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J Korean Acad Psychiatr Ment Health Nurs > Volume 33(1); 2024 > Article
Jung, Yim, and Ryu: The Impact of COVID-19 Stress, Interpersonal Relations, and Information Literacy on the Adaptation of Nursing Students to College Life



Rapid changes have occurred in the educational environment of colleges since the outbreak of COVID-19. This study was conducted to determine the factors influencing college life adaptation for nursing students.


The participants included 124 nursing students. A self-administered online questionnaire, available from March 30 to April 10, 2022, was used for data collection. The online questionnaires included COVID-19 stress, interpersonal relations, information literacy, and college life adaptation. Statistical analysis was performed using t-test, ANOVA, Pearson's correlation coefficient, and multiple regression analysis.


The average score for adapting to college life was 3.32±0.58. Significant differences in college life adaptation were found based on the number of exercise days per week (F=3.62, p=.015), regular daily routine (t=-3.41, p<.001), amount of sleep (t=-3.61, p<.001), sleep quality (t=-3.90, p<.001), and diagnostic self evaluation (F=19.55, p<.001). Factors that influenced college life adaptation included interpersonal relations (β=.36, p<.001), diagnostic self evaluation (good) (β=.48, p<.001), diagnostic self evaluation (fair) (β=.38, p=.005), and COVID-19 stress (β=-.11, p=.027), which explained 38.0% of the college life adaptation.


Development of a program that integrates interpersonal relations, diagnostic self-evaluation, and COVID-19 stress for nursing students is recommended to improve college life adaptation.


College life is a critical stage in the transition to adulthood, with an emphasis on developing self-identity, psychological independence, and adapting to various social changes [1]. In March 2020, after declaring a pandemic resulting from the spread of COVID-19, the World Health Organization recommended social distancing as a measure to minimize spreading of the infection [2]. The COVID-19 pandemic caused a rapid and involuntary shift in the field of education to a digital paradigm, with non-face-to-face classes beginning in the first semester of 2020. The academic progress and aspirations of many students have been seriously affected by the pandemic, which has also impacted their psychological well-being [3]. A meta-analysis of psychological well-being of undergraduate students during the pandemic revealed 29.1% for anxiety symptoms and 23.2% for depression symptoms, suggesting that the pandemic had a significant effect on the students' psychological well-being [4]. Students exposed to the new experience of online learning experienced confusion and chaos. Abrupt remote online learning was stressful and nursing students reported significant psychological burdens including helplessness, burdens, and burnout [5]. The pandemic has made adjusting to college life more difficult for nursing students. Adaptation to college life is an important factor for nursing students in development of a positive attitude and the skills necessary for practice in a clinical setting [6].
Nursing students' adaptation to college life was negatively impacted by the COVID-19 pandemic [6]. The stress on clinical practice for nursing students was greater than usual due to a limited clinical practice and fear of infection with COVID-19[7]. Stress was a significant concern in regard to online learning of nursing students during the pandemic [8]. Therefore, assessing the status of nursing students' stress related to COVID-19 pandemic is important.
Interpersonal relations are essential for nursing students to provide high-quality care to patients in clinical settings [9]. Interpersonal relations showed a positive correlation with adaptation to college life and were a significant predicting factor affecting adaptation to college life for nursing students during the COVID-19 condition [10] as well as before the pandemic [11,12]. However, students’ interpersonal relations were limited and encumbered by policies requiring social distancing during the COVID-19 pandemic. Therefore, additional studies should be conducted to examine the way interpersonal relations have influenced college life adaptation of nursing students during the pandemic.
As a consequence of the COVID-19 pandemic, college students have been required to improve their information literacy skills, which contributed to the success of students in the academic world [13]. Information literacy is defined as the capacity for recognizing and acquiring the information required for problem solving or decision making, and for analysis and utilization of the acquired information [14]. The latest information can change rapidly, thus learning the use of digital information is becoming a necessity rather than an option, unlike learning through books in the past. In addition, because clinical practice was replaced online due to the COVID-19 pandemic, nursing students reported having difficulty in utilizing more diverse online content [15]. The burden of assignments on students has increased to ensure fairness in grade evaluation. The importance of information literacy has increased as acquisition of information using online media has increased for working on assignments [16]. Therefore, cultivating information literacy is becoming more important.
According to previously reported studies, factors influencing adaptation to college life of nursing students include major selection motivation [6], self-efficacy [6], academic stress [10], interpersonal relations [11-13], nursing professionalism [17], major satisfaction [17], emotional awareness [18], social network service (SNS) addiction tendency [11], resilience [12], and perceived health [19]. However, it was difficult to find a study that examined the effect of information literacy on adaptation to college life in nursing students. With the increasing popularity of online learning, information literacy has become an important aspect of college life [16]. Therefore, the question regarding whether information literacy of nursing students can affect their adaptation to college life should be examined. In addition, non-face-to-face classes became the norm as the COVID-19 pandemic continued, affecting nursing students of all grades. This rapid change in the educational environment has resulted in substantial stress for nursing students, as well as numerous challenges with interpersonal relations. As a result, studies to determine the factors impacting adaptation to college life for nursing students of all grades is required. Therefore, this study was conducted as an attempt to determine the influence of COVID-19 stress, interpersonal relations, and information literacy on college life adaptation for nursing students of all grades.


1. Study Design

This is a descriptive study to determine factors affecting college life adaptation for students in nursing in the COVID-19 pandemic.

2. Participants

Under the condition of the COVID-19 Omicron variant in spring 2022, wearing masks, physical distancing, and self-quarantine were still in effect, and normal campus life had not been fully restored and the method for class operation varied by university, department, and courses. Therefore, the study participants were nursing students at the same university as the researchers who agreed to voluntary participation in the study. The number of samples was calculated using the G Power program. By setting the effect size for multiple regression analysis to 0.15, the significance level (⍺) to .05, the power (1-β) to .80, and the number of independent variables to 10 (grades, reason for choosing nursing major, number of exercise days per week, regular daily life, quantity of sleep, quality of sleep, diagnostic self evaluation, COVID-19 stress, interpersonal relations, and information literacy), 118 participants were required. An online survey was developed using Google Forms and distributed through the student council’s social media. The data were gathered from March 30 to April 10, 2022. In the final analysis, a total of 124 questionnaires were included, satisfying the required minimum sample number.

3. Instruments

1) COVID-19 stress

After obtaining approval, the COVID-19 Pandemic Stress Questionnaire [20] was used for measurement of COVID-19 stress. The questionnaire consists of six domains: difficulties in general life, interpersonal stress, financial stress, education or professional goal related stress, health of the self, and health of close acquaintances. The total number of questions is 21, each on a 6-point likert scale. A greater score suggests an increased amount of stress associated with the COVID-19 pandemic. The Cronbach’s ⍺ reliability of the instrument was .84[20], and it was .84 in this study.

2) Interpersonal relations

After obtaining approval, the Relationship Change Scale (RCS) modified by Chun [21] was used for assessing the level of interpersonal relations. The RCS includes 25 questions, consisting of seven sub-factors including satisfaction, communication, trust, friendliness, sensitivity, openness, and understanding. Each item is on a 5-point likert scale, with a higher rating indicats greater interpersonal relationships. The reliability of the instrument was Cronbach’s ⍺=.88 [21] and .94 in this study.

3) Information literacy

After obtaining approval, the information literacy scale for college students developed by Rhee et al.[14] and revised by Jang et al.[22] was used for assessment of information literacy. The information literacy scale includes 39 questions, consisting of six sub-factors, information needs, information retrieval, information evaluation, information integration, information expression, and information ethics. Questions are rated on a 5-point likert scale, with higher rating suggesting a greater degree of information literacy. The Cronbach’s ⍺ reliability was .92[22], and it was .96 in this study.

4) College life adaptation

After obtaining approval, the Student Adjustment to College Questionnaire (SACQ) adapted by Lee [23] was used for measurement of college life adaptation. Negative questions were reversely converted. The questionnaire is composed of 25 items on a 5-point likert scale, and greater scores reflecting better adaptation. Cronbach’s ⍺ reliability of the instrument was .87[23] and .86 in this study.

5) General characteristics of the participants

General characteristics included age, sex, religion, grades, reason for choosing nursing major, number of exercise days per week, regular daily life, quantity of sleep, quality of sleep, and diagnostic self evaluation. Diagnostic self evaluation is defined as the subjective health status perceived by an individual. Chau and Saravia [19] reported that perceived health was a significant influencing factor in adaptation to college life. Higher levels of COVID-19 stress showed a negative association with sleep duration, sleep quality, and the number of exercise days. In addition, COVID-19 stress was a specific predictor of poor university adjustment [24]. Regarding the COVID-19 pandemic, health-related factors could have a greater impact on adaptation to college life when compared with the nonpandemic period, therefore, health related factors and diagnostic self evaluation were included in the study.

4. Data Collection

For collection of data, an online survey that could be easily accessed through a link without authentication and a low risk of infection was conducted. The link to the online survey was posted on social media for the nursing students’ council from March 30 to April 10, 2022. Participants were told about the study's goal and procedure, as well as their confidentiality and rights. Students who accepted to participate in the study were asked to check the consent box on the first page of the questionnaire before moving on to the next. Approximately 20 minutes were required for completion of the survey.

5. Data Analysis

Analysis of the data was performed using SPSS/WIN 28.0 statistical program (Version 28.0; IBM Corp., USA). Descriptive statistic was performed for analysis of the general characteristics of the participants, COVID-19 stress, interpersonal relations, information literacy, and college life adaptation. t-test, ANOVA, and Scheffé test were used to determine the difference in college life adaptation based on the general characteristics of the participants. Pearson's correlation coefficient was used to assess correlations between COVID-19 stress, interpersonal relations, information literacy, and college life adaptation. A stepwise multiple regression analysis was performed to determine factors affecting college life adaptation.

6. Ethical Consideration

The Institutional Review Board (IRB) approved the conduct of the study (IRB No. BUIRB-202203-HR-001). For collection of data, participants were informed on the importance of anonymity and voluntary participation, and online consent was obtained only from those who agreed, and the survey was then administered. Participants were also informed in advance that consent could be withdrawn at any time during their participation in the survey and that there would be no consequences for withdrawal. Because students' personal information was not collected, the researchers had no knowledge regarding which students participated, and measures were taken to ensure students' anonymity and voluntary status.


1. General Characteristics of the Participants

The mean age of the participants was 24.51 years old, and the majority, 84.7% (n=105), were female. Second-year students represented the highest percentage at 32.3% (n=40), and 49.2%(n=61) of students were without religion. The reason that most students chose a nursing major was their aptitude (49.2%, n=61). Approximately 31% (n=38) of students exercised 3~4 days a week, and 55.6% (n=69) responded that their daily life was normal. Approximately 53% (n=66) of participants responded that their required quantity of sleep was not satisfied, and 44.4% (n=55) expressed dissatisfaction with quality of sleep, and 56.5% (n=70) responded that their diagnostic self evaluation was good (Table 1).

2. The Degree of COVID-19 Stress, Interpersonal Relations, Information Literacy, and College Life Adaptation

The mean for COVID-19 stress was 2.05±0.81. The mean score for interpersonal relations was 3.96±0.61 and the mean score for information literacy was 3.97±0.54. The mean score for college life adaptation was 3.32±0.58 (Table 2).

3. Differences in College Life Adaptation according to General Characteristics

Significant differences in college life adaptation were observed according to the general characteristics depending on the number of days of exercise (F=3.62, p=.015), regular daily life (t=-3.41, p=.001), quantity of sleep (t=-3.61, p<.001), quality of sleep (t=-3.90, p<.001), and diagnostic self evaluation (F=19.55, p<.001). The post-hoc analysis demonstrated that considerably lower scores were observed in the group of students who did not exercise at all compared with the group of students who exercised at least more than one day per week. Significantly higher scores for college life adaptation were observed in the group of students who perceived their diagnostic self evaluation as fair or good compared with the group of students who perceived their diagnostic self evaluation as poor (Table 1).

4. Correlation between COVID-19 stress, Interpersonal Relations, Information Literacy, and College Life Adaptation

College life adaptation showed a significant negative correlation with COVID-19 stress (r=-.18, p=.043), and a positive correlation with interpersonal relations (r=.48, p<.001) and information literacy (r=.26, p=.003) (Table 3).

5. Factors affecting College Life Adaptation for Nursing Students

The number of exercise days per week, regular daily life, quantity of sleep, quality of sleep, and diagnostic self evaluation, which showed significant differences in adaptation to college life, were treated as dummy variables for identification of factors that affect adaptation to college life for nursing students. These dummy variables were input as independent variables for performance of a stepwise multiple regression analysis. The correlation coefficient between variables was less than .7, the tolerance limit of all variables was more than 0.1, and the Variance Inflation Factor was 1.03~1.43, less than 10, indicating that multicollinearity between independent variables was not an issue. The Durbin-Watson statistic was 2.03, a value close to 2, confirming that there was no autocorrelation and that the regression model was appropriate. Factors affecting college life adaptation include interpersonal relations (β=.38, p<.001), good diagnostic self evaluation (β=.41, p<.001), and fair diagnostic self evaluation (β=.28, p=.005), COVID-19 stress (β=-.16, p=.027). The regression model had statistical significance (F=16.30, p<.001) and an explanatory power of 38.0%(Adj. R2=.38) (Table 4).


The long-term impact of the COVID-19 pandemic poses a significant challenge, potentially leading to significant changes in adaptation to college life [6]. The purpose of this study is to determine the factors affecting college life adaptation for nursing students during the COVID-19 pandemic. According to the findings of the study, COVID-19 stress, interpersonal relations, and diagnostic self evaluation are the main factors influencing adaptation to college life for nursing students in the COVID-19 pandemic.
In this study, the level of college life adaptation for nursing students was 3.32±0.58, slightly lower than the pre-COVID-19 college life adaptation level for nursing students reported by Choi [17], which was 3.34±0.63. This difference could be attributed to the impact of the COVID-19 pandemic. The pandemic has indeed been a cause of significant changes in the lives of university students, including barriers to attending in-person classes, restrictions on campus activities such as club involvement, the transition to online learning, etc. [25]. In particular, due to the numerous changes in the practical training curriculum, the COVID-19 pandemic caused further weakening of college life adaptation for nursing students. Jokar and colleagues reported on the potential for severe impairment of nursing practice skill competencies due to the challenges of adapting to online clinical training and conflicts associated with a reluctance to engage in clinical practice, supporting the potential for encountering such challenges in the future [26]. However, it should be noted that An and Lee [6] reported higher levels, 3.68±0.52, for adaptation to college life of nursing students during the COVID-19 pandemic. These differences could be related to support and contextual characteristics of the university, including how rapidly the university responded to educational changes resulting from the COVID-19 pandemic. When transitioning to non-face-to-face activities due to restrictions established as a result of the COVID-19 pandemic, maximizing educational efficiency and development of content for incorporation into active educational activities should be a priority. This study targeted nursing students at one university, therefore, conduct of comparative studies including students from various universities will be required.
The results of this study indicated that COVID-19 stress had a statistically negative impact on college life adaptation for nursing students. This finding was consistent with a previously reported study [6]. For nursing students who plan on working in a clinical practice setting, a situation involving a pandemic can become a reason for fear that extends beyond a significant stress factor and could pose a threat to their well-being [27]. Nursing programs have been regarded as high-stress due to their rigorous curriculum, intense competition, and clinical practice [18]. In a study reported by Thomas [27], who confirmed that the stress levels were significantly higher for nursing students in the COVID-19 pandemic compared with students in other majors, emphasized the importance of a sense of belonging for students' adaptation to college. Therefore, incorporation of a comprehensive program for stress management for nursing students, including preparation for national crises, as an essential component of the educational curriculum is recommended. This type of program should be included as a part of the college life adaptation program for nursing students. Design of a program to enhance emotional adaptation and promote stronger attachment to the college or department, with the aim of facilitating more effective adaptation to college life is recommended. Stress-related factors that may affect students from the time they are freshmen, and for tracking and management of the factors over time should be determined. In particular, management under a step-by-step professional counseling system for management of students’ mental health will be important.
This study’s findings also showed a positive relationship between interpersonal relations and college life adaptation of students in nursing in the COVID-19 pandemic and interpersonal relation was a factor affecting college life adaptation. This is in line with those described in the existing literature highlighting the significant influence of interpersonal relations on adaptation to college [11,12]. Therefore, establishing programs with the goal of enhancing interpersonal relations for nursing students to improve their ability to adapt to college life is important. The COVID-19 pandemic has imposed restrictions on in-person activities, resulting in various attempts to establish non-face-to-face programs with the goal of enhancing interpersonal relations. Non-face-to-face university activities, including programs that utilize social media platforms such as Instagram and other diverse programs [28,29], can have a positive impact in the effort to strengthen interpersonal relations among nursing students. In the setting of the COVID-19 pandemic, because many students have become accustomed to non-face-to-face learning and activities, the tendency to prefer non-face-to-face activities has also increased because interpersonal relations can be maintained regardless of physical distance [29]. As individual attitudes and thoughts regarding interpersonal relations can vary, there is a critical need for immediate establishment of tailored programs for enhancement of interpersonal relations. Development of programs with the goal of enhancing interpersonal relations is important in the effort to achieve this objective.
In addition, in the COVID-19 pandemic, a higher degree of college life adaptation was observed for nursing students who reported their diagnostic self evaluation as good or fair. Diagnostic self evaluation was a significant factor influencing college life adaptation. This finding is similar to the results of a study conducted by Chau and Saravis [19], who reported a positive correlation between college students' perceived health status and adaptation to college life. However, the study reported by Chau and Saravis [19] was not conducted during the COVID-19 pandemic. Considering that there are heightened concerns and anxiety regarding the health of an individual as a result of the COVID-19 pademic, consistent health management for nursing students is of utmost importance. Above all, monitoring and management of the physical and mental health of college students is essential. Thus, continuous health counseling should be available through various channels to provide support in students’ adjustment to college life. These efforts should be very helpful to students in their effort to adapt to college life.
Regarding the main variables in this study, information literacy was not considered a primary factor influencing college life adaptation. However, information literacy is regarded as a key factor for student success and an essential component of continuous learning, as emphasized by Petermanec and Sebjan [30]. In an era where generation of a massive amount of knowledge and information is a daily occurrence, information literacy is essential not only for adaptation to college life but also for adaptation to future society. Therefore, incorporating curricular and extracurricular programs designed to enhance these skills within the educational curriculum is essential. However, in this era college students have accumulated experience in using information from a young age, so that adapting to non-face-to-face online learning during the COVID-19 pandemic may not be difficult, which may be a reason why nursing students’ information literacy was not a decisive factor in their adaptation to college life. Therefore, in the conduct of future research, various types of studies on the impact of nursing students’ information literacy on college adaptation life will be required.
This study has several limitations. First, it was administered as a single survey to nursing students during the COVID-19 pandemic, thus, making a comparison with the pre-COVID-19 condition was challenging. Therefore, continuous monitoring of these factors may be required in the future. In addition, this study included participants at a single university, thus generalizing the results may be challenging. Therefore, future studies should include nursing students from various universities located in different regions in order to enhance the validity of the findings. The college life adaptation scale developed for general college students was used in this study. Use of a tool for measuring nursing students’ adaptation to college life would have been more appropriate.


According to the findings of this study, the key factors influencing the college life of nursing students under the conditions resulting from the COVID-19 pandemic include COVID-19 stress, interpersonal relations, and diagnostic self evaluation. Therefore, in preparation for a situation involving a national disaster such as the COVID-19 pandemic, inclusion of stress management, enhancement of interpersonal relations, and management of physical and mental health is critical when planning programs to enhance the college life adaptation of nursing students.


Miran Jung and Young Mi Ryu have been members of the editorial board since January 2024 and January 2022, respectively, but they had no role on the decision to publish this article. Except for that, no potential conflict of interest relevant to this article was reported.


Conceptualization or/and Methodology: Jung, M, Yim, S, & Ryu, YM
Data curation or/and Analysis: Ryu, YM
Funding acquisition: N/A
Investigation: Jung, M
Project administration or/and Supervision: Ryu, YM
Resources or/and Software: Ryu, YM
Validation: Jung, M, Yim, S
Visualization: Ryu, YM
Writing: original draft or/and review & editing: Jung, M, Yim, S, & Ryu, YM

Table 1.
The Difference of College Life Adaptation according to Characteristic of the Participants (N=124)
Variables Categories n (%) or M±SD College life adaptation
M±SD t or F (p) Scheffé
Age (year) 24.51±6.50
Sex Male 19 (15.3) 3.45±0.17 0.87 (.393)
Female 105 (84.7) 3.33±0.05
Grade 1 31 (25.0) 3.40±0.50 2.04 (.112)
2 40 (32.3) 3.26±0.54
3 25 (20.2) 3.13±0.68
4 28 (22.5) 3.48±0.59
Religion Christianity 51 (41.1) 3.31±0.59 0.03 (.971)
Catholicism 12 (9.7) 3.36±0.56
None 61 (49.2) 3.31±0.58
Reason for choosing nursing major Easy to find a job 35 (28.2) 3.25±0.58 2.58 (.062)
Aptitude 61 (49.2) 3.44±0.57
Other 28 (22.6) 3.14±0.56
Number of exercise days per week 0a 29 (23.4) 3.04±0.58 3.62 (.015)
1~2 daysb 32 (25.8) 3.36±0.57 a<b
3~4 daysc 38 (30.6) 3.49±0.60
≥5 daysd 25 (20.2) 3.33±0.47
Regular daily life Irregular 55 (44.4) 3.13±0.61 -3.41 (.001)
Regular 69 (55.6) 3.47±0.51
Quantity of sleep Dissatisfied 66 (53.2) 3.15±0.61 -3.61 (<.001)
Satisfied 58 (46.8) 3.51±0.48
Quality of sleep Dissatisfied 55 (44.4) 3.10±0.55 -3.90 (<.001)
Satisfied 69 (55.6) 3.49±0.55
Diagnostic self evaluation Poora 23 (18.5) 2.75±0.53 19.55 (<.001)
Fairb 31 (25.0) 3.30±0.47 a<b, c
Goodc 70 (56.5) 3.51±0.52
Table 2.
The Level of COVID-19 Stress, Interpersonal Relations, Information Literacy, and College Life Adaptation (N=124)
Variables Range Min Max M±SD
COVID-19 stress 0~5 0.29 4.10 2.05±0.81
Interpersonal relations 1~5 2.52 5.00 3.96±0.61
Information literacy 1~5 2.00 5.00 3.97±0.54
College life adaptation 1~5 1.68 4.52 3.32±0.58

M=mean; Min.=minimum; Max=Maximum; SD=standard deviation.

Table 3.
Correlations among COVID-19 Stress, Interpersonal Relations, Information Literacy, College Life Adaptation (N=124)
Variables COVID-19 stress
Interpersonal relations
Information literacy
College life adaptation
r (p) r (p) r (p) r (p)
COVID-19 stress 1
Interpersonal relations -.00 (.967) 1
Information literacy -.03 (.747) .45 (<.001) 1
College life adaptation -.18 (.043) .48 (<.001) .26 (.003) 1
Table 4.
Factors Affecting College Life Adaptation (N=124)
Variables B SE β t p
Interpersonal relations 0.36 0.07 .38 5.01 <.001
Diagnostic self evaluation (good) 0.48 0.13 .41 3.78 <.001
Diagnostic self evaluation (fair) 0.38 0.13 .28 2.87 .005
COVID-19 stress -0.11 0.05 -.16 -2.24 .027
F=16.30, p<.001, R2=.41, Adj. R2=.38, Durbin-Watson=2.04

Dummy variable: Diagnostic self evaluation (poor=0);

Adj. R2=adjusted R2; SE=standard error.


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