Psychological and behavioral responses of nursing interns from 12 Chinese universities during the COVID-19 epidemic: a knowledge, attitude and practice survey

Psychological and behavioral responses of nursing interns from 12 Chinese universities during the COVID-19 epidemic: a knowledge, attitude and practice survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Psychological and behavioral responses of nursing interns from 12 Chinese universities during the COVID-19 epidemic: a knowledge, attitude and practice survey Ying Chen, Hailin Zhang, Yuzi Xu, Fengqin Xu, Yinhe Wang, Yang Cao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-59638/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Coronavirus disease 2019 (COVID-19) has spread globally and resulted in the COVID-19 pandemic worldwide. To depict the psychological and behavioral responses, and knowledge of nursing interns who are facing the COVID-19 epidemic in China, we conducted a knowledge, attitude, and practice (KAP) survey using a convenience sample in the First People’s Hospital of Lianyungang, Kangda College of Nanjing Medical University, Jiangsu Province, China. Methods: A combination of a face-to-face questionnaire survey and an online survey was used for nursing interns from 12 Chinese universities. The Symptom Checklist 90 was used to investigate anxiety and depression of the nursing interns during the COVID-19 epidemic. Self-designed questionnaires were used to investigate behavioral responses, COVID-19-related knowledge, and preventive measures. Results: During the COVID-19 epidemic, the mean score of anxiety of 237 surveyed nursing interns were not statistically significantly different with that of the Chinese norm (1.42 vs. 1.39, P = 0.354). However, the mean score of depression of them were lower than that of the Chinese norm (1.22 vs. 1.50, P < 0.001). However, no statistically significant difference in the anxiety or depression was found between demographic subgroups. The most common way for the nursing interns to seek for help was asking for instructor or other medical professionals (89.45%). When the nursing interns had suspected symptoms, they will most likely go to the hospital for treatment (97.89%). The nursing interns have good knowledge regarding the origin and prevention of COVID-19 (correct percentage > 94%), however less knowledge regarding treatment and incubation (correct percentage < 10%). Conclusion: The nursing interns showed relative lower depression in the face of COVID-19 public health emergencies, and took proper preventive measures during the epidemic, however, were lack of certain epidemiology knowledge about COVID-19. Nursing Nursing internship and residency stress behavior COVID-19 severe acute respiratory syndrome coronavirus 2 surveys and questionnaires Background Coronavirus disease 2019 (COVID-19), as a global public health emergency, is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)[ 1 ]. The disease broke out in Wuhan, Hubei, China in December 2019, and has spread globally and resulted in the COVID-19 pandemic [ 2 , 3 ]. According to the National Health Commission of China, till February 29, 2020, a total of 79,824 confirmed COVID-19 cases were reported in China, with 41,625 cured and 2,870 died [ 4 ]. The main source of infection are the COVID-19 infected patients, while the asymptomatic infected people may also be a source of infection [ 5 ]. Two main routes of COVID-19 transmission are respiratory droplets and person-to-person contact [ 6 ]. When exposed to high concentration aerosols for a long time in a relatively closed environment, there is the possibility of aerosol transmission [ 7 ]. China has made great efforts to effectively curb the COVID-19 spreading and reduced its harm to public health by a comprehensive strategy, including early detection, early diagnosis, and early treatment for the infected cases, standardized management of potentially exposed persons, guidance for the public about personal protection, and strict disinfection for specific places. Experience from China provides a successful example to prevent and control against the spreading of COVID-19 and to treat the infected patients [ 8 ]. Medical health personnel face the challenge of a higher risk of infection when they treat COVID-19 patients. It has been reported that some physicians and nurses were infected when they treated COVID-19 patients [ 9 ]. Nursing interns have gained certain clinical ability and knowledge of infection prevention after years of training and clinical practice. However, due to limited knowledge of COVID-19, a completely new virus to human, and limited clinical skills and experience, nursing interns tend to have higher risk of infection when they care for COVID-19 patients during the outbreak. Lack of knowledge about infection may not only increase the risk of infection but also cause anxiety, depression, and fear among nurses who care for patients with confirmed or suspected infection [ 10 , 11 ]. Nursing interns have to work in clinical areas outside their usual practice or unfamiliar surroundings during a COVID-19 epidemic. Their knowledge, attitude, and psychological responses may affect their practice substantially, and are critical to provide timely, necessary, and quality care for COVID-19 patients. Our study aimed to depict the psychological and behavioral responses, and knowledge of the nursing interns who are facing public health emergency such as COVID-19 epidemic, which may provide useful information to design relevant training program, and to improve their nursing skills and consciousness to take effective measures to prevent and control COVID-19 infection in their work. Methods Study design and participants This is a knowledge, attitude and practice (KAP) questionnaire survey, and was conducted in the First People’s Hospital of Lianyungang, Kangda College of Nanjing Medical University, Jiangsu Province, China, China between February 15th and 29th, 2020. As a descriptive and explorative study, the study used a convenience sampling method, and no predefined power and type I error were used for sample size determination [ 12 ]. We used a combination of a face-to-face questionnaire survey and an online survey using the Questionnaire Star (Ranxing Technology Company Ltd., Changsha, China). The target study population was all the nursing interns who were conducting their internship at the First People’s Hospital of Lianyungang during the COVID-19 epidemic period and had at least eight months of clinical practices. In total, we sent the questionnaire to 240 qualified nursing interns who were from 12 universities of China. Two hundred and thirty-seven nursing interns returned the questionnaires. We got 237 valid questionnaires with a response rate of 98.8%. The study was approved by the Ethics Committee of First People's Hospital of Lianyungang (Approval number: 20200215) and informed consent was obtained from all the participants. Structure of the survey instrument The questionnaire used in the survey consists of three parts. The first part is a brief introduction to the survey, including the aim of the study and guidance of how to fill in questionnaire. The second part is demographic information of the respondent, which includes sex, age, religion, educational background, area of residence during the epidemic, hometown, and whether the respondent has relatives or friends who were infected. The third part are psychological and KAP questions, including psychological responses, behavioral response, knowledge, and preventive measures of COVID-19 during the epidemic period. Psychological response questions Psychological responses of the nursing interns were investigated using the Symptom Checklist 90 (SCL-90). The SCL-90 is a widely used mental health assessment scale with good reliability and validity, which is mainly used to investigate the existence and severity of certain psychological symptoms in a group of people over a period of time. It is designed to measure the intensity of nine different symptoms, including somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and global distress index [ 13 , 14 ]. The SCL-90 includes 90 factors of distress and the respondents may give response to each factor using Likert scale 0–4 points corresponding to five levels: 0 = not at all; 1 = a little; 2 = moderately; 3 = quite a bit; 4 = extremely. The higher the score is, the more serious is a psychological response that the respondent presents [ 15 ]. The SCL-90 may also be used to estimate incidence of each symptom during a certain period. In the current study, we only focused on the symptoms anxiety and depression. The factors of anxiety used in SCL-90 are 10 factors as following: 2) nervousness or shakiness inside; 17) trembling; 23) being suddenly scared for no reason; 33) feeling fearful; 39) heart pounding or racing; 57) feeling tense or keyed up; 72) spells of terror or panic; 78) feeling so restless you could not sit still; 80) feeling familiar things strange or unreal; 86) having thought to get things done quickly. The Cronbach’s reliability α of the 10 items for anxiety was 0.87 [ 16 ]. The factors of depression are 13 factors as following: 5) loss of sexual interest/pleasure; 14) feeling low in energy - slowed down; 15) suicidal thoughts; 20) crying easily; 22) feelings of being trapped; 26) blaming yourself for things; 29) feeling lonely; 30) feeling blue; 31) worrying too much about things; 32) feeling no interest in things; 54) feeling hopeless about the future; 71) feeling everything is an effort; 79) feeling of worthlessness. The Cronbach’s reliability α of the 13 items for depression was 0.91 [ 15 ]. The total score of anxiety or depression was converted into a percentile in later analysis The higher value of the convert score indicates worse psychological response [ 17 ]. Behavioral response, knowledge, and practice questions According to the issues that are generally concerned during COVID-19 epidemic, we designed 3 questions for behavioral response as following: When the epidemic is approaching, 1) Whom would you like to ask for advices/help first? 2) What will you do if you present suspected symptoms? 3) What kind of information that you will pay more attention to? The respondents may select multiple choices that we provide or write down their own answers. The questions for COVID-19-related knowledge were designed according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (the sixth edition) and the Prevention and Control Strategy for New Coronavirus Infection (the third edition) published by the National Health Committee of the People's Republic of China [ 18 , 19 ]. There are in total of 17 questions, including epidemiological characteristics of COVID-19 (5 questions), source and transmission route of infection (2 questions), clinical manifestations (1 question), test/diagnosis (2 questions), treatment (1 question), prevention (5 questions), and patient care (1 question). The nursing interns may answer True or False for each question. A correct answer was scored 1 and a wrong one was scored 0. A higher total score of the answers indicates better knowledge of COVID-19. Taking timely and correct preventive measures may prevent self-infection and virus transmission to other people. For practice, we used the 13 recommended preventive measures including not meeting with friends or eating together, and not using public transportation etc. to prevent COVID-19 infection and transmission [ 19 ]. The participants may get 1 score if she/he took one measure during the epidemic, and a higher total score of the 13 measures means that she/he took better individual prevention during the COVID-19 epidemic. In a pilot study, we tested the KAP questions among 20 interns who were not included in the formal survey. The content validity and the Cronbach’s reliability α were 0.92 and 0.87 for knowledge-related questions, and 0.91 for 0.84 for preventive measure questions, respectively. Statistical Analysis The data obtained was managed and analyzed using statistical software SPSS version 20.0 (IBM Co., Ltd., Armonk, New York). Frequency and percentage were used for count data. Mean ± standard deviation (SD) was used for continuous data. The Student t-test or analysis of variance (ANOVA) were used for comparing mean values between groups. A two-sided p-value less than 0.05 was considered as statistically significant. Results Demographic characteristics and psychological responses The demographic characteristics of the studied nursing interns are shown in Table 1 . The average age of the interns is 20.9 (± 1.5) years, and most of them (92.0% of 218) are female. Only one (0.4%) interns was graduated or had religion or had COVID-19-infected relatives and/or friends (Table 1 ). Table 1 Demographic characteristics and scores of psychological responses (self-rating symptom scale n = 237) Variables N (%) Anxiety Depression Mean ± SD t or F p Mean ± SD t or F p Gender 0.42 0.672 0.24 0.810 Male 19(8.0) 1.48 ± 0.61 1.62 ± 0.63 Female 218(92.0) 1.42 ± 0.61 1.58 ± 0.58 Age (years) 0.24 0.788 1.03 0.358 ≤ 20 101(42.6) 1.39 ± 0.56 1.61 ± 0.61 21 ~ 22 175(79.5) 1.44 ± 0.62 1.60 ± 0.60 ≥ 23 32(13.5) 1.44 ± 0.68 1.45 ± 0.24 Religion NA NA Yes 1(0.4) 3.00 ± 0.00 1.90 ± 0.00 No 236(99.6) 1.42 ± 0.60 1.58 ± 0.46 Education level 0.47 0.637 1.16 0.247 Junior undergraduate 181 (76.4) 1.41 ± 0.60 1.55 ± 0.53 Senior undergraduate 55(23.2) 1.45 ± 0.59 1.65 ± 0.63 Graduated 1 (0.4) 1.30 ± 0.00 1.40 ± 0.00 Area of residence 0.38 0.703 0.06 0.951 Hospital 17 (7.2) 1.48 ± 0.62 1.58 ± 0.62 Home 220(92.8) 1.42 ± 0.61 1.59 ± 0.57 Location of home 0.44 0.640 1.79 0.169 City 54 (22.8) 1.48 ± 0.62 1.69 ± 0.70 Town 78(32.9) 1.38 ± 0.59 1.60 ± 0.64 Countryside 105 (44.3) 1.42 ± 0.61 1.52 ± 0.42 Having infected relatives and/or friends NA NA Yes 1(0.4) 3.00 ± 0.00 3.90 ± 0.00 No 236(99.6) 1.42 ± 0.60 1.58 ± 0.56 Note: SD = standard deviation Student t-test for two groups and ANOVA for three groups. During the COVID-19 epidemic period, the nursing interns presented statistically lower depression scores compared to those of the Chinese norm (mean score 1.22 ± 0.58 vs. 1.50 ± 0.59, p < 0.001) (Table 2 ) [ 20 ]. For anxiety (1.42 ± 0.61 vs. 1.39 ± 0.43, p = 0.354), it did not show statistically significant difference. Table 2 Anxiety and depression scores of the nursing interns and the norm in China Items Nursing interns (n = 237) Norm in China (n = 1388) t p Anxiety 1.42 ± 0.61 1.39 ± 0.43 0.93 0.354 Depression 1.22 ± 0.58 1.50 ± 0.59 6.77 0.000 In the demographic subgroup analysis, for anxiety and depression, there was no statistically significant difference observed (Table 1 ). Even so, compared to the junior undergraduates or the interns who live in countryside, the senior undergraduate or the interns who live in cities show higher anxiety and depression scores (Table 1 ). Behavioral responses During the COVID-19 epidemic period, the most common way for nursing interns to seek for advices/help is instructor or other medical professionals (89.5%); followed by family, friends or classmates (58.7%); and Social media (42.6%). If they had suspected symptoms, the nursing intern would most probably go to the hospital for treatment (97.9%) or consult with their instructor or other professionals (66.2%). Few of them would stay at home and treat it by themselves (2.1%). None of them would go to other cities for safety or ignore it. During the epidemic, they paid more attention to people with suspected symptoms (87.8%) and preventive measures (86.9%), followed by the number of suspected and/or confirmed patients (84.0%), and research on vaccine and medication (79.8%). But some of them also paid more attention to and daily necessities (53.2%) (Table 3 ). Table 3 Behavioral response to COVID-19 epidemic (n = 237) Items N Percentage (%) When the epidemic is approaching: Whom would you like to ask for advices/help first? Instructor or other medical professionals 212 89.5 Family, friends or classmates 139 58.7 Social media 101 42.6 What will you do if you present suspected symptoms? Consult instructor or other medical professionals 157 66.2 Go to the hospital for treatment 232 97.9 Stay at home and treat it by myself 5 2.1 Go to other cities for safety 0 0.0 Ignore 0 0.0 What kind of information that you will pay more attention to? Preventive measures 206 86.9 The number of suspected/confirmed cases 199 84.0 Research on vaccine or medication 189 79.8 Anyone with suspected symptoms around 208 87.8 Rising prices and shortage of daily necessities 126 53.2 COVID-19-related knowledge The average correct score of the nursing interns’ knowledge about COVID-19 is 14.81 ± 0.82, or averagely they answered 15 of the 17 (88.2%) questions correctly. The most correctly answered items are “To prevent COVID-19 infection, people need to wear a face mask, wash hands frequently, and ventilate rooms.” (100.0%) and “For the residential communities and similar places where transmission or contagious epidemic have occurred, disinfection and control measures such as restriction on gathering and entering should be taken.” (100.0%). The least correctly answered items are “According to epidemiological investigations, the incubation period of COVID-19 is 3–14 days, mostly 3–7 days.” (5.9%) and “COVID-19 can be treated by antibiotics.” (11.4%). The correct percentages of other question range from 94.5–99.2% (Table 4 ). Table 4 The nursing interns’ knowledge about COVID-19 (n = 237) Items (correct answer: T, true; F, false) Correct answers N Percentage (%) COVID-19 is a respiratory infectious disease. (T) 229 96.6 Some COVID-19 patients have been detected in Wuhan, Hubei Province. (T) 235 99.2 2019-nCoV has more than 85% homology with bat SARS-like coronavirus (bat-SL-CoVZC45). (T) 232 97.9 2019-nCoV is sensitive to ultraviolet rays and heat. 56 ° C for 30 minutes, and lipid solvents such as ether, 75% ethanol, chlorine-containing disinfectant, peracetic acid, and chloroform can effectively deactivate the virus. (T) 224 94.5 The main symptoms of COVID-19 patients are fever, dry cough, and fatigue. A few patients have symptoms of nasal congestion, runny nose, sore throat, myalgia, and diarrhea. (T) 233 98.3 COVID-19 is transmitted by droplets and close person-to-person contact through respiratory tract.(T) 233 98.3 The main transmission source of COVID-19 is 2019-nCoV-infected patients. (T) 229 96.6 According to epidemiological investigations, the incubation period of COVID-19 is 3–14 days, mostly 3–7 days. (F) 14 5.9 COVID-19 patients had normal or decreased total white blood cells in peripheral blood, decreased lymphocyte count, and positive sputum nucleic acid test. (T) 229 96.6 COVID-19 patients have multiple patchy and ground glass shadows on the chest image, and lung consolidation may occur in severe cases. (T) 230 97.1 Isolation and medical observation should be taken for the people who have close contact with COVID-19 patients, and body temperature should be measured at least twice a day. (T) 229 96.6 To prevent COVID-19 infection, people need to wear a face mask, wash hands frequently, and ventilate rooms. (T) 237 100.0 For the residential communities and similar places where transmission or contagious epidemic have occurred, disinfection and control measures such as restriction on gathering and entering should be taken. (T) 237 100 When caring for patients with suspected or confirmed COVID-19 infection, nurses should wear N95 mask or surgical mask, protective clothing and eye glasses, face shield, and other necessary protective equipment. (T) 233 98.3 COVID-19 can treated by antibiotics. (F) 27 11.4 Medical staff should strengthen hand hygiene, and may use alcohol-based quick-drying hand disinfectants or wipe hands with 75% ethanol directly. (T) 230 97.1 Medical or healthcare institutions should clean and disinfect medical equipment, contaminated items and surfaces, and floors sufficiently.(T) 229 96.6 Preventive measures The average score of the nursing interns’ preventive measures against COVID-19 infection is 11.00 ± 0.80, or averagely they took 11 of the 13 (84.6%) recommended measures. The most adopted measure are “I wear a mask when I go out or work in the hospital.” (100.0%), “I follow the progress of the epidemic every day from TV, internet, etc.” (100.0%), and “If I had a fever and respiratory symptoms, I will consult a doctor in time and go to the hospital.” (100.0%). The least adopted measures are “Every time when I wash my hands I follow the recommended seven-step method.” (88.6%) and “I disinfect door handles and object surfaces frequently.” (90.3%). Other preventive measures are adopted by at least 96.6% of the interns during the epidemic (Table 5 ). Table 5 Preventive measures against COVID-19 infection (n = 237) Items (answer: Yes or No) Yes N Percentage (%) I don't meet or eat with friends and classmates. 235 99.2 I avoid to use public transportation. 235 99.2 I avoid to go to crowded places such as shopping mall. 236 99.6 I wear a mask when I go out or work in the hospital. 237 100.0 I open the windows of my room twice a day for at least 30 minutes each time. 233 98.3 I avoid coughing or sneezing in public. 236 99.6 Every time when I wash my hands I follow the recommended seven-step method. 210 88.6 I wash my hands more often than usual. 232 97.9 I disinfect door handles and object surfaces frequently. 214 90.3 I follow the progress of the epidemic every day from TV, internet, etc. 237 100.0 I discuss with my family about how to prevent COVID-19 infection. 236 99.6 If I had a fever and respiratory symptoms, I will consult a doctor in time and go to the hospital. 237 100.0 I exercise at home to increase immunity. 229 96.6 Discussion Although the new infectious disease COVID-19 caused some negative psychological responses like anxiety and depression among the nursing interns in our survey, their anxiety was not statistically different with that of normal Chinese people and the magnitudes of their depression were averagely lower than that of Chinese norm (Table 2 ). This is consistent with the findings from a previously published study, in which the researchers found that a new infectious disease could cause negative psychological responses such as anxiety, depression, fear, and panic among patients, their contactor, relatives and surrounding people [ 21 ]. The potential reason might be the lack of knowledge and understanding of the disease. As a new infectious disease, when COVID-19 appears, the country needs time to explore, understand, and learn its pathogenesis, transmission routes, preventive measures, and treatment methods. The public also needs time and information channels to learn relevant knowledge. During the lag time period when the infection cases increase, both the healthcare professionals and the public may worry about the infectious disease not being controlled in time, being infected, or unable to study, work, or live normally. In our study, the nursing interns had studied at medical universities for about two or three years and practiced in the hospital for about eight months, therefore they showed certain basic medical knowledge and skill in the prevention. We should note that, when COVID-19 outbroke, most of the nursing interns had been at home and did not take care for COVID-19 patients. It might contribute to the less risk of infection and lower mental stress. Although no statistically significant difference, compared to the junior undergraduates, the senior undergraduates showed higher anxiety and depression scores (Table 1 ). The possible reason might be that the higher level of education of the interns, the better ability the interns may have to acquire and analyze necessary or relevant knowledge and information, to understand the situation, and know the risk. Therefore they may face the COVID-19 epidemic with more pressure. From Table 1 , we also see that the interns who live in cities showed higher anxiety and depression scores. The possible reason might be that in China the large and top hospitals with high quality and complete facilities are mainly located in urban areas, and few are in suburban or countryside. When Chinese people are sick, they tend to visit large and top hospitals first [ 22 , 23 ]. When people were diagnosed with COVID-19 infection, they would be transferred to the hospitals in cities. In this case, the number of infected patients would be more and more in cities. During the COVID-19 epidemic, the local and central Chinese government required people to stay at home as much as possible [ 19 ]. Furthermore, the public traffic was restricted or even canceled in order to prevent virus transmission and spread of the disease. Although internet hospitals or online medical services have been adopted more and more, where people can seek for help from medical professionals, being afraid of failure in getting proper diagnosis or treatment in a timely manner may cause the nursing interns’ anxiety. It is interesting that the nursing interns would like to seek for help from different resources. We also see that they prefer their instructors instead of family or friends, social media, or other medical professionals when they would like to ask for advices/help. Most of nursing interns would go to the hospital for treatment if they suspected symptoms (Table 3 ). The potential reason might be as following: When the epidemic was approaching, few (n = 17) nursing interns who remained on duty received relevant training on the latest knowledge of COVID-19 in the hospital or department, and participated in the work against the epidemic together with their teachers or instructors. Therefore, when they appeared suspicious symptoms or wanted help they would ask for their teacher or other healthcare professional in the department or see a doctor in the hospital first. In this hospital, there is an online “Wechat” group including all nursing interns and their teachers and instructors who may discuss about COVID-19. Teachers and instructors may provide consultation immediately and continuously.[ 24 ] Nowadays the internet have been very popular in China, searching information from the internet is ubiquitous among adolescents [ 25 ]. The nursing interns can also learn the incidence and progress of the disease throughout the local area to the country, and extract related information and knowledge through various news medias and the internet, and change their behaviors or make corresponding reactions [ 26 ]. It is also a convenient and quick way to obtain necessary information or knowledge rather than bother their instructors. The COVID-19 epidemic began during the Chinese traditional Spring Festival holiday, 220 (92.8%) of the 237 nursing interns went back hometown for vacation, and the rest of the interns remained on duty or did not went back to hometown due other reasons. Therefore, there are more nursing interns who selected seeking for advices/help online or from family or friends. But we should be aware of that there are many fake news and wrong information about COVID-19 on the internet[ 27 ], the instructors and teachers should teach the nursing interns how to distinguish between true and false information. Because the nursing interns have certain medical knowledge, they pay more attention to preventive measures, the number of suspected patients and patients instead of other information (Table 3 ). When the local and national governments advocate and require all the people to stay at home, which will help the medical professional fight against the epidemic, at the same time, the governments have only taken measures to maintain the basic daily life of the people, for example, people can apply for medical masks and buy various living necessities through official online shops or platforms. For all these reasons, some nursing interns worry about probably rising prices and shortages of daily necessities in the future. Regarding COVID-19-related knowledge, the nursing interns participating in the survey have a good grasp of the prevention, followed by sources of infection and routes of transmission, clinical manifestations, test/diagnosis, the guidelines for patient care, however have relative less knowledge on disease epidemiological characteristics of COVID-19 and treatment (Table 4 ). In order to find every suspicious patients, provide accurate treatment to every confirmed or suspected patients, and avoid the spreading of infection in medical institutions, for each latest updating of the diagnosis and treatment guidelines, the medical institutions provide relevant training to all the staff including both the nursing interns on duty and on vacation through various on-line, off-line, or on-site forms, and take immediate implementation and supervision [ 28 ]. However, there are still some nursing interns who took vacation at hometown and did not timely attend the latest training on the updated diagnosis and treatment guidelines issued by the National Health Commission of China. We are glad to see that the nursing interns show a relative good score (84.6% recommended measures were adopted) for preventive behaviors (Table 5 ), which indicates that they had high compliance, and took good prevention and control measures during the COVID-19 epidemic. The research team believes that this is related to the national propaganda campaign and policies [ 28 ]. When the epidemic emerged, people were required to wear masks when going out and wash their hands when entering home. In residential communities and public places, there are volunteers who check and remind people to wear mask. Supermarkets and shops have set temporary regulation that customers should wear mask and those who did not follow the regulation would be rejected to enter [ 19 ]. The hospital (and other hospital also) requires washing hands with seven-step method and daily disinfection of floors and object surfaces, such as door handles, using chlorine-containing disinfectants or 75% alcohol [ 19 ]. Although the interns may conduct routine clearing when they stay at home, they cannot conduct disinfection as frequent as what they do in hospital. It might be the reason that the percentage of “Every time when I wash my hands I follow the recommended seven-step method.” and “I disinfect door handles and object surfaces frequently.” are low. In addition, because many nursing interns live at home, they may not have an appropriate place and venue to exercise, it might be the reason the percentage of “I exercise at home to increase immunity.” is also low. Limitation and strength There are several advantages in our study. First, to our knowledge, this is the first KAP survey that investigated the psychological and behavioral responses of the nursing interns working during the COVID-19 epidemic, which provides first-hand information regarding the psychological and educational intervention for the nursing interns to both improve their caring for the COVID-19 patients and protect themselves. Second, although the survey used a convenience sample, the nursing interns are from 12 universities in China, which to some extent may be representative of CONVID-19-related KAP of nursing interns at least at a regional level. Third, the study was conducted in the country where COVID-19 epidemic broke out first and has a large amount of confirmed patients, therefore its results may provide references for other countries. However, there are also limitations in our study. First, considering the efficiency and response rate of the survey, we only investigated 2 of 9 psychological symptoms in the SCL-90, which cannot reflect the overall psychological responses of the nursing interns. Second, because the study was only limited within nursing interns due to the pedagogy-driven objectives, which cannot reflect the situation among the general nurse practitioners. Last but not least, the inherent limitation in the study design hinders the generalization of the results. A follow-up study using a representative sample with larger sample size is needed to provide deeper insights in this field. Conclusion Compared to the Chinese norm, the nursing interns from 12 Chinese universities showed lower depression in the face of COVID-19 public health emergencies. Although the nursing interns presented good prevention during the epidemic, to some extent they lack certain epidemiology knowledge of COVID-19. The battle against the COVID-19 seems a tough and long-term task worldwide, the nursing departments or schools should strengthen training for the interns to improve the compliance in preventing infection, face the public health emergencies calmly and deliberately, and implement effective and feasible measures for patient care. Abbreviations ANOVA: analysis of variance; COVID-19: Coronavirus disease 2019; KAP: knowledge, attitude, and practice; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; SCL: Symptom Checklist; SD: standard deviation; Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of the First People's Hospital of Lianyungang (Approval number: 20200215) and informed consent was obtained from all the participants. There is no personal identification disclosed in our data. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This study was funded by the Research and Development Fund of Kangda College of Nanjing Medical University, China (KD2019KYJJZD006) Authors’ contribution X.F. designed the study; Y.C., H.Z., and Y.W. conducted the survey; Y.Z. analyzed the data; X.F. and Y.C. prepared the manuscript. All authors gave critical review and final approval for publication and agree to be accountable for all aspects of the work. Acknowledgements We thank the 237 participating nursing interns from Nanjing Medical University, Xuzhou Medical University, Nanjing Medical University Kangda College, Bengbu Medical College, Nanjing University of Chinese Medicine, Suzhou Vocational Health College, Jiangsu Health Vocational College, Jiangsu College of Nursing, Taizhou polytechnic College, Lianyungang higher Vocational and Technical School of Traditional Chinese Medicine, Jiuzhou polytechnic, and Jiangsu Vocational College of Medicine. Data availability The data are publicly available at the Dryad data repository ( doi: 10.5061/dryad.0p2ngf1wx , https://datadryad.org/stash/share/DjuemkC5W9W0nCJIjyvdGcAeKsRRyyHjDrZIftEaICY ). References Chen J. Pathogenicity and transmissibility of 2019-nCoV-A quick overview and comparison with other emerging viruses. Microbes Infect. 2020;22(2):69–71. 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Hellewell J, Abbott S, Gimma A, Bosse NI, Jarvis CI, Russell TW, Munday JD, Kucharski AJ, Edmunds WJ, Centre for the Mathematical Modelling of Infectious Diseases C-WG et al: Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts. Lancet Glob Health 2020. Huh S. How to train the health personnel for protecting themselves from novel coronavirus (COVID-19) infection during their patient or suspected case care. Journal of Educational Evaluation for Health Professions. 2020;17:10. Huang L, rong Liu H: Emotional responses and coping strategies of nurses and nursing college students during COVID-19 outbreak. medRxiv 2020. Choi JS, Kim JS. Factors influencing preventive behavior against Middle East Respiratory Syndrome-Coronavirus among nursing students in South Korea. Nurs Educ Today. 2016;40:168–72. Suen LJ, Huang HM, Lee HH. A comparison of convenience sampling and purposive sampling. Journal of Nursing (Chinese). 2014;61(3):105–11. Derogatis LR, Unger R: Symptom checklist-90‐revised: Wiley & Sons; 2010. Adilay U, Guclu B, Goksel M, Keskil S. The Correlation of SCL-90-R Anxiety, Depression, Somatization Subscale Scores with Chronic Low Back Pain. Turk Neurosurg. 2018;28(3):434–8. Wang ZH, Ye Y, Shen Z, Sun LG, Hu L, Yu WL, Xu M, Sun ZF, Cheng JD, Sun X. [A meta-analysis of Symptom Checklist-90 assessment results in Chinese nurses]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2018;36(2):129–33. Bernet W, Baker AJ, Verrocchio MC. Symptom Checklist-90-Revised scores in adult children exposed to alienating behaviors: an Italian sample. J Forensic Sci. 2015;60(2):357–62. Kim JS, Choi JS. Middle East respiratory syndrome-related knowledge, preventive behaviours and risk perception among nursing students during outbreak. J Clin Nurs. 2016;25(17–18):2542–9. National Health Commission of China. Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (the sixth edition). In. Edited by National Health Commission of China. Beijing, China: National Health Commission of China; 2020. National Health Commission of China. Prevention and Control Strategy for New Coronavirus Infection (the third edition). In. Edited by National Health Commission of China. Beijing, China: National Health Commission of China; 2020. Wei Y, Li H, Wang H, Zhang S, Sun Y. Psychological Status of Volunteers in a Phase I Clinical Trial Assessed by Symptom Checklist 90 (SCL-90) and Eysenck Personality Questionnaire (EPQ). Med Sci Monit. 2018;24:4968–73. Mohammed A, Sheikh TL, Gidado S, Poggensee G, Nguku P, Olayinka A, Ohuabunwo C, Waziri N, Shuaib F, Adeyemi J, et al: An evaluation of psychological distress and social support of survivors and contacts of Ebola virus disease infection and their relatives in Lagos, Nigeria: a cross sectional study-2014. Bmc Public Health 2015, 15. Zhong H. Effect of patient reimbursement method on health-care utilization: evidence from China. Health Econ. 2011;20(11):1312–29. Pan X, Dib HH, Wang X, Zhang H. Service utilization in community health centers in China: a comparison analysis with local hospitals. BMC Health Serv Res. 2006;6:93. Zhang S, Wang Z, Chang R, Wang H, Xu C, Yu X, Tsamlag L, Dong Y, Wang H, Cai Y. COVID-19 containment: China provides important lessons for global response. Front Med 2020. Huang H. Social Media Generation in Urban China: A Study of Social Media Use and Addiction among Adolescents. Switzerland: Springer Nature; 2014. Fredriksson SV, Alley SJ, Rebar AL, Hayman M, Vandelanotte C, Schoeppe S. How are different levels of knowledge about physical activity associated with physical activity behaviour in Australian adults? Plos One 2018, 13(11). Ioannidis JPA. Coronavirus disease 2019: the harms of exaggerated information and non-evidence-based measures. Eur J Clin Invest 2020:e13223. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, Fang C, Huang D, Huang LQ, Huang Q, et al: A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Med Res 2020, 7(1). Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-59638","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":1841821,"identity":"37a6ebda-b196-4300-8f55-e6be6c640ae3","order_by":0,"name":"Ying Chen","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Chen","suffix":""},{"id":1841822,"identity":"cb4f9141-3845-459d-91af-04a0d091a6b4","order_by":1,"name":"Hailin Zhang","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hailin","middleName":"","lastName":"Zhang","suffix":""},{"id":1841823,"identity":"6b79a109-7547-4c17-afd9-4775a887acdb","order_by":2,"name":"Yuzi Xu","email":"","orcid":"","institution":"Zhejiang University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuzi","middleName":"","lastName":"Xu","suffix":""},{"id":1841824,"identity":"886dfd09-e546-4b95-ab36-313433331e33","order_by":3,"name":"Fengqin Xu","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fengqin","middleName":"","lastName":"Xu","suffix":""},{"id":1841825,"identity":"7d436bc8-5de1-40ee-9335-3d1bfb69232f","order_by":4,"name":"Yinhe Wang","email":"","orcid":"","institution":"Nanjing University Medical School","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yinhe","middleName":"","lastName":"Wang","suffix":""},{"id":1841826,"identity":"3e5f1e11-dbf1-4b71-95d4-1c96163e0386","order_by":5,"name":"Yang Cao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuElEQVRIiWNgGAWjYDADftK1SDaQrMXgANEqj589/IKhxk7O+HjvMwmGPzZEaDmTl2bBcCzZ2OzMcTMJxrY0YtyTY2bA2MCcuO1GGpsEY8NhIrScfwPSUp+4eQZQC8Of/0RouZFj/ABoeOIGCZAWtgOEtUjeeGPGkHDsuLHEmWPMFoltyYS18J3PMf7woaZajr+9jfHGhz92hLUoHGBgk0iA8RJwK0QA+QYG5g/EKBwFo2AUjIIRDABVFzb+audkXAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-3552-9153","institution":"Örebro Universitet","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Cao","suffix":""}],"badges":[],"createdAt":"2020-08-14 12:13:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-59638/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-59638/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13587871,"identity":"69250024-56dc-4120-8260-f6b9c4106f54","added_by":"auto","created_at":"2021-09-17 04:52:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":434818,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-59638/v1/e1408e31-5d23-4305-8f1b-b7c7a03266ac.pdf"}],"financialInterests":"","formattedTitle":"Psychological and behavioral responses of nursing interns from 12 Chinese universities during the COVID-19 epidemic: a knowledge, attitude and practice survey","fulltext":[{"header":"Background","content":" \u003cp\u003eCoronavirus disease 2019 (COVID-19), as a global public health emergency, is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The disease broke out in Wuhan, Hubei, China in December 2019, and has spread globally and resulted in the COVID-19 pandemic [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to the National Health Commission of China, till February 29, 2020, a total of 79,824 confirmed COVID-19 cases were reported in China, with 41,625 cured and 2,870 died [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The main source of infection are the COVID-19 infected patients, while the asymptomatic infected people may also be a source of infection [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Two main routes of COVID-19 transmission are respiratory droplets and person-to-person contact [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. When exposed to high concentration aerosols for a long time in a relatively closed environment, there is the possibility of aerosol transmission [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. China has made great efforts to effectively curb the COVID-19 spreading and reduced its harm to public health by a comprehensive strategy, including early detection, early diagnosis, and early treatment for the infected cases, standardized management of potentially exposed persons, guidance for the public about personal protection, and strict disinfection for specific places. Experience from China provides a successful example to prevent and control against the spreading of COVID-19 and to treat the infected patients [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMedical health personnel face the challenge of a higher risk of infection when they treat COVID-19 patients. It has been reported that some physicians and nurses were infected when they treated COVID-19 patients [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Nursing interns have gained certain clinical ability and knowledge of infection prevention after years of training and clinical practice. However, due to limited knowledge of COVID-19, a completely new virus to human, and limited clinical skills and experience, nursing interns tend to have higher risk of infection when they care for COVID-19 patients during the outbreak. Lack of knowledge about infection may not only increase the risk of infection but also cause anxiety, depression, and fear among nurses who care for patients with confirmed or suspected infection [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Nursing interns have to work in clinical areas outside their usual practice or unfamiliar surroundings during a COVID-19 epidemic. Their knowledge, attitude, and psychological responses may affect their practice substantially, and are critical to provide timely, necessary, and quality care for COVID-19 patients. Our study aimed to depict the psychological and behavioral responses, and knowledge of the nursing interns who are facing public health emergency such as COVID-19 epidemic, which may provide useful information to design relevant training program, and to improve their nursing skills and consciousness to take effective measures to prevent and control COVID-19 infection in their work.\u003c/p\u003e"},{"header":"Methods","content":" \u003cdiv id=\"Sec3\" class=\"Section3\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003eThis is a knowledge, attitude and practice (KAP) questionnaire survey, and was conducted in the First People\u0026rsquo;s Hospital of Lianyungang, Kangda College of Nanjing Medical University, Jiangsu Province, China, China between February 15th and 29th, 2020. As a descriptive and explorative study, the study used a convenience sampling method, and no predefined power and type I error were used for sample size determination [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. We used a combination of a face-to-face questionnaire survey and an online survey using the Questionnaire Star (Ranxing Technology Company Ltd., Changsha, China). The target study population was all the nursing interns who were conducting their internship at the First People\u0026rsquo;s Hospital of Lianyungang during the COVID-19 epidemic period and had at least eight months of clinical practices. In total, we sent the questionnaire to 240 qualified nursing interns who were from 12 universities of China. Two hundred and thirty-seven nursing interns returned the questionnaires. We got 237 valid questionnaires with a response rate of 98.8%. The study was approved by the Ethics Committee of First People's Hospital of Lianyungang (Approval number: 20200215) and informed consent was obtained from all the participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eStructure of the survey instrument\u003c/h2\u003e \u003cp\u003eThe questionnaire used in the survey consists of three parts. The first part is a brief introduction to the survey, including the aim of the study and guidance of how to fill in questionnaire.\u003c/p\u003e \u003cp\u003eThe second part is demographic information of the respondent, which includes sex, age, religion, educational background, area of residence during the epidemic, hometown, and whether the respondent has relatives or friends who were infected.\u003c/p\u003e \u003cp\u003eThe third part are psychological and KAP questions, including psychological responses, behavioral response, knowledge, and preventive measures of COVID-19 during the epidemic period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003ePsychological response questions\u003c/h2\u003e \u003cp\u003ePsychological responses of the nursing interns were investigated using the Symptom Checklist 90 (SCL-90). The SCL-90 is a widely used mental health assessment scale with good reliability and validity, which is mainly used to investigate the existence and severity of certain psychological symptoms in a group of people over a period of time. It is designed to measure the intensity of nine different symptoms, including somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and global distress index [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe SCL-90 includes 90 factors of distress and the respondents may give response to each factor using Likert scale 0\u0026ndash;4 points corresponding to five levels: 0\u0026thinsp;=\u0026thinsp;not at all; 1\u0026thinsp;=\u0026thinsp;a little; 2\u0026thinsp;=\u0026thinsp;moderately; 3\u0026thinsp;=\u0026thinsp;quite a bit; 4\u0026thinsp;=\u0026thinsp;extremely. The higher the score is, the more serious is a psychological response that the respondent presents [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The SCL-90 may also be used to estimate incidence of each symptom during a certain period. In the current study, we only focused on the symptoms anxiety and depression.\u003c/p\u003e \u003cp\u003eThe factors of anxiety used in SCL-90 are 10 factors as following:\u003c/p\u003e \u003cp\u003e2) nervousness or shakiness inside; 17) trembling; 23) being suddenly scared for no reason; 33) feeling fearful; 39) heart pounding or racing; 57) feeling tense or keyed up; 72) spells of terror or panic; 78) feeling so restless you could not sit still; 80) feeling familiar things strange or unreal; 86) having thought to get things done quickly. The Cronbach\u0026rsquo;s reliability α of the 10 items for anxiety was 0.87 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe factors of depression are 13 factors as following:\u003c/p\u003e \u003cp\u003e5) loss of sexual interest/pleasure; 14) feeling low in energy - slowed down; 15) suicidal thoughts; 20) crying easily; 22) feelings of being trapped; 26) blaming yourself for things; 29) feeling lonely; 30) feeling blue; 31) worrying too much about things; 32) feeling no interest in things; 54) feeling hopeless about the future; 71) feeling everything is an effort; 79) feeling of worthlessness. The Cronbach\u0026rsquo;s reliability α of the 13 items for depression was 0.91 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe total score of anxiety or depression was converted into a percentile in later analysis The higher value of the convert score indicates worse psychological response [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eBehavioral response, knowledge, and practice questions\u003c/h2\u003e \u003cp\u003eAccording to the issues that are generally concerned during COVID-19 epidemic, we designed 3 questions for behavioral response as following: When the epidemic is approaching, 1) Whom would you like to ask for advices/help first? 2) What will you do if you present suspected symptoms? 3) What kind of information that you will pay more attention to? The respondents may select multiple choices that we provide or write down their own answers.\u003c/p\u003e \u003cp\u003eThe questions for COVID-19-related knowledge were designed according to the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (the sixth edition) and the Prevention and Control Strategy for New Coronavirus Infection (the third edition) published by the National Health Committee of the People's Republic of China [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. There are in total of 17 questions, including epidemiological characteristics of COVID-19 (5 questions), source and transmission route of infection (2 questions), clinical manifestations (1 question), test/diagnosis (2 questions), treatment (1 question), prevention (5 questions), and patient care (1 question). The nursing interns may answer True or False for each question. A correct answer was scored 1 and a wrong one was scored 0. A higher total score of the answers indicates better knowledge of COVID-19.\u003c/p\u003e \u003cp\u003eTaking timely and correct preventive measures may prevent self-infection and virus transmission to other people. For practice, we used the 13 recommended preventive measures including not meeting with friends or eating together, and not using public transportation etc. to prevent COVID-19 infection and transmission [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The participants may get 1 score if she/he took one measure during the epidemic, and a higher total score of the 13 measures means that she/he took better individual prevention during the COVID-19 epidemic.\u003c/p\u003e \u003cp\u003eIn a pilot study, we tested the KAP questions among 20 interns who were not included in the formal survey. The content validity and the Cronbach\u0026rsquo;s reliability α were 0.92 and 0.87 for knowledge-related questions, and 0.91 for 0.84 for preventive measure questions, respectively.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe data obtained was managed and analyzed using statistical software SPSS version 20.0 (IBM Co., Ltd., Armonk, New York). Frequency and percentage were used for count data. Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) was used for continuous data. The Student t-test or analysis of variance (ANOVA) were used for comparing mean values between groups. A two-sided p-value less than 0.05 was considered as statistically significant.\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":" \u003cp\u003e \u003cb\u003eDemographic characteristics and psychological responses\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe demographic characteristics of the studied nursing interns are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The average age of the interns is 20.9 (\u0026plusmn;\u0026thinsp;1.5) years, and most of them (92.0% of 218) are female. Only one (0.4%) interns was graduated or had religion or had COVID-19-infected relatives and/or friends (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics and scores of psychological responses (self-rating symptom scale n\u0026thinsp;=\u0026thinsp;237)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e or \u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e or \u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e218(92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.358\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101(42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026thinsp;~\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e175(79.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e236(99.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior undergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e181 (76.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior undergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55(23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.703\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e220(92.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78(32.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountryside\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving infected relatives and/or friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e3.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e236(99.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: SD\u0026thinsp;=\u0026thinsp;standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStudent t-test for two groups and ANOVA for three groups.\u003c/p\u003e \u003cp\u003eDuring the COVID-19 epidemic period, the nursing interns presented statistically lower depression scores compared to those of the Chinese norm (mean score 1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58 vs. 1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For anxiety (1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61 vs. 1.39 \u0026plusmn; 0.43, p\u0026thinsp;=\u0026thinsp;0.354), it did not show statistically significant difference.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnxiety and depression scores of the nursing interns and the norm in China\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing interns (n\u0026thinsp;=\u0026thinsp;237)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNorm in China (n\u0026thinsp;=\u0026thinsp;1388)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the demographic subgroup analysis, for anxiety and depression, there was no statistically significant difference observed (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Even so, compared to the junior undergraduates or the interns who live in countryside, the senior undergraduate or the interns who live in cities show higher anxiety and depression scores (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eBehavioral responses\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDuring the COVID-19 epidemic period, the most common way for nursing interns to seek for advices/help is instructor or other medical professionals (89.5%); followed by family, friends or classmates (58.7%); and Social media (42.6%). If they had suspected symptoms, the nursing intern would most probably go to the hospital for treatment (97.9%) or consult with their instructor or other professionals (66.2%). Few of them would stay at home and treat it by themselves (2.1%). None of them would go to other cities for safety or ignore it. During the epidemic, they paid more attention to people with suspected symptoms (87.8%) and preventive measures (86.9%), followed by the number of suspected and/or confirmed patients (84.0%), and research on vaccine and medication (79.8%). But some of them also paid more attention to and daily necessities (53.2%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBehavioral response to COVID-19 epidemic (n\u0026thinsp;=\u0026thinsp;237)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen the epidemic is approaching:\u003c/p\u003e \u003cp\u003eWhom would you like to ask for advices/help first?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstructor or other medical professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily, friends or classmates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat will you do if you present suspected symptoms?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsult instructor or other medical professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGo to the hospital for treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStay at home and treat it by myself\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGo to other cities for safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgnore\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat kind of information that you will pay more attention to?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreventive measures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe number of suspected/confirmed cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch on vaccine or medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnyone with suspected symptoms around\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRising prices and shortage of daily necessities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eCOVID-19-related knowledge\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe average correct score of the nursing interns\u0026rsquo; knowledge about COVID-19 is 14.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82, or averagely they answered 15 of the 17 (88.2%) questions correctly. The most correctly answered items are \u0026ldquo;To prevent COVID-19 infection, people need to wear a face mask, wash hands frequently, and ventilate rooms.\u0026rdquo; (100.0%) and \u0026ldquo;For the residential communities and similar places where transmission or contagious epidemic have occurred, disinfection and control measures such as restriction on gathering and entering should be taken.\u0026rdquo; (100.0%). The least correctly answered items are \u0026ldquo;According to epidemiological investigations, the incubation period of COVID-19 is 3\u0026ndash;14 days, mostly 3\u0026ndash;7 days.\u0026rdquo; (5.9%) and \u0026ldquo;COVID-19 can be treated by antibiotics.\u0026rdquo; (11.4%). The correct percentages of other question range from 94.5\u0026ndash;99.2% (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe nursing interns\u0026rsquo; knowledge about COVID-19 (n\u0026thinsp;=\u0026thinsp;237)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItems (correct answer: T, true; F, false)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCorrect answers\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOVID-19 is a respiratory infectious disease. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSome COVID-19 patients have been detected in Wuhan, Hubei Province. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019-nCoV has more than 85% homology with bat SARS-like coronavirus (bat-SL-CoVZC45). (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019-nCoV is sensitive to ultraviolet rays and heat. 56 \u0026deg; C for 30 minutes, and lipid solvents such as ether, 75% ethanol, chlorine-containing disinfectant, peracetic acid, and chloroform can effectively deactivate the virus. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe main symptoms of COVID-19 patients are fever, dry cough, and fatigue. A few patients have symptoms of nasal congestion, runny nose, sore throat, myalgia, and diarrhea. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOVID-19 is transmitted by droplets and close person-to-person contact through respiratory tract.(T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe main transmission source of COVID-19 is 2019-nCoV-infected patients. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccording to epidemiological investigations, the incubation period of COVID-19 is 3\u0026ndash;14 days, mostly 3\u0026ndash;7 days. (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOVID-19 patients had normal or decreased total white blood cells in peripheral blood, decreased lymphocyte count, and positive sputum nucleic acid test. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOVID-19 patients have multiple patchy and ground glass shadows on the chest image, and lung consolidation may occur in severe cases. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolation and medical observation should be taken for the people who have close contact with COVID-19 patients, and body temperature should be measured at least twice a day. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo prevent COVID-19 infection, people need to wear a face mask, wash hands frequently, and ventilate rooms. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFor the residential communities and similar places where transmission or contagious epidemic have occurred, disinfection and control measures such as restriction on gathering and entering should be taken. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen caring for patients with suspected or confirmed COVID-19 infection, nurses should wear N95 mask or surgical mask, protective clothing and eye glasses, face shield, and other necessary protective equipment. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOVID-19 can treated by antibiotics. (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical staff should strengthen hand hygiene, and may use alcohol-based quick-drying hand disinfectants or wipe hands with 75% ethanol directly. (T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical or healthcare institutions should clean and disinfect medical equipment, contaminated items and surfaces, and floors sufficiently.(T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePreventive measures\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe average score of the nursing interns\u0026rsquo; preventive measures against COVID-19 infection is 11.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80, or averagely they took 11 of the 13 (84.6%) recommended measures. The most adopted measure are \u0026ldquo;I wear a mask when I go out or work in the hospital.\u0026rdquo; (100.0%), \u0026ldquo;I follow the progress of the epidemic every day from TV, internet, etc.\u0026rdquo; (100.0%), and \u0026ldquo;If I had a fever and respiratory symptoms, I will consult a doctor in time and go to the hospital.\u0026rdquo; (100.0%). The least adopted measures are \u0026ldquo;Every time when I wash my hands I follow the recommended seven-step method.\u0026rdquo; (88.6%) and \u0026ldquo;I disinfect door handles and object surfaces frequently.\u0026rdquo; (90.3%). Other preventive measures are adopted by at least 96.6% of the interns during the epidemic (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePreventive measures against COVID-19 infection (n\u0026thinsp;=\u0026thinsp;237)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItems (answer: Yes or No)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI don't meet or eat with friends and classmates.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI avoid to use public transportation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI avoid to go to crowded places such as shopping mall.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI wear a mask when I go out or work in the hospital.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI open the windows of my room twice a day for at least 30 minutes each time.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI avoid coughing or sneezing in public.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvery time when I wash my hands I follow the recommended seven-step method.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI wash my hands more often than usual.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI disinfect door handles and object surfaces frequently.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI follow the progress of the epidemic every day from TV, internet, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI discuss with my family about how to prevent COVID-19 infection.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIf I had a fever and respiratory symptoms, I will consult a doctor in time and go to the hospital.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI exercise at home to increase immunity.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Discussion","content":" \u003cp\u003eAlthough the new infectious disease COVID-19 caused some negative psychological responses like anxiety and depression among the nursing interns in our survey, their anxiety was not statistically different with that of normal Chinese people and the magnitudes of their depression were averagely lower than that of Chinese norm (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This is consistent with the findings from a previously published study, in which the researchers found that a new infectious disease could cause negative psychological responses such as anxiety, depression, fear, and panic among patients, their contactor, relatives and surrounding people [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The potential reason might be the lack of knowledge and understanding of the disease. As a new infectious disease, when COVID-19 appears, the country needs time to explore, understand, and learn its pathogenesis, transmission routes, preventive measures, and treatment methods. The public also needs time and information channels to learn relevant knowledge. During the lag time period when the infection cases increase, both the healthcare professionals and the public may worry about the infectious disease not being controlled in time, being infected, or unable to study, work, or live normally. In our study, the nursing interns had studied at medical universities for about two or three years and practiced in the hospital for about eight months, therefore they showed certain basic medical knowledge and skill in the prevention. We should note that, when COVID-19 outbroke, most of the nursing interns had been at home and did not take care for COVID-19 patients. It might contribute to the less risk of infection and lower mental stress.\u003c/p\u003e \u003cp\u003eAlthough no statistically significant difference, compared to the junior undergraduates, the senior undergraduates showed higher anxiety and depression scores (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The possible reason might be that the higher level of education of the interns, the better ability the interns may have to acquire and analyze necessary or relevant knowledge and information, to understand the situation, and know the risk. Therefore they may face the COVID-19 epidemic with more pressure. From Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, we also see that the interns who live in cities showed higher anxiety and depression scores. The possible reason might be that in China the large and top hospitals with high quality and complete facilities are mainly located in urban areas, and few are in suburban or countryside. When Chinese people are sick, they tend to visit large and top hospitals first [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. When people were diagnosed with COVID-19 infection, they would be transferred to the hospitals in cities. In this case, the number of infected patients would be more and more in cities. During the COVID-19 epidemic, the local and central Chinese government required people to stay at home as much as possible [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Furthermore, the public traffic was restricted or even canceled in order to prevent virus transmission and spread of the disease. Although internet hospitals or online medical services have been adopted more and more, where people can seek for help from medical professionals, being afraid of failure in getting proper diagnosis or treatment in a timely manner may cause the nursing interns\u0026rsquo; anxiety.\u003c/p\u003e \u003cp\u003eIt is interesting that the nursing interns would like to seek for help from different resources. We also see that they prefer their instructors instead of family or friends, social media, or other medical professionals when they would like to ask for advices/help. Most of nursing interns would go to the hospital for treatment if they suspected symptoms (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The potential reason might be as following:\u003c/p\u003e \u003cp\u003eWhen the epidemic was approaching, few (n\u0026thinsp;=\u0026thinsp;17) nursing interns who remained on duty received relevant training on the latest knowledge of COVID-19 in the hospital or department, and participated in the work against the epidemic together with their teachers or instructors. Therefore, when they appeared suspicious symptoms or wanted help they would ask for their teacher or other healthcare professional in the department or see a doctor in the hospital first. In this hospital, there is an online \u0026ldquo;Wechat\u0026rdquo; group including all nursing interns and their teachers and instructors who may discuss about COVID-19. Teachers and instructors may provide consultation immediately and continuously.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Nowadays the internet have been very popular in China, searching information from the internet is ubiquitous among adolescents [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The nursing interns can also learn the incidence and progress of the disease throughout the local area to the country, and extract related information and knowledge through various news medias and the internet, and change their behaviors or make corresponding reactions [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. It is also a convenient and quick way to obtain necessary information or knowledge rather than bother their instructors. The COVID-19 epidemic began during the Chinese traditional Spring Festival holiday, 220 (92.8%) of the 237 nursing interns went back hometown for vacation, and the rest of the interns remained on duty or did not went back to hometown due other reasons. Therefore, there are more nursing interns who selected seeking for advices/help online or from family or friends. But we should be aware of that there are many fake news and wrong information about COVID-19 on the internet[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], the instructors and teachers should teach the nursing interns how to distinguish between true and false information.\u003c/p\u003e \u003cp\u003eBecause the nursing interns have certain medical knowledge, they pay more attention to preventive measures, the number of suspected patients and patients instead of other information (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When the local and national governments advocate and require all the people to stay at home, which will help the medical professional fight against the epidemic, at the same time, the governments have only taken measures to maintain the basic daily life of the people, for example, people can apply for medical masks and buy various living necessities through official online shops or platforms. For all these reasons, some nursing interns worry about probably rising prices and shortages of daily necessities in the future.\u003c/p\u003e \u003cp\u003eRegarding COVID-19-related knowledge, the nursing interns participating in the survey have a good grasp of the prevention, followed by sources of infection and routes of transmission, clinical manifestations, test/diagnosis, the guidelines for patient care, however have relative less knowledge on disease epidemiological characteristics of COVID-19 and treatment (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In order to find every suspicious patients, provide accurate treatment to every confirmed or suspected patients, and avoid the spreading of infection in medical institutions, for each latest updating of the diagnosis and treatment guidelines, the medical institutions provide relevant training to all the staff including both the nursing interns on duty and on vacation through various on-line, off-line, or on-site forms, and take immediate implementation and supervision [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, there are still some nursing interns who took vacation at hometown and did not timely attend the latest training on the updated diagnosis and treatment guidelines issued by the National Health Commission of China.\u003c/p\u003e \u003cp\u003eWe are glad to see that the nursing interns show a relative good score (84.6% recommended measures were adopted) for preventive behaviors (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), which indicates that they had high compliance, and took good prevention and control measures during the COVID-19 epidemic. The research team believes that this is related to the national propaganda campaign and policies [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. When the epidemic emerged, people were required to wear masks when going out and wash their hands when entering home. In residential communities and public places, there are volunteers who check and remind people to wear mask. Supermarkets and shops have set temporary regulation that customers should wear mask and those who did not follow the regulation would be rejected to enter [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The hospital (and other hospital also) requires washing hands with seven-step method and daily disinfection of floors and object surfaces, such as door handles, using chlorine-containing disinfectants or 75% alcohol [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Although the interns may conduct routine clearing when they stay at home, they cannot conduct disinfection as frequent as what they do in hospital. It might be the reason that the percentage of \u0026ldquo;Every time when I wash my hands I follow the recommended seven-step method.\u0026rdquo; and \u0026ldquo;I disinfect door handles and object surfaces frequently.\u0026rdquo; are low. In addition, because many nursing interns live at home, they may not have an appropriate place and venue to exercise, it might be the reason the percentage of \u0026ldquo;I exercise at home to increase immunity.\u0026rdquo; is also low.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitation and strength\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere are several advantages in our study. First, to our knowledge, this is the first KAP survey that investigated the psychological and behavioral responses of the nursing interns working during the COVID-19 epidemic, which provides first-hand information regarding the psychological and educational intervention for the nursing interns to both improve their caring for the COVID-19 patients and protect themselves. Second, although the survey used a convenience sample, the nursing interns are from 12 universities in China, which to some extent may be representative of CONVID-19-related KAP of nursing interns at least at a regional level. Third, the study was conducted in the country where COVID-19 epidemic broke out first and has a large amount of confirmed patients, therefore its results may provide references for other countries.\u003c/p\u003e \u003cp\u003eHowever, there are also limitations in our study. First, considering the efficiency and response rate of the survey, we only investigated 2 of 9 psychological symptoms in the SCL-90, which cannot reflect the overall psychological responses of the nursing interns. Second, because the study was only limited within nursing interns due to the pedagogy-driven objectives, which cannot reflect the situation among the general nurse practitioners. Last but not least, the inherent limitation in the study design hinders the generalization of the results. A follow-up study using a representative sample with larger sample size is needed to provide deeper insights in this field.\u003c/p\u003e "},{"header":"Conclusion","content":" \u003cp\u003eCompared to the Chinese norm, the nursing interns from 12 Chinese universities showed lower depression in the face of COVID-19 public health emergencies. Although the nursing interns presented good prevention during the epidemic, to some extent they lack certain epidemiology knowledge of COVID-19. The battle against the COVID-19 seems a tough and long-term task worldwide, the nursing departments or schools should strengthen training for the interns to improve the compliance in preventing infection, face the public health emergencies calmly and deliberately, and implement effective and feasible measures for patient care.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eANOVA: analysis of variance; COVID-19: Coronavirus disease 2019; KAP: knowledge, attitude, and practice; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; SCL: Symptom Checklist; SD: standard deviation;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of the First People's Hospital of Lianyungang (Approval number: 20200215) and informed consent was obtained from all the participants. There is no personal identification disclosed in our data.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was funded by the Research and Development Fund of Kangda College of Nanjing Medical University, China (KD2019KYJJZD006)\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contribution\u003c/h2\u003e\n\u003cp\u003eX.F. designed the study; Y.C., H.Z., and Y.W. conducted the survey; Y.Z. analyzed the data; X.F. and Y.C. prepared the manuscript. All authors gave critical review and final approval for publication and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe thank the 237 participating nursing interns from Nanjing Medical University, Xuzhou Medical University, Nanjing Medical University Kangda College, Bengbu Medical College, Nanjing University of Chinese Medicine, Suzhou Vocational Health College, Jiangsu Health Vocational College, Jiangsu College of Nursing, Taizhou polytechnic College, Lianyungang higher Vocational and Technical School of Traditional Chinese Medicine, Jiuzhou polytechnic, and Jiangsu Vocational College of Medicine.\u003c/p\u003e\n\u003ch2\u003eData availability\u003c/h2\u003e\n\u003cp\u003eThe data are publicly available at the Dryad data repository (\u003ca href=\"https://doi.org/10.5061/dryad.0p2ngf1wx\"\u003edoi: 10.5061/dryad.0p2ngf1wx\u003c/a\u003e, \u003ca href=\"https://urlproxy.sunet.se/canit/urlproxy.php?_q=aHR0cHM6Ly9kYXRhZHJ5YWQub3JnL3N0YXNoL3NoYXJlL0RqdWVta0M1VzlXMG5DSklqeXZkR2NBZUtzUlJ5eUhqRHJaSWZ0RWFJQ1k%3D\u0026amp;_s=eWFuZy5jYW9Ab3J1LnNl\u0026amp;_c=a7e3392e\u0026amp;_r=b3J1LXNl\"\u003ehttps://datadryad.org/stash/share/DjuemkC5W9W0nCJIjyvdGcAeKsRRyyHjDrZIftEaICY\u003c/a\u003e).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChen J. 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Turk Neurosurg. 2018;28(3):434\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eWang ZH, Ye Y, Shen Z, Sun LG, Hu L, Yu WL, Xu M, Sun ZF, Cheng JD, Sun X. [A meta-analysis of Symptom Checklist-90 assessment results in Chinese nurses]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2018;36(2):129\u0026ndash;33.\u003c/li\u003e\n\u003cli\u003eBernet W, Baker AJ, Verrocchio MC. Symptom Checklist-90-Revised scores in adult children exposed to alienating behaviors: an Italian sample. J Forensic Sci. 2015;60(2):357\u0026ndash;62.\u003c/li\u003e\n\u003cli\u003eKim JS, Choi JS. Middle East respiratory syndrome-related knowledge, preventive behaviours and risk perception among nursing students during outbreak. J Clin Nurs. 2016;25(17\u0026ndash;18):2542\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eNational Health Commission of China. Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (the sixth edition). In. Edited by National Health Commission of China. 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Med Sci Monit. 2018;24:4968\u0026ndash;73.\u003c/li\u003e\n\u003cli\u003eMohammed A, Sheikh TL, Gidado S, Poggensee G, Nguku P, Olayinka A, Ohuabunwo C, Waziri N, Shuaib F, Adeyemi J, et al: An evaluation of psychological distress and social support of survivors and contacts of Ebola virus disease infection and their relatives in Lagos, Nigeria: a cross sectional study-2014. \u003cem\u003eBmc Public Health\u003c/em\u003e 2015, 15.\u003c/li\u003e\n\u003cli\u003eZhong H. Effect of patient reimbursement method on health-care utilization: evidence from China. Health Econ. 2011;20(11):1312\u0026ndash;29.\u003c/li\u003e\n\u003cli\u003ePan X, Dib HH, Wang X, Zhang H. Service utilization in community health centers in China: a comparison analysis with local hospitals. BMC Health Serv Res. 2006;6:93.\u003c/li\u003e\n\u003cli\u003eZhang S, Wang Z, Chang R, Wang H, Xu C, Yu X, Tsamlag L, Dong Y, Wang H, Cai Y. COVID-19 containment: China provides important lessons for global response. \u003cem\u003eFront Med\u003c/em\u003e 2020.\u003c/li\u003e\n\u003cli\u003eHuang H. Social Media Generation in Urban China: A Study of Social Media Use and Addiction among Adolescents. Switzerland: Springer Nature; 2014.\u003c/li\u003e\n\u003cli\u003eFredriksson SV, Alley SJ, Rebar AL, Hayman M, Vandelanotte C, Schoeppe S. How are different levels of knowledge about physical activity associated with physical activity behaviour in Australian adults? \u003cem\u003ePlos One\u003c/em\u003e 2018, 13(11).\u003c/li\u003e\n\u003cli\u003eIoannidis JPA. Coronavirus disease 2019: the harms of exaggerated information and non-evidence-based measures. \u003cem\u003eEur J Clin Invest\u003c/em\u003e 2020:e13223.\u003c/li\u003e\n\u003cli\u003eJin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, Fang C, Huang D, Huang LQ, Huang Q, et al: A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). \u003cem\u003eMilitary Med Res\u003c/em\u003e 2020, 7(1).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nursing, internship and residency, stress, behavior, COVID-19, severe acute respiratory syndrome coronavirus 2, surveys and questionnaires","lastPublishedDoi":"10.21203/rs.3.rs-59638/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-59638/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCoronavirus disease 2019 (COVID-19) has spread globally and resulted in the COVID-19 pandemic worldwide. To depict the psychological and behavioral responses, and knowledge of nursing interns who are facing the COVID-19 epidemic in China, we conducted a knowledge, attitude, and practice (KAP) survey using a convenience sample in the First People’s Hospital of Lianyungang, Kangda College of Nanjing Medical University, Jiangsu Province, China.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA combination of a face-to-face questionnaire survey and an online survey was used for nursing interns from 12 Chinese universities. The Symptom Checklist 90 was used to investigate anxiety and depression of the nursing interns during the COVID-19 epidemic. Self-designed questionnaires were used to investigate behavioral responses, COVID-19-related knowledge, and preventive measures.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eDuring the COVID-19 epidemic, the mean score of anxiety of 237 surveyed nursing interns were not statistically significantly different with that of the Chinese norm (1.42 vs. 1.39, P = 0.354). However, the mean score of depression of them were lower than that of the Chinese norm (1.22 vs. 1.50, P \u0026lt; 0.001). However, no statistically significant difference in the anxiety or depression was found between demographic subgroups. The most common way for the nursing interns to seek for help was asking for instructor or other medical professionals (89.45%). When the nursing interns had suspected symptoms, they will most likely go to the hospital for treatment (97.89%). The nursing interns have good knowledge regarding the origin and prevention of COVID-19 (correct percentage \u0026gt; 94%), however less knowledge regarding treatment and incubation (correct percentage \u0026lt; 10%).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe nursing interns showed relative lower depression in the face of COVID-19 public health emergencies, and took proper preventive measures during the epidemic, however, were lack of certain epidemiology knowledge about COVID-19.\u003c/p\u003e","manuscriptTitle":"Psychological and behavioral responses of nursing interns from 12 Chinese universities during the COVID-19 epidemic: a knowledge, attitude and practice survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-09-01 22:37:21","doi":"10.21203/rs.3.rs-59638/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b34c1537-f46f-496f-91f1-a778fb1fcbe8","owner":[],"postedDate":"September 1st, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":410628,"name":"Nursing"}],"tags":[],"updatedAt":"2020-11-21T20:03:37+00:00","versionOfRecord":[],"versionCreatedAt":"2020-09-01 22:37:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-59638","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-59638","identity":"rs-59638","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}