{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:14:31Z","timestamp":1760235271669,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T00:00:00Z","timestamp":1628812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Frontline nurses face an unpreceded situation with the coronavirus disease (COVID-19) pandemic, and many report suffering from physical and psychological stress. This online, cross-sectional survey used questionnaires, such as the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire (PHQ-2), the Connor\u2013Davidson Resilience Scale, stress-related questions, and Brief Coping Orientation to Problems Experienced (Brief-COPE), to determine the psychological impact of COVID-19 on licensed full-time practicing nurses undertaking part-time studies in higher education. Recruitment commenced from August to September 2020; 385 students were approached, and 124 completed the survey (response rate: 32%). Most of the respondents were frontline nurses working in public sectors (89.5%), 29% of whom reported symptoms of depression, and 61.3% reported mild to severe levels of anxiety. The GAD-7 was significantly associated with the resilience score (\u03b2 = \u22120.188; p = 0.008) and exhaustion (\u03b2 = 0.612; p &lt; 0.001). The PHQ-2 was significantly associated with \u2018anxiety about infection\u2019 (\u03b2 = 0.071; p = 0.048). A lower anxiety level was significantly associated with a higher resilience level and a lower level of exhaustion, and a lower depression level was significantly associated with a lower anxiety about infection. Nursing programs incorporating resilience building may mitigate psychological distress of the study population.<\/jats:p>","DOI":"10.3390\/ijerph18168569","type":"journal-article","created":{"date-parts":[[2021,8,15]],"date-time":"2021-08-15T21:43:55Z","timestamp":1629063835000},"page":"8569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Psychological Impact of the COVID-19 Pandemic on Licensed Full-Time Practicing Nurses Undertaking Part-Time Studies in Higher Education: A Cross-Sectional Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Siu-Ling","family":"Chan","sequence":"first","affiliation":[{"name":"School of Nursing, The University of Hong Kong, Hong Kong 999077, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2950-5251","authenticated-orcid":false,"given":"Naomi","family":"Takemura","sequence":"additional","affiliation":[{"name":"School of Nursing, The University of Hong Kong, Hong Kong 999077, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0287-8020","authenticated-orcid":false,"given":"Pui-Hing","family":"Chau","sequence":"additional","affiliation":[{"name":"School of Nursing, The University of Hong Kong, Hong Kong 999077, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Chin","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Nursing, The University of Hong Kong, Hong Kong 999077, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4000-2388","authenticated-orcid":false,"given":"Man-Ping","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing, The University of Hong Kong, Hong Kong 999077, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2000180","DOI":"10.2807\/1560-7917.ES.2020.25.10.2000180","article-title":"Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020","volume":"25","author":"Mizumoto","year":"2020","journal-title":"Eurosurveillance"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/jpm.12639","article-title":"COVID-19 under the SARS cloud: Mental health nursing during the pandemic in Hong Kong","volume":"28","author":"Cheung","year":"2021","journal-title":"J. Psychiatr. Ment. Health Nurs."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Choi, E.P.H., Hui, B.P.H., and Wan, E.Y.F. (2020). Depression and anxiety in Hong kong during COVID-19. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17103740"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1007\/s40200-020-00643-9","article-title":"The mental health of healthcare workers in the COVID-19 pandemic: A systematic review","volume":"19","author":"Vizheh","year":"2020","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1093\/qjmed\/hcaa110","article-title":"Mental health in the COVID-19 pandemic","volume":"113","author":"Cullen","year":"2020","journal-title":"QJM"},{"key":"ref_6","unstructured":"World Health Organization (2021, July 28). COVID-19 Disrupting Mental Health Services in Most Countries, WHO Survey. Available online: https:\/\/www.who.int\/news\/item\/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey."},{"key":"ref_7","unstructured":"World Health Organization (2021, April 19). Frontline Workers and COVID-19: Coping with Stress. Available online: http:\/\/www.emro.who.int\/mnh\/news\/frontline-workers-and-covid-19-coping-with-stress.html."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2470547020977891","article-title":"Psychological impact of the COVID-19 pandemic on frontline health care workers during the pandemic surge in New York City","volume":"5","author":"Feingold","year":"2021","journal-title":"Chronic Stress"},{"key":"ref_9","first-page":"449","article-title":"Psychological impact of COVID-19 pandemic in Western frontline heatlhcare professionals: A systematic review","volume":"156","author":"Danet","year":"2021","journal-title":"Clin. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"598712","DOI":"10.3389\/fpsyt.2020.598712","article-title":"Psychological impact of the COVID-19 outbreak on nurses in China: A nationwide survey during the outbreak","volume":"11","author":"Liu","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_11","unstructured":"Hong Kong Hospital Authority (2021, April 19). Communication kit\u2014Coronavirus Disease 2019 Version 6.8. Available online: https:\/\/www.ha.org.hk\/haho\/ho\/pad\/Comkit.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1016\/S2215-0366(20)30078-X","article-title":"Mental health care for medical staff in China during the COVID-19 outbreak","volume":"7","author":"Chen","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1177\/2347631120983481","article-title":"A literature review on impact of COVID-19 pandemic on teaching and learning","volume":"8","author":"Pokhrel","year":"2021","journal-title":"High Educ. Future"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Doggrell, S.A., and Schaffer, S. (2016). Attrition and success rates of accelerated students in nursing courses: A systematic review. BMC Nurs., 15.","DOI":"10.1186\/s12912-016-0145-7"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40359-020-00444-y","article-title":"Psychological resilience and positive coping styles among Chinese undergraduate students: A cross-sectional study","volume":"8","author":"Wu","year":"2020","journal-title":"BMC Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.mnl.2014.03.013","article-title":"The resilient nurse: An emerging concept","volume":"12","author":"Turner","year":"2014","journal-title":"Nurs. Leadersh."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1037\/0022-3514.56.2.267","article-title":"Assessing coping strategies: A theoretically based approach","volume":"56","author":"Carver","year":"1989","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_19","unstructured":"Segal, D.L. (2010). The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), John Wiley & Sons, Inc.. [4th ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jpsychores.2004.09.006","article-title":"Detecting and monitoring depression with a two-item questionnaire (PHQ-2)","volume":"58","author":"Kroenke","year":"2005","journal-title":"J. Psychosom. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1002\/jts.20271","article-title":"Psychometric analysis and refinement of the Connor\u2013Davidson resilience scale (CD-RISC): Validation of a 10-item measure of resilience","volume":"20","author":"Stein","year":"2007","journal-title":"J. Trauma Stress"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Scali, J., Gandubert, C., Ritchie, K., Soulier, M., Ancelin, M.-L., and Chaudieu, I. (2012). Measuring resilience in adult women using the 10-items Connor\u2013Davidson Resilience Scale (CD-RISC). Role of trauma exposure and anxiety disorders. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0039879"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1098\/rstb.2004.1483","article-title":"The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: Lessons learned","volume":"359","author":"Maunder","year":"2004","journal-title":"Philos. Trans. R. Soc. Lond. Ser. B Biol. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1111\/j.1440-1819.2012.02336.x","article-title":"Psychological impact of the pandemic (H1N1) 2009 on general hospital workers in Kobe","volume":"66","author":"Matsuishi","year":"2012","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1207\/s15327558ijbm0401_6","article-title":"You want to measure coping but your protocol\u2019s too long: Consider the brief cope","volume":"4","author":"Carver","year":"1997","journal-title":"Int. J. Behav. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1023\/B:JOBM.0000013643.36767.22","article-title":"Independent and mediated contributions of personality, coping, social support, and depressive symptoms to physical functioning among patients in cardiac rehabilitation","volume":"27","author":"Shen","year":"2004","journal-title":"J. Behav. Med."},{"key":"ref_27","first-page":"e203976","article-title":"Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019","volume":"3","author":"Lai","year":"2020","journal-title":"JAMA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.genhosppsych.2020.06.007","article-title":"Psychological distress, coping behaviours, and preferences for support among New York healthcare workers during the COVID-19 pandemic","volume":"66","author":"Shechter","year":"2020","journal-title":"Gen. Hosp. Psychiatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4217","DOI":"10.1111\/jocn.15454","article-title":"Psychological impact of COVID-19 outbreak on frontline nurses: A cross-sectional survey study","volume":"29","author":"Nie","year":"2020","journal-title":"J. Clin. Nurs."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.3389\/fpsyg.2020.01960","article-title":"Psychosocial support for healthcare workers during the COVID-19 pandemic","volume":"11","author":"Tomlin","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/JMDH.S276655","article-title":"Anxiety and resilience of healthcare workers during COVID-19 pandemic in Indonesia","volume":"14","author":"Setiawati","year":"2021","journal-title":"J. Multidiscip. Healthc."},{"key":"ref_32","first-page":"e13537","article-title":"The relationship between mental health and resilience: A systematic review and meta-analysis","volume":"19","author":"Gheshlagh","year":"2017","journal-title":"Iran. Red Crescent Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/joop.12123","article-title":"Can resilience be developed at work? A meta-analytic review of resilience-building programme effectiveness","volume":"89","author":"Vanhove","year":"2016","journal-title":"J. Occup. Organ. Psychol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"32","DOI":"10.7748\/ns.26.47.32.s45","article-title":"Mindfulness as a key resource for development and resilience","volume":"26","author":"Breckman","year":"2012","journal-title":"Nurs. Stand."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"545","DOI":"10.3928\/00485713-20131206-06","article-title":"Mindfulness meditation for increasing resilience in college students","volume":"43","author":"Rogers","year":"2013","journal-title":"Psychiat. Ann."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1080\/13548506.2013.806815","article-title":"Evaluating the effectiveness of enhancing resilience in human service professionals using a retreat-based Mindfulness with Metta Training Program: A randomised control trial","volume":"19","author":"Pidgeon","year":"2014","journal-title":"Psychol. Health Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.cbpra.2010.08.002","article-title":"Mindfulness-based mind fitness training: A case study of a high-stress predeployment military cohort","volume":"18","author":"Stanley","year":"2011","journal-title":"Cogn. Behav. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.jpainsymman.2009.11.279","article-title":"Clinician self-care: The applications of mindfulness-based approaches in preventing professional burnout and compassion fatigue (336)","volume":"39","author":"Geller","year":"2010","journal-title":"J. Pain Symptom. Manag."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.cpr.2011.04.006","article-title":"Effects of mindfulness on psychological health: A review of empirical studies","volume":"31","author":"Keng","year":"2011","journal-title":"Clin. Psychol. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1037\/0022-3514.84.4.822","article-title":"The benefits of being present: Mindfulness and its role in psychological well-being","volume":"84","author":"Brown","year":"2003","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Peir\u00f3, T., Lorente, L., and Vera, M. (2020). The COVID-19 crisis: Skills that are paramount to build into nursing programs for future global health crisis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17186532"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s11920-020-01166-z","article-title":"The psychological impact of epidemic and pandemic outbreaks on healthcare workers: Rapid review of the evidence","volume":"22","author":"Preti","year":"2020","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"17","DOI":"10.17547\/kjsr.2019.27.1.17","article-title":"The comparison study of nurses\u2019 exhaustion and depression, anxiety, ADHD, and impulsivity","volume":"27","author":"Kim","year":"2019","journal-title":"Stress"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ding, Y., Qu, J., Yu, X., and Wang, S. (2014). The mediating effects of burnout on the relationship between anxiety symptoms and occupational stress among community healthcare workers in China: A cross-sectional study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0107130"},{"key":"ref_45","first-page":"1","article-title":"Fear of COVID-19 and depression: A comparative study among the general population and healthcare professionals during COVID-19 pandemic crisis in Bangladesh","volume":"19","author":"Sakib","year":"2021","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Soraci, P., Ferrari, A., Abbiati, F.A., Del Fante, E., De Pace, R., Urso, A., and Griffiths, M.D. (2020). Validation and psychometric evaluation of the Italian version of the Fear of COVID-19 Scale. Int. J. Ment. Health Addict., 1\u201310.","DOI":"10.1007\/s11469-020-00277-1"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/16\/8569\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:45:46Z","timestamp":1760165146000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/16\/8569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,13]]},"references-count":46,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["ijerph18168569"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18168569","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2021,8,13]]}}}