Studying During the COVID-19 Pandemic: A Qualitative Inductive Content Analysis of Nursing Students’ Perceptions and Experiences
2. Materials and Methods
2.1. Design and Theoretical Framework of the Study
2.3. Data Collection
2.4. Data Analysis
2.5. Ethical Considerations
3.1. Students’ Perceptions of the COVID-19 Crisis
“Our national government is successfully protecting its population. They properly regulate and control isolation measures”(P. 7).
“Institutions provide useful guidance on how to suppress COVID-19”(P. 2).
“More rigorous measures should be taken immediately, state borders closed and quarantine declared. Now, it is too late”(P. 9).
“There are long rows of people in front of pharmacies which lack medications, face masks, or medical gloves. We are not well-prepared for this crisis”.(P. 21).
“Praise to the Coronavirus Crisis Management Team for frequent and proper public informing on TV networks”(P. 3).
“I don’t think the population is getting accurate data on the actual numbers of infected and deceased. It may be a panic prevention measure”(P. 31)
“Some media, and especially social networks, are responsible for millions of fake news and misinformation, and that must be severely sanctioned”(P. 24).
“Incredible nonsense is spreading through social networks”(P. 12).
“People do not follow the instructions of the Coronavirus Crisis Team. They do not maintain a proper 2-m distance indoors, they gather and shake hands. It is self-destructive behavior”(P. 25).
“I know that the elderly are the most vulnerable group and I worry greatly about my grandparents”(P. 22).
“I admit, I’m very scared of the infection”(P. 33).
“My fear of COVID-19 is growing more intense every day, this is terrible, I can’t wait for it to end”(P. 19).
“It may be ironic, but ‘thanks’ to people and technology, especially to planes and our cellphones that we do not disinfect, the virus has spread worldwide in just a few months”(P. 1).
“I don’t shake hands with people and I keep recommended social distance of two meters. This is how I protect myself, but also my family and friends”(P. 14).
“I almost always wash my hands according to the protocol, because this is the most important measure of protection”(P. 27).
“I always wear a face mask in the supermarket”(P. 3.)
“I only get information via the Internet or TV when the Coronavirus Crisis Team makes official statements”(P. 3).
“I avoid unverified information circulating on social networks”(P. 7).
“I follow TV news programme and official web sites of the Croatian Institute of Public Health and our university”(P. 2).
“I want to help people because it makes me happy“ (P. 8); and “Helping people is now necessary”(P. 17).
“I now see the power and importance of people uniting. Unfortunately, we need a tragedy to understand the significance and strength of community”(P. 23).
“I am now aware of the significance, the responsibility and the dangers of our profession. The nurses are at extreme risk at work because of the COVID-19”(P. 17).
“The COVID-19 crisis confirms the risks of our future profession ”(P. 8).
3.2. Students’ Experiences while Studying During the Global COVID-19 Pandemic
“I no longer take the bus to college because people are undisciplined and do not wear face masks”(P. 5).
“Now my parents drive to college because it is a risk to travel by tram”(P. 26).
“In the dorm, we no longer hang out with our colleagues, we eat and study separately”(P. 15).
“I feel tense and nervous in the dormitory”(P. 18).
“It is true that only 16 cases of COVID-19 have been reported in Croatia so far, but still I am little afraid of contact with students at the faculty”(P. 30).
“I feel a little nervous during the lectures because some students work in the hospital and are in physical contact with patients”(P. 16).
“I am very much afraid of future clinical training in the hospital, even after the end of the epidemic”(P. 10).
“Hospitals sometimes do not have protective equipment for us”(P. 7).
“I am afraid of the clinical environment, but it is a very important part of our study and I cannot wait to work with patients again”(P. 12).
“I am afraid of becoming infected in the hospital, however, our profession is based on real clinical conditions and direct contact with patients”(P. 3).
“I’m afraid of COVID-19 and I just cannot learn”(P. 4).
“Because of this crisis I cannot concentrate, and when I study I cannot remember anything”(P. 13).
“It is hard to learn when the lives of me and my family are at stake”(P. 28).
“Our teachers are doing well, supporting and encouraging us, even though they are at risk of infection”(P. 11).
“Teachers fully understand our fears”(P. 12).
“The faculty is functioning great in this COVID-19 crisis”(P. 8).
“I support the official decision to suspend classroom teaching soon and to start distance education”(P. 12).
“Online teaching during the COVID-19 crisis is a lifesaver for us”(P. 1).
“The faculty really cares about our safety. We have a lot of hand disinfectants and protective equipment here”(P. 6).
“The faculty is important in controlling the spread of viral infection because it carries out continuous education on prevention measures, and suspension of classroom teaching and clinical training is a strong and effective preventive measure”(P. 17).
4.1. Students’ Perceptions of the COVID-19 Crisis
4.2. Students’ Experiences while Studying During the Global COVID-19 Pandemic
4.3. Limitations of the Study
4.4. Usefulness and Applicability of Study Results
Conflicts of Interest
- Spagnuolo, G.; De Vito, D.; Rengo, S.; Tatullo, M. COVID-19 outbreak: An overview on dentistry. Int. J. Environ. Res. Public Health 2020, 17, 2094. [Google Scholar] [CrossRef][Green Version]
- Van Doremalen, N.; Bushmaker, T.; Morris, D.H.; Holbrook, M.G.; Gamble, A.; Williamson, B.N.; Tamin, A.; Harcourt, J.L.; Thornburg, N.J.; Gerber, S.I.; et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N. Engl. J. Med. 2020. [Google Scholar] [CrossRef]
- World Health Organization (WHO). Coronavirus Disease (COVID-19) Outbreak Situation. Available online: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (accessed on 15 March 2020).
- Han, Y.; Yang, H. The transmission and diagnosis of 2019 novel coronavirus infection disease (COVID-19): A Chinese perspective. J. Med. Virol. 2020. [Google Scholar] [CrossRef][Green Version]
- Liu, Y.; Yan, L.-M.; Wan, L.; Xiang, T.-X.; Le, A.; Liu, J.-M.; Peiris, M.; Poon, L.L.; Zhang, W. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect. Dis. 2020. [Google Scholar] [CrossRef][Green Version]
- Zou, L.; Ruan, F.; Huang, M.; Liang, L.; Huang, H.; Hong, Z.; Yu, J.; Kang, M.; Song, Y.; Xia, J.; et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N. Engl. J. Med. 2020, 382, 1177–1179. [Google Scholar] [CrossRef] [PubMed]
- Park, S.W.; Jang, H.W.; Choe, Y.H.; Han, B.K.; Ahn, Y.C.; Chung, M.J.; Lee, K.-S.; Lee, K.; Han, T. Avoiding student infection during a Middle East respiratory syndrome (MERS) outbreak: A single medical school experience. Korean J. Med. Educ. 2016, 28, 209–217. [Google Scholar] [CrossRef][Green Version]
- Elrggal, M.E.; Karami, N.A.; Rafea, B.; Alahmadi, L.; Al Shehri, A.; AlAmoudi, R.; Koshak, H.; Alkahtani, S.; Cheema, E. Evaluation of preparedness of healthcare student volunteers against MERS-CoV in Makkah, Saudi Arabia: A cross-sectional study. J. Public Health 2018, 26, 607–612. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Stirling, B.V.; Harmston, J. Readying nurses for clinical practice: Protecting students during an outbreak of Middle Eastern-Coronavirus in Saudi Arabia. J. Nurs. Educ. Pract. 2015, 5, 40–44. [Google Scholar] [CrossRef][Green Version]
- Asaad, A.M.; El-Sokkary, R.H.; Aedh, A.I.; Alamanan, M.A.A.; Khalil, F.O. Exploring knowledge and attitude toward Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) among university health colleges’ students, Saudi Arabia: A cross-sectional study. Am. J. Infect. Dis. 2019, 15, 37–43. [Google Scholar] [CrossRef][Green Version]
- Al-Rabiaah, A.; Temsah, M.-H.; Al-Eyadhy, A.A.; Hasan, G.M.; Al-Zamil, F.; Al-Subaie, S.; Al-Sohime, F.; Jamal, A.; Alhaboob, A.; Al-Saadi, B.; et al. Middle East Respiratory Syndrome-Corona Virus (MERS-CoV) associated stress among medical students at a university teaching hospital in Saudi Arabia. J. Infect. Public Health 2020. [Google Scholar] [CrossRef]
- World Health Organization (WHO). Coronavirus Disease 2019 (COVID-19) Situation Report–82. Subject in Focus: Infection in Health Care Workers. Available online: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200411-sitrep-82-covid-19.pdf?sfvrsn=74a5d15_2 (accessed on 31 March 2020).
- Kim, J.S.; Choi, J.S. Middle East respiratory syndrome–related knowledge, preventive behaviors and risk perception among nursing students during outbreak. J. Clin. Nurs. 2016, 25, 2542–2549. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention (CDC). Severe respiratory illness associated with a novel coronavirus-Saudi Arabia and Qatar, 2012. MMWR Morb. Mortal. Wkly. Rep. 2012, 61, 820. [Google Scholar]
- Hassan, H.M. Knowledge and attitude of Al-Ghad college students towards corona virus infection. January. Int. J. Med. Res. 2016, 4, 19–26. [Google Scholar] [CrossRef]
- Al-Hazmi, A.; Gosadi, I.; Somily, A.; Alsubaie, S.; Bin Saeed, A. Knowledge, attitude and practice of secondary schools and university students toward Middle East Respiratory Syndrome epidemic in Saudi Arabia: A cross-sectional study. Saudi. J. Biol. Sci. 2018, 25, 572–577. [Google Scholar] [CrossRef][Green Version]
- Tork, H.M.M.; Mersal, F.A. Middle East Respiratory Syndrome-Corona virus: Knowledge and attitude of Qassim University students, KSA. Glob. Adv. Res. J. Med. Med. Sci. 2018, 7, 90–97. [Google Scholar]
- Kim, M.-J. The convergence study of nursing students’ knowledge, attitudes and preventive behaviors against MERS in South Korea. J. Korea Converg. Soc. 2017, 8, 149–157. [Google Scholar] [CrossRef][Green Version]
- Zarocostas, J. How to fight an infodemic. Lancet 2020, 395, 676. [Google Scholar] [CrossRef]
- World Health Organization (WHO). Coronavirus Disease 2019 (COVID-19). Situation Report–53. Available online: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200313-sitrep-53-covid-19.pdf?sfvrsn=adb3f72_2 (accessed on 15 March 2020).
- Hsieh, H.F.; Shannon, S.E. Three Approaches to Qualitative Content Analysis. Qual. Health Res. 2005, 15, 1277–1288. [Google Scholar] [CrossRef]
- Elo, S.; Kyngäs, H. The qualitative content analysis process. J. Adv. Nurs. 2008, 62, 107–115. [Google Scholar] [CrossRef]
- Oatley, K.; Johnson-laird, P.N. Towards a Cognitive Theory of Emotions’. Cogn. Emot. 1987, 1, 29–50. [Google Scholar] [CrossRef]
- Aldwin, C.M. Stress, Coping, and Development: An Integrative Perspective, 2nd ed.; The Guilford Press: New York, NY, USA, 2009. [Google Scholar]
- Stevens, R.; Erik, H. Erikson: Explorer of Identity and the Life Cycle; Palgrave Macmillan: New York, NY, USA, 2008. [Google Scholar]
- Holland, J.J.; Johnston, J.; Asama, N. The Vocational Identity Scale: A diagnostic and treatment tool. J. Career. Assess. 1993, 1, 1–12. [Google Scholar] [CrossRef]
- Johnson, M.; Cowin, L.S.; Wilson, I.; Young, H. Professional Identity and Nursing: Contemporary Theoretical Developments and Future Research Challenges. Int. Nurs. Rev. 2012, 59, 562–569. [Google Scholar] [CrossRef] [PubMed]
- Palinkas, L.A.; Horwitz, S.M.; Green, C.A.; Wisdom, J.P.; Duan, N.; Hoagwood, K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm. Policy Ment. Health 2015, 42, 533–544. [Google Scholar] [CrossRef][Green Version]
- Bengtsson, M. How to plan and perform a qualitative study using content analysis. Nurs. Plus. Open. 2016, 2, 8–14. [Google Scholar] [CrossRef][Green Version]
- Saunders, B.; Sim, J.; Kingstone, T.; Baker, S.; Waterfield, J.; Bartlam, B.; Burroughs, H.; Jinks, C. Saturation in qualitative research: Exploring its conceptualization and operationalization. Qual. Quant. 2018, 52, 1893–1907. [Google Scholar] [CrossRef]
- Sandelowski, M. Sample size in qualitative research. Res. Nurs. Health 1995, 18, 179–183. [Google Scholar] [CrossRef]
- Mason, M. Sample size and saturation in PhD studies using qualitative interviews. Forum Qual. Health Res. 2010, 11, 8. [Google Scholar] [CrossRef]
- Polit, D.F.; Beck, C.T. Nursing Research: Generating and Assessing Evidence for Nursing Practice, 9th ed.; Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2012. [Google Scholar]
- Lovrić, R.; Prlić, N.; Milutinović, D.; Marjanac, I.; Žvanut, B. Changes in nursing students’ expectations of nursing clinical faculties’ competences: A longitudinal, mixed-methods study. Nurse Educ. Today 2017, 59, 38–44. [Google Scholar] [CrossRef]
- Wilder-Smith, A.; Freedman, D.O. Isolation, quarantine, social distancing and community containment: Pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J. Travel. Med. 2020, 27. [Google Scholar] [CrossRef]
- Akan, H.; Gurol, Y.; Izbirak, G.; Ozdatlı, S.; Yilmaz, G.; Vitrinel, A.; Hayran, O. Knowledge and attitudes of university students toward pandemic influenza: A cross-sectional study from Turkey. BMC Public Health 2010, 10, 1–8. [Google Scholar] [CrossRef][Green Version]
- Khan, M.U.; Shah, S.; Ahmad, A.; Fatokun, O. Knowledge and attitude of healthcare workers about Middle East Respiratory Syndrome in multispecialty hospitals of Qassim, Saudi Arabia. BMC Public Health 2014, 14, 1281. [Google Scholar] [CrossRef][Green Version]
- Wong, J.G.; Cheung, E.P.; Cheung, V.; Cheung, C.; Chan, M.T.; Chua, S.E.; McAlonan, G.; Tsang, K.W.; Ip, M.S.M. Psychological responses to the SARS outbreak in healthcare students in Hong Kong. Med. Teach. 2004, 26, 657–659. [Google Scholar] [CrossRef]
- Khalid, I.; Khalid, T.J.; Qabajah, M.R.; Barnard, A.G.; Qushmaq, I.A. Healthcare workersemotions, perceived stressors and coping strategies during a MERS-CoV out-break. Clin. Med. Res. 2016, 14, 7–14. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Steimer, T. The biology of fear- and anxiety-related behaviors. Dialogues Clin. Neurosci. 2002, 4, 231–249. [Google Scholar]
- Chin, A.W.H.; Chu, J.T.S.; A Perera, M.R.; Hui, K.P.Y.; Yen, H.-L.; Chan, M.C.W.; Peiris, M.; Poon, L.L.M. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe. 2020. [Google Scholar] [CrossRef]
- Feng, S.; Shen, C.; Xia, N.; Song, W.; Fan, M.; Cowling, B.J. Rational use of face masks in the COVID-19 pandemic. Lancet Respir. Med. 2020. [Google Scholar] [CrossRef]
- World Health Organization (WHO). Coronavirus Disease (COVID-19) Advice for the Public: When and How to Use Masks. Available online: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks (accessed on 2 April 2020).
- Leung, N.H.L.; Chu, D.K.W.; Shiu, E.Y.C.; Chan, K.-H.; McDevitt, J.J.; Hau, B.J.P.; Yen, H.-L.; Li, Y.; Ip, D.K.M.; Peiris, J.S.M.; et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat. Med. 2020. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Stirling, B.V.; Harmston, J.; Alsobayel, H. An educational programme for nursing college staff and students during a MERS- coronavirus outbreak in Saudi Arabia. BMC Nurs. 2015, 14, 20. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Fukada, M. Nursing competency: Definition, structure and development. Yonago Acta Med. 2018, 61, 1–7. [Google Scholar] [CrossRef][Green Version]
- Lavin, R.P.; Adelman, D.S.; Veenema, T.G. Society for the Advancement of Disaster Nursing: Exploring the Path to Excellence. Disaster Med. Public Health Prep. 2017, 11, 641–646. [Google Scholar] [CrossRef]
- Paterson, J.G.; Zderad, L.T. Humanistic Nursing; John Wiley & Sons: New York, NY, USA, 1976. [Google Scholar]
- Brooks, S.K.; Webster, R.K.; E Smith, L.; Woodland, L.; Wessely, S.; Greenberg, N.; Rubin, G.J. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020, 395, 912–920. [Google Scholar] [CrossRef][Green Version]
- Wang, Y.; Xu, B.; Zhao, G.; Cao, R.; He, X.; Fu, S. Is quarantine related to immediate negative psychological consequences during the 2009 H1N1 epidemic? Gen. Hosp. Psychiatry 2011, 33, 75–77. [Google Scholar] [CrossRef] [PubMed]
- Lovrić, R.; Prlić, N.; Zec, D.; Pušeljić, S.; Žvanut, B. Students’ assessment and self-assessment of nursing clinical faculty competencies: Important feedback in clinical education? Nurse. Educ. 2015, 40, E1–E5. [Google Scholar] [CrossRef] [PubMed]
- Jeong, I.; Cho, J.; Park, S. Compliance with standard precautions among operating room nurses in South Korea. Am. J. Infect. Control. 2008, 36, 739–742. [Google Scholar] [CrossRef]
- Choi, J.S.; Kim, J.S. Factors influencing preventive behavior against Middle East Respiratory Syndrome-Coronavirus among nursing students in South Korea. Nurse Educ. Today 2016, 40, 168–172. [Google Scholar] [CrossRef]
|MC||Generic Categories||Sub-Categories||Codes (Frequency of Statements)|
|Students’perceptions of the global|
|State institutions and the population in the COVID-19 crisis||Actions of state institutions||- Effective population protection measures (21)|
- Delayed and insufficient population protection measures (12)
- Shortages of protective equipment and medication in pharmacies (12)
|Informing the public||- An efficient system of informing the public (23)|
- Doubtful veracity of the information provided by state institutions (9)
- Spread of misinformation through media and social networks (33)
|Population behavior||- The gravity of the situation is not taken seriously (21) |
- Inappropriate and risky behavior of the population (21)
|Students in the COVID-19 crisis||Emotions and opinions of students||- Fear of the COVID-19 infection (19)|
- Concerns for the senior members of the family (33)
- Influence of human factors and technology on the spread of disease (5)
|The behavior of students and their sources of information||- Applying prevention procedures to control the infection (30)|
- Using only reliable sources of information (32)
|Students’ value systems and beliefs||- Awareness of the responsibility towards the community (23)|
- Recognizing the benefits of the human communion (23)
- Recognizing the importance and risks of the nursing profession (23)
|Students‘experiences while studying during the global COVID-19 pandemic||Experiences with student life activities||Public transportation services||- Avoid using public transportation (14)|
- Non-compliance of passengers with prescribed protection measures (14)
|Residence in a student dormitory||- Restriction of socializing and learning with friends (3)|
- Feeling uneasy about social distancing of students (3)
|Teaching and learning process||- Mild fear of becoming infected in the classroom (5)|
- Severe fear of becoming infected in the clinical setting (15)
- Learning difficulties (13)
- Professionalism, courage and humanity of the teachers (33)
|Experiences with the organization of work at the faculty||Teaching activities of the faculty||- Supporting the suspension of the classroom and clinical activities (33)|
- Satisfaction with distance learning (33)
|Preventative measures||- The important role of the faculty in preventing the spread of infection (30)|
- Effective protective measures imposed by the faculty (30)
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Lovrić, R.; Farčić, N.; Mikšić, Š.; Včev, A. Studying During the COVID-19 Pandemic: A Qualitative Inductive Content Analysis of Nursing Students’ Perceptions and Experiences. Educ. Sci. 2020, 10, 188. https://doi.org/10.3390/educsci10070188
Lovrić R, Farčić N, Mikšić Š, Včev A. Studying During the COVID-19 Pandemic: A Qualitative Inductive Content Analysis of Nursing Students’ Perceptions and Experiences. Education Sciences. 2020; 10(7):188. https://doi.org/10.3390/educsci10070188Chicago/Turabian Style
Lovrić, Robert, Nikolina Farčić, Štefica Mikšić, and Aleksandar Včev. 2020. "Studying During the COVID-19 Pandemic: A Qualitative Inductive Content Analysis of Nursing Students’ Perceptions and Experiences" Education Sciences 10, no. 7: 188. https://doi.org/10.3390/educsci10070188