key: cord-355015-e681jmix authors: Cici, Remziye; Yilmazel, Gülay title: Determination of anxiety levels and perspectives on the nursing profession among candidate nurses with relation to the COVID‐19 pandemic date: 2020-08-10 journal: Perspect Psychiatr Care DOI: 10.1111/ppc.12601 sha: doc_id: 355015 cord_uid: e681jmix PURPOSE: This study aimed to determine the anxiety level of candidate nurses and capture their perspective on the nursing profession in light of the coronavirus disease 2019 (COVID‐19) pandemic. DESIGN AND METHODS: This descriptive study consisted of 322 nursing students in Turkey after the pandemic announcement of the World Health Organization. A web‐based survey was used and anxiety levels was determined via State Anxiety Scale and Beck Anxiety Inventory. FINDINGS: Positive perspectives (63.4%) on the nursing profession before the pandemic decreased to 50.6%, whereas the negative (26.7%), and the undecided (9.9%) perspectives increased to 32.3% and 17.1%, of the total respectively. A significant increase was found in the anxiety scores with negative perspectives combined with an unwillingness to practice their profession in the future (P < .05). PRACTICE IMPLICATIONS: Pregraduate training should be provided to candidate nurses about pandemic nursing and professional difficulties they may possibly encounter in infection epidemics. questions in the Beck Anxiety Inventory. The participants were called by phone and were informed about the purpose of the study. It was questioned whether they could participate in this study through online survey. After the verbal consents of the participants were obtained, written informed consents were sent to them by e-mail. Data were collected when participants filled out online questionnaire. A form includes the sociodemographic characteristics (age, gender, classroom level) and the perspective of the candidate on the profession before and during the pandemic. The candidate's perspective on the profession was captured with help of two survey questions: first, "What was your perspective on the nursing profession before and during the COVID-19 pandemic?", to which the answer choices were "positive," "negative," and "undecided." The second question asked, "Are you willing to practice your profession in the future?" and the answer choices were "yes" and "no." Self-assessments of the influence of the pandemic on mental health and the fear with regard to the risk of contagion were also captured with questions with the answers "yes and no." The State Anxiety Scale was developed by Spielberger in 1970, and the Turkish version and its corresponding validity-reliability study was adapted by Oner and Le Compte in 1983. 18, 19 In the Turkish version of the scale, consistency and reliability were found to be between 0.94 and 0.96. The scale consists of 20 items and answers range from 1 to 4 (1: never, 2: some, 3: very, 4: completely). The total score value obtained from the scale is between 20 and 80. High scores indicate high anxiety levels. 18, 19 Although the scale does not have a cutoff point, it is generally accepted that the cutoff point is 39 to 40 points. 20 In this study, Cronbach's α coefficient of the scale was determined to be .72. are evaluated as "0" (none), "1" (mild), "2" (moderately), and "3" (severely). The total score obtained from the scale varies between 0 and 63, and high scores are representative of high anxiety levels. 21, 22 In this study, Cronbach's α coefficient of the scale was determined to be 0.92. This study was planned according to the Helsinki Principles, and ethical approval was obtained from the Hitit University Non-Interventional Research Ethic Committee. Data were analyzed using the SPSS 17 program with percentages, mean, independent t test, and a one-way analysis of variance (posthoc Tukey). In the analysis, P < .05 value considered statistically significant. Of the study group, 72% were between 18 and 21 age groups with mean age of 20.8 years. A total of 76.4% of those who were surveyed were female, and 31.1% were training in the second grade. Table 1 shows the distribution of anxiety scores. As seen in Table 1 , students' Beck Anxiety scores ranged from 0 to 63 with an average of 15.2 ± 8.4 points. It was determined that 50.9% of the participants scored 16 and above. It was determined that the state anxiety level of the participants was at the full limit (40.3 ± 4.9) and the state anxiety score was 40 and above in 51.9% of the cases. The changes in students' perspectives on the nursing profession due to the COVID-19 pandemic are shown in Figure 1 . It was observed that the positive views of the participants toward the nursing profession, stood at 63.4% before the pandemic, but decreased to 50.6% during the pandemic. On the other hand, negative and undecided views of the profession were held by 26.7% and 9.9% of those who were surveyed before the pandemic, and increased to 32.3% and 17.1%, respectively. In Table 2 , the distribution of anxiety scores according to the perspectives on nursing profession is given. As seen in Table 2 , while the anxiety scores did not differ significantly according to the perspectives on the nursing profession before the COVID-19 pandemic (P > .05), a significant increase in anxiety scores was found in those with a negative perspective of the profession during the pandemic (P < .05). Anxiety scores were found to be significantly higher for those with the unwillingness to practice the profession in the future (P < .05). The distribution of anxiety scores according to mental influence due to pandemic and fear of being infected with COVID-19 is given in Table 3 . Anxiety scores were found to be significantly higher among those with mental influence and afraid of being infected (P < .05). In the present study, anxiety levels of candidate nurses were determined to be wide ranging due to the COVID-19 pandemic. Anxiety and state anxiety were found in more than half of the participants (Table 1) . Facing large-scale infectious disease threats may increase the psychological pressure on individuals. 23 Epidemics may also trigger psychological problems among health workers who work in the front line. A recent community-based study in China reported that approximately one-third of the participants had moderate to severe anxiety and more than half of the participants had moderate to severe psychological effects, as a result of the pandemic. 24 Whereas the psychological pressure caused by pandemics affects the general public, its effect on health care providers working in the frontline is markedly greater. Experiences of healthcare professionals in the current COVID-19 epidemic, underlined the psychological pressure on healthcare professionals who find themselves at the forefront of attempts to suppress the outbreak. 23, 25 In another study conducted in China, it was demonstrated that the incidence of anxiety and stress disorder was high among healthcare workers working in the frontline due to COVID-19 and the incidence was comparatively higher among nurses than doctors. 16 Rapid decision making for suspected cases, careful isolation of patients, determining the specific departments to work, and using the The perception of risk, and the confidence in professional skills among health workers were factors that facilitate the willingness to work. 26 When the participants' perspectives on the profession before and during the pandemic were compared, it was determined that there was a clear change in their perspectives on the negative and undecided responses toward the profession (Figure 1 ). Anxiety and state anxiety scores were found to be significantly higher among those with a negative perspective regarding their profession as a result of the pandemic and they were unwilling to practice their job in the future ( Anxiety scores were quite high among those who were mentally affected due to pandemic and had a fear of being infected (Table 3) . It is recommended to develop psychological support for health workers working in the frontlines and provide adequate interventions so as to assist them to endure the increased psychological pressure as a result of the pandemic. 25, 27 In light of past epidemic experiences, protective strategy should be planned for all healthcare professionals, especially nurses and candidate nurses. In summary, in our study, it was found that anxiety levels increased due to the COVID-19 pandemic, and perspectives on the profession showed a negative trend due to the pandemic among candidate nurses. Nursing is a life-saving profession and addresses reflecting every aspect of treatment and care in health services. Global health threats such as pandemics may bring unprecedented demands on most nurses' knowledge, skill and moral resolve and anxiety management. Pregraduate training should be provided to candidate nurses about pandemic nursing and professional difficulties they may encounter in infection epidemics. Anxiety may decrease willingness and ability of candidate nurses to profession during a pandemic. To minimize these problems, education plans should be made to keep candidate nurses more active in community health services. In the pandemic phase, more studies should be planned to determine the mental health problems of the candidate nurses, and psychological counseling, guidance, and mental health services should be provided for those at risk. 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Influenza Other Respir Viruses A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak Determination of anxiety levels and perspectives on the nursing profession among candidate nurses with relation to the COVID-19 pandemic The authors declare that there are no conflict of interests. https://orcid.org/0000-0003-3977-492XGülay Yilmazel http://orcid.org/0000-0002-2487-5464