The COVID-19 pandemic – A focus on nurse managers’ mental health,coping behaviours and organisational commitment

BackgroundThe emergence of COVID-19 has substantially impacted frontline health care workers, including nurse managers. To date, no studies have been conducted to examine the impact COVID-19 has had on Nurse Managers’ mental health, coping strategies and organisational commitment.AimTo investigate the mental health, coping behaviours, and organisational commitment among Nurse Managers during the COVID-19 pandemic.MethodsCross-sectional study involving 59 Nursing Managers from one Local Health District in Sydney Australia during the first wave of the COVID-19 pandemic. Data were collected relating to demographics, anxiety, coping strategies and organisational commitment.ResultsOverall, approximately three quarters of the Nurse Managers had high anxiety scores. Managers who had worked longer as a nurse had higher scores for adaptive coping strategies and 41% of Nurse Managers considered leaving their jobs.ConclusionsStrategies to minimise anxiety and enable coping as part of organisational disaster, emergency or crisis planning for Nurse Managers may result in decreased anxiety and stress levels, increased use of adaptive coping strategies and lower intent to leave the organisation and the nursing profession.     

Undergraduate nursing students’ perceptions on nursing education during the 2020 COVID-19 pandemic: A national sample

BackgroundIn 2020, nursing educational programs were abruptly interrupted and largely moved online due to the COVID-19 pandemic.PurposeTo explore nursing students’ perspectives about the effects of the pandemic on their education and intention to join the nursing workforce.MethodsUndergraduate nursing students from 5 universities across 5 United States regions were invited to participate in an online survey to elicit both quantitative and qualitative data.FindingsThe final sample included quantitative data on 772 students and qualitative data on 540 students. Largely (65.1%), students reported that the pandemic strengthened their desire to become a nurse; only 11% had considered withdrawing from school. Qualitatively, students described the effect of the pandemic on their psychosocial wellbeing, adjustment to online learning, and challenges to clinical experiences.ConclusionFindings highlighted the need to develop emergency education preparedness plans that address student wellbeing and novel collaborative partnerships between schools and clinical partners.     

Psychological well-being and coping strategies of healthcare students during the prolonged COVID-19 pandemic

BackgroundThis study aimed to investigate the psychological well-being, and stress coping strategies, as well as their relationships, among healthcare students during prolonged COVID-19 pandemic.MethodsAn online questionnaire was used to assess psychological well-being (the Ryff Scale) and coping strategies (the brief Coping Orientation to Problems Experienced Inventory [COPE] Scale). COPE scores were categorized to identify the primary coping strategies: “approach” indicates more active coping strategies; “avoidant” indicates more dysfunctional and maladaptive mechanisms.ResultsA total of 202 valid questionnaire were collected. Those with lower academic confidence and lower self-rated peer and family relationship scores during the COVID-19 pandemic had lower Ryff scores, indicating poorer psychological well-being. Nursing students reported the lowest psychological well-being and the highest levels of adopting avoidant coping strategies (26.4%).ConclusionThe study's findings may help educators identify the healthcare students most vulnerable to stress and develop interventions to empower students to adopt problem-focused stress coping strategies.     

The process of learning and professional development according to nursing students’ experience during Covid-19: A constructivist grounded theory study

AimThis study explored the experiences of nursing students with respect to learning processes and professional development during internships with COVID-19 patients to build a novel theoretical model.BackgroundThe COVID-19 outbreak had a profound impact on the worldwide learning system and it interrupted the internship experiences of nursing students. After the second wave of COVID-19, to balance academic activities with COVID-19 containment, some Italian universities allowed nursing students’ internships in COVID-19 units. This new experience may have influenced nursing students’ learning processes and professional development, but this is yet to be investigated.DesignA qualitative study using a constructivist grounded theory (CGT) approach.MethodsNursing students were recruited from two hospitals in northern Italy between January and April 2021. Data are gathered from interviews and a simultaneous comparative analysis were conducted to identify categories and codes, according to Charmaz’s (2006) theory.ResultsThe sample consisted of 28 students. The results suggested the core category, that is the ‘Students’ sense of belonging to the nursing profession’ and four main categories: (1) From knowledge to know-how, (2) A new relationship modality, (3) Sharing and socialisation and (4) Responsibilization. Finally, a premise and a corollary, respectively (5) Motivation and the (6) Circularity of the process, were identified.ConclusionOur study proposed a new theory of nursing students’ learning processes in clinical contexts during internships with COVID-19 patients. Despite significant difficulties, the nursing students developed a unique learning process characterised by motivation. Therefore, our study provided insight into the learning process during a pandemic and investigated the support needed for nursing students to continue their internships.     

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

BackgroundThe duration and magnitude of the coronavirus (COVID-19) posed unique challenges for nursing students, whose education was altered because of the pandemic.PurposeTo explore the perceptions and experiences of nursing students whose clinical rotations were abruptly interrupted by COVID-19's initial surge in the United States.MethodsThis qualitative study was conducted at a midwestern, academic medical center to elicit senior nursing students' experiences. An online survey was administered with eight open-ended questions asking about: initial impressions of the pandemic; experiences of being a senior nursing student; sources of stress and coping mechanisms; preparing to work as a registered nurse; and views on the nursing profession.ResultsAmong the 26 students who completed the survey, the majority were female (92%), aged 28 ∓ 4.1 years. A total of 18 subcategories emerged with four main themes identified as: a) breakdown of normal systems, b) feeling alone and the inability to escape, c) protective factors/adaptability, and d) role identify and formation.ConclusionsFindings indicate students implemented a variety of strategies while adapting to the abrupt interruption of in-person clinical rotations, mandated restrictions, and social unrest. The cascading themes illustrate the enormity of sudden changes and their significant impact on daily life.     

The financial challenges for Australian nursing students attending placement-based work-integrated learning.

BackgroundMandatory placement-based work-integrated learning (WIL) poses challenges for nursing students who work whilst studying. The financial burden of WIL links to other known direct and indirect challenges, yet no Australian study has quantified the financial challenges resulting from attending mandatory WIL placements. Placement-based WIL costs may preclude some students from completing WIL, which may impact student attrition and the future health workforce.AimTo investigate Australian nursing students’ financial challenges related to mandatory WIL.MethodsAn online cross-sectional survey conducted with nursing students from nine Australian universities across five Australian states. The 28-question survey investigated the location of, and travels to, the most recent WIL placement; and students’ employment, accommodation, financial support, expenses and debts, and financial strain pertaining to WIL placements.ResultsOverall, 2,359 students participated. The majority were employed (84%); 65% of these reported that they were unable to work during WIL, affecting their employment. One-third incurred a financial liability from their placement, 79% reported financial hardship, and 73% found their placement stressful due to financial strain. Financial issues affected 62% of students’ health and wellbeing.DiscussionFinancial pressures related to WIL impact nursing students. While students have strategies to reduce these pressures, universities can also better manage their placement preferencing and support of students to reduce financial impacts of placement-based WIL on students.ConclusionsNursing students face substantial financial challenges related to placement-based WIL. Scholarship programs and other forms of support are required to assist nursing students to undertake WIL.     

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.     

An online 5-week professional identity program for nursing student in clinical rotation practice during the first wave of COVID-19 pandemic: A two-arm randomized trial

AimDevelopment and evaluation of the effectiveness of an online 5-week professional identity program among nursing students in clinical internship practice during the COVID-19 restrictions.BackgroundNurse professional identity is a strong predictor of career commitment. Clinical internship practice is a key stage when nursing students build and rebuild their professional identity. Meanwhile, the COVID-19 restrictions has strongly influenced the professional identity of nursing students as well as nursing education. A well-designed online professional identity program may contribute to nursing students who are in clinical internship practice developing positive professional identity during the COVID-19 restrictions.DesignThe study was a two-armed, randomised, controlled trial conducted and reported based on Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines.MethodsA total of 111 nursing students undergoing clinical internship were randomised into an intervention group and a control group. The five-weekly session intervention was developed based on social identity theory and career self-efficacy theory. The primary outcomes were professional identity and professional self-efficacy and the second outcome was stress. Qualitative feedback was analysed by thematic analysis. Outcomes were assessed before and after the intervention and analysed using an intention-to-treat principle.ResultsThe generalised linear model showed that group-by-time effects were significant for the total score of professional identity and three factors of professional self-image, social comparison and self-reflection and independence of career choice, with small effect sizes (Cohen’s d from 0.38 to 0.48). Only one factor of the capacity of information collection and planning in professional self-efficacy was significant (Wald χ² =0.4.82, P < 0.01) with a medium effect size (Cohen d=0.73). The group effect, time effect and group-by-time effect of stress were not significant. Three themes were: ‘Gaining in professional identity, self-recognition and peer belonging’; ‘Content, self-motivation and intervenor as participation facilitators’; and ‘Combining offline and courses, setting group rules and building mutual trust as recommendations’.ConclusionsThe online 5-week professional identity program effectively promoted the development of professional identity and the capacity for information collection and career planning but did not significantly relieve pressure during the internship.     

Nursing home staff perceptions of challenges and coping strategies during COVID-19 pandemic in China

BackgroundFirst-line nursing staff are responsible for protecting residents, the most vulnerable population, from COVID-19 infections. They are at a high risk of being infected with COVID-19 and experience high levels of psychological distress.AimsTo explore the challenges and coping strategies perceived by nursing staff during the COVID-19 pandemic in China.MethodsIn April,2020, we conducted a qualitative study using in-depth semi-structured interviews with nursing staff. Participants were selected from seven nursing homes in three cities in Hunan Province, China.ResultsA total of 21 nursing staff participated in the study, including seven nurse managers, seven registered nurses and seven nursing assistants. Three main themes were identified. Different groups encountered different sources of stress and adopted various coping strategies to fulfil their responsibilities.ConclusionsNursing home staff were underprepared for dealing with COVID-19-related challenges. Educational programs to improve the ability to deal with COVID-19 prevention and control are needed.     

Navigating nursing curriculum change during COVID-19 pandemic: A systematic review and meta-synthesis

AimTo consolidate the evidence around the experiences of nursing undergraduates and faculty members navigating through remote and online education during the COVID-19 pandemic.BackgroundThe Coronavirus disease 2019 caused by the SARS-CoV-2 Virus (COVID-19) has placed massive pressure on healthcare, economic and education systems globally. Restrictive social distancing policies and public health measures necessitated educational institutions to switch from face-to-face to remote and online education to sustain the learning process. These changes have created an uncertain path and undue stress for healthcare learners and faculty, especially for professional roles that traditionally require more hands-on and access to clinical practice particularly pre-licensure nursing students. As such, there is an urgent need to consolidate evidence on the experiences of nursing undergraduates and faculty members as they navigate the rapid transition from face-to-face to remote and online education to ensure continuity of learning in achieving optimal learning outcomes and to support them during current and future public health crises.DesignA systematic review and meta-synthesis of the qualitative literature was undertaken using Sandelowski and Barroso’s approach.MethodsSix electronic databases, CINAHL, Embase, ERIC, PsycINFO, PubMed and Scopus, were searched systematically using the eligibility criteria from December 2019 to September 2022. The Critical Appraisal Skills Program checklist for qualitative studies was used to conduct the critical appraisal of the selected articles.ResultsForty-seven studies were included in this review, which encapsulates the experiences of 3052 undergraduates and 241 faculty members. An overarching meta-theme ‘Remote and online education: a rollercoaster ride’, emerged along with three main meta-themes: (1) Transition to remote and online education: A turbulent road, (2) Acceptance of the untravelled road, (3) Hopes and recommendations for the road ahead.ConclusionTo improve nursing undergraduates’ and faculty member’s navigation of remote and online education, more institutions should move towards establishing hybrid education as the new ‘normal’ and exercise prudence in the organisation and delivery of curriculum, teaching, well-being and clinical attachment contingencies of their healthcare courses.     

Similarities and differences in well-being between Australian,Saudi Arabian and South African pre-registration nursing students

BackgroundEmotional wellbeing is essential for mental and physical health. Although all university students are vulnerable to psychological distress, nursing students are particularly susceptible, and recognised at higher risk due to the stressful nature of the nursing program.AimThe aim of this cross-sectional study was to compare the demographic characteristics and emotional wellbeing with regard to levels of anxiety, depression, behavioural control, positive affect and general distress of preregistration nursing students in Australia, Saudi Arabia and South Africa.DesignCross-sectional design.MethodsA total of 1381 pre-registration nursing students from two universities in Saudi Arabia and one university in both Australia and South Africa completed the self-report measurement tool, the Mental Health Inventory. A one-way analysis of variance was used to compare well-being among pre-registration nursing students in these three countries.FindingsThe results revealed that when compared to the Australian and South African cohorts, the Saudi Arabian cohort had significantly higher anxiety (Australia M = 26.79, SD = 8.15; Saudi Arabia M = 33.12, SD = 8.24; South Africa M = 29.48, SD = 7.54), depression, (Australia M = 10.15, SD = 3.65; Saudi Arabia M = 13.10, SD = 4.49; South Africa M = 11.83, SD = 3.72), and lower scores in the Mental Health Inventory (Australia M = 152.44, SD = 28.60; Saudi Arabia M = 138.11, SD = 30.09; South Africa M = 145.67, SD = 26.32).ConclusionThere were statistically significant differences in overall psychological distress and well-being among students in the three countries. Strategies to improve emotional wellbeing and reduce the negative aspects of mental health such as anxiety and depression of preregistration nursing students are needed.     

Australian and Danish nurses’ and midwives’ wellbeing during COVID-19: A comparison study

BackgroundMost investigations of nurses’ and midwives’ psychological wellbeing during the COVID-19 pandemic have been conducted in a single setting.AimTo assess and compare the psychological wellbeing of nurses and midwives in Australia and Denmark during the COVID-19 pandemic.MethodsNurses and midwives employed at four metropolitan health services in Australia and one in Denmark completed an anonymous online survey, which assessed depression, anxiety, and stress symptoms (The Depression, Anxiety and Stress Scale - 21 Items (DASS-21)), and sociodemographic and employment factors.FindingsCompleted surveys were received from 3001 nurses and midwives (1611 Australian and 1390 Danish). Overall, approximately one in seven of the nurses and midwives surveyed reported moderate to extremely severe levels of depression (n = 399, 13.5%), anxiety (n = 381, 12.9%) and stress (n = 394, 13.4%). Australian nurses’ and midwives’ scores on all DASS-21 subscales were significantly higher (representing higher levels of depression, anxiety and stress) than the scores for the Danish nurses and midwives. Fewer years of clinical experience, living in Australia and being employed on a part-time basis were significantly associated with higher levels of psychological distress.DiscussionA considerable proportion of nurses and midwives experienced distress during the COVID-19 pandemic; however, the proportion and severity varied by country. Australian nurses and midwives experienced higher levels of distress than their Danish colleagues.ConclusionNurses and midwives working in countries with relatively low numbers of COVID-19 cases and deaths are also likely to experience psychological distress. Nurses and midwives would benefit from targeted country-specific support and wellbeing initiatives.     

Mental health nurses' experience of resilience during COVID-19: A qualitative inquiry

The COVID-19 pandemic created unprecedented demands and additional stress for nurses in mental health settings. There is no prior evidence on nurses' experience of building and maintaining resilience in the context of work during COVID-19. The aim of this study was to explore the experience and impacts of the COVID-19 pandemic on the resilience of nurses in mental health settings. Data from semi-structured interviews with 20 nurses from an Australian mental health service were analysed using reflexive thematic analysis. Four main themes were generated: experiencing significant disruptions; making sense of shared chaos; having professional commitment; and growing through the challenges. Nurses' practice and teamwork were disrupted by COVID-19 related changes to care models and infection prevention policies. They successfully adjusted by having awareness of self and others' emotions, using mental and emotional self-regulatory strategies, engaging in self-care, using ‘bricolage’ to create different ways to provide care, and having mutually supportive relationships. Nurses connected to their sense of purpose and professional commitment to fuel their therapeutic work and sustain care delivery. They experienced personal and professional growth with an increased understanding of their strengths and resilience. In the post-pandemic period, although the challenges presented by the pandemic have lessened, there are ongoing negative impacts on nurses' wellbeing. To maintain and strengthen their wellbeing and practice, the findings indicate the importance of professional development in emotional regulation skills, and strategies to strengthen self-care and build collegial relationships in teams. Resilience education can be implemented to support nurses' resilient practice skills.     

An evaluation of the impact of the Coronavirus (COVID 19) pandemic on interventional radiographers' wellbeing

BackgroundInterventional radiographers have substantially contributed to patient care during the pandemic by providing imaging guidance during minimally invasive procedures. The aim of this research is to quantify the impact of the pandemic on an interventional radiographers’ wellbeing during the COVID-19 pandemic.MethodsEthical approval was obtained at the outset of this study. An explanatory sequential mixed methods approach, using questionnaires and interviews, was used to explore and evaluate interventional radiographers' wellbeing; physical, mental and social. An electronic self-administered questionnaire was administered to interventional radiographers and a semi-structured interview was conducted on two respondents.ResultsResponses were received from 40 interventional radiographers. Physical, mental and social wellbeing of interventional radiographers deteriorated since the onset of COVID-19. All forms of wellbeing were negatively impacted during the pandemic with mental wellbeing (82.5%) the most impacted, closely followed by physical (75%) and social wellbeing (50%). Half of responding interventional radiographers reported being “highly stressed” while working during COVID-19. Physical activity levels decreased, caffeine consumption increased and consumption of a healthy diet decreased. Almost all interventional radiographers (95%) had anxiety about passing the virus onto family or friends and 60% of noted a deterioration in relationship with friends. Three key themes identified included the importance of teamwork, the physical demand and mental impacts of working in interventional radiology during the pandemic.ConclusionsThe COVID-19 pandemic has had a negative effect on interventional radiographers' wellbeing. The implications of staff having a diminished sense of wellbeing is that productivity is likely to have been reduced and potentially related burnout can lead to illness. This research highlights the need to focus on identifying methods of addressing the shortcomings in support services and identifying the specific needs of interventional radiographers to improve their wellbeing.