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. 2025 Mar 8;13(1):218.
doi: 10.1186/s40359-025-02562-x.

Psychological distress among nursing students during the COVID-19 pandemic: a hybrid concept analysis

Masoud Feyzbabaie  1 , Nahid Rajai  2 , Azizeh Alizadeh  3 , Maryam Azizi  4
Affiliations

Psychological distress among nursing students during the COVID-19 pandemic: a hybrid concept analysis

Masoud Feyzbabaie et al. BMC Psychol. .

Abstract

Background: This study aimed to investigate the concept of psychological distress among nursing students during the COVID-19 pandemic. Understanding its dimensions and characteristics of this phenomenon can enhance preparedness for future pandemics. Psychological distress has emerged as a significant mental health concern during the pandemic, with nursing students experiencing high levels of psychological distress caused by substantial disruptions in their educational environment.

Method: This study employed the Schwartz-Barcott and Kim's hybrid concept analysis model, integrating a systematic literature review with qualitative research to examine psychological distress among nursing students during the COVID-19 pandemic. The literature review included a comprehensive search across multiple databases, resulting in the identification of 60 relevant articles for data extraction. In the qualitative phase, semi-structured interviews were carried out with nursing students from the Army Nursing Faculty, and the data were analyzed which were analyzed using a directed content analysis approach. The findings from both phases were synthesized to provide a comprehensive definition of psychological distress in nursing students during the pandemic.

Results: Psychological distress among nursing students during the COVID-19 pandemic was analyzed through three key dimensions: antecedents, characteristics, and consequences. Antecedents included factors such as personality traits, demographic factors, social influences, and health-related conditions, with demographics standing out as particularly impactful. The characteristics of distress were categorized into emotional-psychological, cognitive, and physical symptoms, with sleep disturbances being especially prominent. The consequences encompassed both negative outcomes-like academic setbacks, social withdrawal, and physical health problems-and positive outcomes, such as post-traumatic growth, improved coping skills, and professional advancement. The findings offer a thorough understanding of the multifaceted nature of psychological distress and its effects on nursing students.

Conclusion: The findings of this study explore the antecedents, characteristics, and consequences of students' psychological distress, providing essential insights for health policymakers and educational planners during similar pandemics. This data can inform the development, planning, and implementation of treatment and training systems designed to prevent such conditions in future pandemics. In essence, by identifying and addressing the underlying factors or antecedents of this distress, its occurrence in future pandemics could be effectively reduced.

Keywords: COVID-19; Hybrid; Nursing students; Psychological distress.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval for this study was obtained from the Ethics Committee of AJA University of Medical Sciences (IR.AJAUMS.REC.1399.209). Participants were free to participate or refused to participate in the study. The participants’ information was kept strictly confidential. Informed consent was obtained from all subjects involved in the interviews without identifying any information. All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. The study protocol was approved by the Ethics Committee of AJA University of Medical Sciences, and written informed consent was obtained from all participants prior to their inclusion in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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Psychological distress among nursing students during the COVID-19 Pandemic
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