Date of Award

Fall 12-9-2021

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Leadership and Advanced Nursing Practice

Committee Chair

Dr. Debra Copeland

Committee Chair School

Leadership and Advanced Nursing Practice

Committee Member 2

Dr. Bonnie Harbaugh

Committee Member 2 School

Leadership and Advanced Nursing Practice

Committee Member 3

Dr. Lachel Story

Committee Member 3 School

Leadership and Advanced Nursing Practice

Committee Member 4

Dr. Hwanseok Choi

Committee Member 4 School

Health Professions


During such an unprecedented time of the largest public health crisis, the COVID-19 pandemic, nursing students are of the utmost concern regarding their psychological and physical well-being. Questions are emerging and circulating about what will happen to the nursing students and the long-term effects of the pandemic, especially now that hospitals are being overwhelmed with COVID-19 cases and patients as well as a significant need for nursing staff (Jividen, 2020). Expectations, demands, change, and the fear of the unknown during this unprecedented time can only contribute to the many stressors that accompany nursing students through laborious clinical and didactic courses in nursing programs. The risk of psychological distress is at a maximum and its effects can negatively impact not only nursing students but also nursing education and academia.

The high exposures to interpersonal, economic, and academic demands contribute to the major health concerns, which include a potential risk for psychological distress (Mitchell, 2018). Achievement of educational success among nursing students is directly affected to the high exposures of anxiety and depression from experiences within the program. Working relationships and achieving academic success are imperative to positive student outcomes within the nursing program. The purpose of this study is to identify and establish influences and associations within multilevel factors, including the effects of the COVID-19 pandemic on psychological distress in nursing students. Neuman’s Systems Model Theory was used to determine nursing students’ responses to internal and external stressors.

The research in this study utilized a mixed-methods, convergent study design. The study population included undergraduate nursing students from Southeastern U.S. The research surveyed a convenience sample of undergraduate nursing students. The quantitative survey was completed by 202 participants and 11 participants participated in the qualitative follow-up interview surveys. Participants completed the Kessler Psychological Distress Scale (K6), the Perceived Stress Scale (PSS4), and the Dundee Readiness Educational Environment Scale (DREEM12) to measure psychological distress, perceived stress, and perceived educational environment. Participants also answered open-ended questions regarding their experience during the COVID-19 pandemic. Statistical tests, including bivariate analyses, multiple linear regression analyses, and binary logistics regression analyses were performed in efforts to identify and highlight the effects of independent variables on the dependent variable, psychological distress. Coding and qualitative content analysis were performed to identify overarching themes within participants’ interviews. Quantitative data were sufficient in identifying correlations between psychological distress and multilevel factors of coping, marital status, COVID-19 stress, perceived stress, educational environment, and social support in nursing students. Qualitative data were sufficient in identifying common themes of students’ perceptions during COVID-19 and included online learning, workload, finances, experience, breaks, time, unknown, support, encouragement, unchanged, communication, and transmission. The findings are significant, specifically regarding contributing factors of nursing students’ psychological distress, which will help to improve learning in the academic environment.