Correspondence to Dr Hyeonkyeong Lee; [email protected]
STRENGTHS AND LIMITATIONS OF THIS STUDY
In this study, the online survey was found to be a useful mode of data collection in a relatively short period of time during the early stage of COVID-19 pandemic.
This study attempted to quantify the concept of social responsibility, which is rarely measured despite the core value that forms the professional attitudes and behaviours of nursing students.
The correlates of COVID-19 preventive behaviours were limited only to the individual level although, it has been reported that environmental and policy factors affect preventive behaviours during the COVID-19 pandemic.
The study population was limited to Korean nursing students indicating that the findings from this study might not be applicable to the population in other settings because the responses to COVID-19 pandemic situation vary depending on the country-specific context.
Background
The first case of COVID-19 was reported in China on 31 December 2019.1 On 11 March 2020, the WHO declared COVID-19 to be a global pandemic2 and for about 2.5 years, it continues to have a major impact worldwide. During this global crisis, healthcare workers have been at risk of developing mental health problems due to the uncertainty of transmission, lack of definitive management protocols and excessive workloads, with increased stress and anxiety levels.3 Nevertheless, many nurses have expressed a sense of social responsibility in caring for suffering patients and fighting against COVID-19, while a higher level professional identity has been demonstrated by front-line nurses as compared with non-front-line nurses.4 Nurses continue to advocate for health equity for people at risk of spreading COVID-19 in terms of health communication, testing and treatment as well as service accessibility for non-COVID-19 patients.5
In the early stages of the COVID-19 pandemic, prior to vaccine availability, the primary community control measures included hand washing, mask-wearing and social distancing.6 Pandemics are global public health emergencies that can cause acute resource shortages. In such cases, preventive behaviours, including coughing etiquette, hand hygiene and mask-wearing, could be considered a key disaster response strategy.7
Prehealthcare professionals need to exhibit a high level of COVID-19 preventive behaviour during a pandemic, similar to healthcare professionals. Due to their frequent contact with the hospital environment during their clinical practice, they may directly or indirectly affect patients and clients; they may also be assigned to an actual site of disaster as reserve personnel.8 9 Moreover, they are vulnerable to mass infection due to being in spaces with high population density, such as schools.10 There have been numerous attempts to identify the disaster response competencies of nursing students, although studies identifying them under a pandemic situation have rarely been conducted. While previous studies mostly examined disaster planning, disaster command systems, decontamination, communication and ethical issues as core competencies, they did not report consistent results.11 12 Several studies have reported that this difference comes from gap between knowledge and competencies,12 and one study discussed that it is difficult to aware a pandemic as a disaster, unlike other kinds of disasters.13
Furthermore, nurses’ participation rate in pandemic response has been reported to be low, compared with the willingness for overall disaster response participation.14 15 However, this motivation to participate in pandemic response has not been fully explained. Several qualitative studies have simply explored that this may be based on nurses’ ‘social responsibility’,16–18 which means ‘to advocate needs of other people and to implement that reflects a focus on social issues affecting contemporary global society and community’.19
In a pandemic, nursing students are prehealthcare professionals who either can be actual responders that implement mitigation measures or potential responders who will respond to future pandemics. Therefore, it is important to explain the competencies of nursing students more, specifically in a pandemic context and to require nursing educators to take action to instil curricula and practices to prepare nursing students to take social responsibility.
The objective of this study was to contribute to the establishment of educational strategies for prehealthcare professionals by identifying the relationship among social responsibility, pandemic awareness and COVID-19 preventive behaviour among nursing students.
Methods
Design
This was a cross-sectional descriptive survey study, conducted in an online setting following the principles of non-face-to-face and minimal contact in a pandemic. The survey used a structured questionnaire consisting of 62 items that asked about social responsibility, pandemic awareness, COVID-19 preventive behaviour, effect of COVID-19 on daily life, COVID-19 stress and general characteristics (see online supplemental appendix 1).
Participants
Korean nursing students (freshmen to seniors) were convenience sampled in a nationwide online club for nurse and nursing students and three nursing colleges located in Seoul, South Korea. Data were collected from 14 May 2020 to 24 May 2020. Based on 17 administrative districts by area of residence, the required sample size for analysis of variance (ANOVA) was calculated using the G*Power V.3.1 software with the parameters of a significance level of 0.05, statistical power of 0.95 and a medium effect size of 0.25. The result indicated a minimum sample size of 476; considering nonresponse rate of 20%, ideal sample size of 595. Ultimately, 591 participants took part. After excluding 1 case with duplicate phone numbers and data, the data from 590 participants who answered all the questions were analysed.
Measures
Social responsibility
Social responsibility was measured using the instrument originally developed in Conrad and Hedin and subsequently adapted to Korean by Kim’s (1999) dissertation.20 21 This instrument consisted of 27 items. Each item is graded on a 5-point Likert scale, from 1=‘not at all’ to 5=‘very much’. The score is calculated as a mean score, with a higher score indicating a higher level of social responsibility. In the current study, the reliability as estimated by Cronbach’s alpha was 0.88, which was higher than the reliability at the time the instrument was developed (Cronbach’s alpha=0.70).
Pandemic awareness
Pandemic awareness was measured using an instrument developed by Lee et al and subsequently modified and supplemented by Han et al, which was specified for a pandemic situation by the researcher.22 23 This instrument consisted of 17 items. Each item is graded on a 5-point Likert scale, from 1=‘not at all’ and 5=‘very much’. The score is calculated as a mean score, with a higher score indicating a higher level of pandemic awareness. The reliability of the instrument at the time of development was Cronbach’s alpha=0.80 and reliability was assured in the present study with Cronbach’s alpha=0.73.
COVID-19 preventive behaviour
COVID-19 preventive behaviour was measured using the instrument originally developed by Kim and Park for measuring MERS preventive behaviour,24 which was subsequently modified by authors based on the COVID-19 prevention rules issued by the Korea Disease Control and prevention Agency. This instrument consisted of 10 items related to hand washing, coughing etiquette and social distancing. Each item is graded on a 5-point Likert scale, from 1=‘never’ to 5=‘always’. The score is calculated as a mean score, with a higher score indicating greater practice of COVID-19 preventive behaviour. In the current study, the reliability as estimated by Cronbach’s alpha was 0.84 which was analogous level of reliability at the time the instrument was developed (Cronbach’s alpha=0.84).
General characteristics
General characteristics of the participants included grade in school, volunteer service experience and area of residence. In addition, the study captured COVID-19-related characteristics, including pandemic response education experience, disaster experience, COVID-19-related information source, COVID-19 impact on daily life and psychosocial impact of COVID-19. The COVID-19 impact on daily life was measured by a single item asking ‘How much did COVID-19 impact your day-to-day life?’ and the response was recorded on a 5-point Likert scale (1=‘not at all’, 5=‘extremely’). Thus, the higher the score, the greater COVID-19’s impact on daily life. The psychosocial impact of COVID-19 was measured by asking ‘Which of the following did you experience during COVID-19?’ adopted from the Pandemic Stress Index using an 18-item checklist.25 The participants were allowed to choose multiple options and the number of options were summed up as an individual score; the higher the score the greater the psychosocial impact of COVID-19.
Procedure
After constructing the online questionnaire using a Google Forms, officials from each recruiting centre were contacted to request their cooperation and a recruitment message was posted in one online community for nursing students and three nursing colleges located in Seoul, South Korea. The candidates gained access to the online questionnaire through the recruitment message link and QR code. Before participating in the survey, the participants were provided with an explanation that included basic ethical principles for participant protection, such as the confidentiality and the possibility of voluntary participation and withdrawal. After reading an explanation, those interested in participating were instructed to click on a ‘button’ in response that they read the consent information and agreed to participate, followed by viewing the survey questionnaire. Completed questionnaires were retrieved immediately to the researcher’s password-protected computer. On completion of data collection, a gift ticket (US$3 worth) of appreciation was sent via short message service (SMS).
Data analysis
Descriptive statistics such as frequency, percentage, mean and SD were used to describe general characteristics of the participants. Correlations between major variables (social responsibility, pandemic awareness, COVID-19 impact and the COVID-19 preventive behaviour) were analysed using Pearson’s correlation coefficients. COVID-19 preventive behaviour according to general characteristics was estimated by t-test or ANOVA. Factors influencing COVID-19 preventive behaviour were identified using multiple linear regression analysis.
Patient and public involvement
No patients nor the public were involved in the design, conduct, reporting or dissemination plans of this study.
Results
COVID-19 preventive behaviour by participant characteristics
Among the participants, 43.1% were seniors and 68.8% intermittently participated in volunteer activities. Only 16.4% had pandemic education experience, while 22.7% had disaster experience, including experience with earthquakes and typhoons. The results also showed that 28.8% obtained COVID-19-related information through television and 14.7% lived in Daegu/Gyeong-buk (table 1). The Daegu/Gyeong-buk area was the region with the highest number of confirmed cases in South Korea during the data collection period. The results also showed statistically significant differences in preventive behaviour based on whether participants regularly participated in volunteer activities (F=6.888, p=.001) or lived in Daegu/Gyeong-buk (t=−2.278, p=.024) (table 1).
Table 1COVID-19 preventive behaviours by participant characteristics (N=590)
| Characteristics | n(%) | Mean±SD | T of F* | P value (post hoc test) |
| Grade | ||||
| Freshman | 56 (9.5) | 4.46±0.45 | 0.592 | .620 |
| Sophomore | 131 (22.2) | 4.38±0.55 | ||
| Junior | 149 (25.3) | 4.38±0.53 | ||
| Senior | 254 (43.1) | 4.36±0.52 | ||
| Voluntary service | ||||
| Yes (Regular)a | 85 (14.4) | 4.54±0.47 | 6.888 | .001 (a>b, a>c) |
| Yes (Intermittent)b | 406 (68.8) | 4.37±0.52 | ||
| Noc | 99 (16.8) | 4.26±0.54 | ||
| Pandemic education experience | ||||
| Yes | 97 (16.4) | 4.45±0.53 | 1.110 | .330 |
| No | 380 (64.4) | 4.36±0.52 | ||
| Don’t know | 112 (19.0) | 4.39±0.53 | ||
| Disaster experience | ||||
| Yes | 133 (22.7) | 4.37±0.52 | −0.164 | .870 |
| No | 453 (77.3) | 4.38±0.52 | ||
| Information source | ||||
| Television | 170 (28.8) | 4.40±4.40 | 10.051 | .076 |
| YouTube | 23 (3.9) | 4.31±4.31 | ||
| SNS | 142 (24.1) | 4.29±4.29 | ||
| Messenger | 11 (1.9) | 4.25±4.25 | ||
| KDCA homepage | 42 (7.1) | 4.52±4.52 | ||
| Public disaster alarm system | 68 (11.5) | 4.50±4.50 | ||
| Internet portal | 128 (21.7) | 4.36±4.36 | ||
| Private information website | 6 (1.0) | 4.52±4.52 | ||
| Residential areas | ||||
| Daegu and Gyeong-buk | 87 (14.7) | 4.48±0.43 | −2.278 | .024 |
| All other areas | 503 (85.3) | 4.36±0.54 |
*t-tests for differences between two groups, F-statistic for >2 groups.
KDCA, Korea disease control and prevention agency; SNS, social networking service.
Level of social responsibility, pandemic awareness, psychosocial impact of COVID-19 and COVID-19 preventive behaviour of nursing students
The mean scores for social responsibility, pandemic awareness, COVID-19 impact on daily life and COVID-19 preventive behaviour were 3.84±0.42, 3.88±0.42, 4.58±0.60 and 4.38±0.52 out of 5 possible points, respectively. The mean score of psychosocial impact of COVID-19 was 4.93±2.40 ranging from 0 to 14 (table 2). Concerning psychosocial impact of COVID-19, in the total episode that the participants experienced during COVID-19 (multiple responses accepted), the 10 most common episodes’ percentage is shown in figure 1.The three most experienced episodes were ‘fear of getting COVID-19 (78.5%),’ followed by ‘worrying about friends, family, partners, etc’ (78.3%) and ‘fear of giving COVID-19 to someone else’ (50.0%).
Table 2Level of social responsibility, pandemic awareness, COVID-19 impact and COVID-19 preventive behaviours of nursing students (N=590)
| Variable (No of items) | Mean±SD | Observed range |
| Social responsibility (27) | 3.84±0.42 | 2.49–4.97 |
| Pandemic awareness (17) | 3.88±0.42 | 2.52–5.00 |
| COVID-19 impact on daily life (1) | 4.58±0.60 | 1–5 |
| Psychosocial impact of COVID-19 (18) | 4.93±2.40 | 0–14 |
| COVID-19 preventive behaviours (10) | 4.38±0.52 | 2.40–5.00 |
Relationships among social responsibility, pandemic awareness, COVID-19 impact and COVID-19 preventive behaviour of nursing students
There were positive correlations among the variables social responsibility and COVID-19 preventive behaviour (r=.358, p<.001), pandemic awareness and COVID-19 preventive behaviour (r=.252, p<.001), and social responsibility and pandemic awareness (r=.478, p<.001). Impact of COVID-19 on daily life showed a significantly positive relationship with COVID-19 preventive behaviour (r=.186, p<.001), indicating that higher levels of COVID-19 impact were related to higher levels of practice of COVID-19 preventive behaviours (table 3). Additional analysis results showed that social responsibility was statistically significantly high among those participating in volunteer activities (t=5.683, p<.001) and those with disaster experience (t=1.979, p=.048).
Table 3Correlation between social responsibility, pandemic awareness and COVID-19 preventive behaviours (N=590)
| Variable | Social responsibility | Pandemic awareness | COVID-19 impact on daily life | Psychosocial impact of COVID-19 | COVID-19 preventive behaviours |
| Social responsibility | 1 | ||||
| Pandemic awareness | .478* | 1 | |||
| COVID-19 impact on daily life | .208* | .167* | 1 | ||
| Psychosocial impact of COVID-19 | .038 | .039 | −.044 | 1 | |
| COVID-19 preventive behaviours | .358* | .252* | .186* | −.039 | 1 |
*p<.001.
Factors influencing COVID-19 preventive behaviour
A multiple linear regression was performed with the input of effect of COVID-19 on daily life, volunteer activities and area of residence, which were major variables that showed significant differences in the univariate analysis with COVID-19 preventive behaviours. In the multicollinearity test, the tolerance of the independent variables was higher than 0.1 (0.593–0.991) and the variance inflation factor was lower than 10 (1.009–1.688), which confirmed that there was no problem with multicollinearity. The model was statistically significant, and the coefficient of determination was 16.4% (F=19.108, p<.001). The factors significantly associated with COVID-19 preventive behaviour were social responsibility, pandemic awareness, COVID-19 impact on daily life and living in the Daegu/Gyeong-buk area (table 4). When each factor increased by one unit, COVID-19 preventive behaviour increased by 0.35(p<.001), 0.13(p=.016), 0.09(p=.012), 0.13(p=.017) (table 4).
Table 4Factors on COVID-19 preventive behaviours (N=590)
| Variables | Unstandardised regression coefficients | 95% CI | T (p value) | |
| Coef. | SD | |||
| (Constant) | 2.081 | 0.239 | 8.694(<.001) | |
| Social responsibility | 0.354 | 0.056 | 0.243 to 0.464 | 6.289(<.001) |
| Pandemic awareness | 0.131 | 0.054 | 0.025 to 0.237 | 2.419(.016) |
| COVID-19 impact on daily life | 0.085 | 0.034 | 0.019 to 0.152 | 2.528(.012) |
| Voluntary service* | ||||
| Yes (regular) | 0.003 | 0.055 | −0.105 to 0.111 | 0.052(.958) |
| Yes (intermittent) | 0.132 | 0.073 | −0.012 to 0.276 | 1.803(.072) |
| Residential areas† | ||||
| Daegu and Gyeong-buk | 0.134 | 0.056 | 0.024 to 0.244 | 2.398(.017) |
| R2=.164, Adj R2=.156, F=19.108, p<.001 | ||||
*Reference: No
†Reference: All other areas.
Discussion
The findings showed that the levels of social responsibility, pandemic awareness and COVID-19 preventive behaviour were high among Korean nursing students and that these factors were positively correlated with each other. Moreover, social responsibility and pandemic awareness were identified as factors influencing COVID-19 preventive behaviours.
The mean COVID-19 preventive behaviour of Korean nursing students was 4.38 out of 5 points. On previous studies that used similar instruments to measure the level of practising MERS preventive behaviour among nursing and medical college students, the mean of COVID-19 preventive behaviour was 4.51 out of 10 points. Compared with previous study, in the present study the level of COVID-19 preventive behaviour was higher.26 Such results may be due to COVID-19 being declared a global pandemic, whereas MERS was not declared a global public health emergency. Theory of planned behaviour explains that three determinants of attitude, subjective norm and perceived behavioural control form behavioural intention and that is direct antecedents of behaviour.27 South Korea government implemented strict measures such as limited operation of high-risk facilities such as churches and restaurants, imposition of fines on persons not wearing face masks in public places, based on its experience from the MERS outbreak. As a result, these factors may have acted as subjective norm. However, even compared with previous studies on preventive behaviour during the 2009 H1N1 pandemic, which was officially declared a pandemic, the results of the present study showed a higher level of preventive behaviour. COVID-19 preventive behaviour was practised at a higher level when COVID-19 had a greater effect on daily life and among those who live in the Daegu/Gyeong-buk area. The measurement of the effect of COVID-19 on daily life was measured by a single item on a 5-point Likert scale, while the Daegu/Gyeong-buk area was the region with the highest number of confirmed cases in South Korea. Such results could be interpreted in the same context as previous studies that reported that perceived concerns, anxiety and perceived efficacy can improve preventive behaviour.28 29
The findings of this study demonstrated the effect of people’s perception of a situation on their preventive behaviour. Existing studies on the relationship between disaster awareness and response have reported inconsistent results.30 31 It is believed that the findings in this study are because a pandemic is a form of disaster, but it should not be overlooked that the pandemic has been perceived differently from other forms of disasters.13 15 Considered together with the additional analysis results from the present study, which showed statistically significantly higher pandemic awareness among students with pandemic education experience (F=6.808, p<.01), customised education for specific disasters should be added to educational strategies suggested for disaster preparedness.32
Meanwhile, social responsibility was identified as the factor with the strongest association with COVID-19 preventive behaviour in the outcome model of the present study. The mean score for social responsibility among Korean nursing students was 3.84 out of 5 points, which was higher than the score reported in previous studies on nursing students and college students in other majors.33 This difference could be attributed to the fact that previous studies were conducted at ordinary times, whereas the present study was conducted under a disaster situation. In a qualitative synthesis study,34 professional values such as ‘responsibility to care’ were discussed as a competency for infectious disease nursing. But studies have reported that under a disaster situation, especially a pandemic, health disparity worsens according to economic level and race.34 35 Under such circumstances, society is demanding more social responsibility and appropriate behaviour from healthcare professionals, along with a reorganisation of the healthcare delivery system.36–40
The findings in the present study showed that social responsibility had a significant association with COVID-19 preventive behaviour, and thus, consideration of social responsibility when delivering education could be a practical strategy for strengthening disaster response competencies. Given the positive relationship between social responsibility and the volunteer experiences of nursing students in the current study, service-learning programmes with various vulnerable populations are recommended for nursing students. Community service learning was found to be an effective pedagogical module for health professional students to enhance their sense of social responsibility.41 Accordingly, providing opportunities to understand health disparity during a disaster through regular participation in volunteer programmes and planning simulation programmes that allow indirect experience and immersion in disaster situations could help improve social responsibility, which could ultimately be a practical educational strategy for disaster response.
In the present study, since the measured concept were limited to the individual level, there were limitations in investigating the correlations with environmental factors such as having dependents, job security and vaccine availability, which have been reported to be factors influencing non-participation in pandemic response. Furthermore, the study population was confined to part of Korean nursing students and conveniently sampled. It differs from other countries concerning pandemic experience or government response and it has limitation in generalisation as well. Therefore, it is necessary to consider the local context (eg, historical, social) when extending inferences from the current study to populations in other settings.
Conclusions
The present study’s significance lies in the fact that it tested the factors influencing disaster response under a unique disaster situation and introduced the exploratory concept of social responsibility as a measurable variable. As part of future strategies to strengthen disaster response competencies of nursing students, customised educational programmes for unique disaster awareness, developmental studies on simulation for inclusion of social responsibility, and correlation studies considering environmental factors are recommended.
This research was supported by the Brain Korea 21 FOUR Project funded by National Research Foundation (NRF) of Korea, Yonsei University College of Nursing.
Data availability statement
Data are available on reasonable request.
Ethics statements
Patient consent for publication
Consent obtained directly from patient(s).
Ethics approval
This study was approved by the Yonsei University Health System, Institutional Review Board (Y-2020-0057). Participants gave informed consent to participate in the study before taking part.
Contributors HL has originally designed the study and MK has acquired and analyzed the data. MK and HL have interpreted the data. MK was responsible for initial drafting of the manuscript and HL has critically revised it. MK and HL have refined and approved the final manuscript, and are the guarantors.
Funding This research was supported by the 2020 Faculty Research Grant from YonseiUniversity College of Nursing.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
1 World Health Organization. Novel coronavirus (2019-nCoV): situation report, 1. in: instructional repository for information sharing, 2020. Available: https://apps.who.int/iris/handle/10665/330760 [Accessed 30 Apr 2020 ].
2 World Health Organization. Coronavirus disease 2019 (COVID-19): situation report, 51. in: instructional repository for information sharing, 2020. Available: https://apps.who.int/iris/handle/10665/331475 [Accessed 30 Apr 2020 ].
3 Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review. Asian J Psychiatr 2020; 51: 102119. doi:10.1016/j.ajp.2020.102119 http://www.ncbi.nlm.nih.gov/pubmed/32339895
4 Li Z, Ge J, Yang M. Vicarious traumatization in the general public, members, and non-members of medical teams Aiding in COVID-19 control. Brain Behav Immun 2020. doi:10.1016/j.bbi.2020.03.007
5 Lisa AC, Joshua MS. A game plan to help the most vulnerable. in: the agenda OPINON coronavirus. POLITICO https://www.politico.com/news/agenda/2020/04/07/game-plan-to-help-those-most-vulnerable-to-covid-19-171863
6 World Health Organization. Considerations for implementing and adjusting public health and social measures in the context of COVID-19. in: instructional repository for information sharing, 2020. Available: https://www.who.int/publications/i/item/considerations-in-adjusting-public-health-and-social-measures-in-the-context-of-covid-19-interim-guidance [Accessed 30 Nov 2020 ].
7 Anderson RM, Heesterbeek H, Klinkenberg D, et al. How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet 2020; 395: 931–4. doi:10.1016/S0140-6736(20)30567-5 http://www.ncbi.nlm.nih.gov/pubmed/32164834
8 Collado-Boira EJ, Ruiz-Palomino E, Salas-Media P, et al. "The COVID-19 outbreak"-An empirical phenomenological study on perceptions and psychosocial considerations surrounding the immediate incorporation of final-year Spanish nursing and medical students into the health system. Nurse Educ Today 2020; 92: 104504. doi:10.1016/j.nedt.2020.104504 http://www.ncbi.nlm.nih.gov/pubmed/32563039
9 Swift A, Banks L, Baleswaran A, et al. COVID-19 and student nurses: a view from England. J Clin Nurs 2020; 29: 3111–4. doi:10.1111/jocn.15298 http://www.ncbi.nlm.nih.gov/pubmed/32298512
10 van Gemert C, McBryde ES, Bergeri I, et al. Description of social contacts among student cases of pandemic influenza during the containment phase, Melbourne, Australia, 2009. Western Pac Surveill Response J 2018; 9: 27–34. doi:10.5365/wpsar.2018.9.5.003 http://www.ncbi.nlm.nih.gov/pubmed/31832251
11 Al Thobaity A, Plummer V, Williams B. What are the most common domains of the core competencies of disaster nursing? A scoping review. Int Emerg Nurs 2017; 31: 64–71. doi:10.1016/j.ienj.2016.10.003 http://www.ncbi.nlm.nih.gov/pubmed/28029612
12 Jose MM, Dufrene C. Educational competencies and technologies for disaster preparedness in undergraduate nursing education: an integrative review. Nurse Educ Today 2014; 34: 543–51. doi:10.1016/j.nedt.2013.07.021 http://www.ncbi.nlm.nih.gov/pubmed/23978779
13 Fung WMO, Lai KYC, Loke AY. Nurses' perception of disaster: implications for disaster nursing curriculum. J Clin Nurs 2009; 18: 3165–71. doi:10.1111/j.1365-2702.2008.02777.x http://www.ncbi.nlm.nih.gov/pubmed/19619209
14 Burke RV, Goodhue CJ, Chokshi NK, et al. Factors associated with willingness to respond to a disaster: a study of healthcare workers in a tertiary setting. Prehosp Disaster Med 2011; 26: 244–50. doi:10.1017/S1049023X11006492 http://www.ncbi.nlm.nih.gov/pubmed/22008278
15 Charney RL, Rebmann T, Flood RG. Hospital employee willingness to work during earthquakes versus pandemics. J Emerg Med 2015; 49: 665–74. doi:10.1016/j.jemermed.2015.07.030 http://www.ncbi.nlm.nih.gov/pubmed/26371972
16 Arbon P, Cusack L, Ranse J, et al. Exploring staff willingness to attend work during a disaster: a study of nurses employed in four Australian emergency departments. Australas Emerg Nurs J 2013; 16: 103–9. doi:10.1016/j.aenj.2013.05.004 http://www.ncbi.nlm.nih.gov/pubmed/23953093
17 Kim Y. Nurses' experiences of care for patients with Middle East respiratory syndrome-coronavirus in South Korea. Am J Infect Control 2018; 46: 781–7. doi:10.1016/j.ajic.2018.01.012 http://www.ncbi.nlm.nih.gov/pubmed/29502886
18 Kim JY. Nurses’ experience of Middle East Respiratory Syndrome patients care. J Korea Academia-Industrial Cooperation Society. 2017. doi:10.5762/KAIS.2017.18.10.185
19 Tyer-Viola L, Nicholas PK, Corless IB, et al. Social responsibility of nursing: a global perspective. Policy Polit Nurs Pract 2009; 10: 110–8. doi:10.1177/1527154409339528 http://www.ncbi.nlm.nih.gov/pubmed/19696088
20 Conrad D, Hedin D. Instruments and scoring guide of the experiential education evaluation project service learning. General 1985; 247: 1–61 https://digitalcommons.unomaha.edu/slceslgen/247
21 JS. K. Impact of youth service learning on the development of personal and social responsibility. Dissertation Seoul: Myongji University, 1999.
22 Lee SY, Yang HJ, Kim G, et al. Preventive behaviors by the level of perceived infection sensitivity during the Korea outbreak of middle East respiratory syndrome in 2015. Epidemiol Health 2016; 38: e2016051. doi:10.4178/epih.e2016051 http://www.ncbi.nlm.nih.gov/pubmed/28092927
23 Han SJ, Cho CM, Lee YR, et al. Comparison between Korean and Japanese nursing students in their disaster preparedness. J Korean Acad Community Health Nurs 2018; 29: 499. doi:10.12799/jkachn.2018.29.4.499
24 Kim HS, Park JH. Predictors of MERS-related preventive behaviors performance among clinical practice students in a tertiary hospital. J Korea Academia-Industrial Cooperation Society 2018. doi:10.5762/KAIS.2018.19.9.174
25 Harkness A. The pandemic stress index. University of Miami: Measures Library, 2020. https://elcentro.sonhs.miami.edu/research/measures-library/psi/psi-english/index.html
26 Choi J-S, Kim J-S. Factors influencing preventive behavior against middle East respiratory syndrome-coronavirus among nursing students in South Korea. Nurse Educ Today 2016; 40: 168–72. doi:10.1016/j.nedt.2016.03.006 http://www.ncbi.nlm.nih.gov/pubmed/27125168
27 Chan DKC, Zhang C-Q, Weman-Josefsson K. Why people failed to adhere to COVID-19 preventive behaviors? perspectives from an integrated behavior change model. Infect Control Hosp Epidemiol 2021; 42: 375–6. doi:10.1017/ice.2020.245 http://www.ncbi.nlm.nih.gov/pubmed/32408917
28 Kim SJ, Han JA, Lee T-Y, et al. Community-Based risk communication survey: risk prevention behaviors in communities during the H1N1 crisis, 2010. Osong Public Health Res Perspect 2014; 5: 9–19. doi:10.1016/j.phrp.2013.12.001 http://www.ncbi.nlm.nih.gov/pubmed/24955307
29 Kim Y, Zhong W, Jehn M, et al. Public risk perceptions and preventive behaviors during the 2009 H1N1 influenza pandemic. Disaster Med Public Health Prep 2015; 9: 145–54. doi:10.1017/dmp.2014.87 http://www.ncbi.nlm.nih.gov/pubmed/25882121
30 Jeong S, Lee O. Correlations between emergency code awareness and disaster nursing competencies among clinical nurses: a cross-sectional study. J Nurs Manag 2020; 28: 1326–34. doi:10.1111/jonm.13086 http://www.ncbi.nlm.nih.gov/pubmed/32657477
31 Ozeki K, Ojima T. Current status of disaster preparedness of pharmacies and differences in disaster awareness based on pharmacy size. Disaster Med Public Health Prep 2019; 13: 753–7. doi:10.1017/dmp.2018.160 http://www.ncbi.nlm.nih.gov/pubmed/30832744
32 Labrague LJ, Hammad K, Gloe DS, et al. Disaster preparedness among nurses: a systematic review of literature. Int Nurs Rev 2018; 65: 41–53. doi:10.1111/inr.12369 http://www.ncbi.nlm.nih.gov/pubmed/28295314
33 Kim J, Lee T, Han N. Factors affecting the perception of social responsibility of nursing students. J Korean Acad Nurs Adm 2018; 24: 21. doi:10.11111/jkana.2018.24.1.21
34 Lam SKK, Kwong EWY, Hung MSY, et al. Nurses' preparedness for infectious disease outbreaks: a literature review and narrative synthesis of qualitative evidence. J Clin Nurs 2018; 27: e1244–55. doi:10.1111/jocn.14210 http://www.ncbi.nlm.nih.gov/pubmed/29193397
35 Dorn AV, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. Lancet 2020. doi:10.1016/S0140-6736(20)30893-X
36 Dyer O. Covid-19: black people and other minorities are hardest hit in US. BMJ 2020; 369: m1483. doi:10.1136/bmj.m1483 http://www.ncbi.nlm.nih.gov/pubmed/32291262
37 Behbahani S, Smith CA, Carvalho M, et al. Vulnerable immigrant populations in the new York metropolitan area and COVID-19: lessons learned in the epicenter of the crisis. Acad Med 2020; 95: 1827–30. doi:10.1097/ACM.0000000000003518 http://www.ncbi.nlm.nih.gov/pubmed/32452838
38 Choi KR, Skrine JK, Cynthia LM. Nursing and the novel coronavirus: risks and responsibilities in a global outbreak. J Adv Nurs 2020. doi:10.1111/jan.14369
39 Cutter CM, Nelson C, Abir M. Accountability to population health in the COVID-19 pandemic: designing health care delivery within a social responsibility framework. Popul Health Manag 2021; 24: 3–5. doi:10.1089/pop.2020.0096 http://www.ncbi.nlm.nih.gov/pubmed/32463721
40 Kelley M, Ferrand RA, Muraya K, et al. An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries. Lancet Glob Health 2020; 8: e888–9. doi:10.1016/S2214-109X(20)30249-7 http://www.ncbi.nlm.nih.gov/pubmed/32416766
41 Dharamsi S, Espinoza N, Cramer C, et al. Nurturing social responsibility through community service-learning: lessons learned from a pilot project. Med Teach 2010; 32: 905–11. doi:10.3109/01421590903434169 http://www.ncbi.nlm.nih.gov/pubmed/21039101
© 2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Details
; Lee, Hyeonkyeong 2
1 Graduate School, Yonsei university College of Nursing, Seoul, Republic of Korea
2 Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea