Nationwide, the COVID-19 pandemic forced nursing faculty and students to adapt to rapidly changing circumstances within nursing education. These changes resulted in major educational challenges for students and faculty. In March 2020, our research team recognized the benefit of understanding nursing students' lived experience during the pandemic. The purpose of the study was to explore nursing students' experiences during the COVID-19 pandemic.

Methods

This online study was conducted at a large southeastern University with undergraduate and graduate nursing students. The research team consisted of 5 investigators, of which 4 were nursing faculty and 1 was a social work faculty member. During the first week, 3 email invitation letters were sent to all currently registered nursing students. Participants received a weekly email reminder with an electronic link to prompt a written response to the research question. The research team met virtually on a weekly basis to review data and to develop future weekly questions. This research received university institutional review board approval.

The research team used Colaizzi's1 method of analysis for phenomenological studies to analyze the weekly data. Investigators independently reviewed the participants' written responses multiple times, immersing themselves in the data. As a result, each investigator identified significant statements and formulated meaning. The team convened to review these statements and meanings, and then common themes were grouped into clusters. Each cluster was carefully examined and gradually distilled into emergent themes common to the students' experiences. The research team agreed that they had reached saturation when no new themes emerged from the data. The investigators then drafted an exhaustive description of the participants' data.

Findings and Discussion

During data analysis, the investigators noticed that participants seemed to be moving through the stages of grief. Kubler-Ross defines the stages of grief as denial, anger, bargaining, depression, and acceptance.2 The data supported the notion that participants transitioned through the stages in a nonlinear fashion during the 11-week study period. Social and political events occurring during the pandemic study period influenced participant responses.

Denial was noticed in the early weeks with participants transitioning to online courses. One respondent wrote, "I am still working like normal (although the normal workflow has changed), so I am still in my normal routine for being able to get my schoolwork done" and "I think it is a little too late on the masks." Students did not yet accept the severity of the pandemic, as evidenced with 1 participant commenting at the end of the 11 weeks: "I believe the virus is real, but it has such a small death rate, and I feel there are a lot of false-positive/not the correct deaths being reported (someone dies of heart attack but is tested positive for COVID so they are ruled a COVID death)."

Anger was noted in all 11 weeks as frustration arose from missing clinical practice, additional work hours, and canceled vacations. Several comments stood out: "This pandemic has canceled so many of the celebrations that were supposed to be 'the year of the nurse and the midwife.' It was supposed to be the perfect year to graduate as a midwife. In some ways it still was the most symbolic year because we are needed the most now." Another participant noted, "My colleagues, one of whom we have now lost to COVID-19, appear to be of no consequence to them [hospitals] because decisions are being made without forethought. Losing staff to this virus by placing them at increased risk is going to be more financially crippling in the end than holding of visitation until we have a clearer understanding of how to reduce the risk."

Bargaining flowed throughout the 11 weeks, as evidenced by a participant response, "For me personally, the shift to online classes has been bittersweet. On one hand, you can make and abide by your own schedule for the most part, but on the other hand, it seems harder to learn without having the face-to-face time with instructors." A participant in week 11 wrote, "This brought me face to face with my age as an older adult and seeing just how sick I can get. It strengthens my desire even more to work with older adults in my practice. It's a complex time when you deal with a lot of changes."

Depression was a common theme. One participant commented in week 3, "The most difficult part has been the loneliness. I live alone, work from home now, nearest family is 5 hours away, and I am new to the area. Being alone so much keeps me from getting support I need and pretty much makes me cope with everything on my own. Nothing new for nurses, I guess." Another participant noted in week 7, "I have taken care of a few positive COVID-19 patents and PUIs (person under investigation). At first, I was very afraid I would contract the disease or pass it on to my parents. I avoided going to see my parents, which made me depressed." During week 10, 1 student commented, "It is disheartening to hear 'you are either with us or against us' mentality among people in the community, patients, or even coworkers."

Acceptance was found from week 4 until the end of the study. Comments included, "Personal vacation was canceled by the travel company finally-so at least I get all of my deposit back plus a nice replacement vacation discount should I like to reschedule." Other participants stated, "Hope and anxiety have greatly waxed and waned throughout this time. Some weeks I feel grateful and soak in the perks of getting more time with my husband at home and the forced slow down. Other weeks feelings of being stuck and caged become overwhelming and at times hard to cope with." Other data supporting acceptance were verbalized by a participant, "I am spending more time with my family. I have also been making sure that I spend more time every day to just sit in my room or at the park by myself to read the Bible and reflect on everything that is going on in my life."

Conclusion

Kubler-Ross' stages of grief became evident when data were examined and common themes identified.2 This study was grounded in the desire to hear the student stories and acknowledge their lived experience during the early days of the COVID-19 pandemic. Although students seemed to adapt to the educational changes, it is worth noting that grief, loneliness, and situational depression emerged from the data. We recommend, as described by White and Ruth-Sahd,3 that nursing faculty adopt compassionate teaching strategies whereby faculty become aware of student suffering, display empathy, and explore educational strategies within the educator's ability to reduce student distress. Caring relationships provide the foundational support for compassionate teaching strategies such as targeted communication to gauge stress levels. Nursing faculty may schedule online "chat" times to discuss coursework and other concerns and suggest educational or mental health resources.

This study adds to the nursing body of knowledge by providing students an opportunity to share and hear their voices through qualitative research. Nursing faculty have an opportunity to acknowledge the lack of normality and grief as similar to the loss associated with death. These student voices have reinforced the benefits of compassionate teaching when the world suddenly changes during a pandemic or other natural disaster.

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