Repercussions of the COVID-19 pandemic on Nursing training: A Scoping Review

Nascimento, Anália Andréia de Araújo; Ribeiro, Sara Eloise Argimiro; Marinho, Anne Caroline Lisboa; Azevedo, Valéria Dantas de; Moreira, Marina Eduarda Mendonça; Azevedo, Isabelle Campos de

doi:10.1590/1518-8345.6414.3911

person Anália Andréia de Araújo Nascimento

Study concept and design · Data analysis and interpretation · Statistical analysis · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content

schoolUniversidade Federal do Rio Grande do Norte, Natal, RN, Brazil.schoolScholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

0000-0001-7492-2735

person Sara Eloise Argimiro Ribeiro

Study concept and design · Obtaining data · Data analysis and interpretation · Statistical analysis · Drafting the manuscript

schoolScholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.schoolUniversidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, RN, Brazil.

0000-0003-0890-3426

person Anne Caroline Lisboa Marinho

Study concept and design · Data analysis and interpretation · Statistical analysis · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content

schoolUniversidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, RN, Brazil.

0000-0002-7582-9636

person Valéria Dantas de Azevedo

Study concept and design · Data analysis and interpretation · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content

schoolUniversidade Federal do Rio Grande do Norte, Natal, RN, Brazil.schoolScholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.

0000-0002-2584-5996

person Marina Eduarda Mendonça Moreira

Study concept and design · Obtaining data · Data analysis and interpretation · Drafting the manuscript

schoolUniversidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, RN, Brazil.

0000-0003-1348-7244

person Isabelle Campos de Azevedo

Study concept and design · Data analysis and interpretation · Statistical analysis · Obtaining financing · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content

schoolUniversidade Federal do Rio Grande do Norte, Natal, RN, Brazil.

0000-0001-5322-7987

personCorresponding author: Isabelle Campos de Azevedo E-mail:
isabellebr2511@gmail.com https://orcid.org/0000-0001-5322-7987

Conflict of interest:

the authors have declared that there is no conflict of interest.

Associate Editor:

Maria Lúcia Zanetti

Databases	Search terms
LILACS	#1– enfermagem AND educação em enfermagem AND pandemias #2– enfermagem AND educação à distância AND pandemias
Science Direct in the CAPES Thesis and Dissertation Catalog and in Teses e Dissertações da América Latina, in DIVA, in ERIC, in TROVE, in DART, in ETD, and in SCOPUS	#1– nursing AND nursing education AND pandemics #2– nursing AND distance education AND pandemics
SCOPUS	#1– ALL (nursing) OR (nursing, students OR nursing, practice OR mentors) AND (education nursing) OR (professional education OR distance education OR nursing education research) AND (pandemics) OR (SARS-CoV-2 OR COVID-19 virus infection). #2 –ALL (nursing) OR (nursing, students OR nursing, practice OR mentors) AND (distance education) OR (education nursing OR professional education OR nursing education research) AND (pandemics) OR (SARS- CoV-2 OR COVID-19 virus infection)
Search strategy for the other databases	#1– nursing (nursing, students OR nursing, practice OR mentors) AND education nursing (professional education OR distance education OR nursing education research) AND pandemics (SARS-CoV-2 OR COVID-19 virus infection). #2– nursing (nursing, students OR nursing, practice OR mentors) AND distance education (education nursing OR professional education OR nursing education research) AND pandemics (SARS-CoV-2 OR COVID-19 virus infection)

ID*	Reference	Country	Type of study	Positive repercussions of the pandemic on Nursing training	Level of Evidence
A1†	Warshawsk S.(¹⁵)	Israel	Cross-sectional	Resilience and social support from family members and friends.	IV‡
A2†	Saab MM, Hegarty J, Murphy D, Landers M.(¹⁶)	Ireland	Qualitative and descriptive	New, inclusive and participatory learning environment.	IV‡
A3†	Kalanlar B.(¹⁷)	Turkey	Cross-sectional	The participants believe that the good results of the Nursing program were achieved by means of education at a distance.	IV‡
A4†	Shorey S, Ang E, Baridwan NsS, Bonito SR, Dones LBP, Flores JLA, et al. (¹⁸)	Multicenter	Qualitative and descriptive	The participants were satisfied because it was more comfortable and for the possibility of studying at their homes with the new teaching modalities; good social well-being levels.	IV‡
A5†	Kunaviktikul W, Ang E, Baridwan NS, Bernal AB, Dones LBP, Flores JL, et al.(¹⁹)	Multicenter	Qualitative and descriptive	The students rated on-line education as appropriate, good and valuable; new sources of resilience; reaffirmation of the choice of Nursing as a profession; convenience of remote learning; reassessment of teaching pedagogies.	IV‡
A6†	Canet-Vélez O, Botigué T, Lavedán Santamaría A, Masot O, Cemeli T, Roca J.(²⁰)	Spain	Qualitative and descriptive	The students were able to notice the gaps resulting from the training process and that were necessary to face the crisis; valuing nurses’ skills and competencies.	IV‡
A7†	Godbold R, Whiting L, Adams C, Naidu Y, Pattison N. (²¹)	United Kingdom	Qualitative and descriptive	Possibility of a clinical experience during the pandemic crisis; development of autonomy and self-confidence by the students; learning new skills and updates.	IV‡
A8†	Zaragoza-García I, Ortuño- Soriano I, Posada-Moreno P, Sánchez-Gómez R, Raurell- Torredà M.(²²)	Spain	Quasi-experimental	Development of a virtual reality environment to assist in the students’ training process; using this technology promoted an improvement in the acquisition of knowledge and skills by means of a training program.	III§
A9†	Park J, Seo M.(²³)	South Korea	Mixed and sequential	The online classes allowed the students to choose the learning time and place; they also allowed repeating the classes; the students were forced to self-regulate their learning.	IV‡
A10†	Nodine PM, Arbet J, Jenkins PA, Rosenthal L, Carrington S, Purcell SK, et al.(²⁴)	United States of America	Cohort	More resilience; possibility of attending classes from the students’ homes.	III§
A11†	Scorsolini-Comin F, De Melo LP, Rossato L, Gaia RDSP.(²⁵)	Brazil	Reflection	The pandemic as an element to reheat the debate on remote Nursing training, critically and based on evidence.	IV‡
A12†	Bastos MC, Canavarro DA, Campos LM, Schulz RS, Santos JB, Santos CF.(²⁶)	Brazil	Experience report	Teachers’ training on the use of online platforms; approach by the course coordination to the students; elaboration of new methodologies adapted to the context.	IV‡
A13†	Rodrigues PS, Marin MJS, Souza AP, Grandin GM, Almeida KRV, Oliveira CSR.(²⁷)	Brazil	Qualitative and descriptive	Need for integration among peers and good group dynamics.	IV‡
A14†	Silva CB, Trindade LL, Kolhs M, Barimacker SV, Schacht L, Bordignon M.(⁶)	Brazil	Theoretical- reflective	Development of educational methodologies adapted to remote teaching; autonomy of remote teaching; ease of study in various spaces; need to promote the elaboration of efficient and inclusive teaching strategies; need to present topics that returned to the discussion agenda, such as mental health and professionals’ safety.	IV‡
A15†	Soccol KLS, Santos NO, Marchiori MRCT.(²⁸)	Brazil	Reflection	It enabled students to develop competencies and skills in a crisis context; strengthening of learning in the face of the new and the information that arises; the pandemic scenario exposed the extent to which Nursing is undervalued.	IV‡
A16†	Li W, Gillies R, He M, Wu C, Liu S, Gong Z, et al.(²⁹)	China	Qualitative and descriptive	The teachers were satisfied with the online education experiences; possibility for students from outside China to complete the remote course; the family environment as support to overcome negative emotions; greater commitment and self-discipline to the learning process by the students.	IV‡
A17†	Emory J, Kippenbrock T, Buron B.(³⁰)	United States of America	Cross-sectional	Exposure to deficit in training on safety and adequate use of Personal Protective Equipment.	IV‡
A18†	Riegel F, Martini JG, Bresolin P, Mohallem AGC, Nes AAG. (³¹)	Brazil	Theoretical- reflective	It sparked the need for an innovative approach to the development of curricula and new learning projects; development of new technologies to add quality to the teaching-learning process; development of different teaching methods and models.	IV‡
A19†	Baixinho CL, Ferreira OR.(³²)	Brazil	Qualitative and descriptive	Need to explore new pedagogical strategies and to evaluate their effectiveness; the students’ participation in the clinical practice reinforces care in times of crisis.	IV‡
A20†	Salmani N, Bagheri I, Dadgari A.(³³)	Iran	Qualitative and descriptive	Remote teaching allowed self-centered flexible learning and reducing the concerns about in-person learning.	IV‡
A21†	Tolyat M, Abolfazl Vagharseyyedin S, Nakhaei M. (³⁴)	Iran	Qualitative and descriptive	Development of new teaching methods adapted to remote teaching; shift from teacher-centered to student- centered education; the media resources highlighted nurses’ role in treating diseases; fewer students in the training rooms.	IV‡
A22†	Thapa P, Bhandari SL, Pathak S.(35)	Nepal	Cross-sectional	Remote teaching enables home-based study with reduced costs; development of new teaching methods adapted to the remote modality; greater learning ease.	IV‡
A23†	Lei T, Yu X, Zou M, Wang P, Yuan RH.(³⁶)	China	Quasi-experimental	Remote teaching can strengthen information; providing an additional demonstration of concepts; encouraging active learning and intuitive animation; teaching through videos.	III§
A24†	Wynter K, Holton S, Considine J.(37)	Australia	Qualitative and descriptive	Development of new online learning methods; flexible education; acquisition of new skills and knowledge; increased productivity by working remotely and participating in virtual meetings; appreciation of Nursing as an important profession in the fight against the virus.	IV‡
A25†	Susmarini D, Sumarwati M, Handayani F, Iskandar A.(³⁸)	Indonesia	Qualitative and descriptive	Emergence of a sense of pride for being part of the Nursing workforce; development of skills and mastery of the technology; more effective communication.	IV‡
A26†	Michel A, Ryan N, Mattheus D, Knopf A, Abuelezam NA, Stamp K, et al.(³⁹)	United States of America	Cross-sectional	Flexibility and openness to unknown situations; the pandemic showed that Nursing schools need to devise suitable plans for disasters.	IV‡
A27†	Araújo ARL, Sousa LMC, Carvalho RBS, Oliveira ADS, Amorim FCM, Sousa KHJF, et al.(⁴⁰)	Brazil	Cross-sectional	Need to develop new teaching methodologies adapted to remote teaching; possibility of home-based work; development of technological skills; better communication; it enhanced teachers’ professional development; it highlighted the need to improve relationships with students, colleagues and coordination.	IV‡
A28†	Terzi B, Azizoğlu F, Özhan F. (⁴¹)	Turkey	Cross-sectional	Development of suitable educational methods in the online environment; current classes; it encouraged the student-professor interaction; improved informatics skills.	IV‡
A29†	Silva CM, Toriyama ATM, Claro HG, Borghi CA, Castro TR, Salvador PICA(⁴²)	Brazil	Experience report	Development of a new methodology adapted to remote teaching that minimizes the impact of interruption of classes; the students’ possibility to attend recorded classes at a suitable moment.	IV‡
A30†	Duprez V, Vermote B, Van Hecke A, Verhaeghe R, Vansteenkiste M, Malfait S.(⁴³)	Belgium	Cross-sectional	Greater commitment to the choice of studying Nursing by final year students; greater clarity about the value of Nursing.	IV‡
A31†	Jones K, Polyakova-Norwood V, Raynor P, Tavakoli A.(⁴⁴)	United States of America	Mixed methods	Behavioral change in the teachers, becoming more understanding in terms of deadlines and open communication.	IV‡
A32†	Kim S, Jeong SH, Kim HS, Jeong YJ.(⁴⁵)	South Korea	Cross-sectional	Encouraging continuous self-directed learning; shift from an instructor-centered to a student-centered teaching model; greater communication between professors and students; need for instructor feedback for better learning; better academic performance; development of new educational methods that increase students’ engagement.	IV‡
A33†	Prata JA, Mello AS, Silva FVC, Faria MGA.(⁴⁶)	Brazil	Experience report	Need to develop educational methods adapted to online teaching; creation of online, didactic and updated courses.	IV‡

ID*	Reference	Country	Type of study	Negative repercussions of the pandemic on Nursing training	Level of Evidence
A1†	Warshawsk S.(¹⁵)	Israel	Cross-sectional	Difficulties perceived by the students, such as overload, difficulty with online learning, lack of academic support, lack of social interaction.	IV‡
A2†	Saab MM, Hegarty J, Murphy D, Landers M.(¹⁶)	Ireland	Qualitative and descriptive	High cost, threats to human connections, potential side effects and lack of interest.	IV‡
A3†	Kalanlar B.(¹⁷)	Turkey	Cross-sectional	Internet-related difficulties, such as connection failures or poor-quality connections.	IV‡
A4†	Shorey S, Ang E, Baridwan NsS, Bonito SR, Dones LBP, Flores JLA, et al.(¹⁸)	Multicenter	Qualitative and descriptive	The students felt that their training was impaired; high stress levels.	IV‡
A5†	Kunaviktikul W, Ang E, Baridwan NS, Bernal AB, Dones LBP, Flores JL, et al.(¹⁹)	Multicenter	Qualitative and descriptive	Increased feelings of loneliness, depression, sadness, boredom, fear, anxiety, stress, worry and vulnerability among the students; unpreparedness to return to their Nursing duties after their absence from the clinical setting; loss of boundaries between work and home; difficulties carrying out group work due to little interaction; technical problems during learning that greatly affected both teaching and learning.	IV‡
A6†	Canet-Vélez O, Botigué T, Lavedán Santamaría A, Masot O, Cemeli T, Roca J.(²⁰)	Spain	Qualitative and descriptive	Only a minority of students felt prepared to face the COVID-19§ crisis; overload, wear out, exhaustion and high stress levels; feelings of fear, worry and tense situations of nervousness.	IV‡
A7†	Godbold R, Whiting L, Adams C, Naidu Y, Pattison N. (²¹)	United Kingdom	Qualitative and descriptive	Need to distance from the family to comply with the clinical practices; due to staff shortages, the students worked with people relocated from other areas; the emotional issues raised by the social distancing restrictions that did not allow using touch and physical comfort; the difficulties of studying at home and simultaneously taking care of the family; physical effects from the use of Personal Protective Equipment, such as sore hands and marks on the face.	IV‡
A8†	Zaragoza-García I, Ortuño- Soriano I, Posada-Moreno P, Sánchez-Gómez R, Raurell- Torredà M.(²²)	Spain	Quasi-experimental	The platform intensifies social distancing.	III\|\|
A9†	Park J, Seo M.(²³)	South Korea	Mixed and sequential	Technical difficulties such as disconnections; decreased concentration and motivation; fatigue due to the long period using digital devices; changes in sleep patterns; increased depression, anxiety and fear of COVID-19§; classes had to be short so that concentration and motivation to learn did not diminish; absence of face-to-face clinical practice during the pandemic; sudden pauses in the in-hospital clinical practices; decreased opportunities during the practices; need to find suitable places to study because the school was closed.	IV‡
A10†	Nodine PM, Arbet J, Jenkins PA, Rosenthal L, Carrington S, Purcell SK, et al.(²⁴)	United States of America	Cohort	Increased stress levels in all the subscales evaluated, including course didactics, papers, family, clinical turnovers, finance, illness in family members and/or friends.	III\|\|
A11†	Scorsolini-Comin F, De Melo LP, Rossato L, Gaia RDSP.(²⁵)	Brazil	Reflection	High evasion rates among the students in this teaching modality.	IV‡
A12†	Bastos MC, Canavarro DA, Campos LM, Schulz RS, Santos JB, Santos CF.(²⁶)	Brazil	Experience report	Teacher-student distancing; low adherence to remote teaching among the students due to distractions in home-based learning; increased workload in teachers and students.	IV‡
A13†	Rodrigues PS, Marin MJS, Souza AP, Grandin GM, Almeida KRV, Oliveira CSR.(²⁷)	Brazil	Qualitative and descriptive	Technological difficulties; emergence of feelings such as anxiety, anguish, discouragement, stress and tiredness; tiring and low-performance process; lower concentration; home environment as a difficulty for the learning process; lack of contact with classmates; lack of access to the library; lack of practices in laboratories.	IV‡
A14†	Silva CB, Trindade LL, Kolhs M, Barimacker SV, Schacht L, Bordignon M.(⁶)	Brazil	Theoretical- reflective	Need for better planning of virtual activities; difficulties accessing the Internet and information; increased stress and tiredness levels; work in an environment with other family members; feelings such as fear, anxiety and loneliness.	IV‡
A15†	Soccol KLS, Santos NO, Marchiori MRCT.(²⁸)	Brazil	Reflection	Intensification of the feelings of insecurity and anxiety in the supervised internship.	IV‡
A16†	Li W, Gillies R, He M, Wu C, Liu S, Gong Z, et al.(²⁹)	China	Qualitative and descriptive	The students were dissatisfied with the online education experiences; increase in future uncertainties; increased stress levels due to extended workdays and fatigue.	IV‡
A17†	Emory J, Kippenbrock T, Buron B.(³⁰)	United States of America	Cross-sectional	Fear in the students about contaminating family members with the virus; high fear and anxiety levels; lack of quality learning; greater uncertainty about the future among the students; increase in cases of stress and mental exhaustion.	IV‡
A18†	Riegel F, Martini JG, Bresolin P, Mohallem AGC, Nes AAG. (³¹)	Brazil	Theoretical- reflective	Access difficulties faced by the students during remote teaching; emergence of a feeling of loneliness; need for human and social interaction with professors and students.	IV‡
A19†	Baixinho CL, Ferreira OR.(³²)	Brazil	Qualitative and descriptive	Impossibility of carrying out clinical teaching with COVID-19§ patients ; confinement for three months caused a setback in the ability to construct clinical reasoning; overload for services and professionals, who still assumed the role of clinical advisors; reduction in the clinical teaching time; increased fear of failure; fear of contact with others due to fear of infection; physical and psychological exhaustion; increased symptoms such as anxiety and poor sleep quality; reduction in terms of performance.	IV‡
A20†	Salmani N, Bagheri I, Dadgari A.(³³)	Iran	Qualitative and descriptive	Changes in the way students interact with teachers; decreased interactions with peers; problems with educational files; shallow learning; family members’ perception of the student’s role; domestic affairs interfering with e-learning; cheating on tests and activities.	IV‡
A21†	Tolyat M, Abolfazl Vagharseyyedin S, Nakhaei M. (³⁴)	Iran	Qualitative and descriptive	Internet access difficulties; less teacher-student interaction; lengthy breaks between practices; decrease in practice time to avoid contagion; most of the students did not acquire the necessary clinical competence in Nursing education; reduction in the number of patients; greater insecurity among the students.	IV‡
A22†	Thapa P, Bhandari SL, Pathak S.(35)	Nepal	Cross-sectional	Internet problems and technical issues hindered remote teaching; lack of interaction with the patients.	IV‡
A23†	Lei T, Yu X, Zou M, Wang P, Yuan RH.(³⁶)	China	Quasi-experimental	Absence of practices for the development of clinical skills.	III\|\|
A24†	Wynter K, Holton S, Considine J.(37)	Australia	Qualitative and descriptive	Reduced social connection during learning; increase in teachers’ workload; uncertainties about how to carry out clinical practices; concern about whether the students would achieve the expected educational and clinical outcomes; onset of depression, anxiety, stress and burnout symptoms.	IV‡
A25†	Susmarini D, Sumarwati M, Handayani F, Iskandar A.(³⁸)	Indonesia	Qualitative and descriptive	Emergence of feelings of fear and anxiety among students and family members; lack of clinical competence to deal with the crisis; rapid changes in the clinical practice sectors; financial burden for COVID-19§ testing during the practices.	IV‡
A26†	Michel A, Ryan N, Mattheus D, Knopf A, Abuelezam NA, Stamp K, et al.(³⁹)	United States of America	Cross-sectional	Increased stress levels and feelings such as fear, loneliness and anxiety; concern about exposure to COVID-19§; connection difficulties; the difficulties of studying in a family environment; learning difficulties; increased workload; lack of faculty preparation for the virtual environment; lack of clinical experiences; feeling of being less engaged with education.	IV‡
A27†	Araújo ARL, Sousa LMC, Carvalho RBS, Oliveira ADS, Amorim FCM, Sousa KHJF, et al.(⁴⁰)	Brazil	Cross-sectional	Work overload; change in domestic routine; little teacher-student interaction; emergence of feelings such as sadness, anguish, fear, anxiety, loneliness and stress; physical wear out, difficulty sleeping, poor diet; visual damage; obligation to quickly adapt to the digital environment.	IV‡
A28†	Terzi B, Azizoğlu F, Özhan F. (⁴¹)	Turkey	Cross-sectional	Difficulty developing practical skills.	IV‡
A29†	Silva CM, Toriyama ATM, Claro HG, Borghi CA, Castro TR, Salvador PICA(⁴²)	Brazil	Experience report	Difficulties adapting to the remote model among the faculty members and the students.	IV‡
A30†	Duprez V, Vermote B, Van Hecke A, Verhaeghe R, Vansteenkiste M, Malfait S.(⁴³)	Belgium	Cross-sectional	The services failed to welcome the students due to the demands linked to COVID-19§.	IV‡
A31†	Jones K, Polyakova-Norwood V, Raynor P, Tavakoli A.(⁴⁴)	United States of America	Mixed methods	Emergence of feelings such as loneliness, anxiety and stress; the students need more emotional support.	IV‡
A32†	Kim S, Jeong SH, Kim HS, Jeong YJ.(⁴⁵)	South Korea	Cross-sectional	Lower concentration and attention levels in the online classes among the students; Internet access difficulties; high anxiety levels; difficulties to improve technological competence among the students.	IV‡
A33†	Prata JA, Mello AS, Silva FVC, Faria MGA.(⁴⁶)	Brazil	Experience report	Internet access difficulties; preconceptions related to better leverage by the students.	IV‡

[tfn1b] ^*
ID = Identification;

[tfn2b] ^†
A = Article;

[tfn3b] ^‡
IV = Evidence from experts’ opinion, descriptive studies, case reports or experts’ committee reports(¹²);

[tfn4b] ^§
III = Evidence from analytical studies, controlled clinical trials without randomization, cohort, case-control, quasi-experimental studies(¹²)

Repercussions of the COVID-19 pandemic on Nursing training: A Scoping Review^*

Highlights:

Repercussions of the COVID-19 pandemic on Nursing training: A Scoping Review*

Highlights:

Repercussions of the COVID-19 pandemic on Nursing training: A Scoping Review^*