A systematic review of the nursing students' quality of life and related factors during the COVID-19 pandemic

Article Type : Reviews

Authors

1 Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

2 Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran

3 Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

Abstract

The goal of the current systematic review was to learn more about nursing students' quality of life (QoL) and associated determinants during the COVID-19 pandemic. Systematic search was done from the earliest date to August 27, 2022 using keywords extracted from Medical Subject Headings including "Quality of life", "Nursing students", and "COVID-19" in international electronic databases including Scopus, PubMed, and Web of Science. Iranian databases such as Iranmedex were also searched. Utilizing the cross-sectional study appraisal tool (AXIS tool), the quality of the studies included in this review was assessed. This systematic review comprised eight cross-sectional studies with a combined total of 5,939 nursing students. The findings of the eight research that made up this systematic review revealed that nursing students had a moderate level of QoL during the COVID-19 pandemic. Overall, the findings of the research included in this study were conflicting, which may be related to the impact of factors such as age, gender, anxiety, residential area, presence of COVID-19 cases near their residence, the care of COVID-19 patients, nursing-related experience, coping behavior, the feeling of loneliness, general point average, program classification, source of knowledge, trust in the government’s handling of the pandemic, years in nursing school, subjective happiness, resilience, anxiety, depression, academic stress, the problem with internet use. Therefore, managers and policymakers in the field of nursing should plan and implement appropriate measures to moderate the negative influencing factors on the QoL among nursing students, taking into account the importance of the QoL of nursing students as people present in the health care service system and their presence at the patient's bedside.

Keywords

1 Introduction

Globally, the extensive COVID-19 outbreak that started in December 2019 has caused a serious public health issue [1]. According to the World Health Organization, there were 594,367,247 confirmed cases of COVID-19 globally as of August 24, 2022, and 6,451,016 people died as a result [2].

People's mental health and quality of life (QoL) have been profoundly affected by the COVID-19 viral pandemic on a global scale [3, 4]. The majority of studies on the QoL before the widespread of COVID-19 focused on non-communicable and chronic disorders, but everything changed once the epidemic started. QoL is a generic term used to describe the patient's overall assessment of how their sickness or medical condition has affected their physical, mental, social, and vocational performance, among other areas [5, 6]. The improvement of everyone's QoL is one of the United Nation's sustainable development objectives [7].

It appears that this epidemic has a greater impact on the QoL of students and young people. One of the repercussions of this pandemic, for instance, can be the sense of loneliness [8]. Additionally, this illness has brought about a lot of changes in higher education and institutions, and the implementation of educational activities has shifted to online education, which has led to additional student isolation throughout the globe [9]. Due to abrupt changes in their everyday lives, students have been suffering from mental discomfort as a result of the disease's spread. This has had a huge impact on nursing students' QoL [10, 11].

Nursing students may be especially susceptible to the COVID-19 pandemic because they are a group of young adults and a part of the healthcare system [8]. According to research, during pandemics, nursing students may face problems with their QoL such as loneliness, mental health issues, sleeplessness, problems concentrating and learning, fear of infection, anxiety over grades, passing examinations, and final graduation [7, 12-14]. The COVID-19 outbreak has had a negative effect on nursing students' QoL, as well as their physical and emotional health, and they frequently feel lonely, according to the findings of the study by Rohde et al [7]. The results of a different study conducted by Hanafy Saber et al., however, showed that nursing interns had a high QoL throughout the COVID-19 epidemic [15].

As far as we are aware, there hasn't been a thorough analysis of nursing students' QoL during the COVID-19 pandemic. This study was carried out to look into the QoL and associated factors among nursing students during the COVID-19 pandemic because of the significance of nursing students' QoL as the future workforce in the healthcare system and the influence of the pandemic on it.

 

2 Methods

2.1 Study registration and reporting

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist served as the basis for the processes used to perform this systematic review [16]. Additionally, the international prospective register of systematic reviews (PROSPERO) database does not have a record of this systematic review.

 

2.2 Search strategy

Systematic search was done from the earliest date to August 27, 2022 using keywords extracted from Medical Subject Headings including "Quality of life", "Nursing students", and "COVID-19" in international electronic databases including Scopus, PubMed, and Web of Science. Iranian databases such as Iranmedex were also searched. For example, the search strategy was in PubMed/MEDLINE database including ((“Quality of life”) OR (“Health-related quality of Life”) OR (“HRQOL”)) AND ((“Nursing students”) OR (“Pupil nurses”)) AND ((“COVID-19”) OR (“COVID-19 pandemic”)). To combine terms, the Boolean operators "OR" and "AND" were employed. The Persian equivalent of the aforementioned keywords was used to search Persian electronic databases. Two researchers independently carried out the systematic search process. This review study excludes gray literature, which includes expert comments, conference presentations, dissertations, research and committee reports, and ongoing research. Gray literature refers to articles that have been published electronically but have not been reviewed by a for-profit publisher [17].

 

2.3 Inclusion and exclusion criteria

This systematic review contains cross-sectional studies conducted in English and Persian that examined the COVID-19 pandemic's effects on nursing students' QoL and related characteristics. Letters to the editor, case studies, conference materials, experiments, studies with qualitative designs, and reviews were not taken into consideration for this study.

 

2.4 Study selection

EndNote 20 software was used to review the searched articles. According to the inclusion and exclusion criteria of this study, two researchers reviewed the studies separately. After the initial electronic review, duplicate research was removed and article titles, abstracts, and full texts were hand-reviewed. To resolve possible conflicts between the first two researchers, the third researcher was asked for help. Finally, to prevent the loss of information, the sources were carefully examined.

 

2.5 Data extraction and quality assessment

From the articles included in this systematic review, details such as the first author's name, the year of publication, the location, the sample size, the male/female ratio, the age, the single/married ratio, the number of years spent in nursing school, the residence area, the questionnaire, and the main findings were taken. The appraisal technique for cross-sectional studies was used to assess the quality of the studies that were included in this review (AXIS tool). This test uses 20 elements using a two-point Likert scale, encompassing yes (score of 1) and no (score of 0), to assess the quality of the included research (score of 0). This instrument evaluates study design quality (7 items), report quality (7 things), and potential bias introduction (6 items). The quality of studies is rated by AXIS on a scale of high (70 to 100%), fair (60 to 69.9%), and low (0 to 59.9%) [18]. Two researchers independently collected data and assessed the studies' quality.

 

3 Results

3.1 Study selection

As mentioned in Figure 1, 1,354 studies were found following an extensive search of electronic resources. 260 papers were removed from the research because they included duplicate information. Out of the remaining 1,094 publications, 69 had non-cross-sectional design and 995 had inconsistencies with the study's objectives, which led to their exclusion. Out of the twenty-eight studies that remained after a careful examination of the full text of articles, twelve studies were excluded from this study because the study design was insufficient, and eight studies were excluded because they lacked essential information. Eight studies [7-9, 15, 19-22] were ultimately included in this review study.

 

3.2 Study characteristics

As mentioned in Supplementary Table 1, this systematic review comprised eight cross-sectional studies [7-9, 15, 19-22] with a combined total of 5,939 nursing students. 65.14% of them were female. Urban areas were where 48.91% of nursing students resided. Among the nursing students, 23.62% were in their first year, followed by 22.13% in their second year, 16.29% in their third year, and 37.96% in their fourth. The studies that made up this review were carried out in Norway (n=2) [7, 8], the Philippines (n=2) [19, 22], China (n=1) [20], Egypt (n=1) [15], Greece (n=1) [9], and Saudi Arabia (n=1) [21].

Figure 1. Flow diagram of the study selection process.

 

3.3 Methodological Quality of included study

Figure 2 illustrates the high caliber of all the research [7-9, 15, 19-22] incorporated in this systematic review. The study limitations were not mentioned in the two studies [15, 22]. Additionally, no funding or conflicts of interest were disclosed in one study [9].

 

3.4 QoL among nursing students during the COVID-19 pandemic

The mean score of QoL among nursing students during the COVID-19 pandemic was 5.95 (SD=1.40) out of 10 [7, 8, 15, 19-22].

 

3.4 Factors associated with the nursing student’s QoL during the COVID-19 pandemic

Among the factors in the eight studies [7-9, 15, 19-22] included in this systematic review, factors such as years in nursing school (n=1) [7], subjective happiness (n=1) [9], and resilience (n=1) [19] had a significant positive relationship with QoL in nursing students. Whereas, factors such as anxiety (n=2) [9, 19], depression (n=1) [9], academic stress (n=1) [19], resilience (n=1) [22], and the problem with internet use (n=1) [20] had a significant negative relationship with QoL in nursing students. Also, QoL in nursing students had a significant relationship with factors such as gender (n=3) [15, 21, 22], age (n=2) [15, 21], residential area (n=1) [15], presence of the COVID-19 cases near their residence (n=1) [22], the care of COVID-19 patients (n=1) [15], nursing-related experience (n=1) [21], fear of COVID-19 (n=1) [8], coping behavior (n=1) [15], the feeling of loneliness (n=1) [8], general point average (n=1) [21], program classification (n=1) [21], source of knowledge (n=1) [15], and trust in the government’s handling of the pandemic (n=1) [8] (Table 1).

 

 Figure 2. Assessment of the quality of the included articles.

 

Table 1. Factors associated with QoL among nursing students during the COVID-19 pandemic.

First Author/year

Factors associated with QoL

Beisland et al., 2021

There was a significant relationship between fear of COVID-19 and QoL (P<0.05).

There was a significant relationship between the feeling of loneliness and QoL (P<0.05).

There was a significant relationship between trust in the government’s handling of the pandemic and QoL (P<0.05).

Cai et al., 2021

There was a significant negative relationship between a problem with internet use and QoL (P<0.001).

Grande et al., 2021

There was a significant relationship between age and QoL (P<0.05).

There was a significant relationship between the general point average and QoL (P<0.05).

There was a significant relationship between sex and QoL (P<0.05).

There was a significant relationship between program classification and QoL (P<0.05).

There was a significant relationship between nursing-related experience and QoL (P<0.05).

Guillasper et al., 2021

There was a significant relationship between sex and QoL (t=-2.713, P=0.008).

There was a significant relationship between the presence of the COVID-19 case near their residence and QoL (t=5.622, P=0.004).

There was a significant negative relationship between resilience and QoL (r=-0.363, P<0.001).

Hanafy Saber et al., 2021

There was a significant relationship between age and QoL (P<0.001).

There was a significant relationship between sex and QoL (P<0.001).

There was a significant relationship between the residential area and QoL (P<0.001).

There was a significant relationship between the care of COVID-19 patients and QoL (P=0.007).

There was a significant relationship between the source of knowledge and QoL (P=0.002).

There was a significant relationship between coping behavior and QoL (P<0.001).

Albani et al., 2022

There was a significant positive relationship between subjective happiness and QoL (P<0.05).

There was a significant negative relationship between anxiety and QoL (P<0.05).

There was a significant negative relationship between depression and QoL (P<0.05).

Berdida & Grande, 2022

There was a significant positive relationship between resilience and QoL (r=0.664, P=0.001).

There was a significant negative relationship between COVID-19 anxiety and QoL (r=-0.532, P=0.001).

There was a significant negative relationship between academic stress and QoL (r=-0.670, P=0.001).

Rohde et al., 2022

There was a significant positive relationship between the years in nursing school and QoL (P<0.001).

 

 4 Discussion

According to the eight studies that made up this systematic review, nursing students' QoL was moderate during the COVID-19 pandemic. Overall, the findings of the articles included in this study were conflicting, which may be related to the impact of factors such as age, gender, anxiety, residential area, presence of COVID-19 cases near their residence, the care of COVID-19 patients, nursing-related experience, coping behavior, the feeling of loneliness, general point average, program classification, source of knowledge, trust in the government’s handling of the pandemic, years in nursing school, subjective happiness, resilience, anxiety, depression, academic stress, the problem with internet use.

The psychological reactions of the population to infection during a pandemic like COVID-19 influence the likelihood of psychological discomfort and social disturbance as well as the spread and containment of the disease [23]. In addition, people's especially students' QoL has decreased as a result of social isolation and separation from family and friends brought on by quarantine and university and school closures [24]. The findings of this study indicated that the QoL of nursing students was moderate. Differences in QoL, on the other hand, may be brought on by factors including age, gender, anxiety, residential area, presence of COVID-19 cases near their residence, the care of COVID-19 patients, nursing-related experience, coping behavior, the feeling of loneliness, general point average, program classification, source of knowledge, trust in the government’s handling of the pandemic, years in nursing school, subjective happiness, resilience, anxiety, depression, academic stress, problem with internet use.

In the current systematic review, anxiety and depression were two of the variables that had an impact on nursing students' QoL throughout the pandemic. A study conducted in Brazil looked at students' QoL during the COVID-19 pandemic. According to the study's findings, medical students scored higher overall than other groups of students in terms of QoL, as well as in the psychological and environmental domains. Additionally, it demonstrated the negative and considerable impact that factors like anxiety and depression have on students' QoL [25]. Another study conducted in Malaysia revealed that the COVID-19 pandemic affected students' QoL. This study also demonstrated that students' QoL in various domains is negatively impacted by stress, anxiety, and depression. Another factor that affected QoL was coping behaviors, which demonstrated that coping throughout the pandemic era helps to reduce stress and enhances QoL [26].

As previously indicated, during the COVID-19 outbreak, medical students demonstrated a greater level of QoL than other students. According to the findings of a Polish study, female technical university students have a lower QoL than female medical students. This interdisciplinary disparity wasn't seen in other QoL dimensions, though [27].

The loneliness experienced while in quarantine also had an impact on the nursing students' QoL. According to the findings of a Polish study, students' social activities will decrease under strict quarantine, which will negatively impact their QoL [28].

Therefore, managers and policymakers in the field of nursing should plan and implement appropriate measures to moderate the negative influencing factors on the QoL among nursing students, taking into account the importance of the QoL of nursing students as people present in the health care service system and their presence at the patient's bedside. Universities are also expected to assume responsibility for assisting students' mental health, physical health, and QoL in the event of future epidemics. Universities are also advised to implement appropriate educational programs for students in low-QoL domains. Additionally, it is advised that in the future, researchers look at the issues and needs that have an impact on nursing students' QoL during the pandemic and, via the use of intervention studies, identify the best course of action to address these issues and raise QoL.

 

4.1 Limitations

Similar to other reviews, the current study had several limitations. Meta-analysis was not possible due to the significant level of methodological and instrumental variation in this study. The methodical approach to data gathering, organizing, and analysis in this study remained constant even though a meta-analysis was not performed. Finally, because only English and Persian-language studies were looked for, there might have been linguistic hurdles. Based on this, it is also possible that not all papers in this field were considered for this research.

 

4.2 Implications for nursing managers and policymakers

Because nursing students are present in the health care delivery system and are often at the patient's bedside, managers and policymakers in the area of nursing should develop and execute appropriate measures to moderate the negative influencing variables on the QoL among nursing students. In the event of future epidemics, universities are also expected to take on responsibility for supporting students' physical, emotional, and QoL.

 

 4.3 Recommendations for future research

It is suggested that researchers examine the problems and requirements that affect nursing students' QoL during the pandemic in the future and, through intervention studies, determine the best course of action to solve these problems and improve QoL.

 

5 Conclusions

Overall, the COVID-19 pandemic had a moderate impact on nursing students' QoL. Overall, the findings of the research included in this systematic review were conflicting, which may be related to the impact of factors such as age, gender, anxiety, residential area, presence of COVID-19 cases near their residence, the care of COVID-19 patients, nursing-related experience, coping behavior, the feeling of loneliness, general point average, program classification, source of knowledge, trust in the government’s handling of the pandemic, years in nursing school, subjective happiness, resilience, anxiety, depression, academic stress, the problem with internet use. Therefore, managers and policymakers in the field of nursing should plan and implement appropriate measures to moderate the negative influencing factors on the QoL among nursing students, taking into account the importance of the QoL of nursing students as people present in the health care service system and their presence at the patient's bedside.

 

Supplementary files

Supplementary Table 1.

 

Acknowledgements

Not applicable.

 

Authors’ contributions

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: SV, OA, MH, PT; Drafting the work or revising it critically for important intellectual content: SV, OA, MH, PT; Final approval of the version to be published: SV, OA, MH, PT; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: SV, OA, MH, PT.

 

Funding

Self-funded.

 

Ethics approval and consent to participate

Not applicable.

 

Competing interests

We do not have potential conflicts of interest with respect to the research, authorship, and publication of this article.

 

Availability of data and materials

The datasets used during the current study are available from the corresponding author on request.

 

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (CC BY-NC 4.0).

© 2023 The Author(s).

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Volume 1, Issue 1
April 2023
Pages 38-44
  • Receive Date: 23 March 2023
  • Revise Date: 24 April 2023
  • Accept Date: 28 April 2023
  • First Publish Date: 24 May 2023
  • Publish Date: 24 May 2023