4.1. Findings
The anxiety levels in the surveyed group of nursing students did not differ significantly from the anxiety levels of the population of medical and nonhealth science students before the COVID-19 pandemic. The largest group of respondents (40%) did not report any anxiety at all, 30% reported mild anxiety, 20% reported moderate anxiety, and only 9% reported severe anxiety. Similar results of studies on the occurrence of anxiety among students before the pandemic were obtained from university and college students in Hong Kong (12.2% had moderate anxiety, and 5.8% had severe anxiety) [
37], Portugal (15.6% had moderate anxiety, and 8.3% had severe anxiety) [
33], and Australia (17.5% had moderate anxiety) [
38]. Among medical students, the prevalence of moderate anxiety was 25% in the United Kingdom, 20% in North America, 13.7% in New Zealand, and 23% in Lebanon [
39].
However, the available analyses of anxiety levels conducted among students at the beginning of the COVID-19 pandemic differ significantly from the results of our study; the level of anxiety among students was significantly higher at that time—the vast majority of American students (84%) declared feeling anxious or overwhelmed [
13], and as many as 13.1% of students from Israel reported severe anxiety [
19]. The discrepancy in the results can be explained, among other things, by the ability to quickly adapt to new conditions. Such adaptation allows one to quickly restore mental balance and, thus, reduce emotional tension [
13,
19].
The main factors contributing to the occurrence of high levels of anxiety at the onset of the COVID-19 pandemic were primarily related to the emergence of a new type of coronavirus. The high level of anxiety in the group of students resulted mainly from the lack of knowledge about the new type of coronavirus, its routes of transmission, and the methods of COVID-19 diagnosis and treatment. This possibly had a negative impact on the mental health of students (e.g., increased stress and anxiety) and possibly modified the cognitive abilities of students, for example, by suspending the selectivity of attention [
26]. The fear of infection and the more common fear of infecting loved ones were important factors triggering anxiety. Issues directly related to studying during the pandemic were also significant factors causing anxiety among students, including the shift to online education, the limited possibility of clinical practice experiences, and developing the most important practical nursing skills. On the contrary, after the resumption of clinical practice experience at the patient’s bedside in a modified form, the students were also afraid of attending practical classes in wards treating COVID-19 patients. Anxiety resulted from the fear of infection caused by a lack of an appropriate amount of personal protective equipment and the inability to use it properly [
10,
19].
Many publications also emphasized fear about graduating as planned and the possibility of entering the job market as important factors affecting the occurrence of increased levels of anxiety among nursing students [
10]. This situation mostly concerned students who were scheduled to graduate in the 2019/2020 academic year [
16,
17,
18,
19]. Moreover, the high level of anxiety among nursing students at the beginning of the pandemic also negatively affected their professional identification and career goals [
20,
21].
Another factor that possibly affected the increased level of anxiety could were economic, that is, the inability to take up temporary work by students (e.g., in tourism or gastronomy) or to obtain additional sources of income [
18,
19,
20,
21]. Branches of those industries in which students are most frequently employed part-time (such as tourism and gastronomy) were most severely impacted economically by the pandemic; therefore, this economic factor could have played a crucial role in increasing anxiety levels among students, particularly at the onset of the pandemic [
17,
18,
19,
20].
To the best of our knowledge, the research results presented in this paper are the first to describe anxiety levels among nursing students after more than a year since the onset of the COVID-19 pandemic, at a time when it is possible to receive the COVID-19 vaccine, and when most medical students in Poland were already vaccinated [
40].
The COVID-19 National Vaccination Program in Poland assumed that the distribution of vaccines in society would be gradual and that the vaccination of society would be carried out in stages. Based on the demographic and occupational characteristics of Polish society, several social groups were selected to receive COVID-19 vaccines in a pre-defined order and stages. The vaccination program was divided into four stages, from Stage 0, comprising those to receive the vaccination first, to Stage III, at which point all willing adults to be vaccinated. The risk of infection, risk of developing a serious illness or death, and the risk of disease transmission were taken into account when determining the target groups for each stage.
Stage 0, the priority stage, which began vaccination on 27 December 2020, comprised employees of the healthcare sector, administrative and support staff of care homes and medical institutions, and academic teachers and students of medical faculties. Moreover, medical schools organized vaccinations for their students at university sites, which certainly made it easier for students to get vaccinated. For this reason, at the time of the study (March/April 2021), the vast majority of respondents (77.2%), who were nursing students from medical universities all over Poland, were vaccinated against COVID-19.
According to the authors, several factors contributed to the low level of anxiety in the studied group of Polish nursing students, the most important of which were getting vaccinated as soon as possible and having high levels of knowledge about COVID-19 vaccination. In the presented research, the level of knowledge about vaccination was high, while the level of anxiety was low. At the same time, the level of student knowledge about vaccination against COVID-19 did not significantly affect the level of anxiety. These results are consistent with the results of other studies [
17,
18,
19,
20,
21]. In the majority of the available publications, the level of student knowledge about the pandemic did not significantly affect the level of anxiety. The lack of a direct link between the amount of knowledge and the severity of anxiety may be explained by the fact that students’ concerns are more self-centered (e.g., students are concerned about the end of the academic year and exams). In this context, knowledge about the virus does not directly influence the student’s concern; the impact is indirect.
The vast majority of the study participants gave correct answers to questions about COVID-19 vaccination, and most of them pointed to their home university as the source of their knowledge about said vaccination. These results can be explained by referring to research in the field of the psychology of stress. Those nursing students who experienced severe stress and fear related to the possibility of infection used their personality resources (e.g., cognitive functions) to obtain reliable knowledge about the virus. Their attention could were more selective toward proven actions that would allow them to protect themselves and their loved ones from becoming infected. It was a way of adapting to a new situation. The impact of stress on the learning process depends on, among other things, the physiological changes that take place in the human body, as well as emotions. Emotional events are remembered better, and low levels of stress can strengthen memory. If the material to be learned is related to stress, it will be remembered better [
26].
Access to up-to-date knowledge on COVID-19 vaccination, as well as the compositions, types, effects on the body, and effectiveness based on clinical trials and the first months of vaccination, may also have had a great influence on reducing anxiety. Students of medical universities may expect to obtain knowledge about COVID-19 vaccination at university. However, only a minority of 40.3% of students declared gaining such knowledge. The study participants assessed differently whether the university provided them with access to up-to-date knowledge about COVID-19 vaccination, depending on the degree of anxiety. The study participants who did not experience anxiety or described it as mild reported that the university provided them with access to up-to-date knowledge more often than those with moderate or severe levels of perceived anxiety. The reported levels were 41% and 32.4% for students with no anxiety and severe anxiety, respectively. The higher the perceived anxiety, the greater the confidence that the university provided or did not provide up-to-date information on vaccination (25.5% of the students in the no anxiety group and 18.3% in the severe anxiety group declared “I don’t know”).
The distribution of responses in particular groups of perceived anxiety is very interesting, and the answers mainly refer to social media and web portals. It turns out that these two sources: social media and web portals, indicated as potentially causing the greatest anxiety [
18,
19,
20,
21] were almost as frequently used as a source of information by all groups, regardless of perceived anxiety. Therefore, it should be assumed that despite the fact that the vast majority of students obtain information on vaccination against COVID-19 from these two sources of information, it did not significantly affect the level of anxiety in the studied group of students.
Another factor that could have significantly reduced the level of anxiety was the fact that the vast majority of the study participants (88%) began their studies during the pandemic. Therefore, the change in the method of education to online education was not much of a change for this group of students. From the very beginning of their studies, most of the students had attended their classes online. Moreover, concerns about completing their studies on time were raised rather by students graduating in June/July 2020. Due to the ongoing pandemic, many universities developed new diploma examination procedures for students graduating in the 2020/2021 academic year. As younger students are now familiar with them, these regulations no longer cause anxiety related to uncertainty. Therefore, it can be said that the quick reactions at the university level improved the mental state of students, especially as far as reducing fear among students is concerned. Quick and effective crisis management was, therefore, essential.