Home Stress, depression, and anxiety among undergraduate nursing students in the time of a pandemic
Article
Licensed
Unlicensed Requires Authentication

Stress, depression, and anxiety among undergraduate nursing students in the time of a pandemic

  • Wanda M. Chernomas EMAIL logo , Carla R. Shapiro , James C. Plohman and Rasheda Rabbani
Published/Copyright: August 21, 2023

Abstract

Introduction

Emerging literature reports on the challenges faced by nursing students internationally during the pandemic as they continue their education. The aim of this mixed methods study was to examine stress, depression, and anxiety among undergraduate nursing students at a Canadian university during the pandemic.

Theoretical Frameworks

Stress and coping and trauma theories informed this study.

Methods

Mixed methods included an online questionnaire composed of the Depression Anxiety Stress scales (DASS), sociodemographic data, and quality of life items with open-ended questions.

Results

Sample included 280 participants. Mean scores for depression and stress were in the mild level, for anxiety in the moderate level; 24 , 37 and 23 % of the sample had scores of severe or extremely severe for depression, anxiety, and stress respectively. Written comments reflected the impact on participants’ relationships, motivation, struggles with remote learning, perceived heavy workloads, and impact on health and self-care, while some described positive experiences, including improved study habits.

Discussion

Uncertainty, isolation, sudden and ongoing changes with program delivery and a variety of psychosocial losses, helped to explain the distress many shared. The disconnect between reported levels of use of mental health services and the higher levels of mental distress raises the question of access to and use of these services.

Implications for an International Audience

The importance of developing and maintaining effective coping, including a support system, and committing to healthy self-care during challenging times was reinforced.

Conclusions

This difficult time for nursing students emphasized the need to ensure attention to student well-being and mental health during their foundational educational experiences.


Corresponding author: Wanda M. Chernomas, Rady Faculty of Health Sciences, University of Manitoba, College of Nursing, Winnipeg, Canada, Phone: 204 474 6819, E-mail:

Funding source: Self-funded

Award Identifier / Grant number: 324032

  1. Research ethics: This research was approved by the Research Ethics Board (REB1 – Fort Garry campus) at the University of Manitoba, where all authors are affiliated; protocol approval HS24540.

  2. Author contributions: All authors have made substantial contributions to the design, critique of the study, and to the analysis, as well as contributing to the analysis based on their expertise. Specifically, James Plohman and Rasheda Rabbani focused on the quantitative data analysis and Wanda Chernomas and Carla Shapiro focused on the qualitative analysis. All authors have contributed to the production of this manuscript either in drafting or reviewing critically for content.

  3. Conflicts of interests: We have no competing interest to declare.

  4. Research funding: This study was self-funded by one of the principal investigators from her travel and expense account.

References

1. Makwana, N. Disaster and its impact on mental health: a narrative review. J Fam Med Prim Care 2019;8:3090–5. https://doi.10.4103/jfmpc.jfmpc_893_19.10.4103/jfmpc.jfmpc_893_19Search in Google Scholar PubMed PubMed Central

2. Rajkumar, RP. COVID-19 and mental health: a review of existing literature. Asian J Psychiatr 2020;52:1–5. https://doi.org/10.1016/j.ajp.2020.102066.Search in Google Scholar PubMed PubMed Central

3. Usher, K, Durkin, J, Bhullar, N. The COVID-19 pandemic and mental health impacts [Editorial]. Int J Ment Health Nurs 2020;29:315–8. https://doi.org/10.1111/inm.12726.Search in Google Scholar PubMed PubMed Central

4. Greenberg, N, Docherty, M, Gnanapragasam, S, Wessely, S. Managing mental health challenges faced by healthcare workers during Covid-19 pandemic. BMJ 2020;368:1–4. https://doi.org/10.1136/bmj.m1211.10.1136/bmj.m1211Search in Google Scholar PubMed

5. Laczko, D, Hodson, A, Dykhuizen, M, Knippie, K, Norman, K, Hand-Cortes, P. Nursing students’ experiences of mental wellness during the COVID-19 pandemic: a phenomenological study. Teach Learn Nurs 2022;17:392–7. https://doi.org/10.1016/j.teln.2022.03.002.Search in Google Scholar PubMed PubMed Central

6. Pfefferbaum, B, North, CS. Mental health and the Covid-19 pandemic. N Engl J Med 2020;383:510–2. https://www.nejm.org/doi/10.1056/NEJMp2008017.10.1056/NEJMp2008017Search in Google Scholar PubMed

7. Aslan, H, Pekince, H. Nursing students’ views on the COVID-19 pandemic and their perceived stress levels. Psychiatr Care 2020;57:695–701. https://doi.org/10.1111/ppc.12597.Search in Google Scholar PubMed PubMed Central

8. Labrague, LJ. Specific coping styles and its relationship with psychological distress, anxiety, mental health, and psychological well-being among student nurses during the second wave of the COVID-19 pandemic. Psychiatr Care 2022;58:2707–14. https://doi.org/10.1111/ppc.13111.Search in Google Scholar PubMed PubMed Central

9. Wynter, K, Redley, B, Holton, S, Manias, E, McDonall, J, McTier, L, et al.. Depression, anxiety and stress among Australian nursing and midwifery undergraduate students during the COVID-19 pandemic: a cross-sectional study. Int J Nurs Educ Scholarsh 2021;18:1–11. https://doi.org/10/1515/ijnes-2021-0060.10.1515/ijnes-2021-0060Search in Google Scholar PubMed

10. Chachula, KM, Ahmad, N. Professional quality of life, stress, and trauma in nursing students: before and during the novel coronavirus pandemic. Psychol Trauma 2022;14:1333–7. https://doi.org/10.1037/tra0001216.Search in Google Scholar PubMed

11. Majrashi, A, Khalil, A, Nagshabandi, EA, Majrashi, A. Stressors and coping strategies among nursing students during the COVID-19 pandemic: scoping review. Nurs Rep 2021;11:444–59. https://doi.org/10.3390/nursrep11020042.Search in Google Scholar

12. Savitsky, B, Findling, Y, Ereli, A, Handel, T. Anxiety and coping strategies among nursing students during the Covid-19 pandemic. Nurse Educ Pract 2020;46:1–7. https://doi.org/10.1016/j.nepr.2020.102809.Search in Google Scholar

13. 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;15:1–12. https://doi.org/10.1371/journal.pone.0237303.Search in Google Scholar

14. Diaz, K, Staffileno, BA, Hamilton, R. Nursing student experiences in turmoil: a year of the pandemic and social strife during final clinical rotations. J Prof Nurs 2021;37:978–84. https://doi.org/10.1016/j.profnurs.2021.07.019. https://dor.org/10.1016/j.profnurs.2021.07.019.Search in Google Scholar

15. Farsi, Z, Sajadi, SA, Afaghi, E, Fournier, A, Aliyari, S, Ahmadi, Y, et al.. Explaining the experiences of nursing administrators, educators, and students about education process in the COVID-19 pandemic: a qualitative study. BMC Nurs 2021;20:1–13. https://doi.org/10.1186/s12912-021-00666-4.Search in Google Scholar

16. AlOsta, MR, Khalaf, IA. Nursing students perception of e-learning during COVID-19 pandemic: a literature review. Med Legal Update 2021;21:269–77. https://doi.org/10.37506/mlu.v21i4.3141.Search in Google Scholar

17. Karaaslan, MM, Çelik, I, Kurt, S, Yavuz, AY, Bektas, M. Undergraduate nursing students’ experiences of distance education during the COVIC-19 pandemic. J Prof Nurs 2022;38:74–82. https://doi.org/10.1016/j.profnurs.2021.11.010.Search in Google Scholar

18. Hu, Y, Yong, JQ, Chng, MC, Li, Z, Goh, Y. Exploring undergraduate nursing students’ experiences towards home-based learning as pedagogy during the COVID-19 pandemic: a descriptive qualitative exploration. BMC Nurs 2022;21:1–9. https://doi.org/10.1186/s12912-021-00788-9.Search in Google Scholar

19. Folkman, S, Greer, S. Promoting psychological well-being in the face of serious illness: when theory, research, and practice inform each other. Psycho Oncol 2000;9:11–9. https://doi.org/10.1002/(sici)1099-1611(200001/02)9:1<11::aid-pon424>3.0.co;2-z.10.1002/(SICI)1099-1611(200001/02)9:1<11::AID-PON424>3.0.CO;2-ZSearch in Google Scholar

20. Lazarus, RS, Folkman, S. Stress, appraisal, and coping. New York: Springer Publishing Company; 1984.Search in Google Scholar

21. Herman, J. Trauma and recovery. New York: Basic Books; 1997.Search in Google Scholar

22. Substance Abuse and Mental Health Services Administration. SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Rockville, MD: HHS Pub. No. (SMA) 14-4884; 2014.Search in Google Scholar

23. Creswell, JW, Plano Clark, VL. Designing and conducting mixed methods research, 2nd ed. Los Angeles, CA: Sage Publications; 2011.Search in Google Scholar

24. Chernomas, WM, Shapiro, C. Stress, depression, and anxiety among undergraduate nursing students. Int J Nurs Educ Scholarsh 2013;10:255–66. https://doi.org/10.1515/ijnes-2012-0032.Search in Google Scholar

25. Lovibond, SH, Lovibond, PF. Manual for the depression anxiety stress Scales. In: Psychology Foundation Monograph, 2nd ed. Sydney, NSW: University of New South Wales, School of Psychology; 1995.10.1037/t01004-000Search in Google Scholar

26. World Health Organization. World Health Organization quality of life (WHOQOL) –BREF. Geneva, Switzerland; 2004. Available from: http://www.who.int/substance_abuse/research_tools/whoqolbref/en/.Search in Google Scholar

27. Fitzmaurice, GM, Laird, NM, Ware, JH. Applied longitudinal analysis, 2nd ed. Hoboken: Wiley; 2011.10.1002/9781119513469Search in Google Scholar

28. Graneheim, UH, Lundman, B. Qualitative content analysis in nursing research: concepts, procedures, and measure to achieve trustworthiness. Nurse Educ Today 2004;24:105–12. https://doi.org/10.1016/j.nedt.2003.10.001.Search in Google Scholar PubMed

29. Chernomas, W, Shapiro, C, Plohman, J, Rabbani, R. Stress, depression, and anxiety among undergraduate nursing students: a replication study [unpublished report]. 2017.Search in Google Scholar

30. Kalikotay, B, Uprety, K, Rai, L, Pathak, S. Anxiety and coping strategies of nursing students during COVID-19 pandemic in selected nursing campuses. Int J Nurs Educ 2023;15:41–7. https://doi.org/10.37506/ijone.v15i2.19251.Search in Google Scholar

31. Goodwin, J, Kilty, C, Kelly, P, O’Donovan, A, White, S, O’Malley, M. Undergraduate student nurses’ views of online learning. Teach Learn Nurs 2022;17:398–402. https://doi.org/10.1016/j.teln.2022.02.005.Search in Google Scholar PubMed PubMed Central

32. Hughes, MJ. Students, stress, and the pandemic: an occupational health perspective for nursing education. J Nurs Educ 2021;60:674–9. https://doi.org/10.3928/01484834-20211004-02.Search in Google Scholar PubMed

Received: 2022-09-02
Accepted: 2023-08-02
Published Online: 2023-08-21

© 2023 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Literature Reviews
  2. Factors associated with mental health among undergraduate nursing students early in the COVID-19 pandemic: an integrative review
  3. Experiences of new tenure-track PhD-prepared faculty: a scoping review
  4. A systematic review of videoconferencing in health professions education: the digital divide revisited in the COVID-19 era
  5. Research Articles
  6. Effectiveness of educational video on standardized nursing language for nursing home nurses
  7. Exploring entry pathways towards nurse practitioner program admissions: a rapid review
  8. Online learning challenges as experienced by nursing students during the COVID-19 pandemic at a higher education institution in Gauteng, South Africa
  9. Clinical judgment in new nurse graduates: identifying the gaps
  10. Metacognition and learning transfer under uncertainty
  11. Perceived knowledge on the ICNP© in undergraduate nursing students: the development of a scale
  12. Psychometric evaluation of critical incident video instruments for nursing education
  13. Understanding the impostor phenomenon in graduate nursing students
  14. E-learning modules to enhance student nurses’ perceptions of older people: a single group pre-post quasi-experimental study
  15. Self-perceived competence and its related factors in nursing students at graduation: the role of self-efficacy
  16. Stress, depression, and anxiety among undergraduate nursing students in the time of a pandemic
  17. Decision-based learning for teaching arterial blood gas analysis
  18. The impact of university-based education on nursing professional identity: a qualitative examination of students’ experiences
  19. “You have to strive very hard to prove yourself”: experiences of Black nursing students in a Western Canadian province
  20. Stressors and learned resourcefulness in baccalaureate nursing students: a longitudinal study
  21. Faculty experiences of teaching internationally educated nurses: a qualitative study
  22. Changes in grit and psychological capital at the time of major crisis: nursing students’ perseverance, resources, and resilience
  23. Improving practicing nurses’ knowledge of the cognitive impairment, continence, and mobility needs of older people
  24. A multi-layered approach to developing academic written communication skills for nursing students
  25. Jordanian nursing students’ engagement and satisfaction with e-learning during COVID-19 pandemic
  26. Barriers and facilitators to enrolling in nursing programs as perceived by male students: a qualitative study in the United Arab Emirates
  27. Nursing students’ achievement emotions in association with clinical practicums and alternative learning
  28. A multisite transition to nursing program: an innovative approach to facilitate incoming nursing students’ academic success
  29. Understanding the student’s experience of community health nursing simulations
  30. Collaborative online international learning in undergraduate nursing education: from inspiration to impact
  31. Educational Process, Issue, Trend
  32. Implementing an LGBTQ+ interprofessional simulation with undergraduate nursing students
  33. Dialogues on nursing curriculum and pedagogy: a critical planning activity for global educational collaboration
  34. Understanding poverty through virtual simulation: implications for student clinical practice
  35. Engaging the creative heArts of nurse educators: a novel conceptual model
  36. Resilience in nursing education: an evolutionary concept analysis
  37. A review and comparison of post registration midwifery curriculum in Sri Lanka with global standards
  38. Steps toward a resilient future nurse workforce
  39. Perspectives of student incivility in the online learning environment and social media platforms
  40. Development and implementation of a novel peer mentoring program for undergraduate nursing students
Downloaded on 16.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/ijnes-2022-0096/html?lang=en
Scroll to top button