Factors influencing the coping abilities in clinic nursing students under public health emergency (COVID-19): a cross-sectional study

Due to the epidemic, this cross-sectional study was conducted in the form of Internet questionnaire via mobile phone app (https://www.wjx.cn/wjx/design/previewmobile.aspx?activity=58,349,810&s = 1) from February 6, 2020 to Feb 20, 2020, in which the purpose and significance of the study were explained. Before the investigation, the researchers contacted the colleges one by one to obtain the consent, and the questionnaire was also distributed through the colleges. Convenience sampling was used to obtain participation among Chinese clinic nursing students from 18 colleges (5 undergraduate and 13 junior colleges), who are doing an internship. They were informed and participation was voluntary. The exclusion criteria include: (1) be absent from clinical practice in the past 3 months; (2) experienced major personal or family events, which may affect their psychological state in the past 6 months, such as traffic accidents or the illness or death of a family member or close friend due to Covid-19, etc. The Ethics Committee of the First Affiliated Hospital of Nanjing Medical University approved the study (approval number: 2019-SR-355).

Of the 2035 samples invited, 1992 submitted valid surveys, so the effective rate was 97.89%. The coping abilities of clinic nursing students by demographic characteristics is shown in Table 1. The vast majority of the clinic nursing students in the survey were female (92.87%) and nearly three-quarters were junior college nursing students (71.99%). Most of them (87%) studied at first-class hospital and a little more than half of the clinic nursing students (52.36%)are studying in hospitals that are designated for infected patients. 858 (43.07%) students live in cities and 435(21.84%) students found infected patients around them. Sex, Education, Infected patients around and Practice hospital as designated treatment unit are significantly related to the dimension of positive response. Place of Residence, Infected patients around, Severity of epidemic around are significantly related to the dimension of negative response.

According to the clinic nursing students cognitive response, the ‘fear of COVID-19’ factor scored 2.95 ± 1.96 points, the ‘confidence to overcome difficulties’ scored 5.27 ± 1.2 points, and the ‘optimism’ scored 6.59 ± 1.95 points. According to the students’ behavioral response, the score of ‘active coping’ factor was 13.15 ± 2.61, the score of ‘avoidance’ factor was 2.24 ± 1.60, the score of ‘help seeking’ factor was 5.16 ± 2.03. The detection rate of the students who scored ≥2 of different factors was 4.22–8.43% according to the SCSQ. Among them, 84(4.22%) students had ‘somatization’, 117(5.87%) students had ‘anxiety’, 168 (8.43%) students had ‘depression’ and 124 (6.22%) students had ‘hostility’. The correlation analysis results of each factor and coping status is shown in Table 2.

Multiple linear regression models were fitted with positive and negative coping scores as dependent variables, and statistically significant general data in correlation analysis as independent variables. The assignment of independent variables is shown in Table 3. Due to the existence of dummy variables, the independent variable selection adopts the entry method, with a p-value of 0.05 for entering and a p-value of 0.10 for removal. ‘Confidence to overcome difficulties’, ‘optimism’, ‘active coping’, ‘help seeking’, ‘practice hospital is a designated treatment unit for infected patients’ were independently associated with the positive coping of clinic nursing students. ‘Fear of COVID-19’, ‘optimism’, ‘avoidance’, ‘help seeking’, ‘severity of epidemic around’ were independently associated with the negative coping of clinic nursing students. See Tables 4 and 5 (only the independent variables with statistical significance are listed).

In our study, the positive coping dimension scores were higher than that of Chinese norm(2.04 ± 0.58 VS 1.78 ± 0.52, p = 0.00), the negative coping dimension scores was less than the Chinese norm (1.08 ± 0.52 VS 1.59 ± 0.66, p = 0.00, 18], which was consistent with the research results of Lin [19]. Clinic nursing students may be somewhat more medically knowledgeable and thus more able to respond to public health emergencies than the general public. From the perspective of general data, in the dimension of positive response, the score of female students is higher than that of male. This is probably due to the expectation of Sex roles. Female are a protected group, When faced with difficulties, they have less pressure and are more willing to take positive measures to achieve psychological balance in the face of difficulties [20]. The positive response scores of clinic nursing students in the designated hospitals for infected patients are higher than the scores of other hospitals that do not treat COVID-19 infected patients, which may be related to the high attention paid to the epidemic by the designated hospitals, and also the adequate protection and comprehensive skill training. In the dimension of negative coping, the score of clinic nursing students living in cities is higher than that in rural areas, which may be related to the epidemic mainly occurs in cities, and the control measures and propaganda in cities are stronger than those in rural areas. In contrast to the results of positive coping, the clinic nursing students with severe epidemic around and with infected patients around had higher negative coping score. Due to their medical background, in the face of unknown epidemic, clinic nursing students may have acute psychological reactions, such as fear, worry about being infected by the disease. The uncertain state of disaster and worries are the awakening factors of fear and anxiety [21], leading to the higher level of their negative coping. Therefore, nursing educators and managers should take different interventions for clinic nursing students of different Sexs especially for male students. In addition, special attention should also be paid to the clinic nursing students who have infected patients around and live in the area where the epidemic is more serious, so as to relieve the group panic psychology and behavior.

Confidence and optimism in overcoming difficulties fall under the category of positive psychology, and studies have shown that people with better psychological responses tend to adopt more positive ways to cope with difficulties [21]. Active coping means taking the initiative to take actions because of a threat to one’s health. After the COVID-19 outbreak, health authorities implemented comprehensive prevention and control measures in a timely manner, and schools took active health education activities to increase clinic nursing students understanding of the epidemic, which made their response to the epidemic more obvious, and the score of active response was bound to rise. The medical level of COVID-19 designated units is relatively high, and the epidemic prevention and control publicity and measures are in place, which enhances the confidence of clinic nursing students and encourages them to adopt a more active coping style. Fear and avoidance of COVID-19, as well as the severity of the COVID-19 outbreak in the place of residence, can lead to negative response by clinic nursing students. It is understanderable and interventions should be taken to reduce the fear of COVID-19 so as to reduce the level of negative coping. Help-seeking entered the models of positive and negative coping, both of which had positive effects. However, the coefficient was higher in the model of positive responses, indicating that the change had a greater impact on positive responses. Therefore, it is suggested that nursing educators and managers should give timely feedback on the help-seeking behaviors of clinic nursing students. Although the correlation between anxiety, depression, hostility and coping style in simplified psychosomatic symptoms is statistically significant, they are not included in the final model, which may be related to the low detection rate of psychosomatic symptoms in the clinic nursing students.

Establish the emergency management mechanism for clinic nursing students. Relevant administrative departments shall formulate and promulgate perfect rules and regulations of ‘contingency plan for clinic nursing students in case of public health emergencies. The administrators should take the initiative to learn new policies, regulations and measures on public health emergencies in time, and strengthen their communication with not only the frontline nurses but also the clinic nursing students [22]. Only by providing relevant information and medical treatments in time can we guarantee the stability of clinic nursing students under public health emergencies, so as to avoid or reduce the panic psychology and behavior of groups.

It is necessary to increase the course of improving students’ crisis coping ability in nursing degree program. The current nursing education system focuses on the cultivation of theoretical knowledge and clinical practice ability, but lacks the cultivation of crisis coping ability in China. Studies have shown that cognitive training can improve the public’s understanding of the unknown, reduce their uncertainty, and provide self relaxation coping skills can also effectively improve the stress state and relieve the psychological pressure [23]. Therefore, in the face of this sudden unknown epidemic, nursing educators and managers should strengthen the training of clinic nursing students on the knowledge of public health emergencies, and advocate initiative response [24]. Furthermore, for the group with poor coping style should be identified and given positive psychological interventions in time. Colleges and teaching hospitals can set up special psychological intervention teams, and provide convenient psychological support for clinic nursing students through group psychology to help improve their confidence and abilities to actively respond to the epidemic, so as to successfully pass the clinical practice.

The study was a descriptive cross-sectional one, and the causal relationship is not very persuasive. Although some strategies for improving clinic nursing students’ coping abilities have been suggested according the results, the effectiveness is unknown. Next step, We will form a series of multi-dimensional interventions and take targeted measures to intervene the clinic nursing students in our hospital as a designated treatment unit.