Received: 12 February 2021 | Revised: 13 February 2022 | Accepted: 8 March 2022 DOI: 10.1002/nop2.1207 RESEARCH ARTICLE Psychological impact of the COVID-­19 pandemic on nursing students in the first wave: A cross-­sectional survey Juan Roldán-­Merino1,2,3 | Barbara Hurtado-­Pardos1,2,4 | Lorena Molina-­Raya1,2 | David Bande5 | Irma Casas6,7 | Mariona Farrés-­Tarafa1,2,8,9 1 Campus Docent, Sant Joan de Déu -­ ​ undació Privada, School of Nursing, F Abstract University of Barcelona, Barcelona, Spain Aim: The aim of the study was to evaluate the psychological impact on nursing stu- 2 Research Group GIES (Grupo de investigación en Enfermería, Educación y dents at the end of period of confinement during the first wave of the COVID-­19 Sociedad), Barcelona, Spain outbreak in Spain. 3 Research Group GEIMAC (Consolidated Design: A cross-­sectional study reported in line with the STROBE guidelines. Group 2017-­1681): Group of Studies of Invarianza of the Instruments of Methods: Nursing students were invited to complete an online questionnaire at the Measurement and Analysis of Change in end of the 2019–­2020 academic year using convenience sampling. The questionnaire the Social and Health Areas, Barcelona, Spain collected data on sociodemographic factors, work, and life experiences in relation to 4 Member Research Group GRIN (Grupo COVID-­19, habits and lifestyle using the World Health Organization Five Well-­Being consolidado de recerca Infermeria, Index (WHO-­5) and the Generalized Anxiety disorder-­7 scale. Variables related to anx- SRG:664), Barcelona, Spain 5 Servicio Anestesiología, Reanimación y iety were analysed using multiple lineal regression analysis, Tratamiento del dolor. Parc de Salut Mar, Results: The prevalence of low psychological well-­being in the 203 students was Barcelona, Spain 6 44.3% and of anxiety 55.7%. In the multivariate analysis the variables associated with Universitat Autònoma de Barcelona, Barcelona, Spain anxiety were having worked in the pandemic, having had symptoms of COVID-­19 and 7 Hospital Germans Tris i Pujol, Badalona, having been afraid of getting infected. Spain 8 Conclusions: The levels of anxiety due to the COVID-­19 pandemic in nursing students Member Research Group GRISIMula (Grupo emergente 2017 SGR 531; Grupo have been high, and levels of psychological well-­being have been low. The fact of hav- en Recerca Enfermera en Simulación), ing worked during the pandemic, having had symptoms compatible with COVID-­19 Barcelona, Spain 9 or being afraid of getting infected are associated with the highest scores for anxiety. Secretaria Research Group GRISCA (Grupo en Recerca Enfermera en Relevance to clinical practice: This study gives more evidence on the psychological Simulación en Cataluña y Andorra), impact on nursing students during the first wave of the pandemic in Spain. This can Barcelona, Spain be used to design anxiety management programmes for inclusion into teaching syl- Correspondence labuses. It also gives arguments for the setting up of psychological and emotional sup- Barbara Hurtado-­Pardos, Campus Docent Sant Joan de Déu. Universitat of port services for these students and other healthcare professionals working during Barcelona, Edifici Esade-­3. Carrer Miret i the pandemic. Sans 10-­16. 08034 Barcelona, Spain. Email: bhurtado@santjoandedeu.edu.es KEYWORDS Funding information anxiety, COVID-­19, nursing students, well-­being This study was funded by the Campus Docent Sant Joan de Déu This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd. Nursing Open. 2022;9:2003–2012.  wileyonlinelibrary.com/journal/nop2 | 2003 2004 | ROLDÁN-­MERINO et al. 1 | I NTRO D U C TI O N What does this paper contribute to the wider The new coronavirus disease 2019 (COVID-­19) is an international global clinical community? public health emergency and was declared a pandemic by the World • There has been a high prevalence of anxiety in nurs- Health Organization (WHO) on 11 March 2020. (WHO, 2020). It has ing students during the confinement for the COVID-­19 spread around the world and is currently affecting most countries and pandemic. millions of people and has caused many deaths European Centre for • Having worked during the pandemic, having symptoms Disease Prevention and Control (ECDC) (ECDC, 2020). In Spain, the compatible with COVID-­19 and fear of getting infected State of Emergency was declared on 14 March 2020 (BOE.es -­Sumario are factors associated with the anxiety. del día14/03/, 2020, n.d.), and confinement on a national level was es- • Psychological support must be given for these students, tablished with the paralysis of most sectors excepting essential ser- and anxiety management programmes designed for the vices with health care, security forces and the food supply chains being syllabuses. amongst the most important. The confinement started on 14 March and ended on 20 June with different phases of relaxation as the epi- demiological situation in the country improved. The population had to remain at home and could go out only for particular tasks such as for depression and anxiety and post-­traumatic stress (González-­ shopping or walking the dog in a radius of 300 metres from their home. Sanguino et al., 2020). This pandemic not only had a large impact on healthcare pro- Health Science students present high levels of anxiety and fessionals, who were in the front line attending affected patients, depression under normal circumstances (Quek et al., 2019; Tung but it also affected nursing and medical students as many of them et al., 2018). Factors identified are workload; the student's dedica- had to join the healthcare workforce suddenly to help and reinforce tion to their work; close human contact; emotional engagement; the the professionals in the battle against the coronavirus (BOE.es -­ continual changes in clinical practice and caring for patients with Documento BOE-­A-­, 2020-­3700, n.d.). long-­term disease or during their last days of life. Additionally, in sit- uations of epidemic and pandemic nursing students are exposed to other added factors such as the fear of contagion or infecting other 2 | BAC KG RO U N D people in their closest circles (Elrggal et al., 2018; Wong et al., 2004). For all of the reasons mentioned above reasons, it is also to Many studies evaluating the psychological impact of the similar situ- be supposed that the pandemic has affected student healthcare ations, such as the outbreak of Severe Acute Respiratory Syndrome professionals. (SARS) of 2003 on healthcare workers working during the epidemic, It is important to know this impact in order to propose strategies have been published (Chua et al., 2004; Maunder et al., 2006; directed at improving the psychological well-­being of future nurs- McAlonan et al., 2007). In these studies, the workers exposed ing professionals. For this reason, the objective of this study was to showed symptoms such as loss of appetite, insomnia, fatigue, frus- evaluate the psychological impact on nursing students at the end of tration, anxiety and depression. A recent study in China showed that the period of lockdown during the first wave in Spain. nurses caring for patients with COVID-­19 have a high risk of anxi- This study took place before vaccinations were available to ety and depression (Lai et al., 2020). The authors’ explanation is that healthcare workers. these symptoms are probably due to healthcare professionals having to cope with the death of colleagues, feelings of loss of control and vulnerability, working excessive hours and being witness to the col- 3 | M E TH O D S lapse of the health system; all while fearing for their own health and safety, not to mention dealing with family responsibilities and other 3.1 | Design stressful aspects of life that continued, or were worsened during the situation of emergency. There are currently several studies that A cross-­sectional study carried out during the first two weeks of have evaluated the impact of the COVID-­19 pandemic on health- June 2020 at the Sant Joan de Déu Teaching Campus University care professionals (Nie et al., 2020; Rana et al., 2020; Tan et al., Nursing School affiliated to the University of Barcelona, Spain. A 2020) and also on the general population (Mukhtar, 2020; Restubog STROBE checklist was completed and included as a supplementary et al., 2020; Shigemura et al., 2020). All of these have shown high file (Supplementary File S1). levels of anxiety and depression, above all in healthcare workers who were exposed to patients diagnosed with COVID-­19. A study carried out on a sample of the Spanish population to evaluate the 3.2 | Sample impact on mental health caused by the pandemic and the measures adopted during the first weeks of confinement showed that being The study population included 650 nursing students. Sample size female, young or feeling lonely were the most important risk factors was calculated based on an estimated prevalence of anxiety of 25% ROLDÁN-­MERINO et al. | 2005 (González-­Sanguino et al., 2020) with an accuracy of 5% and an alpha greater than 10 to define moderate anxiety and a cut-­off at equal to risk of 5%. Accordingly, it was estimated that the minimum sample or greater than 15 for severe anxiety (Spitzer et al., 2006). The psy- size necessary was 200 nursing students. Non-­probability conveni- chometric properties of the Spanish validation were excellent. The ence sampling was used; nursing degree students who wanted to Cronbach's alpha coefficient was 0.93 and the confirmatory factor participate were included until the sample size was reached. solution obtained produced a good fit. Sociodemographic data on the students were also collected such as age in years; sex; academic course and working conditions: 3.3 | Procedure and data collection working during the pandemic, working in the healthcare sector and years of work experience. They were also asked about symptoms The information technology department generated a database of compatible with the coronavirus, whether they had been diagnosed nursing students registered during the 2019–­2020 academic year with COVID-­19, whether they lived with people diagnosed with which included name, email and a unique anonymized code for each COVID-­19, fear of family members getting infected and death of student. Using the Exchange server located on the campus and a family members or close contacts. Data was also collected on life- mail merge a personalized email was sent to each student including style and habits during the confinement period: consumption of cof- information on informed consent and the corresponding unique an- fee, tobacco, alcohol, sugary drinks, fast food, anxiolytics and the onymized code that allowed completion of the questionnaire while use of the television and social media. avoiding duplications. When the student responded to the mail (pro- viding the scanned signed informed consent) they received an auto- matic email with the instructions and a link to access and complete 3.5 | Ethical considerations the questionnaire. The www.encue​stafa​cil.com platform used to create the online questionnaire this platform is completely General The study was approved by the Clinical Investigation Ethics Data Protection Regulation (GDPR) compliant. Committee (CEIC) of the Sant Joan de Déu Foundation under the The study period coincided with the end of the period of con- code CEIC PIC-­94–­20. finement in Spain and the end of the 2019–­2020 academic year. 3.6 | Statistical analysis 3.4 | Variables and measures Before evaluating the level of anxiety and psychological well-­ The well-­being index was measured using the Spanish version of the being the normal distribution of the data was checked using the World Health Organization Five Well-­Being Index (WHO-­5) (Campo-­ Kolmogorov-­Smirnov test. Non-­parametric tests were used as the Arias et al., 2015; Lucas-­C arrasco, 2012), and anxiety was measured data were not distributed normally. Frequency and percentage were using the Generalized Anxiety disorder-­7 Scale (GAD-­7) (Spitzer calculated for each of the categorical variables and for quantitative et al., 2006) adapted to Spanish by García-­C ampayo et al. (2010). variables the median and inter-­quartile range was calculated. The The Spanish version of the WHO-­5 Well-­Being Index consists prevalence of psychological well-­being and anxiety was also calcu- of five positively written items that reflect the presence or absence lated according to the cut-­off points with confidence intervals of of well-­being. Participants are asked to report the presence of 95%. these positive feelings in the previous two weeks on a scale of six The univariate comparative analysis was calculated with the points from 0 (never) to 5 (all the time). Total scores go from 0 to Kruskal-­Wallis test and the Spearman correlation coefficient. 25, where a higher score indicates better well-­being. Scores under A multiple linear regression analysis was used to analyse vari- 13 are considered indicative of poor well-­being (WHO, 1998). This ables related to the scores for total anxiety. Variables with a p less scale, validated in Spanish (Lucas-­C arrasco, 2012), presented ade- than 0.10 were included in the age and sex model. quate psychometric properties. The Cronbach's alpha coefficient The statistical analyses were run using the SPSS V 22.0 statis- was 0.86. Exploratory factor analysis showed a one-­factor solution tical package (SPSS Inc.). A bilateral p < .05 was accepted to detect which accounted for 66% of the total variance of WHO-­5. statistically significant differences. The Generalized Anxiety disorder-­7 scale (GAD-­7) is used to screen for generalized anxiety. It consists of seven items (symptoms). Participants are asked to report on the frequency with which each 4 | R E S U LT S symptom has bothered them during the previous two weeks. The reply options are not at all; several days; more than half the days and 4.1 | Description of the sample nearly every day, scored as 0, 1, 2 and 3 respectively. The total score is obtained from the total sum of the scores of all the items, it can A total of 203 nursing students participated. Table 1 shows their oscillate between 0 and 21. A higher score indicates greater anxiety. sociodemographic characteristics and work and life experiences In the original version the authors propose a cut-­off at equal to or about COVID-­19. The mean age was 24.7 (SD 6.6) and 87% were 2006 | ROLDÁN-­MERINO et al. TA B L E 1 Sociodemographic characteristics, labour and women. 77% lived with their families. Of the students who de- experiences in relation to COVID-­19 of the study sample (n = 203) clared they had been working during the pandemic 63.5% worked in the healthcare sector. Of 25.2% who stated they had symptoms N % compatible with COVID-­19, only 7.4% had been diagnosed. In rela- Age in years (SD) 24.7 (SD 6.6) tion to fear of contagion 52.2% stated that they had been fright- Sex ened of getting infected, but 93.1% were frightened of a family Woman 177 87.2 member getting infected. 27.7% said a family member or close Man 26 12.8 contact had died. Cohabitation Table 2 shows the data on lifestyle and habits during confine- With family 158 77.8 ment. It is notable that there was a lower consumption of stimulat- With partner 25 12.3 ing drinks (12.3%), alcohol (27.6%) and fast food (37.4%) reported, Other 15 7.4 in contrast there was an increases in the consumption of anxio- Alone 5 2.5 lytics (6.4%); the use of television (38.4%); social media (69%) and WhatsApp (59.1%); and reading (40.4%). Course About their state of mind, 44.3% of the students presented low First 34 16.7 psychological well-­being (95% CI 37.6–­51.2), with 22.2% presenting Second 55 27.1 severe anxiety (95% CI 16.8–­28.2). Third 40 19.7 Fourth 74 36.5 Worked during the pandemic 4.2 | Relationship between the index of well-­ Yes 138 68.0 being, anxiety, the work environment and No 65 32.0 participants’ sociodemographic and professional Worked in health care characteristics Yes 129 63.5 No 74 36.5 The median of the total score on the WHO-­5 was 13 (range 5–­25) Had symptoms compatible with coronavirus and on the GAD-­7 it was 11 (range 0–­21). The scores on the well-­ Yes 52 25.2 being scale were lower in students who had had symptoms compat- ible with COVID-­19 (p = .025). The students who stated that their No 151 74.4 consumption of fast food had increased also had lower scores for Diagnosed with coronavirus well-­being, although the differences were not statistically significant Yes 15 7.4 (Tables 3 and 4). No 188 92.6 Scores for anxiety were higher for students who stated that they People you are living with were diagnosed with COVID-­19 had worked during the pandemic (p = .025); that they had worked Yes 17 8.4 in the healthcare sector (p = .041); that they had had symptoms No 186 91.6 compatible with COVID-­19 (p = .039); or that they had been scared Was frightened of catching COVID-­19 of getting infected (p = .0001). Scores for anxiety were also higher Yes 106 52.2 for students who stated they had consumed more coffee (p = .001); No 97 47.8 stimulating drinks (p = .035); or sugary drinks (p = .014). The stu- Was frightened of a family member catching COVID-­19 dents who stated that they had read less (p = .034), watched less Yes 189 93.1 television (p = .05) and used WhatsApp more (p = .05) were those who had the highest scores for anxiety (Tables 3 and 4). No 14 6.9 In the multivariate analysis, the final model was statistically sig- Someone close (family member/friend) died of COVID-­19 nificant (F (6.876) = 6.564, p < .001). The variables associated with Yes 46 27.7 anxiety were having worked during the pandemic (p = .021), having No 157 77.3 presented COVID-­19 symptoms (p = .044) and being afraid of get- Abbreviation: SD, Standard deviation. ting infected (p < .0001) (Table 5). between demographic characteristics and experiences of living with 5 | DISCUSSION the disease and the impact that this might have had on habits and lifestyle during confinement. This study measured the level of anxiety and psychological well-­ The results of this study show that half of the students reported being in nursing students at the end of the confinement that took having anxiety, with a quarter of them presenting high levels. These place during the COVID-­19 pandemic. It also analysed the relation are slightly lower levels than a those found in a study carried out in ROLDÁN-­MERINO et al. | 2007 TA B L E 2 Lifestyle and habits of No Less Same More the study sample during the period of consumption consumption consumption consumption confinement n % n % n % n % Coffee 70 34.5 34 16.7 68 33.5 31 15.3 Stimulating drinks 105 51.7 25 12.3 53 26.1 20 9.9 Tobacco 165 81.3 11 5.4 14 6.9 13 6.4 Alcohol 114 56.2 56 27.6 22 10.8 11 5.4 Sugary drinks 86 42.4 40 19.7 57 28.1 20 9.9 Fast food 67 33.0 76 37.4 41 20.2 19 9.4 Anxiolytics 181 89.2 3 1.5 6 3.0 13 6.4 Use of television 26 12.8 39 19.2 60 29.6 78 38.4 Social networks 1 0.5 14 6.9 48 23.6 140 69.0 WhatsApp 0 0 10 4.9 73 36.0 120 59.1 Reading 25 12.3 28 13.8 68 33.5 82 40.4 Israel in the third week of confinement (Savitsky et al., 2020), in which In a study carried out in a sample of nursing students in Spain 42.8% of nursing students presented moderate anxiety and 13.1% se- and Portugal higher levels of stress were found with the pres- vere anxiety. In contrast, the results are very similar to another study ence of family members diagnosed with COVID-­19 in the home carried out in nursing students in California, USA (Kim et al., 2021). (Laranjeira et al., 2021). Another study carried out in Turkey also At the start of the pandemic, a study of the general population in showed a statistically significant correlation between having Spain showed lower levels of anxiety (González-­Sanguino et al., 2020). anxiety and having COVID-­19-­p ositive family members at home Other studies carried out under normal circumstances show that anxi- (Kuru Alici & Ozturk Copur, 2022). In this study, significant differ- ety is higher in female students (Lun et al., 2018; Mirón et al., 2019; Quek ences between anxiety levels and living with a person positive for et al., 2019; Sanad, 2019), and the prevalence of anxiety is generally COVID-­19 were not found. An association between higher anxiety higher in females (Haro et al., 2006). The fact that most of the popula- and the fact of presenting symptoms compatible with COVID-­19 tion in the present study is female could partially explain the prevalence has also been found in another study at population level (González-­ of anxiety amongst the students. Other studies carried out in the gen- Sanguino et al., 2020). eral population have also shown higher scores for anxiety in young peo- About habits and lifestyle, a lower consumption of alcohol, stim- ple (González-­Sanguino et al., 2020; Ozamiz-­Etxebarria et al., 2020), ulating drinks and fast food was found. This could be due to confine- which again might explain the higher anxiety in the students. ment, when young students did not have access to consumption in The variables associated with higher scores for anxiety were leisure time. By contrast, and also due to confinement, reading and having worked during the pandemic, fear of contagion and hav- use of the television and social media also increased. An interesting ing symptoms compatible with COVID-­19. The fear of contagion is find is the relation between less reading and television consumption consistent with other studies carried out in other epidemics such in students with higher scores for anxiety. This could be due to a lack as SARS or MERS (Middle East Respiratory Syndrome) (Elrggal of concentration brought on by the anxiety itself. et al., 2018; Wong et al., 2004). In these studies, the nursing stu- Consumption of fast food and sugary drinks was associated with dents related perceiving a higher risk of contagion and not wanting low psychological well-­being or higher levels of anxiety. They could to work in centres in conditions inadequate for the prevention and be strategies to reduce levels of anxiety, although they could also control of infection. be associated with confinement at home. Another study has shown The study carried out in Israel (Savitsky et al., 2020) in this pan- an association between the consumption of sugary and carbonated demic also showed a positive association between scores of anx- drinks and fast food, and sleeping disorders due to anxiety in ado- iety and the level of fear of contagion. Similar findings have been lescents (Khan & Uddin, 2020). Laranjeira et al. (2021) also shown an found in another qualitative study carried out in final year nursing association between psychological impact and excess consumption and medical students (Collado-­Boira et al., 2020). These students of junk food. However, the association between increased anxiety were asked about their perceptions as a consequence of their vol- and the consumption of coffee and stimulating drinks could just be a unteering and immediate incorporation into the workforce driven consequence of this consumption. by the Spanish Government as an exceptional measure during the This study has several limitations which should be taken into COVID-­19 pandemic. An important fear reported was that of the account. Firstly, the inherent limitation of all cross-­s ectional stud- opportunity of passing the disease to their families. This fear has ies that make it difficult to make causal associations. Secondly, all also been found in healthcare professionals who worked in hospitals the students participating in the study did so voluntarily and this during the COVID-­19 pandemic (Liang et al., 2020). could have produced selection bias. Thirdly, no questionnaires 2008 | ROLDÁN-­MERINO et al. TA B L E 3 Variables related to the well-­ WHO Anxiety being and anxiety indexes Range Range Median inter p Median inter p Age in years Rho = 0.012 .149 Rho = 0.077 .275 Sex Woman 13 11–­17 .766 10 7–­14 .996 Man 14 9.7–­17.2 11 7–­14.2 Cohabitation With family 14 11–­17 .437 10 7–­14 .755 With partner 12 10–­14.5 12 8–­15 Other 12 10–­18 9 6–­16 Alone 14 8–­17.5 15 4–­17 Course First 13.5 10–­17 .159 10.5 7–­14 .123 Second 12 9–­16 13 8–­16 Third 14 12–­17.7 10 6.2–­14 Fourth 14 10.7–­17 9 5–­14 Worked during the pandemic Yes 13 10–­17 .372 12 7–­15 .025 No 14 11–­17 9 5–­13.5 Worked in health care Yes 13 10–­17 .570 12 7–­15 .041 No 14 11–­17 10 6–­13.2 Had symptoms of coronavirus Yes 12 10–­14 .025 12.5 7–­15 .039 No 14 11–­17 10 6–­14 Diagnosed with coronavirus Yes 13 9–­17 .812 14 6–­15 .458 No 13 11–­17 10.5 7–­14 Cohabitants diagnosed with COVID−19 Yes 14 9.5–­18 .988 8 5–­14.5 .633 No 13 11–­17 11 7–­14 Fear of catching COVID−19 Yes 13 10.7–­16 .433 12.5 8–­15 <.001 No 13 10.5–­17 8 5–­13.5 Fear of family member catching COVID−19 Yes 13 10.5–­17 .377 11 7–­14 .076 No 14.5 10.5–­20 7 3.5–­13.2 Person close (family or friend) died of COVID−19 Yes 12.5 10–­16 .263 13 7–­14.2 .268 No 13 11–­17 10 7–­14 Univariate analysis. were used to evaluate psychological distress; future studies 6 | CO N C LU S I O N S should use these instruments as well. Lastly, the study was only carried out in one nursing school, and this should be borne in This study shows that levels of anxiety in nursing students due to the mind when generalizing the results. However, the profile of the outbreak of COVID-­19 have been high and that levels of psychologi- students in the sample is similar to that of students in the rest in cal well-­being have been low. The fact of having worked during the our environment. pandemic, having presented symptoms compatible with COVID-­19 ROLDÁN-­MERINO et al. | 2009 TA B L E 4 Relation between habits WHO Anxiety and lifestyle and well-­being and anxiety indexes Range Range Variables Median inter p Median inter p Coffee Less consumption 12.5 10–­17.2 .296 12.5 5–­15 .001 Same consumption 14 10.2–­17 9 5–­13 More consumption 11 10–­15 14 11–­16 Stimulating drinks Less consumption 11 8–­17 .213 8 5–­14.5 .035 Same consumption 12 11–­17 11 7–­14 More consumption 13.5 12–­16 14.5 9.5–­17.7 Tobacco Less consumption 13 9–­18 .834 14 5–­17 .479 Same consumption 12 9–­15.2 13 6.5–­14 More consumption 11 11–­19 14 8–­16.5 Alcohol Less consumption 13.5 10.2–­16 .529 10.5 6.2–­14 .648 Same consumption 12.5 9.7–­19 9 5.7–­14.2 More consumption 15 11–­20 14 7–­17 Sugary drinks Less consumption 12 9.2–­15 .496 9 7–­14 .014 Same consumption 13 10.5–­16 11 7–­14 More consumption 12 9.2–­14.7 14 12–­17.5 Fast Food Less consumption 13 11–­16 .087 12 7–­14 .089 Same consumption 12 10–­15 10 7–­14 More consumption 11 9–­14 14 10–­16 Anxiolytics Less consumption 8 5–­21 .659 14 11–­21 .689 Same consumption 9.5 6–­13 17 11.7–­19.5 More consumption 10 8.5–­14.5 1 13.5–­16.5 Use of television Less consumption 12 11–­16 .117 12 8–­15 .051 Same consumption 14.5 11–­17 8 7–­13 More consumption 13 10–­16 11.5 7–­14 Social Media Less consumption 12.5 11.7–­17.2 .915 9.5 7.7–­14.2 .923 Same consumption 13.5 9.2–­17 10.5 5.2–­14 More consumption 13 11–­16.7 11 7–­14 WhatsApp Less consumption 14 12–­19.25 .219 9 6.25–­14 .050 Same consumption 14 9.5–­17 8 5–­14 More consumption 12.5 11–­16 11 7–­15 Reading Less consumption 13 9–­17.5 .380 13 8–­16 .034 Same consumption 13 11–­16 11 7–­14 More consumption 14 11–­17 9 5–­13 Univariate analysis. 2010 | ROLDÁN-­MERINO et al. TA B L E 5 Relation between habits Model (Adj R 2 = 0.142) and lifestyle and well-­being and anxiety B SE p-­ value indexes Age (years) −0.073 0.054 .181 Gender (female) 0.144 1.022 .888 Worked during pandemic 1.770 0.761 .021 COVID−19 symptoms 1.573 0.775 .044 Fear of contagion 3.446 0.683 <.0001 Fear of contagion of family member 1.369 1.343 .309 Abbreviation: SE, Standard error. Multivariate analysis. and having a fear of contagion have been associated with the high- submitted and will take public responsibility for the content of the est scores for anxiety. Particular habits and lifestyles have also been paper. found to be associated with higher scores for anxiety and lower scores for psychological well-­being. E T H I C A L A P P R OVA L The study was approved by the Clinical Investigation Ethics Committee of the San Joan de Déu Foundation with the assigned 7 | R E LE VA N C E FO R C LI N I C A L PR AC TI C E code CEIC PIC-­94–­20. The participants were informed about the authorship and pur- Despite the limitations listed above, this study gives more evidence pose of the investigation and were ensured that all the data obtained that the first wave of the COVID-­19 had a considerable psycho- would remain anonymous and confidential. logical impact on nursing students in Spain. Many of them were suddenly incorporated into the healthcare workforce in unusually DATA AVA I L A B I L I T Y S TAT E M E N T complex and challenging conditions. Such actions may be repeated The data that support the findings of this study are available upon and could become more frequent in the future. It is highly recom- reasonable request from the corresponding author. The data are not mended to design anxiety management programmes specifically for publicly available due to privacy and ethical restrictions. The data nursing students and other trainee healthcare professionals and to were taken from our own study. incorporate then into the syllabuses for these courses. Identifying the specific factors that increase anxiety is useful to design of such ORCID programmes so that they help students manage these factors and Juan Roldán-­Merino https://orcid.org/0000-0002-7895-6083 increase their resilience when working in stressful conditions. It also Barbara Hurtado-­Pardos https://orcid. gives information for healthcare providers for setting up psychologi- org/0000-0002-3162-6255 cal support services for healthcare workers. These measures will not Lorena Molina-­Raya https://orcid.org/0000-0002-0131-5026 only benefit the well-­being of individual healthcare professionals but Irma Casas https://orcid.org/0000-0002-5902-5777 also strengthen the mental resilience of the workforce as a whole Mariona Farrés-­Tarafa https://orcid.org/0000-0001-6151-3844 and improve the management of healthcare teams in general. REFERENCES AC K N OW L E D G E M E N T S BOE.es. Documento BOE-­A-­2020-­3700. (n.d.). Retrieved August The authors would like to thank the staff and students of the Sant 29, 2020, from https://www.boe.es/diario_boe/txt. php?id=BOE-­A-­2020-­3700 Joan de Déu Teaching Campus University Nursing School who par- BOE.es. Sumario del día 14/03/2020. (n.d.). Retrieved August 29, 2020, ticipated voluntarily in this study and the Information Technology from https://www.boe.es/boe/dias/2020/03/14/ Department for their help in administrating it. Campo-­Arias, A., Miranda Tapia, G. A., Cogollo, Z., & Herazo, E. 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