Disease Prevention Knowledge, Anxiety, and Professional Identity during COVID-19 Pandemic in Nursing Students in Zhengzhou, China

Anxiety in Nursing Students during the COVID-19 Pandemic: Systematic Review and Meta-Analysis

OBJECTIVES

To analyse the influence of the COVID-19 pandemic on the development of anxiety in nursing students and the factors involved.

DESIGN

A systematic review and meta-analysis.

DATA SOURCE

PubMed, CINAHL, Scopus and Web of Science.

BACKGROUND

Nursing students are at an increased risk of developing mental overload, due to the presence of many sources of stress during their academic training. Therefore, the COVID-19 pandemic has had an impact on the mental health of the general population, especially on healthcare workers and consequently on students undertaking placements in healthcare settings.

METHODS

A systematic review was conducted using PubMed, CINAHL, Scopus and Web of Science databases. A total of 24 articles were included in the review, and 20 articles were selected for the meta-analysis.

RESULTS

We found that the anxiety scores of nursing students during the COVID-19 pandemic were slightly higher (50%) than before the pandemic. The most influential risk factors for developing anxiety were academics, age, gender, having children, living in urban areas or with family, having an addiction to social networks, and having a fear of becoming infected with COVID-19. Resilience, spiritual support and feelings of happiness protected students against the risk of developing high levels of anxiety.

CONCLUSIONS

The COVID-19 pandemic has led to increased levels of anxiety in nursing students. Thirty-five percent of the meta-analytically analysed sample had elevated levels of anxiety.

Evaluation of the effectiveness of the training on "Home care of COVID-19 positive/suspicious patients" given to nursing students: A quasi-experimental study

BACKGROUND

This study aims to evaluate the effects of education on home care of infected or suspected COVID-19 patients on the levels of knowledge, anxiety, and awareness of nursing students in Turkey.

MATERIALS AND METHODS

The study is in quasi-experimental design. A sample of 158 volunteer students studying nursing at a private university in Turkey was formed. Data were collected using, descriptive information form, "Coronavirus Anxiety Scale," "COVID-19 Awareness Scale," and the "Knowledge of COVID-19 Home Care Test." Pre-test was performed before the participants received education. Post-test was performed seven days after the intervention. SPSS version 25.0 was used for data analysis. "TREND checklist" was used for quasi-experimental/non-randomized evaluations to report the findings of the study.

RESULTS

Anxiety levels decreased and the levels of awareness and knowledge on COVID-19 increased after receiving education on home care of infected or suspected COVID-19 patients (p < 0.001), indicating the effectiveness of the education. Education on home care of infected or suspected COVID-19 patients was an effective method to reduce anxiety and increase knowledge and awareness in nursing students.

CONCLUSIONS

To contribute to community health, home care training can be given to nursing students, other people receiving home care, or providing home care to COVID-19 patients, infected or suspected COVID-19 patients.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

The relationship between anxiety and academic identity and the motivation to study nursing and midwifery in the covid-19 pandemic: A structural model

BACKGROUND

The coronavirus disease (COVID-19) pandemic had a great psychological effect on health service providers and students of related fields. The study aimed to investigate the relationship between COVID-19 anxiety and academic identity and the motivation to study nursing and midwifery during the COVID-19 pandemic.

MATERIALS AND METHODS

In a cross-sectional study 221 nursing and midwifery students at-University of Medical Sciences in 2020 using census sampling were studied. The questionnaires were GADQ-7, the student's academic identity standard questionnaire, the coronavirus anxiety scale, and academic motivation in nursing and midwifery. Pearson's correlation coefficient, regression coefficient, and path analysis were used in statistical software AMOS (version 21) and SPSS (version 22).

RESULTS

The results showed that motivation and anxiety with a significant overall effect of 0.43 and -0.36 were the main determining variables of academic identity respectively (P < 0.001). COVID-19 anxiety was recognized as responsible for 24% of the changes in motivation to study nursing (P < 0.001).

CONCLUSIONS

Academic identity and motivation to study nursing and midwifery have been affected by the COVID-19 pandemic. The need for psychological attention in this situation is required for nursing and midwifery students.

Nursing Students' Perceptions of Factors Influencing Nursing Intentions toward COVID-19 Patients

Coronavirus disease (COVID-19) is a pandemic to which nursing students are particularly susceptible. This study aims to comprehensively examine nursing students' knowledge, attitudes, risk perceptions, preventive behaviors related to COVID-19, and nursing intentions toward patients with the virus. A questionnaire was administered to 149 nursing students from two universities. Data on the respondents' general characteristics, knowledge levels, attitudes, perceived risk, preventive behaviors toward COVID-19, and nursing intentions toward COVID-19 patients were collected. The collected data were statistically analyzed using SPSS software (version 26.0). This involved descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation coefficient, and stepwise multiple regression analyses. The analyses of the factors affecting nursing students' nursing intentions for COVID-19 patients showed that the most predictive factor was perceived risk (β = -0.38, p < 0.001), followed by attitudes (β = 0.29, p < 0.001) and preventive behaviors (β = 0.17, p = 0.017), which explained 26% of the variance in nursing intentions. Lowering the perceived risk of infectious diseases and cultivating positive attitudes and preventive behaviors can increase nursing students' intentions toward COVID-19 patients. Finally, infection management education programs and research on interventions for nursing students are necessary to enhance the quality of nursing care provided to patients with novel infectious diseases.

Prevalence and levels of burnout in nursing students: A systematic review with meta-analysis

AIM

The aim of this study was to analyze burnout levels and prevalence in nursing students and to estimate prevalence levels with meta-analyses.

BACKGROUND

Nurses are one of the healthcare professionals most affect by burnout, but nursing students, during their studies, can also suffer burnout.

DESIGN

a systematic review with meta-analysis was performed.

METHODS

The search equation used in Pubmed, CINAHL and Scopus databases was "burnout AND nursing students". Quantitative primary studies including information about burnout, emotional exhaustion, depersonalization, or personal accomplishment in nursing students were included. Four meta-analysis were performed.

RESULTS

the sample was of n = 34 studies, with n = 15 studies being included in the meta-analysis with n = 2744 nursing students. Burnout prevalence was 19% (95% CI 11-28%). Regarding burnout dimensions, the most affected was high emotional exhaustion with a prevalence of 41%(95% CI 23-61%; n = 2222) followed by 27% low personal accomplishment(95% CI 9-49%; n = 2096), 25% high depersonalization (95% CI 15-36%; n = 2096).

CONCLUSIONS

Prevalence of burnout and its dimensions vary from 19% to 41%, being emotional exhaustion the main problem in nursing students. This problem may affect their future as nursing professionals, and it would be of important to prevent and to treat burnout at university levels.

Prevalence and Risk Factors for Anxiety Symptoms among Student Nurses in Gauteng Province of South Africa

Background: Globally, mental disorders are common among nursing students; therefore, effective prevention and early detection are urgently needed. However, the prevalence rate of anxiety symptoms has not been investigated in South African nursing colleges. Aim: The study aimed to assess the prevalence of anxiety symptoms and their sociodemographic risk factors among nursing students in Gauteng province, South Africa. Methods: This cross-sectional descriptive study was conducted at Chris Hani Baragwanath and SG Lourens nursing colleges in the first week of June 2022. A purposeful sampling technique selected the third- and fourth-year nursing students aged ≥ 18 years registered at the two nursing colleges. The seven-item Generalised Anxiety Disorder scale was used to assess anxiety symptoms. Results: The prevalence of anxiety symptoms was 74.7% (95% confidence interval: 69.9-78.9). Being a student at nursing college B, being in the fourth academic year of study and use of substances were identified as predictors of anxiety symptoms in these nursing students. Conclusions: The prevalence of anxiety symptoms in this study is relatively high, with predictors of developing anxiety being a student at nursing college B, in the fourth academic year and current use of psychoactive substances were predictors of anxiety symptoms. These findings highlight the need to develop interventions and strategies to promote mental health assessments and management to prevent and reduce the problem of mental disorders among nursing students.

Psychological impacts of transition to distance learning due to COVID-19 on nursing students

The purpose of this study was to assess the psychological impacts of the abrupt transition to distance learning due to COVID-19 and associated factors among Jordanian nursing students. A cross-sectional online survey with a sample of 224 nursing students in three universities was carried out. The survey measured students' depression, anxiety, stress, post-traumatic stress disorder (PTSD), academic self-efficacy, and demographic and distance learning-related data. Students have moderate levels of depression, anxiety, and stress. Depression, anxiety, stress, and PTSD were significantly associated with various demographic, disease-related, and distance learning-related variables. Further work is required to prepare professional psychological help for nursing students and develop future teaching plans that take into consideration factors underlying students' negative symptoms.

Perceived social support and professional identity in nursing students during the COVID-19 pandemic era: the mediating effects of self-efficacy and the moderating role of anxiety

BACKGROUND

Health professionals, including nurses, experienced heavy workloads and significant physical and mental health challenges during the coronavirus disease (COVID) 19 pandemic, which may affect career choices for those considering nursing and for nursing students. The COVID-19 pandemic is not only a period of risk, but also an occasion to redeploy the professional identity (PI) of nursing students. However, the relationship between perceived social support (PSS), self-efficacy (SE), PI and anxiety remains unclear under the background of COVID-19. This study aims to explore whether PSS has an indirect effect on PI through mediation of SE and whether the anxiety can moderate the relationship between PSS and SE in nursing students during their internship period.

METHODS

An observational, national cross-sectional study was conducted following the STROBE guidelines. An online questionnaire was completed by 2,457 nursing students from 24 provinces in China during their internship during September to October 2021. Measures included Chinese translations of the Professional Identity Questionnaire for Nursing Students, the Perceived Social Support Scale, the General Self-Efficacy Scale, the 7-item Generalized Anxiety disorder scale.

RESULTS

Both PSS (r = 0.46, p < 0.001) and SE (r = 0.51, p < 0.001) were positively correlated with PI. The indirect effect of PSS on PI through SE was positive (β = 0.348, p < 0.001), with an effect of 72.7%. The results of the moderating effect analysis showed that anxiety attenuated the effect of PSS on SE. Moderation models indicated that anxiety has a weak negative moderating effect on the effect of PSS on SE (β =-0.0308, p < 0.05).

CONCLUSIONS

A better PSS and higher scores in SE were associated with PI in nursing students, and a better PSS had an indirect effect on the PI of nursing students through SE. Anxiety played a negative moderating role in the relationship between PSS and SE.

[Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students]

PURPOSE

This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students.

METHODS

A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ²-test, Fisher's exact test, t-test, Wilcoxon signed-rank test, and Mann-Whitney U test.

RESULTS

The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning.

CONCLUSION

The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students' clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

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.

How has the COVID-19 pandemic influenced nursing students' academic experience and career choices? A qualitative descriptive analysis

COVID-19 control measures influenced education and training environments and profoundly impacted nursing students' career prospects and academic lives. This study intends to elucidate the impact of the COVID-19 pandemic on nursing students' academic experience and career choices. A qualitative descriptive study was conducted at a 4-year university in Japan, using semi-structured interviews with 14 nursing students. Sandelowski's qualitative descriptive analysis was conducted. We identified 11 categories that summarize COVID-19's influence on students' academic experience and career choices: "Forced change to a new learning system," "Difficult learning thoroughly with restricted face-to-face interactions," "Worries regarding teacher evaluations when face-to-face interactions are restricted," "Adapting to changes in the learning environment," "Finding new ways to learn due to the different learning environment," "Worries regarding career decision-making after losing opportunities to obtain career information," "Fully utilizing limited information resources in deciding where to work while being influenced by others," "Coping with a confusing new job hunting system," "Worries about becoming a nurse without enough practical experience," "Conscious of working as a nurse while facing infections," and "Support from those around me is helpful in an unfamiliar environment." The categories comprised four elements: academic impact, employment/career impact, future impact on working as a nurse, and environmental support. Building an online education/training program, ensuring the availability of regular psychological support, providing abundant information on employment, installing an information desk, and providing regular feedback were considered imperative for supporting nursing students.

Factors associated with mental health among undergraduate nursing students early in the COVID-19 pandemic: an integrative review

OBJECTIVES

We aimed to synthesize research findings identifying factors associated with mental health in undergraduate nursing students early in the COVID-19 pandemic.

METHODS

Seven electronic databases were searched using key terms and subject headings. JBI Critical Appraisal Checklists were used to evaluate research report quality.

RESULTS

Among 23 reports (19 quantitative and four qualitative) meeting inclusion criteria, negative emotional responses to COVID-19 (fear of infection, perceived risk, uncertainty about care/future), negative behavioral responses to COVID-19 (eating behaviors, problematic internet use, insomnia), and negative coping strategies were associated with more adverse mental health symptoms. Conversely, social support, professional identity, preventive behaviors, sufficient personal protective equipment (PPE), and positive coping strategies were related to fewer symptoms.

CONCLUSIONS

During a pandemic, undergraduate nursing students require educational support to promote their ability to avoid severe mental health disorders. Also, educators should strengthen students' professional identity, provide infection prevention knowledge and skills, and supply sufficient PPE.

The study of psychological traits among Chinese college students during the COVID-19 campus lockdown

To investigate the prevalence of interpersonal sensitivity, anxiety, depression symptoms and associated risk factors among a large-scale sample of college students in China during the COVID-19 campus lockdown. The survey was conducted among undergraduate students at a university in eastern part of China in April 2022. The Chi-square test was used to compare the different variable groups and multivariable analysis was performed for the risk factors associated with interpersonal sensitivity, anxiety, and depression symptoms. A total of 12,922 college students were included, with an average age of (20.96 ± 1.66) years. The prevalence of interpersonal sensitivity, anxiety and depression symptoms in this study was 58.1, 22.7, and 46.8%, respectively. Male (OR = 1.16, p &lt; 0.001), 22–23 years (OR = 1.40, p &lt; 0.001), freshman (OR = 1.35, p = 0.002), and non-only child (OR = 1.15, p &lt; 0.001) were positively associated with interpersonal sensitivity. Male (OR = 1.20, p &lt; 0.001), sophomores (OR = 1.27, p = 0.020) and seniors (OR = 1.20, p = 0.027) were positively associated with anxiety symptoms. Compared with female students, male students (OR = 0.89, p &lt; 0.001) were less likely to have depression symptoms. 22–23 years (OR = 1.37, p &lt; 0.001), sophomores (OR = 1.26, p = 0.009) and non-only child (OR = 1.11, p = 0.009) were positively associated with depression symptoms. In addition, college students aged 18–21 years, learning status, skipping breakfast, roommate relationship and sleep quality were associated with interpersonal sensitivity, anxiety and depression symptoms (all p &lt; 0.05). The findings of this study suggest a high prevalence of interpersonal sensitivity, anxiety and depression symptoms among Chinese college students during the COVID-19 campus lockdown. Younger ages, low grades, poor dormitory relationship, negative learning status, skipping breakfast and poor sleep quality were the risk factors for college students’ mental health, which should be concerned by the relevant departments of school during the campus lockdown.

Has the COVID-19 pandemic affected nursing students' career self-efficacy and professional calling? The mediating impact of professional identity

BACKGROUND

Professional calling (PC) is crucial for ascertaining their professional goals and fulfilling career choices in nursing students. Thus, understanding its antecedents and helping schools improve PC among nursing students is critical. This study aims to explore whether professional identity (PI), as a crucial antecedent of PC, acts as an intermediary between career self-efficacy (CSE) and professional calling during the COVID-19 pandemic.

METHODS

A sample of 565 nursing students were selected by a web-based survey through convenience sampling. The study was conducted from October to November 2020. Measures of CSE, PI, and PC were assessed during the COVID-19 pandemic. We analyzed demographic data and the correlation of the research variables. The significance of the mediation effect was assessed using a bootstrap method with SPSS.

RESULTS

CSE during the COVID-19 pandemic outbreak (r = 0. 359, p < 0. 01) and PI (r = 0. 670, p < 0. 01) were both relevant to PC among nursing students. In addition, CSE had a positive indirect effect on PC through PI (β = 0. 288, p < 0. 05).

CONCLUSIONS

Higher scores in CSE and a better PI were associated with PC in nursing students. Furthermore, a better CSE had an indirect effect on the PC of students through PI. The favorable evidence in our study confirms that nursing educators can adopt PI interventions to improve the sense of PC among nursing students.

Relationship between nursing students' attitudes toward nursing profession and online learning satisfaction during COVID-19 lockdown

Formal education is crucial for the development of nurses’ professional identity and can play a decisive role in attracting students to the nursing profession. This is even more important during a public health emergency such as the COVID-19 pandemic. This study aimed to investigate nursing students’ attitudes and feelings toward their future profession and academic studies during the first COVID-19 lockdown. A cross-sectional, descriptive study was conducted on 361 nursing students. The data were collected through the Students’ attitudes toward the nursing profession during the COVID-19 outbreak scale, and the Satisfaction with online learning scale. Nursing students expressed higher levels of commitment and dedication to their profession compared to perceived job security. They were generally satisfied with their distance learning experience in terms of accessibility of study materials, adaptation of lectures and quality of communication with academic staff. However, students perceived the ICT-supported distance learning as moderately effective. Students’ satisfaction with online learning was positively related to their perceived professional commitment. In times of health crisis, faculties should consider students’ perceived quality of nursing education and attitudes toward future profession to promote appropriate professional identity.

The Beneficial Effects of Professional Identity: The Mediating Role of Teaching Identification in the Relationship between Role Stress and Psychological Distress during the COVID-19 Pandemic

At the start of the COVID-19 pandemic, teachers and students rapidly transitioned to remote teaching and learning. In South Africa, this initial transition was followed by periods of reopening and closing of schools during the various waves of the pandemic. When schools were reopened, rotational schooling was implemented, with students attending in shifts. All this change created a climate of uncertainty for teachers. The current study investigates the relationship between role stress and indices of psychological distress, as well as the potential mediating role of teaching identification in this relationship, using a cross-sectional survey design. Participants (n = 355) were school teachers in South Africa who completed the Role Stress Questionnaire, the Professional Identification Scale, the trait scale of the State-Trait Anxiety Inventory, and the Beck Hopelessness Scale during the second wave of the pandemic (May-July 2021). The results of a structural equation analysis indicate significant positive direct effects of role conflict and ambiguity on anxiety and hopelessness, as well as significant negative direct effects of teaching identification on anxiety and hopelessness. In addition, teaching identification was found to mediate the effect of role conflict and ambiguity on anxiety and hopelessness. The demonstrated role of teaching identification has implications that suggest the importance of leadership and supervisory support, as well as enhancing the societal value of teaching as a profession.

Prevalence of anxiety symptoms among Chinese university students amid the COVID-19 pandemic: A systematic review and meta-analysis

College students in China are particularly vulnerable to worry. In the meanwhile, the COVID-19 pandemic might worsen anxiety symptoms. However, due to the inconsistency of many studies regarding anxiety symptoms, it has proven challenging to provide accurate psychiatric health treatments to undergraduates. Therefore, in order to determine the prevalence of anxiety among Chinese university students during the COVID-19 epidemic, this study will undertake a systematic review and meta-analysis.

English databases (i.e Embase (Ovid), APA PsycInfo, Medline, Pubmed, Cochrane Library) were utilized to identify papers that provide information on the incidence of anxiety among Chinese college students during the pandemic. Two authors evaluated the qualifications of relevant studies, assessed the risk of bias (RoB), and retrieved data. RoB was evaluated using the cross-sectional study quality evaluation criteria from the American Agency for HealthCare Quality and Research (AHRQ). Three hundred seventy-three records were retrieved. Twenty-five studies were eventually included, involving 1,003,743 Chinese college students. The findings of the study identified that the pooled prevalence of anxiety symptoms was 25.0% (95% CI: 21%–29%, P < 0.001), and those among medical-related professionals were lower than those of the general population (22.1% vs. 25%, P < 0.001). In addition, the prevalence of studies with more female respondents was higher than those with fewer female respondents (26.4% vs. 8%). In the later phases of the COVID-19 pandemic compared to the early stages, anxiety prevalence is higher (29.1% vs. 17.2%). Finally, using meta-regression to explore the source of heterogeneity, this study found that the most potential source was whether the graduate students or otherwise.

This meta-analysis revealed that during the COVID-19 pandemic, a quarter of Chinese college students had anxiety symptoms. Therefore, it is necessary to provide continuous psychological assessment and treatment services for college students.

Mental Health Among Medical Students During COVID-19: A Systematic Review and Meta-Analysis

Background

The mental health of medical students is an issue worthy of attention, especially during COVID-19. Many studies have shown that depression and anxiety are the main problems faced by medical students. To assess the pooled prevalence of depression and anxiety among medical students worldwide, we conducted this meta-analysis.

Methods

According to PRISMA, we used a computerized strategy to search studies in EMBASE, PubMed, PsycArticles, Web of Science, and China Biology Medicine disc. The pooled prevalence of depression and anxiety was calculated by a random-effects model. Heterogeneity was explored by subgroup analysis. Sensitivity analysis and publication bias were also carried out in this meta-analysis.

Results

Of 1316 studies, 41 studies were selected based on 36608 medical students. The pooled depression prevalence was 37.9% (95% CI: 30.7-45.4%), and pooled anxiety prevalence was 33.7% (95% CI: 26.8-41.1%). The prevalence of depression and anxiety among medical students varied by gender, country, and continent.

Conclusion

The data reported that the prevalence of depression and anxiety among medical students during COVID-19 was relatively higher than those of the general population and the healthcare workers. The impact of COVID-19 on medical students and how to protect the mental health of medical students are needed to determine through further research.

Systematic Review Registration

[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021274015], identifier [CRD42021274015].

Professional Identity of 0.24 Million Medical Students in China Before and During the COVID-19 Pandemic: Three Waves of National Cross-Sectional Studies

Background

Professional identity (PI) influences the doctor's thoughts and behaviors. Thus, PI formation (PIF) plays an important role in medical students' education. Major changes to the learning environment could impact PIF, but the influence of the novel coronavirus disease 2019 (COVID-19) pandemic on medical students' PI had confusing conclusions in previous studies. We aimed to compare PI of medical students by using the data from three waves of national cross-sectional surveys conducted in China in 2019, 2020, and 2021, and to examine factors that influence PIF.

Method

We used data from the China Medical Student Survey (CMSS) which has conducted three national cross-sectional surveys. From 2019 to 2021, CMCC retrieved data on PI from a nationally representative sample of medical students from 33, 121, and 123 colleges, respectively. We analyzed the data using Chi-square test, analysis of variance, and multivariable logistic regression according to sociodemographic characteristics, pre-university experience, college characteristics, and college experience.

Results

A total of 244,040 medical students in China participated in the surveys. The overall score of PI increased from 3.80 in 2019 to 3.85 in 2021. Medical students with family medical background, high intrinsic and extrinsic motivation of major selection, teachers' positive role model, and high personal comprehensive quality ranking were more likely to have higher PI (all p < 0.05). The more attention students paid to the COVID-19 pandemic, the higher PI they would have (aOR 1.93, 95% CI 1.67-2.24 for more attention; aOR 2.31, 95% CI 2.00-2.68 for the most attention). However, parents' participation on the front lines of COVID-19 pandemic negatively influenced the PI of medical students (aOR 0.72, 95% CI 0.57-0.93).

Conclusions

PI of medical students increased during the COVID-19 pandemic. The impact of the pandemic on PI was complex. To improve the PI of medical students, the education sector, health sector and the society need to make concerted efforts.

Factors Affecting Infection Control Performance of School Health Nurses During the COVID-19 Pandemic in South Korea

Purpose

Many patients with coronavirus disease 2019 (COVID-19) are asymptomatic or infected by unclear infection routes. Significant group infections may result from transmission in schools, and thus, it is necessary to improve infection control efficiency in schools by identifying the factors associated with the performance of COVID-19 infection control by school health nurses.

Methods

The participants were 130 school health nurses in Korea. The survey variables included knowledge of COVID-19, infection control attitude, job stress, and school organizational culture.

Results

The results demonstrated that among the variables, infection control attitude, job stress, and the level of infection control in schools perceived by school health nurses were significant. The explanatory power of the model including these variables was 25.8% (F=14.39, p<0.001, R²=0.255, Adj-R²=0.258).

Conclusion

The results showed that the infection control attitude and job stress of school health nurses had a significant effect on their infection control performance during the COVID-19 pandemic. The results will be used as basic data for developing programs to enhance the competence of school health nurses to manage new infectious diseases.

The multidimensionality of anxiety among nursing students during COVID-19 pandemic: A cross-sectional study

BACKGROUND

Over the past year, healthcare workers constantly report their COVID-19 anxiety. However, this concept remained understudied among nursing students (NSs).

AIM

This study investigated the difference between NSs' three types of anxiety and their profile variables during the COVID-19 pandemic.

METHODS

This study used a cross-sectional, descriptive-correlational design. Three instruments were used: COVID-19 anxiety scale (CAS), COVID-19 anxiety syndrome scale (COVID-19ASS), and short health anxiety inventory (SHAI) to collect data from 484 Saudi NSs. We applied the Mann-Whitney U test and linear regression to analyze the data.

RESULTS

Across the three instruments; CAS, Item 1 "I feel bad when thinking about COVID-19"; COVID-19ASS, Item 11 "I have imagined what could happen to my family members if they contracted COVID-19"; and SHAI, Item 17 "A serious illness could ruin many aspects of my life" yielded the highest means. COVID-19ASS showed a significant difference for the profiles "known positive" (p = 0.05) and "action taken after with testing" (p = 0.05). NS, who knew someone with COVID-19, was the only predictor of CAS.

CONCLUSION

Our study concludes NSs experience anxiety symptoms. Anxiety is specific to COVID-19 or a set of similar anxiety symptoms. Further research is needed to explore the anxiety state of NSs during the pandemic.

Anxiety and fear of COVID-19 among nursing students during the COVID-19 pandemic: A descriptive correlation study

PURPOSE

The aim of this study was to assess current situations regarding anxiety and fear of coronavirus disease 2019 (COVID-19) level among nursing students.

DESIGN AND METHODS

A descriptive correlation design was adopted. The sample consisted of 234 nursing students. Data were collected using sociodemographic form, Beck Anxiety Inventory (BAI), and Fear of COVID-19 scale.

FINDINGS

The mean BAI score of the students was 26.56 ± 8.86 and Fear of COVID-19 total score was 18.95 ± 7.00. A positive correlation between total scores of the BAI and Fear of COVID-19. The results of this study reveal that anxiety and fear of COVID-19 levels were high among nursing students.

PRACTICE IMPLICATIONS

These findings have underlined there is an urgent need for interventions to reduce anxiety and fear of COVID-19 among nursing students.

Impact of Anxiety on Readiness for COVID-19 Vaccination among Polish Nursing Undergraduate Students: Nationwide Cross-Sectional Study

The COVID-19 pandemic had a huge impact on the mental health of people around the world, and it increased the level of fear of infection and anxiety about the consequences of the disease caused by the SARS-CoV-2 virus. We examined the relationship between the level of anxiety among nursing students and their knowledge about COVID-19 vaccination. In addition, we explored the correlations among the level of anxiety, knowledge about vaccination, and the willingness to vaccinate against COVID-19. A total of 790 undergraduate nursing students participated in the study. The results demonstrated that the level of anxiety among the surveyed nursing students was low; 40% of the study participants did not report any anxiety at all, 30% reported mild anxiety, 20% reported moderate anxiety, and 9% reported severe anxiety. At the time of the study, 77.2% of the participants were already vaccinated against COVID-19. Student knowledge about vaccination against COVID-19 was high and anxiety levels were low, with no direct correlation between the knowledge of vaccination and the severity of anxiety.

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

AIM

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

BACKGROUND

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

DESIGN

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

DATA SOURCES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Attitudes of Nursing Students towards Vaccination and Other Preventive Measures for Limitation of COVID-19 Pandemic: Cross-Sectional Study in Three European Countries

Several preventive measures have been applied to limit the COVID-19 pandemic, including successful the development and introduction of vaccines. The aim of this study was to investigate adherence to preventive measures and vaccination intentions among nursing students in three European countries and the factors associated with vaccination intention and advising vaccination. A cross-sectional study using convenience/snow-ball sampling strategy was performed in Slovenia, Poland, and Serbia between 12 February and 5 March 2021. Data from 872 eligible respondents were analyzed (mean age 23.5 ± 6.5 years, 89% female). Higher adherence to preventive behavior was declared by those working in healthcare (p < 0.001), engaged in COVID-19 departments (p < 0.001), had not had the disease yet (p < 0.001), and had children (p = 0.01). Those groups also expressed higher vaccination intention and advised vaccination to others. Higher vaccination intention and advising vaccination were mostly associated with belief in benefits of vaccine, trust in institutions, perceived effectiveness of vaccine, influence of social environment, protection of patients and perceived health care professionals' duty. Fear of side effects and general refusal of vaccines are the main reasons for vaccination hesitancy. The results of the study indicate how higher education institutions can support the development of appropriate professional attitudes and behaviors among nursing students.

Ethical Leadership and Organizational Citizenship Behavior: Mediation of Trust and Psychological Well-Being

PURPOSE

Nurses' behaviors are largely influenced by their managers' leadership style. The relationships between ethical leadership, trust, psychological well-being, and organizational citizenship behaviors have rarely been investigated in nursing studies. The current study attempted to examine the relationships between perceived ethical leadership, trust, psychological health, and nurses' organizational citizenship behaviors towards their patients in the context of Chinese hospitals.

METHODS

This research adopted a cross-sectional research design. Participants were 495 nurses solicited from six hospitals in China. Hayes's PROCESS and SPSS 22 were employed to analyze the data.

RESULTS

This study demonstrated ethical leadership perceived by nurses is positively associated with trust in management and psychological well-being. Trust in management is also positively associated with nurses' organizational citizenship behaviors. The indirect effects of perceived ethical leadership on organizational citizenship behaviors through trust in management and psychological well-being were statically significant.

CONCLUSION

This study adds value to the literature by revealing ethical leadership boosts nurses' trust in leadership and their psychological well-being, resulting in more organizational citizenship behaviors towards patients in the context of the Chinese hospitals. It is suggested that the hospital management creates an environment in which all members are treated fairly to boost nurses' psychological health and improve their service quality toward patients' satisfaction.

Nursing Students in Crisis Mode: Fluctuations in Anxiety During the COVID-19-Related Lockdown

Supplemental digital content is available in the text.

The COVID-19 pandemic initiated a period of new and difficult challenges for nursing students.

Beyond Sociodemographic and COVID-19-Related Factors: The Association Between the Need for Psychological and Information Support from School and Anxiety and Depression

BACKGROUND In addition to sociodemographic and COVID-19- related factors, the needs of school support, including material, psychological and information support, have seldom been discussed as factors influencing anxiety and depression among college students during the COVID-19 pandemic. MATERIAL AND METHODS In this cross-sectional study, 3351 college students from China were surveyed through questionnaires about their sociodemographic and COVID-19 characteristics, the needs of school support, and their experiences with anxiety and depression. RESULTS Anxiety and depression were reported by 6.88% and 10.50% of students, respectively. Married, higher education, non-medical, and urban students had significantly higher risks of anxiety or depression. Additionally, symptoms such as cough and fever, especially when following a possible contact with suspected individuals, quarantine history of a personal contact, going out 1-3 times a week, not wearing a mask, and spending 2-3 hours browsing COVID-19-related information were significantly associated with the occurrence of anxiety or depression. Those who used methods to regulate their emotional state, used a psychological hotline, and who had visited a psychiatrist showed higher anxiety or depression. Those who used online curricula and books, used preventive methods for COVID-19, and who had real-time information about the epidemic situation of the school showed lower anxiety and depression. CONCLUSIONS In addition to sociodemographic and COVID-19-related aspects, students' needs for psychological assistance and information from schools were also associated with anxiety and depression among college students.

Factors Influencing the Preventive Practice of International Students in South Korea against COVID-19 during the Pandemic

As the novel coronavirus disease (COVID-19) spreads worldwide, quarantine guidelines are being constantly updating to prevent the transmission of this virus. Regardless of which country international students live in, they might receive limited crucial quarantine guidelines from that country’s government. The purpose of this study was to identify factors influencing the preventive practice of international students in South Korea during the COVID-19 pandemic. This was a cross-sectional descriptive study. Data were collected from international students in three universities from July 10 to July 31 in 2020. A total of 261 international students participated in the survey, using an online questionnaire. Data were analyzed by independent t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regression analysis. Preventive practice during the COVID-19 pandemic was affected by duration of stay in Korea (β = −0.21, p < 0.001), attitudes (β = 0.22, p = 0.001), and trust in Korea’s quarantine system (β = 0.33, p < 0.001). This study showed that attitudes and trust in the quarantine system could affect personal preventive practice during the outbreak of a highly contagious disease such as COVID-19.

Transition in learning during COVID-19: Student nurse anxiety, stress, and resource support

The purpose of this study was to explore anxiety and stress experienced by first‐semester nursing students and identify sources of support during a transition from a face‐to‐face to an online learning platform during the first months of the COVID‐19 pandemic. This descriptive study used a web‐based survey distributed to nursing students 2 months after the completion of their first semester. The survey questions were adapted from the Anxiety Symptoms Checklist and the College Student Stress Scale. The survey link was emailed to 79 students, with 56 consenting, and 50 completing the survey. The most commonly reported symptoms were difficulty concentrating (90%) and feeling anxious or overwhelmed (84%). Most respondents reported anxiety related to the pandemic, with 84% being concerned about a friend or relative contracting COVID‐19, and with 70% fearful of becoming infected themselves. The majority of respondents expressed concerns related to difficulty handling academic workload (62%), and the need to perform well in school (56%). To decrease anxiety and stress, the faculty should foster a structured learning environment; abide by the course schedule; communicate changes or updates in a timely fashion; adapt assignments to fit the learning environment; utilize campus, local, state, and national resources; practice self‐care; and extend grace.

Perceived Control, Preventative Health Behaviors, and the Mental Health of Nursing Students During the COVID-19 Pandemic: A Cross-Sectional Study

Introduction: Perceived control is an individual's subjective beliefs about the amount of control he or she has over the environment or outcome. Objective: To examine the relationship between perceived control, preventive health behaviors, and mental health effects of undergraduate nursing students during the COVID-19 pandemic. Methods: This cross-sectional correlational study used online self-administered questionnaires. Participants were nursing students attending 3 universities in Tokyo, Japan. Relationships among variables were quantitatively analyzed using linear regressions and a structural equation modeling after adjusting for demographic factors. Results: A total of 557 students participated in the survey. The analysis indicated that higher levels of perceived control were significantly related to higher levels of preventive health behaviors. Although higher preventive health behaviors were related to negative mental health effects, higher levels of perceived health competence translated to improved mental health effects. Perceived control was not directly related to mental health effects but positively related to perceived health competence. Long work hours per week and short hours of sleep per day were associated with lower preventive health behaviors. There were significant differences in the levels of perceived control and preventive health behaviors among students at the 3 universities. Discussion: To improve health behaviors and health competence and subsequently alleviate the mental health effects caused by strictly adhering to recommended health behaviors, students may be supported by the strategies that increase their perceived control. In addition to institutional support, students also require adequate sleep and financial stability to help prevent infections while protecting their mental health.