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

Global perspectives: learning from the experiences of nursing students during the pandemic to enhance education

This research explored the lived experiences of 40 undergraduate nursing students from the UK, Canada, Australia and Gibraltar during the COVID-19 pandemic. A retrospective survey of nursing students was aimed at understanding the impact of the pandemic on nursing education, placements and student wellbeing, as well as the challenges and emotional impact students endured associated with caring for COVID-19 patients. The narratives were collected through an online questionnaire disseminated via a Twitter (X) platform on social media. The findings revealed five key themes: the impact of the pandemic on nursing education and support; the impact of the pandemic on placements and student wellbeing; the challenges and realities of caring for COVID-19 patients as a nursing student; the impact of the pandemic on the students' education and placements; and the emotional impact of the pandemic on them. Based on these findings, evidence-based recommendations are provided for supporting nursing students worldwide during pandemics and other public health crises.

Nursing students' readiness towards the 'new normal' in clinical practice: a distributed cognition qualitative perspective

BACKGROUND

Clinical practicums are a core component of baccalaureate nursing education. Following the coronavirus pandemic, there have been extensive changes in the workforce environment that may potentially affect nursing students' experience and readiness for clinical practicums.

METHODS

A qualitative study was conducted to explore final-year nursing students' experiences and readiness for their final clinical practicum before becoming a registered nurse. A purposive sample of 24 final-year baccalaureate nursing students was included in this study. Individual semi-structured interviews were conducted face-to-face via Zoom. The data was analysed using an inductive thematic analysis approach.

RESULTS

Three themes depicting students' experiences and clinical readiness were elucidated. The themes included: (1) Experiencing multiple concerns, (2) requiring a network of support, and (3) easing the transition to professional practice. Students considered the final clinical practicum as challenging and demanding which evoked numerous concerns.

CONCLUSIONS

Considering the stress that final-year nursing students experience, it will be important to devise strategies ranging from personal, relational, and environmental protective factors to enable their successful transition and completion of clinical practice.

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.

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.

The impact of COVID-19 on stress and resilience in undergraduate nursing students: A scoping review

BACKGROUND

Being a nursing student can be a stressful experience, faced with considerable academic and clinical demands. It has been suggested that the Coronavirus Disease 2019 (COVID-19) may have further exacerbated the pressure nursing students face. It has been posited that resilience, a complex psychological concept, may help nursing students overcome stressful situations.

AIMS

The aim of this scoping review was to examine the relationship between resilience and stress in nursing students during the COVID-19 pandemic.

METHODS

Relevant publications were identified by a comprehensive search of the literature from January 2019 to September 2022 to capture relevant publications during the COVID-19 global pandemic period from the following databases: CINAHL, Medline Complete, APA PsycInfo, Ovid EmCare and Web of Science. Fifteen studies met our inclusion criteria and were included in the review using Arskey & O'Malley's (2005) methodological framework for scoping reviews.

RESULTS

Our findings suggest that nursing students from all around the world have experienced high levels of stress during the COVID-19 pandemic. Almost unanimously, resilience was identified as a key protective factor against stress and the development of psychological morbidity. Those nursing students with higher levels of resilience were deemed more likely to stay on track with their studies, despite COVID-related challenges.

CONCLUSION

In conclusion, this scoping review adds to the well-established argument to incorporate resilience-building activities in undergraduate nursing curricula. Developing levels of resilience has the potential to empower nursing students for academic and clinical success, whilst facing the challenges of an ever-changing world.

Managing the Current Workforce: Status of New Graduate Nurse Well-being and Clinical Development 2018-2021

A structured transition to practice (TTP) program is beneficial to the professional success and retention of new graduate nurses (NGNs). The COVID-19 pandemic impacted clinical preparation and the TTP experience of NGNs. Data from the Versant National Database between 2018 and 2021 were analyzed to determine the current state of NGN well-being and clinical development. Key findings from the analysis indicate that NGNs that are a part of a comprehensive TTP program remain highly committed to their organization, have increased satisfaction working with their colleagues, and indicate low intent to leave their position. However, there are opportunities to address individual rewards and recognition, clinical assignments, morale, feelings of belongingness, and well-being. These findings further support the importance of a nurse residency program as part of an overall workforce strategy and that individual, programmatic, and practice environment outcomes must be longitudinally measured and analyzed to be able to make necessary evidence-based changes to meet the future needs of NGNs and the profession.

Initial outcomes and lessons learned from implementation of an online diversity & inclusion community

BACKGROUND

There is an opportunity to build online communities and digitize inclusive excellence such that all students, staff, and faculty can benefit. However, literature illustrating actionable strategies for creating online communities and mitigating barriers related to engagement is limited.

PURPOSE

We evaluated the feasibility, functionality, and usage of a college of nursing's (CON) online diversity and inclusion communication platform (i.e., D&I Community).

METHODS

From survey and college-wide discussion, we found that CON members are interested in employing opportunities for diversity, equity, and inclusion (DEI) discussions and engaging with DEI resources, but lack of time, competing priorities, and lack of awareness of the D&I Community were barriers to participation.

DISCUSSION

We are prepared to modify processes to improve engagement and promote a sense of belonging for all CON members.

CONCLUSION

Implementation and sustainability of this D&I Community require continual resource investment. Scalability can be considered once processes have been fully refined.

Coping Strategies During the COVID-19 Pandemic and Self-Determination: A Review of Russian Studies

Background

The COVID-19 pandemic is a multifaceted stressor. Its impact suggests long-term psychological effects. Self-determination promotes flexibility of goals and actions and helps to overcome the difficulties caused by stress.

Objective

To analyze coping strategies during the COVID-19 pandemic presented in Russian scientific studies (RQ1), and their relationship with self-determination (RQ2).

Design

Relevant studies (2020-2022) were selected from the Russian citation index (RSCI) database. Strict selection criteria were used. Twenty-four articles were selected for the final review. For dynamic analysis, four stages of the pandemic were identified.

Results

Prevailing coping strategies have changed over time. At the beginning of the pandemic, respondents used familiar coping mechanisms. Six months later, active coping strategies were more often used, but deprivation and avoidance strategies increased. A year later, there was an increase in denial and avoidance strategies. Using non-constructive coping strategies may indicate that, due to the long course of the pandemic, meeting basic psychological needs became increasingly frustrated, leading to helplessness, alienation, and lack of control. Later dynamics reflect the growth of effective coping strategies and confirm that when basic needs are blocked for a long time, people seek alternative ways to satisfy them.

Conclusion

The dynamics of coping strategies during the pandemic reflected their close relationship with basic psychological needs, as described in the theory of self-determination. The results confirmed the importance of self-determination as a dispositional variable in predicting coping mechanisms.

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

Background

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

Methods

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

Results

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

Conclusion

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

Stress, depression, and anxiety among undergraduate nursing students in the time of a pandemic

INTRODUCTION

Emerging literature reports on the challenges faced by nursing students internationally during the pandemic as they continue their education. The aim of this mixed methods study was to examine stress, depression, and anxiety among undergraduate nursing students at a Canadian university during the pandemic.

THEORETICAL FRAMEWORKS

Stress and coping and trauma theories informed this study.

METHODS

Mixed methods included an online questionnaire composed of the Depression Anxiety Stress scales (DASS), sociodemographic data, and quality of life items with open-ended questions.

RESULTS

Sample included 280 participants. Mean scores for depression and stress were in the mild level, for anxiety in the moderate level; 24 , 37 and 23 % of the sample had scores of severe or extremely severe for depression, anxiety, and stress respectively. Written comments reflected the impact on participants' relationships, motivation, struggles with remote learning, perceived heavy workloads, and impact on health and self-care, while some described positive experiences, including improved study habits.

DISCUSSION

Uncertainty, isolation, sudden and ongoing changes with program delivery and a variety of psychosocial losses, helped to explain the distress many shared. The disconnect between reported levels of use of mental health services and the higher levels of mental distress raises the question of access to and use of these services.

IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE

The importance of developing and maintaining effective coping, including a support system, and committing to healthy self-care during challenging times was reinforced.

CONCLUSIONS

This difficult time for nursing students emphasized the need to ensure attention to student well-being and mental health during their foundational educational experiences.

Final-Year Nursing Students' Experiences During the COVID-19 Pandemic: A Scoping Review

BACKGROUND

The transitional experience from final-year nursing students (FYNS) to newly graduated RNs (NGRN) challenges individuals' professional and personal identities. Multiple studies have documented the experiences of FYNS graduating in the pandemic, but no studies have synthesized the findings.

METHOD

This scoping review examined the barriers and facilitators FYNS experience as they transitioned to become NGRN during the coronavirus disease 2019 (COVID-19) pandemic. Databases were searched for relevant articles, and articles published in peer-reviewed journals between 2019 and 2021 that focused on the support of FYNS in clinical settings in North America, Europe, and Australia were included.

RESULTS

Three themes were identified: emotional turmoil and coping, clinical competence and readiness for practice, and teaching strategies.

CONCLUSION

This review revealed important insight on how the pandemic affected FYNS' transition to practice and identified gaps in the literature for future research. [J Nurs Educ. 2023;62(1):6-11.].

Student nurses' educational experiences during COVID-19: A qualitative study

BACKGROUND

Due to the COVID-19 pandemic, many unexpected changes occurred in healthcare. With the abrupt change to online education in 2020, nursing students experienced challenges with virtual learning which impacted their perception of preparedness to practice. There were few qualitative studies completed in the U.S. that investigated the nursing students' experiences. The aim of this study was to explore pre-licensure nursing students' experiences with the transition to virtual learning and their perception of nursing amidst a pandemic.

OBJECTIVES

This study investigated nursing students' experiences and perceptions of the nursing profession amidst a pandemic and explored whether students would continue pursuing a career in nursing.

DESIGN

A descriptive exploratory qualitative study utilizing focus group interviews and questions using the Theory of Planned Behavior as a framework.

SETTING

A university in Northern Illinois educating baccalaureate degree pre-licensure nursing students.

PARTICIPANTS

Twenty-four pre-licensure nursing students first through fifth semesters. Ten focus groups were established and consisted of two to three students.

METHODS

A descriptive qualitative study design using the Theory of Planned Behavior to construct 9 semi-structured questions. These questions were utilized in the focus groups (n = 24) and Framework Analysis was utilized to analyze data.

RESULTS

Five themes and three sub-themes emerged from the study. Themes included: inspiration to become nurses with sub-themes-students' own inspiration and inspired by family; relationship strain with friend/family due to poor adherence to isolation guidelines; transition to online learning with sub-theme mental health strain; unprepared to begin nursing practice; and ambiguity regarding how to impact government health policy.

CONCLUSIONS

This study found that the students' perceptions of the nursing profession did not waiver, and their desire to pursue a nursing career was resolute. This study demonstrated the challenges students experienced with a transition to virtual learning. Students expressed having insufficient in-person experiences and felt unprepared to begin practice.

Adaptive behaviors in education institutions before and after COVID-19: A systematic literature review

Background

The final third of the year 2019 was marked by the outbreak of the deadly coronavirus (COVID-19) pandemic. This virus paralyzed almost all economic sectors, including governments, forcing educational institutions to close. School closures resulted in significant learning losses and increased inequality in the education sector across the world. Despite these disruptions, however, available evidence reveals that some countries quickly developed adaptive mechanisms of emergency remote learning systems and other alternative methods to recover from learning losses, such as televisions, telephones, Zoom, social media, Google Classrooms, email, and even the post office. These learning recovery programs are instrumental in preparing world economies for future shocks. Various studies are being conducted to assess the impact of this pandemic from different sectors and perspectives. However, systematic literature reviews documenting the adaptive behaviors in educational institutions before and after COVID-19 are either sparse or nonexistent. Additionally, systematic reviews provide a synthesis of the available evidence, indicate directions for further research, and inform decision-making. This systematic literature review focuses on documenting the adaptation strategies and subsequent positive outcomes emerging from the COVID-19 pandemic.

Purpose

The purpose of this study was to review published articles on adaptive behavior in educational institutions, and, in particular, review the outcomes of adaptive behavior and coping strategies/mechanisms over time.

Methodology

The study used a systematic literature review approach as a core methodology for defining answerable research questions, searching the literature for the best available evidence, appraising the quality of the evidence, and collecting and aggregating available data for answering the identified questions. The material was collected using the Science Direct and Emerald databases, which are highly regarded as comprehensive and authoritative. Other documents, especially the reports, were collected from the Google Scholar search engine. Search strings used include "COVID-19 adaptive behavior in educational institutions", "COVID-19 coping strategies in educational institutions", "COVID-19 adaptation mechanisms in the education sector", "adaptive work behavior and COVID-19", "COVID-19 positive outcomes", "adaptive work behavior in educational institutions", and "adaptation strategies in educational institutions".

Findings and conclusion

Although the outbreak of the COVID-19 pandemic wreaked havoc on many aspects of life, the education sector was hit more than most other enterprises, and most, if not all, educational institutions were closed as all students were sent home. Educational institutions transitioned to remote teaching and learning strategies. Several studies report a number of positive outcomes ranging from personal (individuals) and institutional (organizations) to technology-based. Among the key technology-based positive outcomes frequently reported in the literature are increased innovations and increased digital resilience in educational institutions, among others.

A longitudinal study of student nurse anxiety and distress during transitions in learning due to the COVID-19 pandemic

This longitudinal study investigated anxiety, distress, and related symptoms experienced by undergraduate student nurses as they transitioned in March of 2020 to a virtual classroom due to the COVID-19 pandemic and in August of 2021 back to in-person learning. Qualtrics survey links were distributed at the end of the spring 2020 and fall 2021 semesters; survey response rates were 63% (n = 50) and 42% (n = 21), respectively. The 2020 cohort had a mean symptom rate of 4.32 out of 13 symptoms; the 2022 mean decreased to 2.47. Overall, symptoms decreased during the study period, but issues of anxiety and distress remained, particularly over academic-related issues.

Self-Determination as a Mechanism for Personality Sustainability in Conditions of Daily Stress

During the COVID-19 pandemic, uncertainty, threat to life, and repeated lockdowns have significantly undermined people’s psychological well-being. In such situations, the basic needs for self-determination (SDT) are disrupted—autonomy, connectedness, and competence—but it is the resulting dissatisfaction that actualizes a search for strategies to cope with the problem. The objective of this article is to critically review the literature on various ways that people are coping with specific experiences during the COVID-19 pandemic and their relationship to basic needs to maintain sustainability. We searched on the Web of Science CC database for relevant studies (2020–2021) and their systematization from the standpoint of Self-Determination Theory (SDT). This showed the dynamics of coping methods, reflecting a transition from confusion when confronted with stress, to the selection of effective strategies, confirming that when basic needs are blocked for a long time, people begin to search for a way to satisfy them. We present three levels of grouped coping methods: (1) physiological, (2) behavioral, and (3) cognitive, demonstrating their interrelationship with orientation (to oneself or to the context), assessment (a threat or a challenge), and basic psychological needs. The proposed model opens up prospects for creating effective coping and training programs for sustainable development of the individual in crisis situations.

Using a Generous Leadership Model to Promote Evidence-Based Practice

This article is part of a series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to https://links.lww.com/AJN/A133). This follow-up series features exemplar success stories, in which authors describe how initiatives using an implementation framework or evidence-based strategy resulted in a successful practice or program change. Column coordinators Sharon J. Tucker and Lynn Gallagher-Ford alternate in providing commentary at the end.

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

Background

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

Purpose

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

Methods

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

Results

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

Conclusions

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