A multi-level examination of nursing students' resilience in the face of the COVID-19 outbreak: A cross-sectional design

Anat Drach-Zahavy, Hadass Goldblatt, Hanna Admi, Ayala Blau, Irit Ohana, Michal Itzhaki

Research output: Contribution to journalArticlepeer-review


Aims: To examine nursing students' stress and coping with the coronavirus disease 2019 (COVID-19) pandemic through an ecological model of resilience. Specifically, to examine the relative contribution of different resilience levels in decreasing nursing students' strain symptoms: at the individual level, resilience trait; at the relational level, students' coping strategies; at the university level, nursing students' perceptions on their university's readiness to handle the virus outbreak; and at the national level, nursing students' trust in policymakers' decisions. Design: The study used a cross-sectional design. Methods: Undergraduate students of five universities were recruited via an electronic link sent to their emails during the first months of the COVID-19 outbreak: May–July 2020. Of them, 492 participants completed the research questionnaire. Results: Hierarchical Regression Analysis revealed that nursing students' resilience, as a multi-level factor, decreased the students' level of strain symptoms above and beyond their stress levels and control variables. Specifically, the nursing students' trait resilience, perceptions of their university's positive response to the pandemic and trust in their national policymakers were negatively associated with their strain symptoms. Conversely, disengagement-in-emotion coping strategies was positively associated with the students' strain symptoms. Conclusions: Nursing students' resilience should be seen as a flexible resource that can be developed and influenced by their academic and clinical training, and by the intentions and actions of their university and the nursing administration at the Ministry of Health (MOH). Impact: The findings call for the nursing administration at the MOH and for the university deans and department heads to prepare in advance a crisis plan that could be rapidly and effectively implemented when needed. Furthermore, topics such as developing flexible coping strategies should be integrated into the nursing curricula. These would allow students to prepare and cope better with adversity in their routine and in times of crisis.

Original languageEnglish
Pages (from-to)109-120
Number of pages12
JournalJournal of Advanced Nursing
Issue number1
StatePublished - Jan 2022

Bibliographical note

Publisher Copyright:
© 2021 John Wiley & Sons Ltd


  • COVID-19
  • nursing students
  • resilience
  • strain symptoms
  • stress

ASJC Scopus subject areas

  • General Nursing


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