Transference

Four articles emphasized the importance of transference as a coping strategy for COVID-19 by nursing students. Another author [17] conducted a study in Spain and noted the effect of the COVID-19 pandemic on nursing students' challenging daily lifestyles. The pandemic created fear, anxiety, and stress among Spanish nursing students. Consequently, transference, such as doing regular exercise and talking with other people, positively reduced stress among nursing students. Authors [13] agreed with [17] on transference behaviors among nursing students after a descriptive cross-sectional study conducted in Egypt and Saudi Arabia. The authors noted that getting social support from peers was one of the most effective coping strategies for nursing students during the COVID-19 pandemic.

The third study was a cross-sectional study by [15], conducted on 316 nursing students in Turkey to evaluate anxiety levels and coping strategies during the pandemic. According to the authors, nursing students suffered from moderate anxiety levels as a result of COVID-19. The study further found out that 48.1% of the students used the eating coping method, and 77.8% spend time on the internet; this indicates ineffective coping strategies, which are associated with stressful events during the pandemic.

The fourth article by [20] underlined the importance of transference after conducting another study in Australia and India. The comparative study assessed anxiety levels and coping strategies among nursing students. The cross-sectional study indicated that these student nurses inevitably experience heightened anxiety. Therefore, one of the coping strategies applied by Indian nursing students to reduce stress levels is exercise and talking to other people.

## **4. Discussion**

The scoping review explored the relevant evidence on the stressors and coping strategies of nursing students during the COVID-19 pandemic. The review relied on evidence from 13 studies. The inclusion of the 13 studies and subsequent critical comparison of the evidence revealed compelling stressors of the nursing students and the various mechanisms for coping with the disruption of the pandemic on the learning process.

The nursing students cited distance learning as a source of stress. The new technologicalbased option of delivering nursing education brings technical issues, internet problems, and poor management of online classes. Challenges arise for the nursing students because they prefer conventional learning as opposed to the online distance learning options [23]. Distance learning might not enhance more student-centered learning, monitoring, and teaching assessments than the conventional classroom does during a lockdown.

Assignments and workload emerged as compelling stressors for the nursing students as COVID-19 created a newly structured learning process. The online learning environment compels educators to provide assignments to keep up with skill development as they do in the normal classroom setting. The stressful learning circumstances may not translate into quality skills, as the students require real-life demonstrations or simulations [24]. The completion of the pre-licensure nursing students becomes difficult because they rely on the excessive workload to meet the non-direct care hours as well as optimizing virtual clinical experience with their supervisors.

The review further revealed that clinical training has created anxiety and stress among nursing students during the pandemic. The pre-licensure students are among healthcare workers without access to PPE at times, so they face the risk of contracting the virus. According to [24], the students might lack proper preparation through mentorship or preceptorship to handle the challenging active care environment with positivity rates of COVID-19 increasing every day. The fears, anxiety, and stress arise from the virus as well as students' inability to reach a proper learning trajectory [25]. The nursing students lack proper familiarity with self-efficacy, communication, and resilience-oriented mechanisms.

The stress of clinical training underscores the impact of the COVID-19 infections without proper clinical skills, treatment mechanisms, and overall response repertoire. The review emphasized the effort of social distancing, wearing masks, and washing hands besides taking other necessary precautions against the virus. The students face microaggressions and a limited chance of making choices for the safety of their physical as well as psychological health as they do in the active care setting or virtual learning environment [26]. The universities or nursing colleges contribute to the challenge by allowing nursing students to enter high-risk health environments without the proper skills.

The stress and anxiety from the learning or high-risk environments have necessitated the adoption of coping mechanisms by the nursing students. The review ascertains the wide-ranging use of information and consultations to develop the right attitude during the COVID-19 pandemic. The information is critical in overcoming confinements, eliminating uncertainties, and teaching new methodologies for overcoming COVID-19 mental health challenges among learners [27]. The information and consultation of supervisors in schools or high-risk environments should eliminate uncertainty about COVID-19 as well as the completion of a nursing curriculum in readiness for registration.

Optimism emerges as the critical coping tool for nursing students hoping to complete their courses through virtual learning. The review affirms the method as a psychological adaptation to the new learning structure created by the pandemic. Optimism underlines the hopes for better eventualities for the learning environment as the nursing transitions to the professional nursing practice [28]. The findings ascertain continued efforts by nursing students to adopt behaviors that promote their well-being while hoping for a restoration of the normal learning approach.

Transference is another effective coping mechanism for nursing students who have hopeful prospects about the trajectory of their nursing education. The nursing students deal with the virtual learning environment, clinical training in a high-risk environment, and workloads with exercises or socialization. Social support is critical due to the overall life interruptions and hopeful prospects of completing nursing programs despite the COVID-19 pandemic [29]. The newly structured learning environment provides nursing students with challenging choices and has immense implications for the nursing practice.

Nursing education should adopt other impactful and interactive methods, such as video-simulated options. The nursing students could reduce fears and anxiety or stress by working with interactive modalities more than working on theoretical tasks without the capacity to enhance their practical nursing skills. On the other hand, continuous counseling and social support are essential in the communities, as universities and colleges seek better engagement for the pre-licensure nursing students. The strategies will complement the coping mechanisms of transference, seeking information or consultation, and optimism because nursing students anticipate a smooth transition to the practice during the COVID-19 pandemic.

However, the scoping review had several limitations. The review pointed towards available studies in stressors and coping mechanisms of nursing students during COVID-19 that opposite the research that allows searching of new findings. The method further lacked the articulation of the risk of bias that reduced the reliability of the outcomes. The

results are based on the relatively novel COVID-19 topic, which continues to evolve over time, and thus, the overall reliability remains contentious.

COVID-19 painted a grim picture of the world's lack of preparedness for a pandemic such as this. In this review about stressors and coping strategies, it was discovered that nursing students suffered from stressors during this pandemic in their academic journeys. There are various stressors that nursing students face, including stress from distance learning, stress from assignments and workloads, stress from clinical training, and stress from COVID-19 infection. In response to these stressors, nursing students have developed coping strategies that were employed to adjust to these COVID-19-related stressors, such as seeking information and consultation, staying optimistic, and transference.
