habits (alcohol consumption, smoking, regular exercise, and body mass index) were also measured. Multivariate regression analyses were performed in order to identify the strengths of associations between psychological alterations and the concentrations of BDNF, cortisol, and other variables.

RESULTS

Salivary BDNF levels were significantly higher in students with more depressive symptoms, whereas no significant differences were found for cortisol levels. When performing the binary logistic regression model, BDNF levels are included as a predictor variable for a high-depressive-symptoms burden (p < 0.05). Students with worse sleep quality on the Pittsburg Scale had higher cortisol levels (p < 0.05). The subdomains of sleep latency and sleep medication were those significantly associated with salivary cortisol levels in logistic regression analyses (OR = 15.150, p = 0.028). Sleep medication only appeared to be related to cortisol levels (OR = 185.142, p = 0.019). Perceived stress levels and anxiety symptoms were not associated with BDNF or cortisol levels.

CONCLUSIONS

BDNF could play a key role in the pathophysiology of mood-related disorders, and elevation of its peripheral levels could contribute to protecting neurons from the development of mental illness. Higher salivary cortisol levels measured in the morning are accompanied by poorer sleep quality. More research is needed, focusing on salivary biomarkers of disorders related to depressive symptoms and poor sleep quality as a potential tool for the diagnosis and prevention of mental illness.

Gender difference in emotional distress among nursing and health science college students: An online survey

This cross-sectional study investigates the self-reported emotional distress of medical, nursing, dental, pharmacy, and public health students and identifies gender-related differences through an online survey. The data of 364 students were analyzed using Pearson correlation coefficients and multiple logistic regression. Emotional distress was more prevalent among female respondents (11.7 %) than male (3.8 %) respondents. The stigma, isolation, and depression experienced by female respondents influenced their emotional distress, whereas only the depression of male respondents influenced their emotional distress. Our findings suggest that mental health professionals should consider gender-specific factors when developing interventions for the study population to minimize emotional distress.

The measured impact of the COVID-19 pandemic on nursing students' wellbeing, clinical placement and learning experiences: a cross sectional study

Background: The epidemiological patterns of COVID-19 varied across Australia and differed from most other countries. Few studies describe the impact that the pandemic had on nursing student wellbeing, education and career.Aim: This study aimed to investigate how the COVID-19 pandemic impacted on nursing students' well-being, clinical placement and learning.Design: Cross-sectional survey.Setting: Sydney, Australia.Participants: Second- and third-year nursing students.Methods: Second- and third-year nursing degree students were asked to participate in an ethically approved study during March to May 2021. The de-identified on-line survey consisted of 63 closed end question and one open ended question. On completion, the dataset was exported from Redcap and imported into SPSS for analysis. Open ended text data were analysed by two researchers.Results: Of the 105 participating nursing students, a third (n = 26/83, 31%) thought about changing their degree to a non-nursing degree. The acknowledged risk of caring for a COVID-19 patient incrementally increased stress (β-coefficient = 0.6, p value = 0.009, 95% CI 0.2-0.9). Conversely students who intended to complete their degree were less likely to report stress. Students who had prior nursing experience were three times more likely to report an increased generalised anxiety level (OR 3.8, p-value = 0.02, 95% CI 1.2-12.2), yet they were less likely to experience personal accomplishment burnout compared to other students. Nursing students who contemplated a change of degree to a non-nursing degree were 15.7 times more likely to experience emotional exhaustion and were 3.5 times more likely to be report a risk of depersonalisation (p = 0.03, 95% CI, 1.3-11.5).Conclusion: The COVID-19 pandemic compromised nursing student well-being, and theoretical and practical learning. Findings have implications for healthcare and academic staff who teach nursing students. Implementation of student-centred evidence-based strategies to manage stress, burnout and anxiety, and to sustain a healthy student cohort is essential to retain the future nursing workforce.

Levels of depression, anxiety and subjective happiness among health sciences students in Croatia: a multi-centric cross-sectional study

BACKGROUND

Previous studies have shown that symptoms of depression and anxiety were highly prevalent among health sciences students. This may lead to other professional and personal difficulties and a decrease in individuals' well-being. This study aimed to analyze levels of depression, anxiety and subjective happiness among health sciences students in Croatia.

METHODS

We conducted a cross-sectional study in 10 higher education institutions in Croatia during March 2023. Eligible participants were health sciences students. Participants filled out an online survey consisting of sociodemographic questions and validated scales for determining the levels of depression (9-question Patient Health Questionnaire, PHQ-9), anxiety (General Anxiety Disorder 7-item scale, GAD-7), and happiness (Subjective Happiness Scale, SHS).

RESULTS

Of 7460 invited students, 2137 students participated in the study (29% response rate). There were 41.4% of students that exhibited at least mild depressive symptoms, with 8% of students exhibiting moderately severe symptoms and 1.8% severe depressive symptoms. Mild anxiety was found in 36.8%, moderate anxiety in 23.9% and severe anxiety in 15.8% of students. The median SHS score was 19 (15.25-22). Women students had significantly higher levels of depression (p < 0.001) and anxiety (p < 0.001) than their men peers. Students in earlier study years showed higher levels of depression, anxiety and lower levels of subjective happiness compared to those in later study years. Students with lower self-assessed financial status had higher levels of depression (p < 0.001) and anxiety (p < 0.001). Students that failed an academic year had higher levels of depression (p < 0.001), but lower levels of anxiety (p = 0.005).

CONCLUSION

In this study, we have shown that health sciences students exhibit high levels of depression and anxiety, at rates exceeding those in the general population reported in other studies. Our results may help educational institutions to put greater effort into the battle against mental health stigma, foster acceptance of mental health issues and encourage students to seek help when needed. Adequate mental health services are needed at universities to promote timely diagnosis and treatment of mental health problems.

Nursing students' experiences of teaching and learning during the COVID-19 pandemic: a systematic review and meta-synthesis of qualitative studies

INTRODUCTION

During the COVID-19 pandemic, the sudden transition to virtual learning led to several challenges for nursing students. This study aimed to synthesis nursing students' experiences of teaching and learning during the COVID-19 pandemic.

CONTENT

A meta-synthesis of qualitative articles were conducted. Three online databases were searched from December 2019 to December 2022. Qualitative studies and qualitative sections of mixed method studies were included.

SUMMARY

Twenty-four qualitative studies and seven mixed-method studies were included in the review. The findings consisted of one main theme "educational transformation", and three categories "challenging face-to-face clinical training", "transition from face-to-face to virtual education", and "support continua". The evidence indicated that during this health-related crisis, most of the training was provided as distance learning in various forms. According to the findings, distance education alone cannot replace face-to-face education and is suggested to be considered as a supplementary learning method.

OUTLOOK

This study provides a comprehensive understanding of nursing students' experiences during the COVID-19 pandemic, offering practical implications for educators and institutions globally. The lessons learned can inform strategic decisions, policies, and practices to enhance the resilience and adaptability of nursing education in the face of unforeseen challenges.

Integrating wellness into curricula using the ten dimensions of wellness as a framework

Burnout is a public health crisis that persists at the expense of clinician well-being, the healthcare workforce, and the quality of care provided. Clinician well-being is a professional imperative, yet nursing students still report higher levels of burnout than non-nursing students. Cultivating an academic learning environment that supports the development of resiliency, well-being, and improved student mental health requires a coordinated and sustained effort from nurse educators and academic leaders. This article aims to inspire nurse educators to take the first or next steps toward integrating wellness into nursing curricula. The ten dimensions of wellness provide a framework for wellness programming. Practical strategies aligned with each dimension are offered. As an exemplar, the Banding Together for Wellness program is summarized, including innovative incentives for student participation. Over the past five years, 426 (approximately 54 %) undergraduate nursing students voluntarily completed the program. While best practices may vary by institution, the strategies and resources offered herein can support nurse educators in the classroom, lab, and clinical setting as we all work to foster personal and professional well-being in nursing students. Nurse educators can be instrumental in cultivating the knowledge, skills, and attitudes required for life-long self-care, well-being, and nursing practice.

Assessment of the quality of life and mental health of healthcare students during the COVID-19 pandemic

OBJECTIVE

to evaluate the quality of life (QOL) and the presence of symptoms related to depression, anxiety, and stress among students in the healthcare field, in comparison to the period before the COVID-19 pandemic.

METHODS

A comparative cross-sectional research was conducted at a Brazilian public university. QOL was assessed using the WHOQOL-bref scale, while symptoms of depression, anxiety, and stress were evaluated using the DASS-21 scale. Descriptive and inferential analyses were employed to compare the two time periods.

RESULTS

A total of 355 students participated in this study. During the pandemic, there were significant increases in severe depression symptoms (15.1% versus 24.8%), moderate anxiety (18.3% versus 29.4%), and moderate stress (40.9% versus 53.8%) observed among the participants. Additionally, a significant reduction in QOL was noted, particularly in the domain of social relationships (65.2 versus 59.6, p-value 0.029).

CONCLUSION

The study highlights a deterioration in both the quality of life and the mental health of healthcare students during the COVID-19 pandemic.

The effect of COVID-19 on fear, anxiety, and sleep in nursing students

PURPOSE

This research was conducted to determine the effect of COVID-19 on fear, anxiety, and sleep in nursing students.

METHODS

The sample of the study consisted of 1222 students in the 2019-2020 academic year who were members of the student nurses association. The data were collected online via Google Form between June and August 2020 using the student information form containing socio-demographic characteristics, the Generalized Anxiety Disorder 7-Item (GAD-7) Scale, the fear of COVID-19 scale, and the Bergen Insomnia Scale.

RESULTS

In our study, the mean score of the fear of COVID-19 scale of nursing students was 18.23 ± 6.31, and it was determined that 51.8% had sleep problems and 70.9% had anxiety (39.9% mild, 20.8% moderate, and 10.2% severe). In simple linear regression analysis, the fear of COVID-19 was found to be statistically significant and positively correlated with anxiety (β: 0.383, p = 0.001), and the fear of COVID-19 (β: 0.120, p = 0.001) and anxiety (β: 0.346, p = 0.001) was found to be statistically significant and positively correlated with sleep.

CONCLUSION

In our study, there is a relationship between nursing students' fear of COVID-19 and anxiety and sleep quality. Accordingly, it is recommended to train students in effective methods for coping with the fear of COVID-19, and to take initiatives to reduce related anxiety and sleep problems.

Influencing factors of sense of responsibility among undergraduate nursing students: A cross-sectional study

BACKGROUND

Nursing students are critical in responding to public health emergencies like the COVID-19 pandemic. Their ability to fulfill their responsibilities is influenced by their sense of responsibility, which holds profound cultural significance, particularly in traditional Chinese culture. However, limited research has specifically explored the sense of responsibility among undergraduate nursing students in China and globally.

OBJECTIVES

This study aimed to determine the sense of responsibility among undergraduate nursing students and identify potential factors associated with it.

DESIGN, SETTING & PARTICIPANTS

We conducted a cross-sectional study and recruited 526 nursing students from June to July 2022 in Guizhou province in southwest China.

METHODS

Participants completed the General Information Questionnaire, Sense of Responsibility, and Self-esteem Scale. We analyzed the relationship between a sense of responsibility and self-esteem using Spearman correlation analysis. Then we determined factors that affect undergraduate nursing students' sense of responsibility using multiple linear stepwise regression.

RESULTS

Nursing students' total sense of responsibility scores were 96(84,106). The study found a positive association between self-esteem and a sense of responsibility (r = 0.433, P < 0.001) and its four dimensions: altruism (r = 0.381, P < 0.001), self-control (r = 0.378, P < 0.001), courage (r = 0.300, p < 0.001), and commitment (r = 0.361, P < 0.001). Self-esteem (β = 1.532, p < 0.001), personality (extroverted personality β = 7.263, P < 0.001; neutral personality β = 3.221, P = 0.029), and social practice experience (β = -3.156, P = 0.010) significantly influenced undergraduate nursing students' sense of responsibility (R2 = 0.268, F = 17.065, P < 0.001).

CONCLUSIONS

The study highlights the importance of nursing students' sense of responsibility and suggests room for improvement in its level. Higher self-esteem was associated with a stronger sense of responsibility. Additionally, self-esteem, personality, and social practice experience emerged as significant influencing factors. Nursing educators should prioritize students' sense of responsibility and explore targeted interventions, such as social practice activities, particularly for students with low self-esteem and introversion.

Addressing the Mental Health of Nursing Students During the Pandemic: The Evaluation of a Needs Assessment by a College of Nursing Mental Health Task Force

BACKGROUND

A Mental Health Task Force (MHTF) was developed in a large public college of nursing in the Southeastern United States to address the urgent mental health needs expressed by growing numbers of nursing students related to the coronavirus disease 2019 (COVID-19).

AIMS

The purpose of this study was to report on a needs assessment conducted by the MHTF.

METHODS

The needs assessment study design was a 16-item cross-sectional online survey and four "Town Hall" focus groups with nursing students, faculty, and staff (n = 1-8 participants per group). Survey data were analyzed using descriptive statistics and free-text questions from the survey and focus groups were analyzed using a qualitative descriptive approach.

RESULTS

Undergraduate and graduate students (n = 115) ranging in age from 17 to 50 years completed the survey; 95% female, 94% full-time, 56% employed, 77% White, and 81% in the Bachelor of Science in Nursing program. Eleven students participated in the focus groups. The analysis of the free-text survey questions identified the students' perceived needs. Mental health care was the most frequently requested, followed by faculty check-ins, stress management, and peer support.

CONCLUSIONS

The administration of the survey provided an opportunity for students to communicate concerns and make requests. To address the ongoing effects of the COVID-19 pandemic on nursing students, multi-modal needs assessments should be conducted periodically to identify priority mental health needs.

Survey on the Mental Health of Dispensing Pharmacists in the Auvergne-Rhône-Alpes Region (France)

BACKGROUND

The COVID-19 pandemic intensely involved pharmacists in France, with new responsibilities on a large scale, introducing to dispensary practice the performance of vaccination and nasopharyngeal swabs. This study aimed to assess the prevalence of burnout, anxiety, and depression in pharmacists after the COVID-19 health crisis and to identify factors associated with psychological distress.

METHODS

A cross-sectional observational study involved 1700 pharmacies in an entire French region. Sociodemographic, geographical, and medical information (burnout tested with the MBI and anxiety/depression measured on the HAD scale) were collected via an online anonymous self-administered questionnaire. The characteristics of the pharmacy and the practice of antigen testing and vaccination were requested. Quantitative and qualitative variables associated with psychological distress were investigated with a factor analysis.

RESULTS

In total, 360 responses were collected (20.5%). Of the responses, 41.9% showed definite anxiety symptoms and 18.3% showed proven depressive symptoms. Three clusters were described according to the intensity of burnout experience, depersonalization, and loss of personal accomplishment. The analysis identified that one cluster was at high risk of burnout (high burnout and depersonalization scores). Of these stressed, exhausted pharmacists, 69.3% showed definite anxiety, 37.9% showed proven depression, and in smaller pharmacies. The carrying out of antigenic testing and anti-COVID vaccination, as well as the geographical location of the pharmacy, were not discriminating factors in these three groups.

CONCLUSION

Mental health care and suicide prevention should be provided to at-risk pharmacists. It seems essential to publicize the range of resources available to support pharmacists.

Fear, stress, anxiety, depression and insomnia related to COVID-19 among undergraduate nursing students: An international survey

The emergence of COVID-19 has produced unprecedented change in daily life activities leading to major impacts on psychological wellbeing and sleep among individuals worldwide. The study aimed to assess levels of fear, stress, anxiety, depression, and insomnia among undergraduate nursing students in four countries two years after the start of the pandemic. An international, multi-centre cross-sectional electronic survey was conducted between December 2021 and April 2022. An on-line questionnaire was distributed via Qualtrics® and JISC® software. Instruments included the Fear of COVID-19 Scale, the Perceived Stress Scale, the Hospital Anxiety and Depression Scale and the Insomnia Severity Index, and a demographics and academic background questionnaire. The independent variables included demographic and academic backgrounds, while fear level, stress, anxiety, depression, and insomnia were the dependent variables. A total of 918 undergraduate nursing students from KSA, Oman, UK, and UAE were participants in the study. Students presented with stress (91.6%), anxiety (69.1%), depression (59.8%), and insomnia (73.2%). The participants' mean Fear of COVID-19 Scale score was 12.97 (SD = 6.14). There were significant positive relationships between fear of COVID-19, stress, anxiety, depression, and insomnia. Undergraduate nursing students experienced moderate to severe levels of Fear of COVID-19, stress, anxiety, depression, and insomnia two years after the onset of the COVID-19 pandemic. Psychological intervention and peer support are needed to reduce the long-term adverse outcomes of mental health problems and insomnia. It is important to introduce education about crisis management of infectious disease during pandemics into the nursing curriculum to increase student knowledge and improve their preparedness for such emergencies.

Fear and stress related to COVID-19 and associated factors among undergraduate nursing students in Qatar

BACKGROUND

The emergence of the coronavirus disease (COVID-19) has had an impact on nearly every human being with millions of related infections and deaths. The negative impact of the pandemic on individuals' mental health such as fear and stress, particularly among university students, have been reported. While the switch to online teaching and learning played an important mitigating role, it also had presented additional challenges to students' mental health.

AIM

To examine the prevalence of fear and stress among undergraduate nursing students in Qatar and the factors associated with fear of COVID-19.

METHOD

A cross-sectional design. An online survey was sent to students at the University of Calgary in Qatar.

RESULTS

135 participants completed the survey. The findings showed differences in fear of COVID-19 and stress and satisfaction with the measures proposed by the academic institution based on participants' demographic and COVID-19 profiles. Furthermore, fear of COVID-19 was associated with the age group (26-35), academic year level, and satisfaction with the measures proposed by the academic institution.

CONCLUSION

The study found that switching teaching and learning online had a negative impact on participants' fear and stress. Several strategies were suggested to alleviate students' fear and stress and support them during future pandemics.

An Exploration of Student Nurses' Experiences of Burnout during the COVID-19 Pandemic Using the Copenhagen Burnout Inventory (CBI)

Burnout amongst healthcare professionals has been a long-considered condition associated with the workplace environment. Student nurses studying at Sheffield Hallam University continued to engage in their training during the COVID-19 pandemic; however, the stressors of this experience were anecdotally highlighted to their academic staff. Furthermore, burnout can be linked to the ongoing difficulties with recruitment and retention of nursing staff within the NHS workforce. This work aimed to determine the burnout among nursing students experience by obtaining quantitative data to understand their experiences. The Copenhagen Burnout Inventory was used to gauge levels of burnout across the different fields of nursing students. Results identified that: (1) mental health students reported feeling tired significantly less often than child and adult field students (mean rating of 69% versus 91.7% and 84.0%, respectively); (2) students aged 30-39 feel tired significantly less often than both younger student age groups (mean rating 59.4% versus 82.8% and 90.6%); (3) there was a significant difference in how often different age groups felt "tired of working with clients" (F(4) = 2.68, p = 0.04) and that "they couldn't take it anymore" (F(4) = 2.53, p = 0.05); (4) child-field students reported generally higher levels of global burnout (mean CBI total = 57.9%) whilst mental health students reported lower levels (mean CBI total = 54.1%). Considering these results, it is imperative for both higher education institutions and potential employers to consider the impact of COVID-19 and burnout, and the levels of support offered to student nurses during their training and transition to practice as newly qualified nurses.

Insomnia and common mental disorder among patients with pre-existing chronic non-communicable diseases in southern Ethiopia: a survey during COVID-19 pandemic

Background

COVID-19 has been causing significant mental health problems and other health-related issues. Despite the fact that COVID-19 has a significant impact on chronic disease patients, there is scant research on insomnia, common mental health disorders (CMD), and their associated factors among chronic disease patients.

Objective

The purpose of this study was to assess the prevalence of insomnia and common mental disorders (CMD) and their associated factors among patients with pre-existing chronic NCDs in Sidama, southern Ethiopia.

Methods

A multicenter cross-sectional study was undertaken between June 1 and September 1, 2021. The study included 633 participants. CMD and insomnia were assessed using a 20-item Self-Reported Questionnaire (SRQ-20) and a 7-item Insomnia Severity Index (ISI) scale, respectively. To describe the various variables, descriptive statistics were used. We performed multivariable logistic regression analysis to identify independent factors associated with CMD and insomnia. A value of p < 0.05 was considered statistically significant at a 95% confidence interval.

Results

The prevalence of insomnia and CMD was found to be 39.3% and 46.8%, respectively. Being merchant (AOR = 0.33; 95% CI = 0.13, 0.82), having a diagnosis of diabetes mellitus (AOR = 1.89; 95% CI = 1.04, 3.46), comorbid diagnosis (AOR = 3.96; 95% CI = 2.27, 6.89), low social support (poor (AOR = 3.37; 95% CI = 1.51, 7.57) and moderate (AOR = 3.13; 95% CI = 1.46, 6.69)), symptoms of insomnia (AOR = 12.08; 95% CI = 7.41, 19.72) and poor quality of life (QOL) (AOR = 1.67; 95% CI = 1.04, 2.72) were independent predictors of CMD. We also found out that, having cardiovascular disorders (CVDs) (AOR = 2.48; 95% CI = 1.18, 5.19), CMD (AOR = 12.09; 95% CI = 7.46, 19.61), and poor QOL (AOR = 2.04; 95% CI = 1.27, 3.26) were significantly associated with insomnia symptoms.

Conclusion

Our study suggests that substantially high prevalence of CMD and insomnia. Significant association between CMD and occupation, diagnosis, comorbidity, social support, insomnia, and QOL were found. We also revealed that having CVDs, CMD, and poor QOL were significantly associated with insomnia symptoms. Therefore, dealing with the mental health problems of patients with chronic NCDs is an essential component of public health intervention during the COVID-19 pandemic.

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.

Prevalence of Insomnia and Factors Influencing Its Incidence in Students of Tbilisi State Medical University: A Cross-Sectional Study

Sleep is essential for overall health and well-being, however, medical students often face challenges in the form of insomnia or sleep-related disorders. This cross-sectional study investigates the factors influencing the incidence of insomnia in medical students at Tbilisi State Medical University during the 2022-2023 academic year. Using an online questionnaire, data was collected from 174 respondents with self-reported insomnia, and processed with spreadsheet software. The questionnaire collected demographic information, and data regarding sleeping patterns, and asked respondents to choose 'yes' or 'no' for each factor and its effect on their self-reported insomnia. After applying inclusion and exclusion factors, 122 responses were used for analysis. A chi-square analysis was conducted to verify the statistical significance of the data (p = 0.002002). The study revealed a high prevalence of 70.11% of respondents reporting sleeping difficulties. A total of 71.30% of respondents reported excessive workload as the most significant factor contributing to the incidence of their insomnia. Sixty-eight percent of respondents reported mental health issues (including anxiety and depression), and 65.5% reported improper sleep hygiene (including daytime napping and irregular sleep schedules) to play a role in the incidence of their insomnia. Social media and entertainment platform usage (59.8%) and stimulant consumption (48.4%) were comparatively less prominent but still noteworthy contributors to insomnia. The study also found that the majority of respondents (59.8%) experience onset-related insomnia, while 40.4% experience maintenance-related insomnia. This study found excessive workload to be the factor that most influenced the incidence of insomnia in medical students at Tbilisi State Medical University. This can be attributed to the increased academic load a medical student has to face and the worry about academic performance. Proper sleep hygiene, mental health support, and workload adjustments are suggested to decrease the incidence of insomnia among medical students at Tbilisi State Medical University.

Magnitude of general anxiety disorder among nursing students and its associated factors

Background

University training in nursing together with other student variables can increase the risk of anxiety in students. It is important to assess the student's level of anxiety, which can have repercussions on their training and mental health. There are several validated tools such as the generalized anxiety disorder scale (GAD-7).

Objective

To know which factors are associated with the appearance of anxiety and which protect against it in university nursing students.

Method

A cross-sectional descriptive study was carried out in which 170 university nursing students from University of Jaén participated. A bivariate and multivariate analysis was performed, calculating odds ratio and adjusted odds ratio (aOR) with 95% confidence intervals (CIs) to determine which factors were associated with a higher score on the GAD-7 questionnaire, and therefore with the presence of anxiety.

Results

In total, 66.5% (113) of the students have suffered an anxiety crisis on some occasion and 48.8% (83) of the students did not carry out activities of any kind to control anxiety and stress. Practicing religious and spiritual beliefs increased the probability of having anxiety compared to those who did not have religious beliefs (aOR = 3.92; 95% CI = 1.09, 14.08), as well as having previously suffered an anxiety crisis (aOR = 5.13; 95% CI = 2.39, 11.04). Protective factors against anxiety appear to be second-year students (aOR = 0.33; 95% CI = 0.16, 0.72) and being deeply satisfied with the teaching staff (aOR = 0.03; 95% CI = 0.01, 0.79).

Discussion/Implications for practice

Knowing the factors that are associated with the appearance of anxiety is necessary to facilitate early detection and care in nursing university students.

Correlation Between Chronotypes and Depressive Symptoms Mediated by Sleep Quality Among Chinese College Students During the COVID-19 Pandemic

Purpose

The COVID-19 pandemic has adversely impacted the mental health of the population. The current study aimed to determine the prevalence of depressive symptoms and sleep disturbances among Chinese college students during the COVID-19 pandemic and investigate the correlations between chronotypes, sleep quality, and depressive symptoms.

Participants and Methods

In the current study, 2526 college students responded anonymously to an online questionnaire survey from 26 May 2020 to 20 July 2020. The participants' chronotypes, sleep quality, and depressive symptoms were evaluated using the Chinese version of the Morning and Evening Questionnaire-5 (MEQ-5), Pittsburgh Sleep Quality Index (PSQI), and Patient Health Questionnaire-9 (PHQ-9). Sociodemographic information of the participants was also acquired. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) 19.0 software, with the mediating effect assessed by Hayes' PROCESS Macro.

Results

During the COVID-19 pandemic, the prevalence of depressive symptoms and sleep disturbances among Chinese college students surveyed was 54.95% and 48.18%, respectively. From absolute evening chronotype to absolute morning chronotype, the surveyed college students' chronotypes were negatively correlated with their depressive symptoms. Moreover, the mediation analysis showed that the correlation between chronotypes and depressive symptoms was fully mediated by sleep quality. Eveningness college students with poorer sleep quality were more likely to report higher levels of depressive symptoms.

Conclusion

Our findings suggest that during the COVID-19 pandemic, delayed circadian preference (ie, eveningness) may be linked to worse depressive symptoms among Chinese college students, and call for more attention to the sleep quality of Chinese college students as sleep quality fully mediated the correlation between chronotypes and depressive symptoms among them. Reasonable adjustment in bedtime/circadian preference and improvement in sleep quality may help to reduce the prevalence and severity of depressive symptoms among Chinese college students.

Positive childhood experiences on flourishing mediated by meaning in life in Chinese undergraduate nursing students: A cross-sectional study

AIM

To examine the associations of positive childhood experiences (PCEs) with positive mental well-being (i.e. meaning in life and flourishing) in Chinese undergraduate nursing students. The mediation effect of meaning in life on the association between PCEs and flourishing was investigated.

BACKGROUND

Mental health problems, such as high stress, have been prevalent in nursing students. Less is known about positive well-being that could be independent of mental health problems.

DESIGN

This was a cross-sectional study in Chinese nursing students of age ≥ 18 years enrolled in either three-year associate degree or four-year bachelor's degree program at 25 different universities across mainland China.

METHODS

PCEs were measured using the 10-item Benevolent Childhood Experiences scale on perceived relational and internal safety and security, positive and predictable quality of life, and interpersonal support by age 18. Measures of positive mental well-being included the Secure Flourish Index on flourishing and the Meaning in Life Questionnaire on presence of meaning and searching for meaning. Associations were analyzed using multivariable linear regression adjusting for perceived stress.

RESULTS

Of 2105 participants, 87.7% were female, the mean [SD] age was 19.8 [1.6] years. More PCEs were associated with higher flourishing (adjusted b=6.82, 95% CI 6.23, 7.41, β = 0.44), presence of meaning (adjusted b=0.91, 95% CI 0.75, 1.06, β = 0.24), and searching for meaning (adjusted b=0.67, 95% CI 0.49, 0.84, β = 0.17). Presence of meaning (indirect effect: adjusted b=1.57, 95% CI 1.27, 1.89) and searching for meaning (indirect effect: adjusted b=0.84, 95% CI 0.60, 1.08) partially mediated 23% and 12% of the association between PCEs and flourishing, respectively.

CONCLUSIONS

PCEs showed dose-response associations with meaning in life and flourishing in Chinese undergraduate nursing students, and the associations remained independent of perceived stress. The association between PCEs and flourishing was mediated through meaning in life. Higher meaning of life and flourishing associated with more PCEs highlighted the importance of increasing awareness and early screening of PCEs in nursing schools. The mediation effects of meaning in life warranted targeted interventions for helping students with fewer PCEs to flourish.

Profile and quality of life of the adult population in good health according to the level of vitality: European NHWS cross sectional analysis

BACKGROUND

The World Health Organization's definition of health highlights the importance of mental and physical wellbeing and not only disease state. However, lack of awareness on the burden of impaired vitality and its impact on the quality of life of the general healthy population prevents healthcare providers from delivering appropriate solutions and advice. This study aims to better characterize this population in Europe and identify the profile and the health reported outcomes associated with impaired vitality.

METHODS

This retrospective observational study included National Health and Wellness Survey (NHWS) data collected in healthy participants aged 18-65 years from five European Union countries in 2018. Socio-demographic and lifestyle characteristics, comorbidities, attitudes towards healthcare systems, Patient Activation Measure, health-related quality of life outcomes (EQ-5D), and work productivity and activity impairment were analysed according to SF-12 vitality score subgroups (≥ 60, 50- < 60, 40- < 50, < 40).

RESULTS

A total of 24,295 participants were enrolled in the main analysis. Being a female, younger, having a lower income and being obese or having sleep and mental disorders was associated with an increased risk of impaired vitality. This was associated with a higher consumption of healthcare resources along with having a weak patient-physician relationship. Participants who were disengaged in the self-management of their health were 2.6 times more likely to have a low level of vitality. For participants in the lowest vitality group, odds of mobility problems increased by 3.4, impairment of usual activity by 5.8, increased of pain and discomfort by 5.6 and depression and anxiety by 10.3, compared with participants in the highest vitality group. Also, odds of presenteeism increased by 3.7, overall work impairment by 3.4 and daily activity losses by 7.1.

CONCLUSION

Evidence-based trends facilitate the identification of a healthy population with impaired vitality in real-world practice. This study highlights the actual burden of low vitality on daily life activities, particularly on mental health and reduced work productivity. Additionally, our results underline the importance of self-engagement in the management of vitality impairment and highlights the need to implement strategies to address this public health concern in the affected population (HCP-patient communication, supplements, meditation).

Psychological Well-Being and Resilience of Slovenian Students During the COVID-19 Pandemic

Introduction

Students’ mental health is recognised as an important public health issue, and the strict measures and many changes resulting from the COVID-19 pandemic may have exacerbated this. The aims of the study were thus to explore psychological well-being among university students in Slovenia during the beginning of the second lockdown, and to assess associations among their psychological well-being, demographic characteristics, presence of a chronic health condition, and resilience.

Methods

The Slovenian online cross-sectional survey was performed as part of a large-scale international survey led by the COVID-HL Consortium, between the 2nd and 23rd November 2020. The study was carried out on a sample of 3,468 university students (70% female) in Slovenia, aged between 18 to 40 (M=22/SD=3). In addition to sociodemographic data and that on the presence of a chronic health condition, data on subjective social status (SSS), psychological well-being (WHO-5) and resilience (CD-RISC 10) was also gathered.

Results

In our study 52% of university students reported good psychological well-being. Hierarchical binary logistic regression revealed that male, older students, those with higher perceived subjective social status, students without a chronic health condition, and those with higher score on resilience were more likely to have good psychological well-being. Resilience was the strongest predictor of psychological well-being in our study.

Conclusions

Systematic preventive approaches/interventions in the field of mental health should be implemented among students in Slovenia. In this context it is important to develop and deliver programmes for enhancing resilience, which is an important protective factor in times of mental distress.

Effect of online modified mindfulness-based stress reduction training on the resilience of nursing interns in China

AIM

This study aimed to adopt online mindfulness-based stress reduction (MBSR) training to increase the resilience of nursing interns and help them to achieve a smooth transition.

DESIGN

A one-group pretest-posttest study design was used.

METHODS

A total of 119 college nursing interns were recruited from 12 tertiary hospitals in Beijing on Feb.20, 2021. The MBSR training was organized into 4 weeks of courses, conducted online using Tencent Meeting and taught by a certified teacher at the Oxford Mindfulness Centre. Resilience was assessed before and 2 weeks after the training, respectively, using Resilience Scale for Chinese Adolescents via an online questionnaire tool.

RESULTS

Seventy-nine college nursing interns finished both of the resilience questionnaire surveys. The mean resilience values before and after the training were 98.7 ± 13.69 and 104.57 ± 16.64 respectively. The 4-week online MBSR training considerably increased the resilience of nursing interns. This can be an effective measure to maintain a balanced state among nursing interns and help them smoothly transition from school to clinical practice. No Patient or Public Contribution.

COVID-19 phobia, loneliness, and dropout intention among nursing students: the mediating role of social support and coping

The coronavirus outbreak led to many students' experiencing tremendous fear, resulting in numerous psychological and mental health issues, and potentially impacting academic outcomes. The purpose of this study was to examine the mediating role of coping and social support on the relationships between COVID-19 phobia, loneliness, and the intention to abandon nursing education in students. An online survey using a cross-sectional research design was used. A total of 301 full-time student nurses from the Philippines who were currently registered in a nursing programme were included. Nearly half 40.8% (n = 127) of the nursing students were found to experience COVID-19 phobia. COVID-19 phobia had direct positive effects on loneliness (β = 0.210, p < .001) and intention to abandon nursing education (β = 0.293, p < .001). Social support and coping had partial mediating effects on the association between COVID-19 phobia and loneliness and the intention to abandon nursing education. COVID-19 phobia was associated with increased loneliness and greater desires to abandon nursing studies in students. However, by providing adequate social support and coping, the negative effects of the pandemic on nursing students' outcome were reduced, resulting in decreased loneliness and improved student retention.

Bereavement and Professional Competencies: Exploring the Personal Experience of Death Among Nursing Students - A Qualitative Study

Purpose: To explore the death experiences of nursing students in their personal lives. Methods: This study employed a qualitative descriptive design using the semi-structured interview approach. A purposive sampling method was used to recruit 24 nursing students from September 2020 to July 2022. Data were analyzed using Colaizzi's analysis method. Lincoln and Guba's criteria was used to evaluate the trustworthiness of the data. Results: Four main themes emerged from the interviews: (a) reactions to encounters with death; (b) adjustment strategies; (c) personal growth induced by the death experiences; and (d) professional reflections for preparing nurse role. Conclusions: Although the death of a loved one makes nursing students suffer from grief and emotional distress, we show that the experience promotes the personal growth and professional competencies of nursing students and thereby, developing their overall aptitude towards the profession. Death experiences of nursing students have shown to allow them to reflect on both life and death, to consider the demands of the nursing profession, and to provide foundation for nursing students to be more empathetic and compassionate when facing death in the future. Exploring death experiences of nursing students is vital in better providing better quality education and personal support for nursing students.

COVID-19 and common mental health symptoms in the early phase of the pandemic: An umbrella review of the evidence

BACKGROUND

There remains uncertainty about the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health. This umbrella review provides a comprehensive overview of the association between the pandemic and common mental disorders. We qualitatively summarized evidence from reviews with meta-analyses of individual study-data in the general population, healthcare workers, and specific at-risk populations.

METHODS AND FINDINGS

A systematic search was carried out in 5 databases for peer-reviewed systematic reviews with meta-analyses of prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms during the pandemic published between December 31, 2019 until August 12, 2022. We identified 123 reviews of which 7 provided standardized mean differences (SMDs) either from longitudinal pre- to during pandemic study-data or from cross-sectional study-data compared to matched pre-pandemic data. Methodological quality rated with the Assessment of Multiple Systematic Reviews checklist scores (AMSTAR 2) instrument was generally low to moderate. Small but significant increases of depression, anxiety, and/or general mental health symptoms were reported in the general population, in people with preexisting physical health conditions, and in children (3 reviews; SMDs ranged from 0.11 to 0.28). Mental health and depression symptoms significantly increased during periods of social restrictions (1 review; SMDs of 0.41 and 0.83, respectively) but anxiety symptoms did not (SMD: 0.26). Increases of depression symptoms were generally larger and longer-lasting during the pandemic (3 reviews; SMDs depression ranged from 0.16 to 0.23) than those of anxiety (2 reviews: SMDs 0.12 and 0.18). Females showed a significantly larger increase in anxiety symptoms than males (1 review: SMD 0.15). In healthcare workers, people with preexisting mental disorders, any patient group, children and adolescents, and in students, no significant differences from pre- to during pandemic were found (2 reviews; SMD's ranging from -0.16 to 0.48). In 116 reviews pooled cross-sectional prevalence rates of depression, anxiety, and PTSD symptoms ranged from 9% to 48% across populations. Although heterogeneity between studies was high and largely unexplained, assessment tools and cut-offs used, age, sex or gender, and COVID-19 exposure factors were found to be moderators in some reviews. The major limitations are the inability to quantify and explain the high heterogeneity across reviews included and the shortage of within-person data from multiple longitudinal studies.

CONCLUSIONS

A small but consistent deterioration of mental health and particularly depression during early pandemic and during social restrictions has been found in the general population and in people with chronic somatic disorders. Also, associations between mental health and the pandemic were stronger in females and younger age groups than in others. Explanatory individual-level, COVID-19 exposure, and time-course factors were scarce and showed inconsistencies across reviews. For policy and research, repeated assessments of mental health in population panels including vulnerable individuals are recommended to respond to current and future health crises.

Being a nursing student during the coronavirus pandemic: a mixed methods study

BACKGROUND

The COVID-19 pandemic led to major changes in people's lives via protective strategies aimed at limiting the transmission of COVID-19, including social distancing, lockdowns, cancelled or limited leisure activities and tutorials and supervision for students taking place digital. All of these changes may have influenced students' health and quality of life.

AIM

To describe and explore fear of COVID-19 and psychological distress, as well as general health and quality of life, among baccalaureate nursing students at 1 year into the COVID-19 pandemic.

METHOD

We used a mixed method study design, including quantitative data from University of Agder, data that was a part of a national survey of baccalaureate nursing students nearly one year into the pandemic. All the nursing students at the university were invited to take part between 27 January and 28 February 2021. The quantitative survey included 396 (out of total 858) baccalaureate nursing students (response rate: 46%). The quantitative data were collected using well-validated measures of fear of COVID-19, psychological distress, general health and quality of life, and the data were analysed using the ANOVA-tests for continuous data and chi-square tests for categorical data. Qualitative data were gathered from focus group interviews from the same university two-three months later. Five focus group interviews were conducted with a total of 23 students (7 men, 16 women). The qualitative data were analysed using systematic text condensation.

RESULTS

The mean score (standard deviation [SD]) for fear of COVID-19 was 2.32 (0.71), for psychological distress was 1.53 (1.00), for general health was 3.51 (0.96) and for overall quality of life was 6.01 (2.06). In the qualitative data, we identified the overarching theme effect of COVID-19 on students' quality of life and the three main themes; importance of personal relations, physical health challenges and mental health challenges.

CONCLUSION

The COVID-19 pandemic influenced negatively nursing students' quality of life and physical and mental health, and they often felt lonely. However, most of the participants also adapted strategies and resilience factors to cope with the situation. Via the pandemic situation, the students learned additional skills and mental mindsets that may be useful in their future professional lives.

Validation of student academic advising and counseling evaluation tool among undergraduate nursing students

BACKGROUND

Academic advising and counseling services support students in achieving their educational outcomes. Unfortunately, there is a paucity of research on academic advising and student-support systems among nursing students. Therefore, the current study aims to develop a student academic advising and counseling survey (SAACS) and measure its validity and reliability.

METHODS

Cross-sectional design was used to collect online self-administered data from undergraduate nursing students in Egypt and Saudi Arabia. The SAACS is developed based on relevant literature and tested for content and construct validity.

RESULTS

A total of 1,134 students from both sites completed the questionnaire. Students' mean age was 20.3 ± 1.4, and the majority of them were female (81.9%), single (95.6%), and unemployed (92.3%). The content validity index (CVI) of SAACS overall score (S-CVI) is 0.989, and S-CVI/UA (universal agreement) is 0.944, which indicates excellent content validity. The overall SAACS reliability showed an excellent internal consistency with a Cronbach's Alpha of 0.97 (95% CI: 0.966 - 0.972).

CONCLUSIONS

The SAACS is a valid and reliable tool for assessing students' experience with academic advising and counseling services and can be utilized to improve those services in nursing school settings.

Delayed sleep-wake rhythm due to staying at home during the COVID-19 pandemic and sleep debt after returning to campus among Japanese nursing university students: A longitudinal study

This study aimed to investigate sleep problems during staying at home due to the coronavirus disease 2019 (COVID-19) pandemic and after returning to campus among university nursing students. We analyzed data from self-reported sleep surveys conducted during a nursing course at a university in Tokyo between 2019 and 2021. During staying at home due to COVID-19, we observed delayed sleep-wake rhythm, prolonged sleep duration on weekdays, a decreased sleep debt, improved daytime sleepiness, and worsened insomnia, especially in terms of difficulty initiating sleep (Study 1; 18 paired data). After returning to campus, we found advanced wake-up time, shortened sleep duration, increased sleep debt, worsened insomnia, and increased daytime sleepiness (Study 2; 91 paired data). The association between advanced midpoint of sleep and commute time over an hour (aOR, 3.29; 95%CI: 1.24-8.72) was confirmed. Furthermore, sleep paralysis and nightmares were more prevalent among nursing students with an advanced midpoint of sleep, whereas nursing students whose midpoint of sleep was delayed had higher daytime sleepiness after returning to campus. To maintain regular sleep-wake rhythms and sufficient sleep duration, the educational environment surrounding nursing university students (e.g., curriculum, class schedule, style of class) should be established considering their age-dependent biological rhythm in addition to sleep hygiene education for students.

"We're Not Going to Be as Prepared": A Qualitative Study of Healthcare Trainees' Experiences after One Year of the COVID-19 Pandemic

The COVID-19 pandemic had significant impacts on the mental health and academic experiences of healthcare trainees. Building on findings from earlier in the pandemic, we explore the impacts on healthcare trainees after a sustained pandemic period of 12-14 months, involving multiple lockdowns, changes in government COVID-19 regulations and the delivery of health education. A qualitative study was conducted between March-May 2021. Participants were 12 healthcare trainees (10 women, 2 men) of medicine, nursing, and midwifery, registered at one of three higher education institutions in the United Kingdom. Interviews were fully transcribed, and data were thematically analysed using a combination of deductive and inductive approaches. We identified three key themes with eight subthemes: (i) academic experiences (adjustment to online learning, loss of clinical experience, confidence in the university), (ii) impacts on wellbeing (psychosocial impacts, physical impacts, pandemic duration and multiple lockdowns), and (iii) support frameworks (university preparedness for increased student support needs, importance of relationship with academic tutors). Findings shed light on the long-lasting and emerging impacts of the pandemic over time. We identify support needs for trainees both during their academic studies, and as they move forwards into professional roles within the healthcare workforce. Recommendations are made for higher education institutions and healthcare employers.

Relationship between Anxiety, Depression and Learning Burnout of Nursing Undergraduates after the COVID-19 Epidemic: The Mediating Role of Academic Self-Efficacy

BACKGROUND

Although cross-sectional studies on the learning status of nursing undergraduates during the COVID-19 epidemic have surged, few studies have explored the normalization of COVID-19 on students' learning burnout and mental health. The study was designed to investigate the learning burnout of nursing undergraduates in school under the normalization of the COVID-19 epidemic and explore the hypothesized mediation effect of academic self-efficacy in the relationship between anxiety, depression and learning burnout in Chinese nursing undergraduates.

METHODS

A cross-sectional study was conducted among nursing undergraduates in the school of nursing of a university in Jiangsu Province, China (n = 227). A general information questionnaire, College Students' Learning Burnout Questionnaire, Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire depression scale (PHQ-9) were administered. Descriptive statistical analysis, Pearson correlation analysis, and multiple linear regression analysis were performed via SPSS 26.0. Process plug-in (Model 4) was used to test the mediating effect of academic self-efficacy (bootstrap 5000 iterations, α = 0.05).

RESULTS

Learning burnout (54.1 ± 0.656) was positively correlated with anxiety (4.6 ± 0.283) and depression (5.3 ± 0.366) (p < 0.01) and was negatively correlated with academic self-efficacy (74.41 ± 0.674) (p < 0.01). Academic self-efficacy plays a mediating role between anxiety and learning burnout (0.395/0.493, 80.12%) and a mediating role between depression and learning burnout (0.332/0.503, 66.00%).

CONCLUSION

Academic self-efficacy has a significant predictive effect on learning burnout. Schools and teachers should strengthen the screening and counselling of students' psychological problems, detect learning burnout caused by emotional problems in advance and improve students' initiative and enthusiasm for learning.

Factors Affecting Sleep Quality of College Students during the Coronavirus Disease 2019 Pandemic: A Cross-Sectional Study

Background and Objectives: The purpose of this study was to identify the correlation between college students' fear of coronavirus disease 2019 (COVID-19), intolerance of uncertainty, and sleep quality during the COVID-19 pandemic, and to identify factors affecting sleep quality. Materials and Methods: Data were collected through an online survey of 310 college students from three universities located in three regions in Korea. Results: The average sleep quality score of college students was 4.76 ± 2.86 points, the average fear of COVID-19 was 14.01 ± 5.05 points, and the average intolerance of uncertainty was 31.50 ± 7.92 points. Fear of COVID-19 and intolerance of uncertainty were positively correlated (r = 0.302, p < 0.001). Sleep quality was positively correlated with fear of COVID-19 (r = 0.246, p < 0.001). Sleep quality was positively correlated with intolerance of uncertainty (r = 0.212, p < 0.001). Health status was the most powerful factor that affected sleep quality (β = 0.377, p < 0.001). The next most powerful factors that affected sleep quality were fear of COVID-19 (β = 0.164, p = 0.003) and intolerance of uncertainty (β = 0.122, p = 0.027), respectively. Conclusions: These results are expected to be used as basic data for the development of health intervention programs to protect and improve the psychological well-being of college students by improving their sleep quality.

The relationship between depression, anxiety, e-health literacy, and health-promoting behavior in nursing students during COVID-19

The purpose of this study was to identify the correlation between depression, anxiety, e-health literacy (eHL), and health-promoting behaviors among nursing students during the coronavirus disease 2019 (COVID-19) pandemic, and to identify the factors affecting health-promoting behaviors. A cross-sectional study was conducted online, recruiting 301 nursing students recruited from 4 universities in the Chungcheng Province and Daejeon Metropolitan City in South Korea between May 28 and June 30, 2021. Data were analyzed using SPSS WIN 27.0. The general characteristics of the study participants were analyzed by frequency and percentage, and the degree of depression, anxiety, eHL, and health-promoting behaviors were calculated as averages and standard deviations. Differences in health-promoting behaviors according to general characteristics were analyzed using independent t tests and analysis of variance, and a post hoc Scheffe test was conducted. Correlations between depression, anxiety, eHL, and health-promoting behaviors were measured using Pearson correlation matrices. Stepwise multiple regression was performed to identify factors affecting health-promoting behaviors. During the COVID-19 pandemic, the average level of depression and anxiety was reported to be 3.93 (4.71) and 3.40 (4.30), respectively; 33.2% of nursing students experienced more than mild depression and 29.2% experienced anxiety. The average eHL level was 3.91 (0.56), and the average of health-promoting behaviors was 2.43 (0.45). Depression was positively correlated with anxiety (R = 0.734, P < .001) and negatively correlated with health-promoting behaviors (r = -0.198, P = .001), whereas eHL had a positive correlation with health-promoting behaviors (R = 0.347, P < .001). The factors affecting health-promoting behaviors were religion (β = -0.160, standard error [SE] = 0.048), current health status (β = -0.097, SE = 0.032), frequency of searching the Internet for health-related information in a week (β = -0.070, SE = 0.026), interest in health (β = -0.191, SE = 0.039), and critical eHL (β = 0.243, SE = 0.040); the explanatory power was 27.4%. Results demonstrate that during the COVID-19 pandemic, higher depression and anxiety among nursing students decreased health-promoting behaviors, while higher eHL increased health-promoting behaviors, and eHL was a major factor affecting health-promoting behaviors. These results contribute to the provision of basic data for the development of nursing intervention programs and educational strategies that can establish correct health-promoting behaviors by managing depression and anxiety among nursing students and improving eHL.

Impact of COVID-19 pandemic on sleep of undergraduate students: A systematic literature review

The 2019 coronavirus pandemic forced the shift to distance education aggravating mental and physical vulnerabilities of undergraduate students, including sleep. This review aims to describe sleep problem rates and prevalence, sleep pattern disruption, sleep duration, sleep quality, insomnia symptoms, psychological and socio-economic factors affecting sleep of undergraduates in 22 countries. A systematic search for articles published from 2020 to 2021 using 'COVID-19,' 'Coronavirus,' 'Pandemic,' 'Sleep,' 'Mental Health,' and 'Students' from PubMed, Scopus, and Cochrane yielded 2550 articles, where 72 were included. Selection criteria were: English full-text available articles, undergraduates and not postgraduates, reported sleep outcomes, and participants not from allied health courses. Risk of bias was assessed using various Joanna Briggs Institute checklists and outcomes were descriptively synthesized. Prevalence of sleep problems was notable, while longitudinal studies showed increased rates. There was significantly increased sleep duration, and sleep pattern disruption during lockdowns. Several psychological, behavioural, environmental, demographic, and socio-economic factors were found to be associated with sleep changes. These highlight the pandemic's impact on sleep of undergraduate students and reveal opportunities for institutions to intervene with policies and programs to promote the well-being of undergraduates. Limitations include recall bias and underrepresentation of other countries. This study is self-funded with registration number RGAO-2021-0071.

Mediating effect of work stress in the relationship between fear of COVID-19 and nurses' organizational and professional turnover intentions

Nursing is one of the most stressful and high-risk professions. It is important to identify the psychological problems experienced by nurses during the COVID-19 pandemic and examine the relationship between these problems to devise measures that can properly address them. This study examined mediating effect of work stress in the relationship between fear of COVID-19 and nurses' organizational and professional turnover intentions. Using a cross-sectional research design, this study was conducted on 486 nurses working in seven hospitals in Turkey. The mean age of the participants was 35.24 ± 6.81 and 59.9 % of them were women. The Fear of COVID-19 Scale, the General Work Stress Scale, and the Turnover Intention Scale were used to collect data. A mediation model showed that fear of COVID-19 was positively associated with work stress and organizational and professional turnover intentions. The model also revealed that work stress was positively associated with organizational and professional turnover intentions. Furthermore, the results demonstrated that fear of COVID-19 did not only have a direct effect on organizational and professional turnover intentions but also had an indirect effect on it via increased work stress. Findings improve our understanding of the role of work stress in the relationship between fear of COVID-19 and organizational and professional turnover intentions. The findings are fruitful for tailoring and implementing intervention programs to reduce the adverse psychological impacts of COVID-19 on nurses.

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.

Integration of e-learning approaches in a post-pandemic learning environment - Norwegian nursing students' recommendations from an action research study

The covid-19 pandemic has profoundly led to changes in use of digital platforms, online teaching, and e-learning strategies. The aim of the present study was to examine how future pedagogical approaches can promote constructive learning environments and facilitate nursing students learning processes in future post-pandemic scenarios based on an action research study, which were conducted through several steps from January 2021 through January 2022 in a Bachelor of Nursing program at UiT the Arctic University of Norway. Students from the 2020 enrollment were invited to focus group interviews in March 2021. The interviews were transcribed, and content analyzed, resulting in concrete advice, which were implemented for the next enrollment. Students from the 2021 enrollment were invited to similar focus groups, resulting in refined advice, which will be presented. The pandemic situation resulted in extensive use of digital platforms for the 2020 enrollment. Students from this cohort described shock and disappointment connected to their study start. They expected a new life, meeting new friends and to develop a student identity, but their expectations were broken. The loss of social connections led to isolation and a weak link to the program and to the nursing profession. They recommended integrated training of theoretical and practical skills in small groups combined with short, well-prepared digital lectures equivalent to "flipped classroom" approaches. Implementing their advice, the 2021 enrollment's experience became different. This group was prepared for extensive use of digital platforms and gave future advise on increased flexibility and balance between the various learning activities centered around the clinical sessions. Based on these experiences during the pandemic, we suggest that digital platforms and e-learning strategies facilitate nursing students learning in combination with active and social learning environments.

The Association between Change in Lifestyle Behaviors and Mental Health Indicators in Immunosuppressed Individuals during the COVID-19 Pandemic

Little is known on how changes in lifestyle behaviors affect mental health among immunosuppressed individuals who observed stricter physical and social distancing measures due to higher risk of complications during the COVID-19 pandemic. This study examines the association between changes in moderate-to-vigorous physical activity (MVPA), sedentary time (ST) and sleep duration following COVID-19 outbreak on mental health indicators of immunosuppressed individuals and their relatives. Participants (n = 132) completed an online questionnaire between May and August 2020. Linear regressions were conducted to assess the associations between an increase or decrease in lifestyle behaviors and mental health indicators. Individuals with decreased MVPA and increased ST experienced higher distress, anxiety and depressive symptoms. Those who reported an increase or decrease in sleep had higher levels of stress, distress and depressive symptoms. Decreases in sleep was associated with higher anxiety symptoms. Lifestyle behaviors in the context of a stressful life event such as the COVID-19 pandemic may impact mental health indicators of immunosuppressed individuals and their relatives.