**1. Introduction**

Since the 1918 Spanish Influenza pandemic, which caused approximately 40 million deaths [1], no other pandemic has impacted society as much as the SARS-CoV-2 virus. Its repercussions have demonstrated the frailty of every vital scope. The rapid spread of the new SARS-CoV-2 coronavirus has forced the adoption of exceptional prevention and containment measures.

In Spain, after the declaration of the World Health Organisation (WHO) recognizing the pandemic due to the disease caused by the SARS-CoV-2 corona virus (COVID-19) on 11 March 2020, one of the greatest challenges of recent decades was confronted [2]. To face this world crisis, social, economic, and political resources were demanded, as well as the

**Citation:** Espina-López, F.; Moreno-Sánchez, E.; Gago-Valiente, F.-J.; Sáez-Padilla, J.; Salado-Navarro, V.; Merino-Godoy, M.-d.-l.-Á. Psychological Discomfort in Nursing Degree Students as a Consequence of the COVID-19 Pandemic. *J. Clin. Med.* **2021**, *10*, 5467. https://doi.org/ 10.3390/jcm10235467

Academic Editor: Michele Roccella

Received: 1 November 2021 Accepted: 19 November 2021 Published: 23 November 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

recognition of the pandemic's possible consequences, requiring an approach to contain the outbreak through basic principles of public health [3].

It is important to highlight that, although the reaction was proportional to different crisis levels [4], difficult situations took place in hospitals due to the high contagion rates. In Spain, the coronavirus expanded from February 2020, and, at the middle of March 2020, an emergency state was imposed, with the aim of containing the contagions and reduce the overload of patients that occurred in hospitals. For over two months, the population went through a strict confinement, which did not prevent the health services from being overwhelmed in many places before flattening the curve of contagion [4]. From the beginning of the pandemic, the virus spread at a great rate throughout the entire territory; however, it did not affect all regions equally. This geographical "inequality" is not only obvious in the vaccination rate or in the parameter of cumulative disease incidence but also in the mortality rate [5].

It is known and proven that the COVID-19 pandemic has caused certain changes in the world population that challenge all aspects of "usual life". Daily actions from before this historical event have changed, and such change has impacted society in terms of personal affairs, human relationships, employment, education, connections with the community, and other social activities [6].

Many countries implemented several isolation measures to prevent the spread of the outbreak until a vaccine was available or until the percentage of vaccinated population increased, which led to important social and economic consequences in the entire community, resulting in negative psychological repercussions. These measures include home isolation, social distancing, closing of educational centers, universities, and businesses, cancellation of events, conferences, and seminars, postponement of sports events, and travel restrictions [3,6].

In fact, the spread of the outbreak of the new 2019 coronavirus SARS-CoV-2 brought a drastic change to all humanity, with a considerable psychosocial impact on the professions related to health and on the university students of health sciences [7].The impact on health professionals has been reported in different Spanish and international studies [8–10]. Roberts, Mc Aloney-Kocaman, Lippiett, Ray, Welch, and Kelly [11] state that there were higher levels of anxiety and depression among nurses with less experience.

It is also important to point out the impact of the state of health emergencyon educational contexts at all stages.

The current pandemic has caused vast and prolonged interruptions in the teaching– learning processes, in the normal support systems, and in the social activities of students, with ongoing consequences that reflect the distance from recovering the past normality in the near future [6].

This impact on students' lives is due to the convergence of many variables related to the interruption of students' university life and other aspects of their everyday life, including family and social life and their capacity to participate in habitual activities such as sports [6].

University students can be one of the most affected populations. Students have modified their routines due to the COVID-19 pandemic [12]. For many students, such as those of the Degree of Nursing, the requirements of isolation and social distancing have caused the cancellation of face-to-face lectures and exams, practicums in healthcare centers, and part-time jobs [6].

Attending lectures and other activities related to studying areof vital importance for professional training. For many students, going to university is a way of learning to face reality, as well as a way of maintaining their relationships with peers, friends, and faculty members [13].

Some students prefer to attend face-to-face lectures over the online modality, due to their personal learning styles, the capacity to learn "face-to-face" to increase their learning confidence, or having access to the support from their peers. For those who do not study in their locality of residence, in a shared flat/house, or in student accommodations, not

attending face-to-face lectures increases their need for economic investment in technological devices to be able to attend the online lectures. Moreover, if they could not attend the face-to-face lectures, students suffered the subsequent loneliness and loss of connection with other people related to their studies (students and faculty members) [13].

In some countries, nursing students experienced situations under certain pressure, where they had to assume the role of health professionals, assisting upon request in the units where they were assigned, with critical patients, putting students' mental health at risk due to these stressful situations [14]. In fact, it has been asserted that the COVID-19 pandemic has placed a considerable number of nursing students in a situation in which they feel that they must choose between safety outside of the healthcare profession or continuing their nursing studies [15]. This dilemma can cause additional psychological distress among nursing students and, as in the case of previous global disease outbreaks such as Ebola, healthcare professionals are at great risk of developing burnout, fatigue, lower job satisfaction and morale, and working stress during pandemics [6].

Therefore, it has been demonstrated that nursing students experience greater anxiety than students of other degrees, due to the specific characteristics of their training [16]. This may be caused by the additional stress factors related to the social and academic adjustments derived from the COVID-19 pandemic within the educational community [17,18].

Several studies on this population report that those aged between 18 and 20 years, mostly women, show higher stress levels. It was found that watching the news about the pandemic, concern about infection, and the time restrictions imposed by the curfew influenced nursing students' stress levels [3].

It is known that the transition of nursing students to the role of healthcare professionals has always been stressful, thus, there are people who have abandoned their profession when it was time for them to practice it. Currently, the COVID-19 pandemic has posed a new and serious stress and anxiety factor to nursing students. These students have lived through situations such as the struggle of their peers who work in healthcare centers with the isolation measures. For example, one of these situations was the lack of basic material, including personal protection equipment (PPE), along with the direct exposure to COVID-19 patients. This may have caused negative perceptions toward nursing students' future occupation [19].

Therefore, several actions have been proposed to implement a solid and suitable support plan aimed at preventing professional discomfort [14]. In this preventive line, it has been stated that study plans should include specific content on the management of pandemics and other disasters, in order to increase the preparation of the students, i.e., the future healthcare professionals, for these types of scenarios [20].

Hernández-Martínez, Rodríguez-Almagro, Martínez-Alce, Romero-Blanco, García-Iglesias, and Gómez-Salgado [2] claim that, although nursing students showed willingness to incorporate into the healthcare centers, they felt unprepared to work in the field of intensive care and demanded further training to improve their levels of anxiety and stress regarding the care of critical patients. Guidance, followup, and emotional support in critical situations have proved key to overcome stressful situations [21].

For all these reasons, the aim of the present study was to analyze the influence of the COVID-19 pandemic on the psychological discomfort of final-year students of the Degree of Nursing due to the temporal proximity of their professional practice. The study'sobjective was to determine the prevalence of psychological discomfort in the study population, as well as the influence of sociodemographic and academic variables. The pandemic has had a direct impact on this new generation of nursing professionals. Discovering the possible psychological repercussions in these students will enable implementation of psychological and didactic corrective measures that reduce the negative effects on their training and personal health. Such measures could facilitate the integration of those who are about to become healthcare professionals, thus contributing to improving the quality of healthcare services.
