Psychological Impact of the COVID-19 Pandemic on Nursing Students Studying in the Southern Part of India

Introduction

The Corona virus disease of 2019 (COVID-19) pandemic is a public health causality and a psychological challenge. On the 11th of March 2020, the World Health Organization (WHO) declared COVID-19 caused by the 2019 novel coronavirus (2019-nCoV) a pandemic.¹ Lockdown was first announced for two weeks on March 21. Subsequently, there were four lockdowns. As a result, significant adjustments were made in all aspects of our life which was very new and never happened during our lifetime.^2,3 All the people in various communities were psychologically affected by this pandemic in different ways. Higher psychosocial impact was seen among younger population.^4,5 College students’ mental health needs to be monitored at the time of epidemic. The COVID-19 pandemic has had an impact on everyone in the world, including medical and nursing students.^6,7 High levels of stress is one of the causes for poor academic performance among medical⁸ and nursing students.⁹ Social distancing and restrictive movements have interrupted the traditional method of teaching learning practices in the nursing curriculum. COVID-19 pandemic has given us a chance to prepare for advanced digital learning. This sudden academic transformation during the pandemic has led students to experience decreased motivation towards studies and increased pressure to learn independently. A re-traumatized nurses compassion, tiredness, and burnout are detrimental to organizational objectives and high quality patient care.¹⁰ Identifying the impact of COVID-19 pandemic on the nursing students is necessary to support them adequately.¹¹ There are reports of significant psychological stress among nursing students.^12,13 However only a few of such studies are reported in India.^14-16 Nearly more than 80% of young adults reported that the pandemic worsened their preexisting mental health conditions due to schools closure, disruption of routine, and lack of social ties.¹³ As nursing education is entering a new era of virtual education and also due to lack of exposure to clinical experience during the pandemic, there is a need to assess anxiety and stress among students for better performance.

Materials and Methods

A cross-sectional survey design with total enumerative sampling technique involving 264 nursing students was adopted for this study to assess the psychological impact of the COVID-19 pandemic among nursing students studying at Sri Devaraj Urs College of Nursing, Kolar. Ethical clearance was taken from the Institutional ethics committee [SDUCON/IEC/58/2019-20] and formal permission was taken from the concerned higher authorities of the college. The data were collected using the General Anxiety scale, Perceived Stress Scale, and psycho-social scale regarding COVID-19 with 11 aspects. The standardized General Anxiety scale (Spitzer LR et al., 2006)¹⁷ is a standardized tool used to assess anxiety levels with internal consistency of 0.9. It is a seven-point self-reporting scale with scores ranging from 0-21, where score 0-4 indicates no to low, 5-9 indicates mild, 10-14 moderate, and scores above 15 indicates severe anxiety. The level of stress among students was assessed by using the Perceived Stress Scale (Cohen et al.,1983)18 which is a 10-point scale with scores ranging from 0-40, where 0-13 indicates low stress, 14-26 moderate stress and 27-40 indicates high perceived stress. For determining COVID-19 related stress, a separate psychosocial scale with 11 parameters was used. A Google form of survey questionnaire was prepared, sent via WhatsApp, which included the information regarding the study and informed consent. The questionnaire was completed by the students after agreeing to participate in the study. This online survey was conducted during the period of July 2020 to August 2020. Descriptive statistics were used to analyse the results.

The average age of the participants was 19±1.61 years. As presented in Table 1, 55.3% students were between 19 to 20 years of age, the majority (92.7%) were females and 64.4% were in their first and second year of BSc Nursing. The majority of students were residing in rural areas (73%), in nuclear families (84.6%), and belonged to the Hindu religion (51.6%).

Regarding the levels of anxiety among nursing students, majority of nursing students showed mild anxiety (50%), while 38.6% showed moderate anxiety, with very minimal students showing severe anxiety (9.8%). Normal levels were noted in 1.6% (Figure 1).

Pertaining to the levels of stress among nursing students, majority were found to be moderately stressed (52%), 15% were severely stressed, 33% were mildly stressed (Figure 2)

Regarding the psychosocial well-being of nursing students, majority of students (60.6%) expressed that their daily routine was affected, 53% were able to indulge in their hobbies as previously, 42% were able to exercise daily, 44.6% expressed that they were able to fulfil their entertainment as previous and 47% were able to connect with their friends and relatives. Also, half of the students (50%) expressed that they were able to include adequate fruits and vegetables in their diet, 42.4% were happy with the digital form of education, and 50% expressed that they were able to access their mobile network easily. Nearly more than half of students (53.4%) were financially stable and half of them (50.3%) expressed that they were able to seek health care (Table 2).

Nearly more than half of students (72.5%) expressed that they were able to travel as they like sometimes. None of the students expressed that their psychosocial well-being was ever affected by their routines.

Discussion

In this study, nursing students’ anxiety and psychological aspect of stress due to COVID-19 was assessed. Nursing student’s anxiety and stress levels were found to be mild to moderate. A similar finding of moderate stress was reported by Sheroun D et al.,¹⁵ Begam B¹⁹ and Aslan H et al.,²⁰ while similar findings in terms of anxiety were reported by Savitzky et al. ¹³ Among the 264 students included, 42.8% showed moderate anxiety while 13.1% showed severe anxiety. Similar findings were reported in a study conducted among nursing students in Israel.

In the present study, 41% of students were not satisfied with online platform of learning which is similar to the findings of the study conducted by Marshaal D et al.,²¹ on distance-related stress among undergraduate nursing during the COVID-19 pandemic. In the present study, nearly more than one-third of the students were not financially stable which was also reported by Deo PK et al. ²²

Limitations

The results of this study are limited to the nursing student’s self-reported perceptions. The responses obtained in this study cannot be generalized to all the nursing students.

Conclusion

The COVID-19 pandemic has had an impact on everyone in the world, including nursing students in diverse ways. Our research revealed that the pandemic increased the nursing student’s anxiety and stress levels. Therefore, it is crucial to assist nursing students in developing stress management skills during the pandemic. Nursing students can help people in the society cope with stress by learning how to manage their own stress.

Conflicts of interest

Nil