1 INTRODUCTION

The COVID-19 pandemic directly affected education and health systems and led to crises around the world. The pandemic has caused challenges in every aspect of life, especially in the education of students in health sciences departments. Nursing education involves theoretical and practical learning experiences that offer nursing students the opportunity to acquire the knowledge, skills, and attitudes required to provide nursing care. One of the biggest challenges for nursing students is to be ready for work in hospitals during the pandemic, which causes them to feel anxiety and fear.1

Societies had to make changes to survive during the pandemic. Education- and training-related activities were transferred to online environments. Hospitals had to reorganize their systems to meet patients’ needs. The first COVID-19 case in Turkey was reported on March 11, 2020. The first restrictions in Turkey came into effect on March 12 and their scope was gradually expanded. The coronavirus spread quickly and affected Turkey deeply.2

Most countries took isolation precautions to prevent the spread of COVID-19, which had negative effects on the economy, politics, and psychology in the entire world. These precautions included working from home, social distancing, temporary school closures, online education, canceling and postponing congresses and seminars, postponing sports activities, and travel restrictions.3 After the detection of COVID-19 cases in Turkey, face-to-face education was suspended in universities, and distance education was started on March 16, 2020. Nearly all theoretical and practical courses were carried out through distance education starting in the mid-spring semester of 2019–2020 academic year. When the new academic year began in September 2020, universities could not shift to face-to-face education because of the increasing number of cases. In January 2021, some universities shifted to face-to-face education after vaccination and normalization steps were started. Senior nursing students were also asked to come back to their school for clinical practices.

University students experienced high levels of anxiety and fear during the COVID-19 pandemic.4, 5 A study found that female nursing students had higher levels of anxiety and fear than male students.6 Nursing students felt fear and anxiety during clinical practices as they could not continue their applied courses because of COVID-19.4 They were also afraid of getting infected when taking part in the care of COVID-19 patients.1, 7, 8 A study found that nursing students in clinics were anxious due to the fear of infecting others, especially their family members.9 Spanish government recruited senior nursing students to meet clinical needs due to a shortage of nurses; and these students stated that they experienced anxiety, fear, sadness, and uncertainty after starting to work in hospitals.9, 10 In England, with the increasing number of cases, undergraduate nursing students were asked to take on long-term employment in clinics to increase the number of professional caregivers.11

This study examines nursing students’ fear and anxiety levels regarding clinical practices during the COVID-19 pandemic. The nursing students were asked how they would like to receive nursing education during the pandemic, whether they wanted to participate in clinical practices, and about their anxiety levels related to COVID-19 infection.

2 METHODS 2.1 Participants and procedure

The study population consisted of 150 senior students who received applied courses in the nursing department. The researchers tried to reach the entire population, and the study was conducted with 124 students who agreed to participate between April 1, 2021, and May 1, 2021. Nursing education in Turkey is at the undergraduate level and lasts 4 years. In their final year, students take courses in mental health and diseases nursing, intensive care nursing, teaching, and research methods in nursing. The data were collected using a 12-question personal information form, the 21-question Beck Anxiety Inventory, and the 7-question Fear of COVID-19 Scale on Google Forms. The survey link was sent via e-mail and social media. After clicking on the link, the participants were automatically informed about the study and asked to give their informed consent and fill out the forms.

2.2 Data collection tools 2.2.1 Personal information form

This form has 12 questions about the participants’ sociodemographic characteristics and their fear and anxiety about COVID-19.4, 9, 10, 12

This form consists of open-ended and multiple choices questions.

2.2.2 The Beck Anxiety Inventory

This 21-item inventory was developed by Beck to assess the symptoms of anxiety and determine its cognitive aspects.13 Ulusoy carried out the first validity and reliability study of its Turkish version (test–retest reliability coefficient r = .57) and found that it is a reliable tool for determining anxiety levels and monitoring treatments.14 This four-point Likert-type scale is scored as follows: not at all (0), mild (1), moderate (2), and severe (3). The highest possible score is 63, and higher scores indicate severe anxiety. Of the items, 13 evaluate physiological symptoms, 5 evaluate cognitive symptoms, and 3 evaluate both somatic and cognitive symptoms.13 The Cronbach's α coefficient of the scale was .96 in the present study.

2.2.3 The Fear of COVID-19 Scale

This scale was developed by Ahorsu et al. (2020)15 to determine fear levels related to coronavirus. Satici et al. (2020)16 carried out the validity and reliability study of its Turkish version. The scale has seven items under a single dimension, none of which are reverse-scored. This five-point Likert-type scale is scored as follows: strongly disagree (1), disagree (2), neither disagree nor agree (3), agree (4), and strongly agree (5).16 The lowest and highest possible scores are 7 and 35, respectively. Higher scores indicate higher levels of fear of COVID-19. The Cronbach's alpha coefficient was α = .82 for the original scale, α = .847 for the Turkish version of the scale,15, 16 and α = .93 in the present study.

2.3 Data analysis

The Statistical Package for Social Sciences for Windows version 22.0 was used for data analysis. The descriptive data were analyzed using numbers, percentages, means, and standard deviations. The Kolmogorov–Smirnov test was used to assess the distribution of the variables for parametric or nonparametric tests. All the variables were normally distributed. Multiple linear regression was used to determine the relationships between demographic variables, fear of COVID-19, and anxiety. Pearson's correlation and simple linear regression were used to determine the effects of the fear of COVID-19 on anxiety.

2.4 Ethical considerations

Before the study, ethical committee approval (March 31, 2021, 2021/06-09) was obtained from the Noninvasive Clinical Research Ethics Committee of the university. Written permission was obtained from the institution where the study was conducted, and the participants gave their consent to participate through online forms.

3 RESULTS

Table 1 shows the participants’ sociodemographic characteristics. Their mean age was 22.51 ± 1.86. More than half of them were female and living with their nuclear families (79.8%). Of them, 75.8% had equal incomes and expenses. Most of their mothers (62.1%) and fathers (41.1%) had completed primary school. Of the participants, 49.2% resided in provinces, and 96.8% had no chronic diseases. Of them, 75% wanted their education to continue online during the COVID-19 pandemic, and 62.1% did not want to do clinical practices in applied courses during the COVID-19 pandemic. Finally, 78.2% of the participants worried about having problems with COVID-19 infection during clinical practices. Their mean Fear of COVID-19 Scale and Beck Anxiety Inventory score were 20.00 ± 7.71 and 14.23 ± 15.44, respectively.

Table 1. The students’ sociodemographic characteristics (n = 124) Variables n (%) Gender Female 99 (79.8) Male 25 (20.2) Family type Nuclear 99 (79.8) Extended 25 (20.2) Economic status Less income than expenses 19 (15.3) Equal income and expenses 94 (75.8) More income than expenses 11 (8.9) Maternal education level Primary school 77 (62.1) Middle school 16 (12.9) High school 25 (20.2) University 6 (4.8) Paternal education level Primary school 51 (41.1) Middle school 14 (11.3) High school 37 (29.8) University 20 (16.1) Postgraduate 2 (1.6) Place of residence Province 61 (49.2) District 47 (37.9) Town or village 16 (12.9) Chronic diseases Yes 4 (3.2) No 120 (96.8) Wanting nursing education to continue online during the COVID-19 pandemic Yes 93 (75.0) No 31 (25.0) Wanting to do clinical practices in applied nursing courses during the COVID-19 pandemic Yes 47 (37.9) No 77 (62.1) Worrying about having problems with COVID-19 infection during clinical practices Yes 97 (78.2) No 27 (21.8) Age*(mean ± SD) 22.51 ± 1.86 * The data are presented as mean ± standard deviation.

Table 2 shows the correlations between the variables. A positive relationship was found between the fear of COVID-19 and anxiety. Table 3 shows the multiple regression analysis results regarding the participants’ sociodemographic variables and their fear of COVID-19 and anxiety levels. The participants’ scores on the Fear of COVID-19 Scale and the Beck Anxiety Inventory were significantly related to the variables of wanting to do clinical practices in applied nursing courses during the COVID-19 pandemic and worrying about having problems with COVID-19 infection during clinical practices. These variables accounted for the Fear of COVID-19 Scale scores at a rate of 27% (R2 = .27, p = .00) and the Beck Anxiety Inventory scores at a rate of 22% (R2 = .22, p = .00). Simple linear regression indicated that 51% of the variance in the anxiety scores were caused by the fear of COVID-19 variable (R2 = .51, p = .00) (Table 4).

Table 2. Correlation values for the variables Variables 1 2 3 4 5 6 7 8 9 10 11 12 13 1. Age - 2. Gendera −0.155* - 3. Family Typeb −0.003 0.349*** - 4. Economic Statusc −0.092 0.214* −0.121 - 5. Maternal Education Leveld −0.153* 0.022 0.105 0.009 - 6. Paternal Education Levele −0.114 −0.029 −0.111 0.099 0.349*** - 7. Place of Residencef 0.243** −0.189* −0.028 −0.105 −0.295*** −0.101 - 8. Chronic Diseasesg −0.050 −0.136 −0.022 −0.078 −0.046 0.033 0.094 - 9. Wanting nursing education to continue online during the COVID-19 pandemich −0.263** 0.081 0.128 −0.013 0.086 −0.123 0.009 0.000 - 10. Wanting to do clinical practices in applied nursing courses during the COVID-19 pandemici −0.001 −0.061 0.063 −0.129 0.006 −0.023 0.071 −0.140 0.317*** - 11. Worrying about having problems with COVID-19 infection during clinical practicesk −0.203 0.125 0.076 −0.047 0.071 0.123 0.011 −0.125 0.327** 0.474*** - 12. The Fear of COVID-19 Scale −0.143 0.052 0.003 −0.064 −0.058 −0.013 −0.113 −0.006 0.141 0.420*** 0.387*** - 13. The Beck Anxiety Inventory −0.176* 0.095 0.113 −0.105 −0.091 −0.105 −0.072 0.083 0.113 0.302*** 0.304*** 0.714** - * p < .05. ** p < .01. *** p < .001. aFemale. bNuclear family. cLess income than expenses. dPrimary school. ePrimary school. fProvince. gYes. hYes. iNo. kYes. Table 3. Regression analyses regarding the demographic characteristics The Fear of COVID-19 Scale The Beck Anxiety Inventory R R2 F p R R2 F p .52 .27 3.82 .00 .47 .22 2.85 .00 B β t p B β t p Age −0.35 −.08 −0.94 .35 Age −1.24 −.15 −1.62 .11 Gendera 0.76 .04 0.42 .67 Gender 2.30 .06 0.62 .58 Family typeb −0.82 −.04 −0.48 .64 Family type 2.41 .06 0.67 .50 Economic statusc −0.78 −.04 −0.43 .67 Economic status −3.03 −.07 −0.80 .43 Maternal education leveld −1.82 −.12 −1.25 .21 Maternal education level −3.67 −.12 −1.22 .23 Paternal education levele −0.50 −.03 −0.35 .73 Paternal education level −3.55 −.11 −1.21 .23 Place of residencef −2.49 −.16 −1.82 .07 Place of residence −3.34 −.11 −1.18 .24 Chronic diseasesg 3.55 .08 0.98 .33 Chronic diseases 13.03 .15 1.73 .09 Wanting nursing education to continue online during the COVID-19 pandemich −1.11 −.06 −0.68 .50