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. Author manuscript; available in PMC: 2023 Nov 1.
Published in final edited form as: J Nurs Educ. 2022 Nov 1;61(11):641–645. doi: 10.3928/01484834-20220912-06

Effects of the Perceived Risk of Contracting COVID-19 on Nursing Students’ Well-Being

Rebecca J Graves 1, Murphy Harrell 2, Jennifer L Barinas 3, Sarah E Taylor 4, Sharon M Fruh 5, Susan G Williams 6, Ryon McDermott 7, Heather R Hall 8, Caitlyn Hauff 9, Scott Sittig 10, Matt Campbell 11, Geoffrey Hudson 12, Bernadette Mazurek Melnyk 13
PMCID: PMC9782991  NIHMSID: NIHMS1855705  PMID: 36343194

Abstract

Background:

Although mental health symptoms increased during the coronavirus disease 2019 (COVID-19) pandemic, little is known about the associations between nursing students’ perceived risk of contracting COVID-19 and their academic and psychological well-being. This study examined associations between perceived COVID-19 risk, likelihood of completing nursing education, and mental health factors of nursing students.

Method:

A total of 979 nursing students completed self-report measures of perceived COVID-19 risk, anticipated academic completion, anxiety and depressive symptoms, stress, coping self-efficacy, hope, and social support.

Results:

Students with higher perceived COVID-19 risk reported increased anxiety and depression as well as decreased likelihood of graduating, coping self-efficacy, and levels of social support.

Conclusion:

Findings indicate the need for increased mental health support for nursing students for successful completion of their programs. Educators should increase support and proactively strengthen positive psychology factors to mitigate the effects of COVID-19 and other crises on nursing students’ well-being.

The well-being of front line health care providers has been of substantial concern during the coronavirus disease 2019 (COVID-19) pandemic. During the COVID-19 pandemic, clinicians were at increased risk for psychological harm caused by extremely stressful experiences caring for patients (Shahrour & Dardas, 2020; Shechter et al., 2020). In the clinical arena, nurses have been immersed in enormously difficult circumstances during the pandemic. However, experience with patients with COVID-19 and the resulting distress has not been limited to practicing nurses; in fact, nursing students frequently provided care to these same patients (Taylor et al., 2020).

Aslan and Pekince (2021) reported increased psychological distress among nursing students during the COVID-19 pandemic; however, little is understood about the association between psychological distress and exposure to COVID-19 in nursing students. Stress in nursing students has been well documented prior to the COVID-19 crisis (Chernomas & Shapiro, 2013; Fruh et al., 2021), yet it has not been established whether increased stress during the pandemic was directly related to the perceived risk of contracting COVID-19.

To increase the understanding of the pandemic’s effects on nursing students and improve the well-being of these future care providers during health crises, this study examined associations between nursing students’ perceptions of their risk of contracting COVID-19 and the likelihood of completing their nursing degree, psychological distress (i.e., depression, anxiety, and stress), and positive psychological factors (i.e., hope, coping self-efficacy, and social support). We hypothesized that compared with nursing students with a lower perceived risk, students with a higher perceived risk would report a significantly lower likelihood of completing their nursing degrees, higher levels of psychological distress, and lower levels of positive psychology factors.

Method

A cross-sectional descriptive study was conducted with students enrolled in the College of Nursing at a medium-sized university in the southeastern United States. The college offers Bachelor of Science in Nursing (BSN) programs via an in-person format and RN (registered nurse)-to-BSN, RN-to-Master of Science in Nursing (MSN), MSN, postgraduate advanced practice RN certificate, and Doctor of Nursing Practice programs completely online. Thus, students resided in all areas of the U.S. as well as in some foreign countries.

After receiving Institutional Review Board approval for the study, a link to the survey with details of the study, anonymity of the responses, and confidentiality of the data was emailed to all nursing students through an online survey platform in May 2020. Participants were entered into a drawing for 1 of 10 $25 e-gift cards via a separate portal after survey submission.

To assess students’ perceived risk of becoming infected with COVID-19, they were asked, “How would you rate your current risk of contracting COVID-19?” Response options included very low (1), low (2), moderate (3), high (4), and very high (5). To assess students’ likelihood of completing their nursing programs, they were asked, “How likely are you to finish the nursing program?” Response options included extremely unlikely (1), somewhat unlikely (2), neither likely nor unlikely (3), somewhat likely (4), and extremely likely (5).

Students’ frequency of anxiety in the previous 2 weeks was assessed using the Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al., 2006). The Patient Health Questionnaire-9 (PHQ-9; Kroenke et al., 2001) assessed students’ frequency of depression in the past 2 weeks. The Perceived Stress Scale (PSS) (Cohen et al., 1983) assessed students’ perception of stress in the past month. The Coping Self-Efficacy Scale (CSE) (Chesney et al., 2006) assessed students’ confidence in implementing coping strategies, and the State Hope Scale (SHS) (Snyder et al., 1996) assessed hope. Finally, the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 1988) assessed support from family, friends, and significant others; for this study, significant others represented support from educators (i.e., professors and clinical preceptors). All of these measures of psychological distress and positive psychological factors have established reliability and validity (Chesney et al., 2006; Cohen et al., 1983; Kroenke et al., 2001; Snyder et al., 1996; Spitzer et al., 2006; Zimet et al., 1988).

Results

Participants

Most participants (N = 979) were women (91.6%) and White (70.9%) with a mean age of 33 years. Nearly one-half (47.5%) of the participants were enrolled in the MSN program. The additional self-reported racial/ethnic make-up of the sample was approximately 18% African American or Black, 3% Hispanic, 3% Asian/Asian American, 3% multiracial, 1% Native American, 0.2% Pacific Islander/Alaskan, 0.1% Jewish, and 0.1% Middle Eastern.

When participants were asked to rate their current risk of contracting COVID-19, 37.4% rated their risk as moderate, 6.7% rated their risk as very low, 22.6% reported their risk as low, 16% reported their risk as high, and 16% reported their risk as very high. When participants were asked how likely they were to finish the nursing program, the majority (67.6%) of students reported they were extremely likely to finish the program. Psychological factors of the participants are summarized in Table 1. Several one-way between-subjects analysis of variances (ANOVAs) were conducted to compare the effects of perceived COVID-19 risk on participants’ likelihood of completing their programs of study, psychological distress, and positive psychology factors.

TABLE 1.

Psychological Factors in Nursing Students

Instrument n Mean SD
Measures of psychological distress
 Generalized Anxiety Disorder-7 837 8.02 6.25
 Patient Health Questionnaire-9 847 6.65 5.80
 Perceived Stress Scale 833 22.47 4.18
Measures of factors of positive psychology
 Coping Self-Efficacy Scale 829 85.81 27.28
 State Hope Scale 838 38.22 7.59
 Multidimensional Scale of Perceived Social Support
  Total 802 5.23 1.07
  Family 843 5.75 1.29
  Friends 838 5.67 1.24
  Educators 808 4.25 1.60
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Note. SD = standard deviation.

Hypothesis 1: Completion of Nursing Degree

There was a significant effect of increased perceived COVID-19 risk on participants’ likelihood of completing the nursing program, F(5, 849) = 3.96, p = .001. Tukey’s honest significant difference (HSD) post hoc comparisons indicated the mean score for completing the program was significantly higher for students perceiving a low risk of contracting COVID-19 (M = 4.61, SD = 0.88) compared with students perceiving either a moderate risk (M = 4.25, SD = 1.32) or a very high risk (M = 4.21, SD = 1.21).

Hypothesis 2: Psychological Distress

There was a significant effect of increased perceived COVID-19 risk on anxiety, F(5, 803) = 4.44, p = .001, and depression, F(5, 812) = 3.14, p = .008. Tukey’s HSD post hoc comparisons indicated mean GAD-7 scores for students perceiving very low (M = 6.25, SD = 6.11), low (M = 7.25, SD = 5.85), and moderate risk (M = 7.67, SD = 6.10) were significantly lower for anxiety than for students perceiving a very high risk (M = 9.85, SD = 6.61). Tukey’s HSD post hoc comparisons also indicated mean PHQ-9 scores for students reporting a perceived low risk (M = 6.13, SD = 5.89) or moderate risk (M = 6.23, SD = 5.56) were significantly lower for depression than for students who perceived a very high risk (M = 8.10, SD = 6.07). There was no relationship between COVID-19 risk and perceived stress.

Hypothesis 3: Positive Psychological Factors

There was a significant effect of perceiving an increased COVID-19 risk on coping self-efficacy [F(5, 803) = 2.65, p = .008]. Tukey’s HSD post hoc comparisons indicated students perceiving a very low risk (M = 94.42, SD = 29.32) reported significantly more coping self-efficacy skills than students perceiving a high risk (M = 81.70, SD = 25.35).

Finally, there was a significant effect of increased perceived COVID-19 risk on perceived friend F(5, 806) = 4.98, p = .000, and educator support, F(5, 777) = 2.91, p = .013, through a one-way between-subjects ANOVA. Tukey’s HSD post hoc comparisons indicated the mean score for students perceiving a very low (M = 6.19, SD = 1.14) or low risk (M = 5.76, SD = 1.17) perceived significantly more support from friends than those who perceived a high (M = 5.33, SD = 1.41) and very high risk (M = 5.63, SD = 1.38). Tukey HSD post hoc comparisons did not confirm significant differences among risk levels and educator support. There was a significant effect of increased COVID-19 risk on total perceived social support [F(5, 772) = 4.17, p = .001]. Tukey’s HSD post hoc comparisons indicated the mean score for total perceived social support was significantly higher for students perceiving very low (M = 5.59, SD = 1.18) and low risk (M = 5.37, SD = 1.04) than for those perceiving high risk (M = 4.95, SD = 1.19). No significant effect of increased risk on perceived family support and no relationship between perceived COVID-19 risk and hope were found.

Discussion

As the COVID-19 pandemic has continued to affect the world’s population, there has been increased attention to the mental health of health care providers (Shahrour & Dardas, 2020; Shechter et al., 2020). Within nursing, students who historically report high levels of psychological distress (Chernomas & Shapiro, 2013; Fruh et al., 2021), have reported even higher levels caused by the COVID-19 pandemic (Aslan & Pekince, 2021). However, the effects of these increased levels of distress are unknown. Therefore, the present study examined group differences between students’ perceived risk of contracting COVID-19 and the likelihood of obtaining their nursing degrees, levels of psychological distress, and levels of positive psychological factors.

Our first hypothesis that nursing students who perceived a high risk of contracting COVID-19 reported a lower likelihood of completing their nursing degrees than students who perceived a lower risk was consistent with research findings that nursing students have dropped out of their programs of study due to financial reasons, strains to work-life balance, and fear of contracting COVID-19 and transmitting it to family members (Dos Santos, 2020). Our second hypothesis was partially supported; students who perceived a higher risk of contracting COVID-19 reported higher levels of anxiety and depression than students who perceived a lower risk. This supports the literature on negative psychological effects of the COVID-19 pandemic on college students (Lovrić et al., 2020; Galvin et al., 2020; Savitsky et al., 2020).

Our findings focus on the effects of COVID-19 on psychological distress, specifically that students’ perceived risk of contracting the virus is associated with greater levels of anxiety and depression. Interestingly, there were no group differences on perceived risk of contracting COVID-19 and perceived stress. Nursing students’ baseline stress is already elevated (Chernomas & Shapiro, 2013; Fruh et al., 2021), suggesting the perceived risk of COVID-19 added no significant stress for these students.

In partial support of our third hypothesis, coping self-efficacy and social support were found to be significantly different among nursing students who perceived higher risk and those who perceived lower risk. These findings support research on coping self-efficacy as a protective factor against psychological distress (Pritchard & Gow, 2012; Shahrour & Dardas, 2020). This research indicates coping self-efficacy also may play an important role in one’s perceived risk of contracting COVID-19. Additionally, there were differences in perceived social support, which is well documented as a positive psychological buffer against the negative effects of stressful events (Thoits, 2011). The current findings suggest social support might play a vital role in nursing students’ perception of contracting COVID-19.

It is important to note that data were collected in May 2020 when COVID-19 infection rates and deaths were increasing nationally and world-wide at an alarming rate, and no vaccine was yet available. This timeframe was pivotal because the world had just begun to realize the magnitude of this pandemic and to face the reality that it would not end swiftly or without mass causalities. Our data were collected at a time when anxieties were heightened, and although much anxiety remains as we continue to battle COVID-19, it is imperative to keep this timeline in perspective.

Limitations and Future Directions

Although the present study has many strengths, there are some limitations. Applicability is limited because participants were all enrolled in the same college of nursing in the southeastern U.S.; however, our graduate students are situated throughout the U.S. as well as in some foreign countries.

The cross-sectional design of the study and collection of data through an online self-administered survey can introduce bias; thus, longitudinal studies would permit exploration of the depth and breadth of these variables throughout the COVID-19 pandemic. Additionally, self-reported data may be subject to bias due to social desirability; however, the descriptive design and large sample size provide an avenue for reducing effects of social desirability bias.

Finally, the sample included both prelicensure and postlicensure nursing students. There are clear differences between students who have been working in the field and those who have yet to earn their BSN. It is possible that the results may not fully reflect the varied experiences of these groups as practicing nurses may experience higher levels of psychological distress and risk. However, this study did not have adequate power to differentiate between the two groups.

Conclusion

Nursing students with higher perceived risk of contracting COVID-19 reported a decreased likelihood of completing their nursing programs, increased psychological distress, and decreased positive psychology. To mitigate the effects of crises on nursing students, it is vital for faculty and administration to support nursing students and help strengthen their positive psychological factors, which protect against psychological distress (Pritchard & Gow, 2012; Shahrour & Dardas, 2020).

The COVID-19 pandemic forced a realization that what we have been doing as a profession to support nursing students may not be enough to protect their mental health during any type of acute crisis. There is a need for nursing programs to help nursing students develop resiliency, create a positive work-life balance, engage in self-care, and navigate crises in unknown and unpredictable situations.

One example of a preventive approach that can support nursing students is the Creating Opportunities for Personal Empowerment (COPE). COPE is a seven-session manualized program that teaches cognitive-behavioral and positive coping skills with findings from multiple studies indicating decreases in anxiety, depression, and suicidal ideation, as well as increases in healthy lifestyle behaviors and academic performance in college students (Hart Abney et al., 2019; Lusk & Melnyk, 2011; Melnyk et al., 2014, 2015).

The COVID-19 pandemic ignited a call to action for nursing educational programs to provide preventive support to nursing students, equipping them with tools to protect their mental health during acute crisis states and natural disasters. Nursing education excels at teaching students how to function in anticipated emergencies; however, the COVID-19 pandemic has forced us to acknowledge that nursing students, as future health care providers, also need preparation to adapt to unexpected and unidentified crises. It is paramount that the culture of nursing education acclimates and that the curriculum is amended to address these critical needs to improve the mental health of nursing students and future nurses on the front lines.

Footnotes

Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR003096. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Contributor Information

Rebecca J. Graves, College of Nursing, University of South Alabama..

Murphy Harrell, Department of Psychology, University of South Alabama..

Jennifer L. Barinas, Department of Psychology, University of South Alabama..

Sarah E. Taylor, Department of Psychology, University of South Alabama..

Sharon M. Fruh, College of Nursing, University of South Alabama..

Susan G. Williams, College of Nursing, University of South Alabama..

Ryon McDermott, Department of Counseling and Instructional Sciences, University of South Alabama..

Heather R. Hall, College of Nursing, University of South Alabama..

Caitlyn Hauff, Department of Health, Kinesiology, and Sport, University of South Alabama.

Scott Sittig, School of Computing, University of South Alabama..

Matt Campbell, School of Computing, University of South Alabama..

Geoffrey Hudson, Department of Health, Kinesiology, and Sport, University of South Alabama..

Bernadette Mazurek Melnyk, College of Nursing, The Ohio State University..

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