Untitled Document

The effect of COVID-19 pandemic on the futuristic worries and happiness in final year nursing students: A cross sectional study

 

Dron Kinnarbhai Bhandutia1*, Swarna Buddha Nayok2, DhanashreeAkshatha H.S.3, SathyanarayanaMalleshwara Thimmaiah4
1Junior Resident, 2Senior Resident, 3Assistant Professor, 4Professor and HOD, Department of Psychiatry, Sri Siddhartha Medical College, Tumakuru.

Year : 2021 | Volume : 4 | Issue : 1 | Page : 18 | DOI -10.46319/RJMAHS.2021.v04i01.004

Abstract
Background: Nurses play an important role in patient care leading to positive outcomes during pandemics. Due to the current shortage of health care workers during the COVID-19 pandemic, final year nursing students may be called for lending their services. The students may be deficient in training and skills required for efficient management of such a pandemic. Previous studies have shown that frontline nurses have experienced significant psychological distress during such crises.
Materials and Methods: We evaluated the subjective happiness and worries about the future in the final year nursing students. Fifty-nine (n) students took an online survey consisting of questions fromthe Subjective Happiness Scale (SHS) and The Dark Future Scale (DFS).
Results: The majority of the nursing students (69.5%) reported to be adequately happy on SHS. However, in regard to COVID-19 related future majority (55.9%) were found to be anxious.
Conclusions: Although the majority of the final year nursing students showed adequate subjective happiness currently, many of them were also worried about the future concerning the current COVID-19 pandemic. The pandemic-related lockdown may have provided them an unexpected time with their families boosting their happiness. However, they remain worried about their uncertain future for COVID-19. This may be a hindrance in their capability to provide proper clinical patient-care if they are required to join for duty.
Keywords: COVID-19; nursing students; Subjective Happiness Scale; The Dark Future Scale.

Introduction
The world is facing a Novel Corona Virus (COVID-19) pandemic, which has created immense stress on the health care systems worldwide.1Insufficient preparedness and lack of infrastructure and personal protective equipment pose difficulties. Because of an acute shortage of doctors and nurses, many medical colleges have allowed or are considering the involvement of even the final year medical and nursing students for patient care and management. This essentially makes them a front-line worker in this pandemic.1It is a significant deviation as often the responsibilities related to the “actual” clinical work are realized only after a student graduates and starts working as a resident himself or herself.2
Nurses play an important role and their contribution is being realized as a major factor for a positive outcome in patient care and mental health during this outbreak.3The mental health issues and needs of nurses who are actively involved are not always the expected fear of getting contaminated themselves. They were less afraid of being infected but were more worried that their families may get infected through them. They face practical problems, such as handling patients who refuse to be quarantined.4Frontline nurses showed lower vicarious traumatization than other nurses.5Many frontline workers and even trainees expressed depressive cognition acutely. Long working hours also are responsible for the stress.6Burnout is foreseeable and hence resilience-building is being considered of prime importance.7
When the frontline nurses were qualitatively assessed, various themes of their concern were fear of their families being infected and intensely demanding jobs. Affection and altruism were the positive aspects.8In-depth interviews have also revealed the need for the nurses to relate to the patients effectively for their personal growth in a humanistic paradigm.9Depression and anxiety in the short term is a very common outcome.10Interpersonal problems were also evident, prompting adequate training with social support.11 Three groups were identified to have higher psychological problems like anxiety and insomnia: Nurses, women, frontline health care workers. Our nursing students belong to all the categories and thus are at greater risk.12Currently, India is facing a shortage of health care workers and some institutions are considering final year nursing students to work as front liners. This prompted us to evaluate two psychological factors, happiness and anticipatory worry about the future. We considered happiness as the positive side and simultaneous anticipatory anxiety as the negative side. This study aimed to evaluate subjective happiness and worries about the future in the final year nursing students.
Materials and Methods
Participants: 
We conducted a cross-sectional study on nursing students pursuing a Bachelor of Science degree. This was at a private medical college attached to a tertiary care general hospital. The participants were currently staying at their respective homes, as India was under a national and mandatory lockdown due to the pandemic. Their academic schedule was being conducted as online classes. There had been no communication from the Institutional Management indicating that the final year nursing students will be posted for the care of COVID patients when this study was conducted.
Tools:
(i)The Subjective Happiness Scale (SHS): It is a 4-item self-reporting measuring an individual’s overall happiness, scored on a seven-point Likert scale. A higher score indicates higher subjective satisfaction. Final scores above 3.5 are considered to reflect adequate happiness.13
(ii)The Dark Future Scale (DFS): This scale specifically deals with anxiety and fear related to the future. It was derived from the Future Anxiety scale and is a 5-item self-reporting scale scored on a seven-point Likert scale. Higher scores indicate higher levels of anxiety.14We informed the participants to fill the DFS scale keeping in mind the current COVID-related circumstances.
Procedure
After obtaining ethical clearance from the Ethical Committee, the Principal Investigator (PI) contacted the Class Representative (CR) of final year nursing students and explained the study. The scales were sent in the form of Google Forms to her mobile phone. The Google Forms were then sent to her classmates. We did not ask for any personal information apart from age, gender, religion. The participants remained anonymous. The option of informed consent was given at the beginning of the form. Doubts, if any, regarding the procedure were informed to the CR who clarified them. If she could not clarify, she contacted the PI. We included only those who gave consent (only one student did not consent). We evaluated 59 students in total. We have followed The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement in this report.15
Statistical analysis:
The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 20 and Pearson’s Chi-square test was used for correlation between categorical variables. There was no missing data.
Results
All the students (59) responded. The mean age was 21.23 years (Standard Deviation (SD) 0.70). All were females and hail from semi-urban residence. Majority of them were Christians (55.9%). Demographic details are given in Table 1. Most (91.52%) found the current lockdown to be justified.The majority (94.9%) viewed it as an obligation to protect society by decreasing the spread of infection. The most common difficulty they faced was restriction imposed on not going out from their houses (37.28%). They were worried that this pandemic will have a combined effect on their educational, economic, and health in the future (44.06%), rather than just educational (32.2%). Only seven of them did not find pandemic to be worrisome in the long run.
Table 1: Socio-demographic details


Demographic domain

Number (n)

Percentage

Age (years)
20
21
22
23

 

5
39
11
4

 

8.5
66.1
18.6
6.8

Religion
Hindu
Muslim

 

26
33

 

44.1
55.9

The final SHS scores ranged from 1 to 5.75 and the mean score was 3.84 (SD 1.06). When the scores were categorized as equal to or above 3.5 scores pointing toward being adequately happy, the majority (69.5%) were in that group. The DFS scores ranged from 0 to 29.0, the mean score being 14.4 (SD 7.17). A total score of 15 or above was taken as an indicator of being anxious about the future and the majority (55.9%) were found to be anxious. For better understanding, we grouped the scales into three main categories. For DFS, the Likert scale consisted of 0-Decidedly false; 1-False; 2-Somewhat false; 3-Hard to say;4-Somewhat true; 5-True; 6-Decidedly true. We cumulated 1, 2 and 3 as “Not worried”, 3 as “Unsure” and 4, 5 and 6 as “Worried”. Similarly for SHS, the Likert points of 1, 2 and 3 were clubbed into “Overall Not Happy”, 4 as “Neutral” and 5, 6 and 7 as “Overall Happy”.We did not find any significant correlation (using Pearson’s Chi-square test) between categorical scores of SHS and DFS (p=0.544, 2-tailed). Details of DFS and SHS scores are given in Table 2 and Table 3 respectively.
Table 2. Question-wise DFS Scores in Percentages


DFS questions

Not
worried

Unsure

Worried

Current problems will persist

33.9

16.9

49.2

Facing crisis ahead

32.8

22.4

44.8

Future will be worse

48.3

12.1

39.7

Threatening economic and political situation

27.5

25.9

46.6

Unable to realise own goals

41.3

19

39.6

Table 3. Question-wise SHS Scores in Percentages


SHS Questions

Overall Happy

Neutral

Overall Not happy

Generally happy

38.9

28.8

32.2

Happier than peers

40.7

20.3

38.9

Relatedness to happy people

45.7

27.1

27.1

Relatedness to unhappy people *

33.9

20.3

45.7

*original scores given; it is reverse scored during final scoring.
Discussion
This study evaluated the subjective happiness and worries about the future in 59 final year nursing students currently during the lockdown. Although most of them were happy and found the lockdown justified, they were also worried about their future concerning this pandemic. Their happiness can be understood as they have got an unexpected break from their busy academic and clinical schedule. They are also spending much needed time at their homes. They found the lockdown and its imposed restrictions justified. They face difficulty mainly regarding non-virtual socializing. However, they find educational, financial, and health problems to be worrisome in the future. Most are also worried about how long the current conditions will persist.
Studies evaluating psychological impact of COVID-19 on nurses show that they worry more than the normal population. This is similar to what is seen with the medical doctors. The worries, as seen in qualitative study revolve around the theme of contamination, infection and death by COVID-19, surrounding themselves and their families, and regarding poor public knowledge related to preventive measures.16A survey of more than 800 nurses and nursing students in China showed that women had severe anxiety. Frontline nurses showed significant frustration and difficulty in coping with the pandemic. 17 It is not just the overall fear, but the perceived risk of getting infected by COVID-19 which increases distress. As frontline workers, it is already mentioned that the nurses are at higher risk of infection. They themselves significantly have more worries regarding this. As a consequence, the perceived threat increases.18 However, among these uncertain times, there are few aspects that help in resilience and may boost motivation. These include healthy coping mechanisms and positive view of one’s life. When positivity and COVID-19 related perceived stress were evaluated, both show significant interactions. Perceived threat reduced happiness, but positive perspectivehad effects on both stress and happiness.1718 In the Turkish population, resilience and subjective happiness correlated significantly. Our participants showed a similar trend. While they remained worried of their future, happiness related to break from work and being with family member may improve coping skills. At the same time, as they were not actively involved in medical management of sick patients and stayed at home, they did not have to worry about the spread of infection to their family members through them. Studies have shown that this was a significant domain of distress for healthcare workers.16
As a frontline health worker during this stressful pandemic, psychological dysfunction is foreseeable.19They face new challenges as the immediate future is still in jeopardy and have to adapt quickly to the rapidly changing situation.20The mental health of nurses needs to be supported by peers.2122There is an increasing realization during the pandemic regarding the importance of the wellbeing of student nurses.23A collective focus on how to deal and cope up with such stressful situations should be included in their curriculum.24The addition of various strategies like psychological preparedness and resilience-building related to pandemic should be included in the curriculum before sending them to the frontline.25
This is one of the first studies evaluating happiness and worries related to the future of final year nursing students during the COVID-19 pandemic. We have certain limitations. We have not enquired whether their family members or friend or relatives have been infected, as that can increase their distress. Also, we have not evaluated the students for any pre-existing or comorbid psychiatric issues which may affect their current psychological status.As the pandemic is prolonging, stress, happiness and resilience may be evaluated at various points of times, such as during the first wave and subsequent waves of the pandemic. This data will help us to understand how the healthcare workers cope to continuous stress and adversity. Future studies should also evaluate the attitudes, perceptions, and stress in students who are in line to face this pandemic or the next as frontline workers. The insights from these studies may help in a better academic curriculum and preparedness.
Conclusion
The COVID-19 pandemic has given us ample opportunities to evaluate and reconsider the current functioning of our health care systems. The majority of the final year nursing students reportedadequate subjective happiness. Simultaneously, they were worried about the future about the current COVID-19 pandemic. Paying attentionto their mental health during their training period may help in better coping skills development. The student nurses should receive appropriate training modules to help them enhance their psychological well-being, curtail unnecessary worries, and effectively cope with crises during such pandemics.
Acknowledgements
Pay tribute to all frontline COVID health workers battling with epidemic.
Financial support and sponsorship: None
Conflict of interest: None of the authors have any conflicts of interest to disclose.

References

  1. Swift A, Banks L, Baleswaran A, et al. COVID-19 and student nurses: A view from England. J ClinNurs. 2020;29(17-18):3111-3114.
  2. Menon A, Klein EJ, Kollars K, Kleinhenz ALW. Medical Students Are Not Essential Workers: Examining Institutional Responsibility During the COVID-19 Pandemic. Acad Med. 2020;95(8):1149-1151.
  3. Treston C. COVID-19 in the year of the nurse. J Assoc Nurses AIDS Care. 2020;31(3):359–360.
  4. Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry. 2020 Apr;7(4):e15–6.
  5. Li Z, Ge J, Yang M, Feng J, Qiao M, Jiang R, et al. Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain Behav Immun. 2020 Aug;88:916–9.
  6. Mo Y, Deng L, Zhang L, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J NursManag. 2020;28(5):1002-1009.
  7. Shaw SCK. Hopelessness, helplessness and resilience: The importance of safeguarding our trainees’ mental well-being during the COVID-19 pandemic. Nurse EducPract. 2020;44:102780. doi: 10.1016/j.nepr.2020.102780.
  8. Sun N, Shi S, Jiao D, Song R, Ma L, Wang H, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control. 2020;48(6):592–8.
  9. Yin X., Zeng L. A study on the psychological needs of nurses caring for patients with coronavirus disease 2019 from the perspective of the existence, relatedness, and growth theory. Int. J. Nurs. Sci. 2020;7:157–160. doi: 10.1016/j.ijnss.2020.04.002.
  10. Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. COVID-19-Pandemie: Belastungen des medizinischen Personals. PsychiatrPrax. 2020 May;47(4):190–7.
  11. Cai W, Lian B, Song X, Hou T, Deng G, Li H. A cross-sectional study on mental health among health care workers during the outbreak of Corona Virus Disease 2019. Asian J Psychiatry. 2020 Jun;51:102111.
  12. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020 Mar 23 ;3(3) e203976. doi: 10.1001/jamanetworkopen.2020.3976.
  13. Lyubomirsky S, Lepper HS. A Measure of Subjective Happiness: Preliminary Reliability and Construct Validation. Soc Indic Res. 1999 Feb 1;46(2):137–55.
  14. Zaleski Z, Sobol-Kwapinska M, Przepiorka A, Meisner M. Development and validation of the Dark Future scale. Time Soc. 2019 Feb 1;28(1):107–23.
  15. Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J ClinEpidemiol. 2008;61(4):344-349.
  16. Galehdar N, Kamran A, Toulabi T, Heydari H. Exploring nurses’ experiences of psychological distress during care of patients with COVID-19: a qualitative study. BMC Psychiatry. 2020 Oct 6;20(1):489.
  17. Huang L, Lei W, Xu F, Liu H, Yu L. Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: A comparative study. PLoS ONE. 2020 Aug 7;15(8).
  18. Yıldırım M, Arslan G, Özaslan A. Perceived Risk and Mental Health Problems among Healthcare Professionals during COVID-19 Pandemic: Exploring the Mediating Effects of Resilience and Coronavirus Fear. Int J Ment Health Addict. 2020 Nov 16;1–11.
  19. Catton H. Global challenges in health and health care for nurses and midwives everywhere. IntNurs Rev. 2020 Mar;67(1):4–6.
  20. Bagnasco A, Zanini M, Hayter M, et al. COVID 19 —a message from Italy to the global nursing community. J AdvNurs 2020; 76: 2212–2214.
  21. Alharbi J., Jackson D., Usher K. The potential for COVID-19 to contribute to compassion fatigue in critical care nurses. J. Clin. Nurs. 2020;29:2762–2764.
  22. Maben J, Bridges J. Covid-19: supporting nurses‘ psychological and mental health. J ClinNurs. 2020;29(15–16):2742–2750.
  23. Daly J., Jackson D., Anders R., Davidson P.M. Who speaks for nursing? COVID-19 highlighting gaps in leadership. J. Clin. Nurs. 2020 May 27. doi:10.1111/jocn.1530510.1111/jocn.15305. Advance online publication.
  24. Wolfe B. Postgraduate Inpatient Training in the Time COVID-19. J Nurse Pract. 2020;16(6):478.
  25. Choi EPH, Ho M, Smith R. What can we do for part-time nursing students during the COVID-19 pandemic?. Med Educ. 2020;54(7):667-668.

Corresponding author: Dr. Dron Kinnarbhai Bhandutia, Junior Resident, Department of Psychiatry, Sri Siddhartha Medical College, Tumakuru, Karnataka -572107. Email: landmark.bhandutia@gmail.com


Attribution-NonCommercial-ShareAlike
CC BY-NC-SA


An official peer reviewed publication of
Sri Siddhartha Medical College & Research Centre
Constituent College of Sri Siddhartha Academy of Higher Education
(Deemed to be University u/s 3 of UGC Act, 1956)
Accredited 'A' Grade by NAAC
Tumakuru, Karnataka, India. 572107


Research Journal of Medical and Allied Health Sciences is a medium for the advancement of scientific knowledge in all the branches of Medicine and Allied Sciences and publication of scientific research in these fields. The scope of the journal covers basic medical sciences, medicine and allied specialities, surgery and allied specialities, dentistry, nursing, pharmacy, biotechnology, public health and other branches of the allied health sciences. This journal is indexed with Advanced Science Index(ASI), National Science Library and Open J Gate.





E-ISSN : 2582-080X |


Attribution-NonCommercial-ShareAlike 4.0 International (CC-BY-NC-SA 4.0)