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      COVID‐19: Knowledge, anxiety, academic concerns and preventative behaviours among Australian and Indian undergraduate nursing students: A cross‐sectional study

      research-article
      , RN, MSN (Cardiovascular, Thoracic Nursing), PhD Candidate 1 , , RN, MN (Critical Care), PhD 2 , 3 , , , BNS, MEd, PhD 2 , , RN, MPH, PhD Candidate 3 , , RN, MSc (Hon), PhD 4 , , RN, MHM, PhD 4 , , BN, MPhil, PhD 2 , , RN, BN (Hons), PhD 2
      Journal of Clinical Nursing
      John Wiley and Sons Inc.
      academic concerns, anxiety, clinical placement, COVID‐19, nursing education, pandemic, student nurses

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          Abstract

          Aims and Objectives

          To compare knowledge, anxiety, academic concerns and preventative behaviours between undergraduate nursing students in Australia and India during the COVID‐19 pandemic.

          Background

          Based on the World Health Organization's direction for containment of the novel coronavirus (COVID‐19), countries implemented varying levels of restrictions including closure of university campuses and providing on line undergraduate education.

          Methods

          Students in NSW, Australia and Kerala, India completed an online survey assessing their (a) knowledge and source of information about COVID‐19; (b) anxiety; and coping strategies; (c) academic concerns; and (d) preventative behaviours. Descriptive and inferential statistics were used to summarise the data.

          Results

          Data from 99 Australian and 113 Indian undergraduate nurses were analysed. Greater number of Indian students indicated having sufficient knowledge of COVID‐19 (OR 0.22; 95% CI 0.08, 0.63), getting information about COVID‐19 from social media (OR 0.03; 95% CI 0.01, 0.07) and being concerned about ‘attending clinical placement’ (MD‐1.08; 95% CI −1.94, −0.23). Australian students reported significantly higher levels of anxiety (MD 1.99 95% CI 1.21, 2.78), difficulty sleeping (OR 18.00; 95% CI 6.76, 47.96), concentrating (OR 33.22; 95% CI 13.85, 79.67) and eating (OR 14.05; 95% CI 3.19, 61.84). Greater number of Australian students indicated that they would go to the University if they needed to meet with other students (OR 9.21; 95% CI 3.08, 27.55), had to access the library (OR 7.20; 95% CI 3.26, 15.90) or had a group assignment (OR 2.93; 95% CI 1.26, 6.77).

          Conclusions

          Wide variations were present in knowledge, anxiety, academic concerns and preventative behaviours among undergraduate nursing students in two countries.

          Relevance to clinical practice

          Undergraduate students may benefit from additional support from the University and staff in the clinical setting with online learning and resources in order to adjust to the ‘new normal’ and enable them to achieve academic success.

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          Most cited references33

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          The psychological impact of the COVID-19 epidemic on college students in China

          Highlights • Methods of guiding students to effectively and appropriately regulate their emotions during public health emergencies and avoid losses caused by crisis events have become an urgent problem for colleges and universities. Therefore, we investigated and analyzed the mental health status of college students during the epidemic for the following purposes. (1) To evaluate the mental situation of college students during the epidemic; (2) to provide a theoretical basis for psychological interventions with college students; and (3) to provide a basis for the promulgation of national and governmental policies.
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            Is Open Access

            The COVID-19 social media infodemic

            We address the diffusion of information about the COVID-19 with a massive data analysis on Twitter, Instagram, YouTube, Reddit and Gab. We analyze engagement and interest in the COVID-19 topic and provide a differential assessment on the evolution of the discourse on a global scale for each platform and their users. We fit information spreading with epidemic models characterizing the basic reproduction number \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R_0$$\end{document}
            \begin{document}$$R_0$$\end{document}
            R 0 for each social media platform. Moreover, we identify information spreading from questionable sources, finding different volumes of misinformation in each platform. However, information from both reliable and questionable sources do not present different spreading patterns. Finally, we provide platform-dependent numerical estimates of rumors’ amplification.
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              Scientific and ethical basis for social-distancing interventions against COVID-19

              On Dec 31, 2019, the WHO China Country Office received notice of a cluster of pneumonia cases of unknown aetiology in the Chinese city of Wuhan, Hubei province. 1 The incidence of coronavirus disease 2019 (COVID-19; caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) has since risen exponentially, now affecting all WHO regions. The number of cases reported to date is likely to represent an underestimation of the true burden as a result of shortcomings in surveillance and diagnostic capacity affecting case ascertainment in both high-resource and low-resource settings. 2 By all scientifically meaningful criteria, the world is undergoing a COVID-19 pandemic. In the absence of any pharmaceutical intervention, the only strategy against COVID-19 is to reduce mixing of susceptible and infectious people through early ascertainment of cases or reduction of contact. In The Lancet Infectious Diseases, Joel Koo and colleagues 3 assessed the potential effect of such social distancing interventions on SARS-CoV-2 spread and COVID-19 burden in Singapore. The context is worthy of study, since Singapore was among the first settings to report imported cases, and has so far succeeded in preventing community spread. During the 2003 severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak in Singapore, numerous non-pharmaceutical interventions were implemented successfully, including effective triage and infection control measures in health-care settings, isolation and quarantine of patients with SARS and their contacts, and mass screening of school-aged children for febrile illness. 4 Each of these measures represented an escalation of typical public health action. However, the scale and disruptive impact of these interventions were small compared with the measures that have been implemented in China in response to COVID-19, including closure of schools, workplaces, roads, and transit systems; cancellation of public gatherings; mandatory quarantine of uninfected people without known exposure to SARS-CoV-2; and large-scale electronic surveillance.5, 6 Although these actions have been praised by WHO, 5 the possibility of imposing similar measures in other countries raises important questions. Populations for whom social-distancing interventions have been implemented require and deserve assurance that the decision to enact these measures is informed by the best attainable evidence. For a novel pathogen such as SARS-CoV-2, mathematical modelling of transmission under differing scenarios is the only viable and timely method to generate such evidence. Koo and colleagues 3 adapted an existing influenza epidemic simulation model 7 using granular data on the composition and behaviour of the population of Singapore to assess the potential consequences of specific social-distancing interventions on the transmission dynamics of SARS-CoV-2. The authors considered three infectivity scenarios (basic reproduction number [R 0] of 1·5, 2·0, or 2·5) and assumed between 7·5% and 50·0% of infections were asymptomatic. The interventions were quarantine with or without school closure and workplace distancing (whereby 50% of workers telecommute). Although the complexity of the model makes it difficult to understand the impact of each parameter, the primary conclusions were robust to sensitivity analyses. The combined intervention, in which quarantine, school closure, and workplace distancing were implemented, was the most effective: compared with the baseline scenario of no interventions, the combined intervention reduced the estimated median number of infections by 99·3% (IQR 92·6–99·9) when R 0 was 1·5, by 93·0% (81·5–99·7) when R 0 was 2·0, and by 78·2% (59·0–94·4) when R 0 was 2·5. The observation that the greatest reduction in COVID-19 cases was achieved under the combined intervention is not surprising. However, the assessment of the additional benefit of each intervention, when implemented in combination, offers valuable insight. Since each approach individually will result in considerable societal disruption, it is important to understand the extent of intervention needed to reduce transmission and disease burden. New findings emerge daily about transmission routes and the clinical profile of SARS-CoV-2, including the substantially underestimated rate of infection among children. 8 The implications of such findings with regard to the authors' conclusions about school closure remain unclear. Additionally, reproductive number estimates for Singapore are not yet available. The authors estimated that 7·5% of infections are clinically asymptomatic, although data on the proportion of infections that are asymptomatic are scarce; as shown by Koo and colleagues in sensitivity analyses with higher asymptomatic proportions, this value will influence the effectiveness of social-distancing interventions. Additionally, the analysis assumes high compliance of the general population, which is not guaranteed. Although the scientific basis for these interventions might be robust, ethical considerations are multifaceted. 9 Importantly, political leaders must enact quarantine and social-distancing policies that do not bias against any population group. The legacies of social and economic injustices perpetrated in the name of public health have lasting repercussions. 10 Interventions might pose risks of reduced income and even job loss, disproportionately affecting the most disadvantaged populations: policies to lessen such risks are urgently needed. Special attention should be given to protections for vulnerable populations, such as homeless, incarcerated, older, or disabled individuals, and undocumented migrants. Similarly, exceptions might be necessary for certain groups, including people who are reliant on ongoing medical treatment. The effectiveness and societal impact of quarantine and social distancing will depend on the credibility of public health authorities, political leaders, and institutions. It is important that policy makers maintain the public's trust through use of evidence-based interventions and fully transparent, fact-based communication. © 2020 Caia Image/Science Photo Library 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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                Author and article information

                Contributors
                Role: Principal
                Role: Professor, Directorritin@uow.edu.au
                Role: Professor
                Role: Clinical Nurse Consultant
                Role: Lecturer
                Role: Senior Lecturer
                Role: Senior Lecturer
                Role: Professor
                Journal
                J Clin Nurs
                J Clin Nurs
                10.1111/(ISSN)1365-2702
                JOCN
                Journal of Clinical Nursing
                John Wiley and Sons Inc. (Hoboken )
                0962-1067
                1365-2702
                26 January 2021
                March 2021
                : 30
                : 5-6 ( doiID: 10.1111/jocn.v30.5-6 )
                : 882-891
                Affiliations
                [ 1 ] Pushpagiri College of Nursing Thiruvalla India
                [ 2 ] Faculty of Science, Medicine and Health School of Nursing University of Wollongong Wollongong NSW Australia
                [ 3 ] Centre for Research in Nursing and Health St George Hospital Kogarah NSW Australia
                [ 4 ] School of Nursing and Midwifery Western Sydney University Liverpool NSW Australia
                Author notes
                [*] [* ] Correspondence

                Ritin S. Fernandez, Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Building 41, Wollongong, NSW, Australia.

                Email: ritin@ 123456uow.edu.au

                Author information
                https://orcid.org/0000-0002-6143-7703
                https://orcid.org/0000-0002-4127-6383
                https://orcid.org/0000-0002-7908-3819
                https://orcid.org/0000-0001-7693-4617
                https://orcid.org/0000-0002-8440-7451
                https://orcid.org/0000-0001-8099-986X
                Article
                JOCN15634
                10.1111/jocn.15634
                8013450
                33434378
                26a987f6-089f-4d9d-9d12-7e6a8e6d2fb2
                © 2021 John Wiley & Sons Ltd

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 10 November 2020
                : 22 September 2020
                : 31 December 2020
                Page count
                Figures: 0, Tables: 4, Pages: 11, Words: 7261
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                March 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.1 mode:remove_FC converted:01.04.2021

                Nursing
                academic concerns,anxiety,clinical placement,covid‐19,nursing education,pandemic,student nurses
                Nursing
                academic concerns, anxiety, clinical placement, covid‐19, nursing education, pandemic, student nurses

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