The mental health impact of COVID‐19 on pre‐registration nursing students in Australia

The COVID-19 pandemic has led to unprecedented changes across the globe challenging every aspect of what was previously considered ‘usual’ or ‘normal’ life. Everyday aspects of previous life as we knew it has changed and impacted our personal lives, employment, education, community connections, and social activities. For many people, the impact of these changes in previous pandemics has resulted in psychological distress (Usher et al. 2020a), associated with high levels of uncertainty leading to feelings of despair, hopelessness, despair, grief, and loss of purpose across individuals, families, and communities (Usher et al. 2020b). Isolation strategies, imposed to contain the spread of the infection, also led to significant social and economic consequences across the community, resulting in increased deleterious psychosocial outcomes (Usher et al. 2020c). Health workers have been consistently shown to experience higher levels of anxiety and depression related to pandemics than the general public (Bettinsoli et al. 2020; Gómez-Duran et al. 2020) and a recent study exploring impacts of COVID-19 reported that health workers experienced unpleasant emotions such as fear, hyper-arousal, intrusive memories and insomnia, and emotional exhaustion (Braquehais et al. 2020). The COVID-19 pandemic has also severely impacted pre-registration nursing students. For many nursing students, social distancing and isolation requirements have resulted in the cancellation of classes, examinations and clinical placement activities, loss of part-time jobs, or alternatively, working or attending clinical placements in hospitals where they may be required to care for people positive for COVID-19, and/or risk exposure to infected patients and staff (Cao et al. 2020). In some countries, nursing students have reportedly felt pressure to take on clinical roles to assist with the numbers of critically ill patients placing them at greater risk of untoward mental health outcomes including post-traumatic stress disorder (Hayter & Jackson 2020). In fact, it has been claimed that the COVID-19 pandemic has placed many nursing students in a position where they feel they have been required to choose between the safety of their homes or pursuing a career in nursing (Fowler & Wholeben 2020). Either alternative has the potential to cause additional psychological distress to nursing students; and as we know from previous global disease outbreaks such as Ebola and SARS, nurses and other health workers are at great risk of developing burnout, compassion fatigue, lower job satisfaction, lower morale, and job stress during pandemics (Kim & Choi 2016). Attending classes and other study-related activities are important aspects of life for students and for many students, the routine associated with university activities is a way of coping as well as a way of staying connected with classmates, friends, and teachers (Garbrah et al. 2020). Many students choose to attend on-campus classes rather than enrol in online units due to their personal learning styles, the ability of face-to-face learning to meet any of their special needs, or to have regular access to peer support. For students living away from home or in shared accommodation, attending classes on-campus also gives them time away from their shared accommodation, and reduces their personal requirement to invest in the required technology to study online. For those students who have been unable to attend on-campus activities, loneliness and loss of connection with other students have been distressing. International students have been identified as particularly vulnerable during the pandemic; many international students were unable to attend classes but also unable to return home. As a result, these students faced extra pressures related to loneliness and lack of support due to the pandemic (Andrew 2020). This current pandemic has thus resulted in extensive and extended disruptions to student learning, their normal support systems, and social activities, with little sign of return to normal in the immediate future. Nursing faculty across the world have rapidly modified learning and teaching activities to meet the requirements of curriculum while ensuring adherence to requirements of social distancing. It is very pleasing to know that due to the hard work of nursing faculty, nursing students are able to continue to participate in high-quality learning activities. However, while students are able to continue to study from their homes, and participate in activities that can be conducted while adhering to social distancing, many mediated through the Internet, we raise concerns about the long period of social disruption students have and are experiencing, and the effects of this on their short- and longer-term mental health outcomes. It is important to remember, that in addition to disruption to their university lives, other aspects of life including family life, social life and the ability to participate in usual activities such as sport are affected. In recognition of the anxiety and stress that students may be facing, we recommend nursing faculty and schools adopt measures to actively assist students during this pandemic. There are a number of excellent online resources with tips and suggestions for maintaining well-being (see, e.g., https://www.penninecare.nhs.uk/wellbeing/wellbeing-packs-and-activities). Drawing on this information, we provide some potential strategies below (Thompson et al. 2020). Suggestions to assist students