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Pandemic stress: How nursing students coped during the COVID-19 pandemic

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Students from HAN University’s bachelor programme in nursing, who were undertaking internships and following theoretical education modules, faced extraordinary challenges during the first wave of the COVID-19 crisis for which they could not fully prepare. The research of Henk Poppen MSc, Marlies van Bemmel MSc, and Marian Adriaansen PhD, focuses on the experiences of those students during the first wave of the pandemic. Their aim was to determine whether sufficient energy sources were available to students during the crisis to allow them to progress both personally and professionally. In addition, they assessed their coping strategies, and whether the first COVID-19 wave affected their perceptions of the nursing profession more generally.
Healthcare costs are rising. Technology is advancing. The population is ageing. These are just some of the factors that were contributing to the strain on the healthcare system in the Netherlands even before we encountered the extraordinary events of the COVID-19 crisis.

Working across a vast range of sectors and services, nurses play a pivotal role in maintaining the quality and safety of healthcare. Three recent studies carried out by academics from HAN University in the Netherlands consider the value of nurses to the healthcare system, as well as the need for leadership within the profession, namely in the form of the perhaps under-valued and under-optimised nurse practitioner (NP) role.

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The first study focuses on the stress faced by student nurses during the first wave of the COVID-19 pandemic, highlighting the students’ perceptions of the profession they are seeking to enter. A further two studies consider specifically the value of the role of the NP in delivering a complete package of care to patients.

Nursing students and COVID stress

The pandemic caught the world off guard – not least the student nurses, whether undertaking internships or following theoretical education models, on the full-time Bachelor of Nursing programme at HAN University of Applied Sciences in the Netherlands. Lecturer/researcher Henk Poppen MSc, lecturer/researcher Marlies van Bemmel MSc, and Professor of Innovation in Care Marian Adriaansen PhD, therefore undertook research into the experiences of those student nurses during the first wave of the pandemic.

“The students intimated that the COVID-19 crisis had boosted their professional development – and leadership skills in particular.”

Unknown unknowns

Interns faced safety concerns over a multitude of factors: having contact with their patients and colleagues, personal protective equipment or lack thereof, overwhelmed patients worried about an unknown and unpredictable disease, and healthcare providers lacking the knowledge to effectively manage the situation (‘unprecedented’ rapidly became the buzzword on everybody’s lips). Similarly, students in the middle of a theoretical education model struggled through the prohibition of interaction with patients and healthcare professionals, meaning they had difficulty in completing their minor or continuing their practitioner research. While education was permitted to continue virtually, in this case via Microsoft Teams, this was a method neither students nor lecturers were familiar with in this setting.

The researchers were keen to assess whether the first wave of the COVID-19 pandemic affected nursing students’ perceptions of the profession. BearFotos/Shutterstock.com

Job Demands–Resources model

The researchers set out to understand whether the students were able to access adequate energy sources during the first wave of the COVID-19 crisis to enable them to progress personally as well as professionally; any coping strategies they used; and whether the first wave of the pandemic affected the students’ perceptions of nursing as a career choice. They used the Job Demands–Resources model (JD-R model) as a starting point for their study. The model assumes that high job demands cause stress and ill health, whereas access to ‘energy sources’ such as autonomy, feedback, and social support fosters motivation and productivity. Of the 608 nursing students who received the online questionnaire from the study, 171 returned it and 36 agreed to participate in online group interviews. The questions focused on the student nurses’ experiences during the first wave of the pandemic.

Risk versus reward

A link was found between higher scores on the scales of personal development and higher scores for professional development. Furthermore, personal and professional development scores were higher among interns than among students following the theoretical education route. However, all survey respondents, whether interns or those following the theoretical route, were concerned about the progress of their studies, experiencing a loss of control.

Nevertheless, while the students perceived the nursing profession to be riskier (3.58 out of a possible 5), they also found it to be more meaningful (3.54 out of 5) during the COVID-19 crisis. The students intimated that the COVID-19 crisis had boosted their professional development – and leadership skills in particular – to a degree that would not otherwise have been achieved to the same extent.
Consistent with the JD-R model, the researchers found that increased demands of the job due to the COVID-19 crisis resulted in fatigue and uncertainty. Conversely, employing personal energy resources fostered greater motivation and productivity, reducing the detrimental effect of job stress.

Many students were prohibited from interacting with patients or other professionals. Jaromir Chalabala/Shutterstock.com

Support relieves stress

The study authors concluded that while students in the internship cohort experienced job stress and uncertainty, they had access to adequate personal energy sources to develop personally as well as professionally. Support sources involved the student nurses using their own capabilities as well as seeking support from their social environment and from their internship site. Fourth-year interns and theoretical education model students made particular mention of support sources in their educational environment. This may have been due to their active requests for support in completing their final projects.

NP leadership perceptions

The importance of leadership within nursing has been highlighted in previous research. In 2019, a qualitative study entitled ‘Nurse practitioners’ perceptions of their ability to enact leadership in hospital care’ was carried out by Julia van Kraaij, Catharina van Oostveen, Marian Adriaansen and colleagues.

The studies highlight the vital importance of the nursing profession. Gorodenkoff/Shutterstock.com

The authors sought to better understand the leadership roles of NPs within Dutch hospitals. They went about doing so by way of 18 semi-structured interviews exploring NP perceptions of their current leadership position and how it compared with their previous role as a registered specialist nurse.

“Employing personal energy resources fostered greater motivation and productivity, reducing the detrimental effect of job stress.”

The researchers recognised that while it is accepted that the NP role could play a key part in bringing about much-needed healthcare reform, the scope of their role is not being optimised. The authors noted that sustaining the role of NP on a long-term basis requires them to be able to perform and develop in a leading role.

Underused leadership skills

They found three primary themes regarding NPs’ current leadership role, which were all related to the successful positioning of the NP. Direct patient care was highlighted, with leadership on other levels being underused. Most NPs had a desire to remodel their role. However, hindering factors included inefficient use of their leadership skills and a lack of support.

Discussing the study’s relevance to clinical practice, the authors emphasised that leadership in nursing helps to improve healthcare quality and efficiency. More must be done to use NPs’ leadership competencies profitably, and to properly value their profession within the healthcare system.

NPs for chronic conditions

An additional study was carried out by Marian Adriaansen and colleagues in 2020. This time the authors sought to understand the impact of nurse practitioner care on patients with chronic conditions. Their method was once again qualitative, using interviews as the method of data collection.

Again, the study highlighted the unique importance of the NP role, with the authors aiming to compare the perception of NP care by two groups of patients: those suffering with long-term illness, specifically chronic heart failure (CHF) or inflammatory bowel disease (IBD), and those requiring oncological or palliative care. They sought to understand why patients view the quality of NP care to be equal to or better than that of doctors.

Communicators and skilled companions

The authors concluded that while patient perspectives can vary depending on whether their condition is chronic or life-threatening, all patients tend to value NPs because they are seen as reliable, helpful, and empathetic. The integrated care given by these dedicated experts helps patients to feel empowered, at peace, and in control. Furthermore, the authors recommended further consideration of the appreciation by patients of the NP as ‘communicator’ and ‘skilled companion’.

The three studies highlight the pivotal role played by the nursing profession in keeping the healthcare system running safely at all times, not least during the COVID-19 crisis, for which the world and its many healthcare systems were not prepared. Key themes which can be drawn from the three studies include the importance of support for both students and experienced practitioners, the value of leadership within the nursing profession, and the need to optimise the role of the NP.

How do you believe the results of your study will affect the training of student nurses going forward?
When educating nurses it is important for them to understand how to use their own resources in order to grow both personally and professionally. The results will give students a better understanding of their situation. Not only a struggle to ‘survive’ their internships in difficult circumstances, but also seizing opportunities and positive growth in their professional image. Students have sufficient access to (personal) energy sources to be able to make progress in their personal and professional development. For lecturers, the challenge is to remain vigilant with students in the wake of the pandemic and to help them with finding individual resources.

 

References

  • Poppen, H, van Bemmel, M, Adriaansen, M (2021) How nursing students coped with stress during the first Covid-19 wave. (Translated). TVZ : verpleegkunde in praktijk en wetenschap.
  • Dusseldorp, LV, Groot, M, Adriaansen, M, Vught, AV, Vissers, K, Peters, J, (2020) Impact of nurse practitioner care on patients with chronic conditions. Journal of the American Association of Nurse Practitioners, 33(9), 728–738. 10.1097/JXX.0000000000000438
  • van Kraaij, J, van Oostveen, C, Vermeulen, H, et al, (2019) Nurse practitioners’ perceptions of their ability to enact leadership in hospital care. J Clin Nurs, 29, 447– 458. doi.org/10.1111/jocn.15105
DOI
10.26904/RF-140-2405977173

Research Objectives

Henk Poppen, Marlies van Bemmel, Marian Adriaansen and their team focus on the experiences of nursing students during the COVID-19 pandemic.

Bio

Dr Henk Poppen

Dr Marlies van Bemmel

Marian Adriaansen is a nurse and Professor of Innovation in Care at HAN University of Applied Sciences, School of Health Studies. She is editor-in chief of a Dutch nursing journal. Her main research theme is technology in care.

Contact
Marian Adriaansen
HAN University of Applied Sciences
Post Box 6960 6503GL Nijmegen
The Netherlands

E: [email protected]
T: +31 (0)626082054

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(CC BY-NC-ND 4.0) This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Creative Commons License

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