Resilience and academic motivation's mediation effects in nursing students' academic stress and self-directed learning: A multicenter cross-sectional study

AimsTo investigate the mediating role of resilience and academic motivation between academic stress and self-directed learning.BackgroundAcademic stress in nursing students is a well-reported concept that affects resilience, academic motivation and self-directed learning. However, there is a dearth of studies investigating the mediating role of resilience and academic motivation between academic stress and self-directed learning.DesignCross-sectional study and mediation analysis.MethodsNursing students (n = 718) were recruited from five nursing schools via convenience sampling. Four self-report scales (Perception of Academic Stress Scale, Connor and Davidson Resilience Scale, Short Academic Motivation Scale and Self-directed Learning Instrument) were used to collect data from August to December 2022. Pearson’s r, bivariate analysis and multistage regression analyses were employed to analyze the data.ResultsAcademic stress negatively influences nursing students' resilience, academic motivation and self-directed learning. Resilience and academic motivation have a positive impact on self-directed learning. Resilience and academic motivation mediate the relationship between academic stress and self-directed learning, as evidenced by a reduction in the negative impacts of academic stress on nursing students.ConclusionResilience and academic motivation, as mediators, reduce the effects of academic stress on self-directed learning. Nursing educators and administrators should promote programs that strengthen resilience and academic motivation. Thus, improving educational and clinical performance.     

Resilience,Social Support,Loneliness and Quality of Life during COVID-19 Pandemic: A Structural Equation Model

AimTo determine the parsimonious model of the interrelationships of personal resilience, social support, loneliness and quality of life (QoL) and to identify the mediating effect of loneliness among nursing students amidst the pandemic.BackgroundThe coronavirus 2019 (COVID-19) pandemic led to control measures which increased loneliness among students due to disrupted social connections and sudden shift to virtual learning. During these changes, resilience and social support can significantly influence how learners deal with pandemic-related stresses thus, minimizing loneliness and enhancing QoL. Although studies posited the influence of resilience and social support with loneliness and QoL, these were conducted prior the COVID-19 pandemic wherein loneliness and feelings of isolation play a crucial part.DesignCorrelational, theory testing using covariance-based structural equation modelingMethodsA total of 550 nursing students from a comprehensive university in Manila, Philippines were recruited from September to October 2021 and answered four standardized, validated scales.ResultsA good and parsimonious model (x²/df = 2.84, RMSEA = 0.058, GFI = 0.999, CFI = 0.999, PNFI = 0.048) highlighted the mediating effect of loneliness between social support, personal resilience and QoL. While personal resilience positively influenced the physical and psychological domains of QoL, social support positively affected the social relationships and environmental domains. Loneliness was a strong, negative predictor of the psychological and social domains of QoL and had a moderate, negative effect on the physical domain. Personal resilience also mediated the influence of social support on loneliness and QoL.ConclusionSocial support and personal resilience positively affected QoL, while loneliness had a negative effect. Through the mediation of loneliness, the effects of social support on QoL decreases. However, the mediation of resilience further decreases loneliness and improves QoL. The presented model assists nurse educators and administrators in developing strategies to enhance social support, resilience and QoL among students while mitigating the negative effects loneliness during the pandemic.Tweetable abstractLoneliness and Resilience are mediators of student nurses’ quality of life during COVID-19 pandemic. Social support is the common predictor.     

Nursing students' perceived stress,social support,self-efficacy,resilience, mindfulness and psychological well-being: A structural equation model

Nursing students' stress, protective factors (e.g. resilience, social support, mindfulness and self-efficacy) and psychological well-being (PWB) have been well reported in the literature. However, the interactions of these variables were scarcely examined in the latter part of the COVID-19 pandemic and in the context of a developing country. This cross-sectional correlational study complying with STROBE guidelines tested a hypothetical model of the interrelationships of nursing students' stress, protective factors and PWB using structural equation modelling (SEM). Nursing students (n = 776) from five nursing schools in the Philippines were conveniently recruited from September 2022 to January 2023. Six validated self-report scales (Perceived Stress Scale, Multi-dimensional Scale of Perceived Social Support, Generalized Self-Efficacy Scale, Connor–Davidson Resilience Scale, Mindful Attention Awareness Scale, and Psychological Wellbeing Scale) were used to collect data. SEM, mediation analyses and path analyses were used for data analysis. The emerging model demonstrated acceptable model fit parameters. Stress negatively impacted protective factors, while all the protective factors positively influenced PWB. Social support mediated the influence of stress on resilience, mindfulness and PWB. Resilience is a significant mediator of stress, self-efficacy, social support and PWB. Mindfulness mediated the influence of stress, social support and self-efficacy on PWB. Finally, self-efficacy had a mediating role between resilience and mindfulness. Nursing institutions and nurse educators can use the proposed model as their basis for empirical and theoretical evidence in creating programmes that will strengthen nursing students' protective factors, thus reducing stress while improving PWB and learning outcomes.     

Mediating effect of resilience on association among stress,depression, and anxiety in Indonesian nursing students

BackgroundStudies on beneficial effects of resilience among nursing students are scarce, particularly in the context of Indonesian cultural characteristics and family socioeconomic status. Consequently, whether resilience affects the associations between clinical practice–related stress and mental health problems remains unknown.PurposeWe aimed to reveal whether resilience mediates the associations among stress, depression, and anxiety.MethodsIn this study, 336 nursing students were recruited and completed the Connor–Davidson Resilience Scale and the Depression, Anxiety, and Stress questionnaires. Students' economic status was assessed using the Self-Reported Questionnaire Family Socioeconomic Status. Data were collected in mid-2016 and analyzed using Pearson's correlation, independent t-test, one-way ANOVA, and simple linear regression with a mediation test.ResultsResults demonstrated that resilience had a partial mediating effect on depression (B = 0.044) and anxiety (B = 0.017) after controlling for student age, living situation, and living allowance. These results indicated that resilience affects stress, depression, and anxiety.ConclusionResilience is thus a crucial mediator of the relationship of clinical practice–related stress with depression and anxiety in nursing students. A well-balanced relationship between academic demands, private life, and financial support can counteract the influence of depression and anxiety in this population.     

The impact of covid-19 on psychosocial well-being and learning for australian nursing and midwifery undergraduate students: a cross-sectional survey

AimTo explore the impact of COVID-19 on psychosocial well-being and learning for nursing and midwifery undergraduate students in an Australian university.BackgroundThe World Health Organization has reported a substantial psychological impact of COVID-19 on healthcare professionals to date. Evidence is lacking, however, regarding university nursing and midwifery students of the pandemic and its impact on their educational preparation and/or clinical placement during the COVID-19 pandemic.DesignCross-sectional survey of nursing and midwifery undergraduate students enrolled in the Bachelor of Nursing suite of courses from the study institution in August- September 2020.MethodsA cross-sectional self-administered anonymous online survey was distributed to current nursing and midwifery undergraduate students. The survey included three open-ended questions; responses were thematically analysed.ResultsOf 2907 students invited, 637 (22%) responded with 288 of the respondents (45%) providing a response to at least one of the three open-ended questions. Three major themes associated with the impact of the pandemic on psychosocial well-being and learning were identified: psychosocial impact of the pandemic, adjustment to new modes of teaching and learning, and concerns about course progression and career. These themes were underpinned by lack of motivation to study, feeling isolated, and experiencing stress and anxiety that impacted on students’ well-being and their ability to learn and study.ConclusionsStudents were appreciative of different and flexible teaching modes that allowed them to balance their study, family, and employment responsibilities. Support from academic staff and clinical facilitators/mentors combined with clear and timely communication of risk management related to personal protective equipment (PPE) in a healthcare facility, were reported to reduce students’ stress and anxiety. Ways to support and maintain motivation among undergraduate nursing and midwifery students are needed.     

A national survey of the impact of COVID-19 on personal,academic, and work environments of nursing students

BackgroundNursing students are experiencing life changing events in their personal, academic, and work environments since the onset of the pandemic.PurposeThe purpose of this study was to describe and explore the effects of COVID-19 on personal, workforce, and academic experiences of nursing students (N = 620).MethodA 68-item survey with three areas of focus surrounding academic, workforce and personal experiences was distributed to multiple schools across the United States. The analysis compares student responses from the five regions of the US.FindingsSignificant differences were found in the pairwise comparisons. The analysis revealed the academic changes were generally viewed as negative. Fear/anxiety and political influences impacted the outcomes of the pandemic.DiscussionUnderstanding the effects of the pandemic on the personal, work and academic experiences of nursing students will assist academia and healthcare in adapting existing policies to meet student needs in the various regions of the United States.     

Understanding the effects of COVID-19 stigmatisation on job performance: a survey of frontline healthcare workers

The level of stigmatisation among health care providers has increased during the COVID-19 pandemic, and understanding the effect of COVID-19 stigmatisation on job performance has become increasingly important. The study explores the influence of COVID-19 stigmatisation on job performance among frontline health workers via the mediating role of anxiety. Furthermore, the moderating effect of resilience in the association between COVID-19 stigmatisation and anxiety is further examined. Participants were made up of 820 frontline health workers working in the epicentres of the Bono Ahafo, Western, Greater Accra, and Northern regions of Ghana. The hierarchical regression technique was employed in estimating the relationship between the variables. COVID-19 stigmatisation among frontline health workers directly affected anxiety and performance. In addition, the results showed that resilience moderated the relationship between COVID-19 stigmatisation and anxiety. The findings again demonstrated that anxiety partially mediated the association between concern for disclosure and public attitude and negative experience and job performance, whereas personalised stigma was insignificant. The study provides implications for establishing anti-stigma interventions and programs to enhance job performance among health workers.

Key messages

1. Many healthcare workers are subject to stigmatisation during the COVID-19 pandemic.
2. The study employs hierarchical regression methods to examine the impacts of COVID-19 stigmatisation on job performance among frontline health workers.
3. The health management team should strengthen interventions to control the stigma experienced by health workers during COVID-19 treatments.

     

Professional identity of Chinese nursing students during the COVID-19 pandemic outbreak: A nation-wide cross-sectional study

Practicing in unprecedented working environment and fighting against the COVID-19 crisis influenced the image of nursing in the general population, as well as among nurses themselves. This study aimed to describe the sense of professional identity among Chinese nursing students during the COVID-19 outbreak and to explore the relationship between psychological resilience and the sense of professional identity in this cohort. A nationwide online cross-sectional survey was conducted. Nursing students were recruited from 18 Chinese universities. The 10-item Connor-Davidson resilience scale (CD-RISC-10) evaluated psychological resilience and professional identity was assessed by the Professional Identity Questionnaire for Nursing Students (PIQNS). A total of 6348 respondents had a moderate level of professional identity to nursing (average PIQNS score at 62.02 ± 12.02). About 86% of respondents attributed the response to the COVID-19 pandemic in elevating the nursing image. Psychological resilience was the strongest contributor to professional identity (β = 0.371, P < 0.001). There was a high level of professional identity among Chinese nursing students during the COVID-19 crisis. Policy support and courses to enhance psychological resilience are critical to sustain professional identity among nursing students.     

Educational and personal burnout and burnout regarding collaborating with fellow university nursing students during COVID-19 in 2020–2021

Background

Knowledge is lacking about the effects of COVID-19 on nursing students' burnout symptoms. Burnout can lead to negative feelings and behaviours towards learning and poor mental health.

Aims

To describe and compare nursing/midwifery students' burnout, explore differences and detect predictors at two time points through COVID-19.

Methods

Students were offered participation in the spring semesters of 2020 and 2021 (N = 2046), during COVID-19. The response rate was 30–33%. By using reliable and valid instruments, the students’ stress and burnout were analysed as well as the students’ health and perceived support.

Results

Symptoms of academic burnout were higher among 1st and 2nd year BSc students in 2021. On the contrary, 3rd and 4th year students had higher academic and personal burnout than graduate students as well as than 1st and 2nd year students. Regarding academic burnout, 47% of the variability was explained by educational level, support, stress and the interactional effect of stress and support. Collaborational burnout, predicted by the students' educational level and support, explained 7% of the variability in the outcome. Additionally, educational level, and stress, predicted 52% of the variability in personal burnout.

Conclusion

Educators or student counsellors need to facilitate effective learning practices and offer academic support, specifically during 3rd and 4th year to boost helpful coping strategies and handle uncertainty and stressors related to crises such as COVID-19.     

Examining nursing students’ wellness and resilience: An exploratory study

Undergraduate nursing students report high levels of stress which can negatively impact their overall wellness, and their academic and clinical performance. Despite this knowledge, there are few studies that have examined the well-being of nursing students and their ability to demonstrate resilience. Therefore, the purpose of this exploratory study was to examine resilience and wellness, together with the key factors that promote a well-being in nursing students from mid-western Canadian university. The sample of 196 undergraduate nursing students completed an online Nursing Well-being and Resilience Survey. Findings indicated that most nursing students had good health; however, many presented with anxiety and/or depression and a decreased sense of wellness in the physical, spiritual, and emotional domain. Other significant findings included participants >26 years old having lower burnout scores, higher ego-resilience and well-being scores compared to students ages 20 to 25; and, 2) there were differences between campus locations in terms of Professional Quality of life (compassion satisfaction, burnout, and traumatic stress) and sense of well-being. Understanding how resilience and wellness are influenced throughout the nursing program is a first step in developing targeted wellness initiatives for different nursing student populations.     

The influence of socio-demographic factors,resilience and stress reducing activities on academic outcomes of undergraduate nursing students: A cross-sectional research study

BackgroundNursing students who stop their education before obtaining their degree (dropout) is a common problem. Scientific studies on factors influencing academic outcomes amongst nursing students are sparse and difficult to transfer to undergraduate nursing students.ObjectivesThe objective of the present study was to explore in undergraduate nursing students the influence of socio-demographic factors, resilience and stress reducing activities on the academic outcomes: intention to leave, academic success and dropout.DesignA cross-sectional design was used.Participants/Setting554 participants form 6 nursing colleges in the Antwerp region in Belgium were included.MethodsData were collected using SurveyMonkey®. In a second phase, these data were linked to the academic outcomes from the school administration.ResultsLower resilience, more destructive and less positive stress reducing activities, having committed a suicide attempt in the past, studying in a densely populated area and starting as a regular student was significantly influenced with higher intentions to leave. Higher resilience significantly predicted academic success. Finally, students that dropped out showed a significantly lower resilience.ConclusionResilience was the only factor that significantly predicted the three academic outcomes: intention to leave, academic success and dropout. Known predictors of academic outcomes such as young age, gender, previous education, nationality and caring for family members were not confirmed in this study. To study in depth dropout within the undergraduate nursing course, conducting a cohort study might be recommended.     

Time to solve persistent,pernicious and widespread nursing workforce shortages

Aim

This paper discusses four main strategies for addressing nursing shortages that have been persistent, widespread and growing. Fallout from the COVID-19 pandemic might offer valuable impetus to address this tenacious challenge.

Background

Nursing shortages are common, widespread and have been persistent for most of a century. Many of the reasons behind these shortages are well known and are themselves enduring, as are the types of strategies put forward for addressing them. These strategies can generally be classified into four main categories: enhancing retention, improving recruitment, encouraging return to practice and drawing on international human resources. The COVID-19 pandemic is the latest major threat to ensuring a sufficiently sized and skilled nursing workforce. Many nurses have succumbed to burnout as well the plethora of factors that predated the pandemic and have a negative impact on nurse wellbeing, turnover and intention to leave.

Sources of evidence

This discussion paper draws on international sources of evidence.

Discussion/conclusion

This paper highlights how many of the factors behind and strategies for addressing nursing shortages at the local, national and global levels are widely studied and known. A sustained combination of strategies that focus both within and beyond health and nursing, including on the broader social context, is necessary. While COVID-19 has been extremely damaging, it might present an opportunity to make sustainable, effective reforms to address nursing shortages.

Implications for policy

Knowledge users must recognise that a combination of approaches across the gamut of policies that influence nursing workforces is necessary to address nursing shortages. Attention must also focus on factors beyond nursing and healthcare if shortages are to be remedied.     

Undergraduate nursing student academic resilience during medical surgical clinical practicum: A constructivist analysis of Taiwanese experience

BackgroundNursing students often experience a reality shock in the course of their practicums that can significantly impact their studies.PurposeThis study aimed to explore the academic resilience of undergraduate nursing students during their Adulting Nursing practicums and identify protective factors to mitigate their impact.MethodsThe constructivist grounded theory approach enabled us to explore nursing students' academic resilience in their practicums. Purposive and theoretical sampling was used to recruit 19 participants. Individual in-depth interviews were audio-recorded and transcribed verbatim. The constant comparative method directed theoretical sampling. The criteria of credibility, originality, resonance, and usefulness were considered to ensure the quality and trustworthiness of the study.ResultsThe main challenges were related to facilitators, the environment, and application of techniques. Students reported feelings of ‘walking on thin ice’ and doubts about their decision to pursue a nursing career. Academic resilience was identified as the ability to maintain optimism while facing challenges. Participants concluded that overcoming their ignorance through practical learning was an important outcome of the process of developing academic resilience.ConclusionThe findings highlight the need for facilitators to re-examine their teaching strategies and provide supplementary support to help students to improve their academic resilience.     

RN-to-BSN student reports of work experiences,academic performance,and program progression during the COVID-19 pandemic

BackgroundIndividuals who were RN to BSN students during the COVID-19 pandemic had the unique experience of being both undergraduate students and nurses during a time of exceptional stress for the healthcare system.PurposeThe aim of this study was to explore student perceptions of their work experiences during the COVID-19 pandemic and how working as a nurse during this time affected their academic performance and progression through their RN to BSN program.MethodsThis qualitative study was conducted using Braun and Clark’s six-step thematic analysis process.ConclusionStudents reported experiencing both challenges and adaptability in their RN to BSN program performance and progression during the pandemic.DiscussionNurse educators and nurse managers can help RN to BSN nursing students during times marked by heavy workloads and increased stress by ascertaining their needs, being flexible, and providing self-care support.     

Resilience,stress, and psychological well-being in nursing students: A systematic review

ObjectiveSynthesize the evidence relating to the interaction of resilience, stress, and well-being in undergraduate nursing students across countries.DesignSystematic reviewData sourcesPeer reviewed studies published from 2008 to December 2018 were searched in CINAHL, Web of Science, Medline (OVID), PsycINFo and four biomedical databases originating from China (China National Knowledge Infrastructure, WanFang Data, VIP and CMB).Review methodsAdhering to the preferred reporting items for Systematic Reviews and Meta-analyses guidelines, eight databases were searched. Twelve studies, which met the inclusion criteria, were extracted, and subject to quality appraisal by two researchers.ResultsIn total, 12 papers were included. Outcome analysis revealed the level of resilience as moderate; stress levels were high and the incidence of negative psychological health accounts for a proportion of nursing students. The interaction between resilience and stress and well-being was high. Resilience and low stress were found to better predict well-being. All the studies cited recommendations to inform educational policy and practice in relation to resilience, well-being, and stress among undergraduate nursing students.ConclusionsThis was the first systematic review to synthesize the evidence relating to the interaction of resilience, stress, and well-being in undergraduate nursing students across cultural settings. Evidence confirms the importance of resilience in nursing students influencing stress and psychosocial morbidity. Nursing educational strategies that foster and enhance resilience is recommended.     

The effect of anxiety on thriving levels of university students during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, university students struggle with unexpected changes in their lives, which have adverse effects on their levels of anxiety and thriving. Thriving with its two subdimensions, namely vitality and learning, is a prominent concept for university students due to contributing the academic achievement and wellbeing.AimThis study aimed to examine the effect of anxiety on thriving levels of university students during the COVID-19 pandemic.MethodsAn analytical and cross-sectional study was conducted between December 1, 2020 and January 6, 2021. Data were collected using online surveys with convenience sampling method. The sample consisted of 322 university students from a health sciences school of a public university in Turkey.FindingsThe students’ anxiety and thriving levels were found to be moderate with 10.38 ± 5.24 and 3.41 ± 0.85, respectively. The results also indicated that anxiety had negative and significant effect on thriving and its subdimensions of vitality and learning. In addition, anxiety level differed significantly according to gender, worried about getting COVID-19 virus and following the COVID-19 cases on a daily basis while thriving level only differed significantly according to the gender.DiscussionConsistent with previous literature, university students experienced high level of anxiety during the COVID-19 pandemic according to the current study. The students with high level of anxiety had lower vitality and learning scores comparing to their peers with low level of anxiety. This result is crucial, because students with high levels of thriving can cope with stress and feel themselves better psychologically than others.ConclusionThis study showed that the students exhibited higher anxiety symptoms and had lower levels of thriving. Therefore, interventions, psychological support, and instrumental support are recommended to improve psychological health of university students.     

COVID-19 vaccination readiness among nurse faculty and student nurses

BackgroundUnprecedented efforts are underway to develop COVID-19 vaccines, widely seen as critical to controlling the pandemic. Academic nursing leaders must be proactive in assuring widespread faculty and student vaccination uptake.PurposeThe purpose of this study was to describe nursing faculty and student nurse factors associated with COVID-19 vaccine readiness.MethodsCross-sectional online survey of nursing faculty and student nurses at a university affiliated with an academic medical center was conducted.FindingsMost full-time faculty (60%) intended to receive the vaccine; but only 45% of adjunct faculty and students reported intending to get vaccinated. The major reasons for not getting vaccinated were vaccine safety and side effects. Collectively, participants reported a low level of knowledge related to vaccine development.DiscussionAs the most trusted profession, nurses will play a decisive role in counseling patients about COVID-19 risks and benefits. Findings suggest that academic nursing leaders need to consider faculty and student vaccine concerns and provide vaccine development education.