INTRODUCTION AND BACKGROUND:

The world has seen outbreaks of epidemics and pandemic since prehistoric times - 5000 BC China, 430 BC Plague of Athens, AD 165-180 Antonine Plague, The Black Death 1346-1353 Asia to Europe, American Plague 16th century, to the present age like Great Plague of London 1665-1666, Great Plague of Marseille 1720-1723, Philadelphia yellow fever epidemic 1793, Spanish Flu 1918-1920, Asian Flu: 1957-1958, SARS pandemic 2003, H1N1 Swine Flu pandemic: 2009-2010, West African Ebola epidemic: 2014-2016, Zika Virus epidemic: 2015-present day. Covid Pandemic, which is currently affecting the world with its origin in Wuhan, China started in Dec 2019. Affecting nearly all the countries in the world it is a historic health emergency condition the world has ever seen which is even worse than World War II.¹

Novel corona virus was named as coronavirus disease 2019 (COVID-19) by WHO in the month of February and on the same day international virus classification commission announced that Novel corona virus was named as Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). In the past two decades corona virus has caused two epidemic diseases namely severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) (Wit, Doremalen, Falzarano, & Munster, 2016).²

Novel corona virus induced pandemic was first reported when the case started appearing in the month of December 2019 in Wuhan city of china. Over a period of a few weeks, the infection spread across the globe at rapid pace and on January 30th, the WHO declared a public health emergency of international concern. The first reported cases started appearing in January 29 2020 in India. As of October 2020 there were about 79,90,322 confirmed cases of which 6,10,8043 cases were active 72,59,509 of them recovered and 1,20,054 deaths have occurred so far in India (COVID-19 India, 2020).⁵

COVID-19 has been since its origins a highly contagious disease, the virus spread rapidly across the planet, and by early May 2020 it had infected more than 3.3 million people in 187 countries. Due to its high infection rate, lethality and lack of previous immunity, this novel infection has been perceived as a major threat to the life and health of the global human population.³

Understanding the transmission of disease is incompletely understood. Initial investigation in Wuhan at the beginning of the outbreak has identified the source of the infection from a wet market. The virus is transmitted from person to person in the form of fomites, when the person coughs and sneezes. The infection also spreads from when an individual comes in direct contact with the infected surface and the touches his or her nose, eyes or mouth. Droplet transmission usually do not travel more than 6 feet and do not linger in air for a longer period (Schwartz & Graham, 2020).⁵

The incubation period is thought to be within 14 days following exposure, with most cases occurring between four to five days of infection. The spectrum of illness depending on the symptoms ranges from mild to critical. The asymptomatic spread of infection has been documented diamond price cruise ship when all its occupants were tested. Approximately 17% of them tested positive for the virus in which half of them are asymptomatic (Lu et al., 2020).

People of any age with certain underlying medical conditions are at increased risk for severe illness from COVID-19: Chronic kidney disease, COPD (chronic obstructive pulmonary disease), Immune compromised state (weakened immune system) from solid organ transplant, Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies, Sickle cell disease, Diabetes mellitus, Asthma (moderate-to-severe), Cerebrovascular disease (affects blood vessels and blood supply to the brain), Hypertension or high blood pressure, Pregnancy, Pulmonary fibrosis (having damaged or scarred lung tissues), Smoking.⁶

As for the management of the affected patients, asymptomatic patients with mild & moderate symptoms should be isolated to prevent viral transmission to others. Severely sick patients should be transferred to respective intensive care units for expert management.⁶

NEED FOR THE STUDY:

Pandemic is the outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population: a pandemic outbreak of a disease. Pandemics like COVID 19, affects the mental health due to numerous reasons –Uncertainty, poor prognosis, economic loss, insecurity, confusion, emotional isolation, stigma, school/work closure, inadequate resources for medical response, and deficient distribution of necessities. As a result people experience a lot of emotional disturbances such as stress, insomnia, frustration, irritability which could lead to psychiatric disorders like depression, anxiety, behavioral changes (substance abuse), also post-traumatic stress disorder in later stages.¹

Some groups may be more vulnerable than others to the psychosocial effects of pandemics. In particular, people who contract the disease, those at heightened risk for it (including the elderly, people with compromised immune function, and those living or receiving care in congregate settings), and people with pre-existing medical, psychiatric, or substance use problems are at increased risk for adverse psychosocial outcomes. In a descriptive study titled Anxiety, worry and perceived stress in the world due to the COVID-19 pandemic, March 2020 which was conducted in 41 countries, revealed that significant higher scores of perceived stress.⁷

According to India Today (07 Apr 20) there are three major education were observed among women, youth, students, and among those who expressed concern and those who perceived increased susceptibility to the COVID-19. Problems that students and educators currently face due to the Covid-19 pandemic:

1. Students caught in the cross-wire. These are those students who are caught in the limbo on account of education outcomes being withheld due to the Covid-19 pandemic. Some of them do not have a result because exams either did not happen or were left in the middle.

2. Students one year away from school or college-leaving exams.

3. Education disruption.

In response to the Covid-19 scare, many schools and colleges have moved online and parents seem to have assumed the role of teachers. Again, while there are a ton of fantastic resources which are available, there are not too many resources which mimic the school that is, provide for multidisciplinary learning, encourage connections across different domains and inspire ideas which help a child develop 21st century skills and prepare themselves for the jobs of the future⁸

The corona outbreak created a world of ambiguity, loss of control and uncertainty. The feeling of losing control is very stressful for the general population and especially for students. The faculty has an important role to create a sense of control and provide the stable educational structure for the students. Maintaining a stable educational framework, including reducing to minimum any changes in the teaching schedule, announcing information about changes as soon as possible, supplying updated information about the continuance of the academic year and exams. The policy of maximum schedule stabilization during the lockdown was successfully introduced in the nursing department⁹

A survey done was by Dartlet 2020 (US) to assess the effect of COVID 19 on college students. 4 in 5 students see their institutes as trustworthy sources of COVID-19 information. 4 in 5 students report having to make large or drastic life changes to accommodate the current COVID-19 situation. Despite being digital natives, most students are not fully comfortable with an exclusive online learning medium. Thus it is obvious that the covid 19 pandemic has a negative impact on the student’s life. With the imposing stress of COVID 19 on the student, .the present study is focused on the perceived anxiety by the GNM nursing students⁹.

Previous studies from UK and India have revealed that nursing students face comparatively higher level of stress as compared to their counterparts in other colleges. Senturk et al (2018) in Turkey determined in a descriptive study done on the nursing students that the level of stress faced by them was above moderate level. Therefore, dealing with the hectic student nursing life the drastic lifestyle changes imposed due to COVID 19 pandemic can be very challenging. As there is no current study done in India among nursing student, the present study attempts to explore the perceived Anxiety and attitude in returning back to school after lock down among GNM nursing students in the COVID 19 pandemic¹⁰

OBJECTIVES OF THE STUDY:

1. To Assess the level of Anxiety of GNM students in returning back to school after lockdown due to COVID -19 pandemic

2. To Assess the level of Attitude of GNM students in returning back to school after lockdown due to COVID -19 pandemic

3. To find an Association between the level of Anxiety of GNM students in returning back to school after lockdown due to Covid - 19 Pandemic with their selected personal variables.

4. To find an Association between the level of Attitude of GNM students in returning back to school after lockdown due to Covid -19 Pandemic with their selected personal variables.

5. To find the Correlation between level of anxiety and attitude of GNM Students in returning back to school after lockdown due to Covid -19 Pandemic

HYPOTHESIS:

H₁: There will be significant correlation between level of Anxiety and Attitude of GNM students in returning back to school after lockdown due to COVID -19 pandemic.

H₂: There will be significant association between Level of Anxiety of GNM students in returning back to school after lockdown due to COVID -19 pandemic and their selected personal variables.

H₃: There will be significant association between level of Attitude of GNM students in returning back to school after lockdown due to COVID -19 pandemic and their selected personal variables.

ASSUMPTIONS:

1. GNM Students may have some level of anxiety in returning back to school after lockdown due to COVID -19 pandemic

2. Students may have Positive Attitude in returning back to school after lockdown due to COVID -19 pandemic

VARIABLES OF THIS STUDY:

1. Research variable: Anxiety and Attitude level

2. Personal Variables: Personal variables such as Gender, Year of Course, Native State, State you are studying, Area of living, Source of information.

DELIMITATION:

The study is limited to

· Among GNM Students

· Students Studying in JSS School of Nursing, Chamarajanagar.

RESEARCH APPROACH / RESEARCH DESIGN:

An Exploratory Descriptive Survey approach was used.

TARGET POPULATION:

Target population for the present study was GNM Students Studying at JSS School of Nursing Chamarajanagar.

SETTING OF THE STUDY:

The study was conducted at JSS School of Nursing, Chamarajanagar.

SAMPLE/SAMPLE SIZE/TECHNIQUE:

The sample of this study comprised of 70 Students Studying at JSS School of Nursing Chamarajanagar, Non-probability, Convenient Sampling Technique was used to draw the sample.

CRITERIA FOR SELECTION OF SAMPLE:

Inclusive Criteria: GNM students who are

· Studying at JSS School of Nursing, Chamarajanagar

· Willing to participate in the study

· Available during the period of data collection.

Exclusion Criteria: GNM students who are

· Not Studying at JSS School of Nursing Chamarajanagar.

· Not willing to participate in the study.

TOOLS USED FOR THE STUDY:

A Structured rating scale was developed by the investigator based on the research problem; review of related needs and with suggestions and guidance from research guide and experts. The tool consists of the following sections.

SECTION A:

It consists of Personal variables such as Gender, Year of Course, Native State, State you are studying, Area of living, Source of information.

SECTIION B:

Anxiety rating scale consists of 15 items to assess level of Anxiety of GNM Students in returning back to School after lockdown due to COVID -19 pandemic

SECTION C:

Attitude scale consists of 10 items to assess level of attitude of GNM Students in returning back to School after lockdown due to COVID -19 pandemic.

RESULTS:

SECTION I: DEMOGRAPHIC CHARACTERISTICS OF GNM STUDENTS

Table: I- Frequency and Percentage distribution of GNM Students according to their personal variables N = 70

Sl. No	Characteristics	Frequency (f)	Percentage (%)
1.	Gender
a.	Male	8	11.4
b.	Female	62	88.6
2.	Year of Course
a.	I YEAR	20	28.6
b.	II YEAR	26	37.1
c.	III YEAR	24	34.3
3.	Native state
a.	Karnataka	59	84.3
b.	Tamilnadu	11	15.7
3.	Area of Living
a.	Rural	57	81.4
b.	Urban	13	18.6
4.	Source of Information
a.	TV media	59	84.3
b.	News paper	4	5.7
c.	Internet	1	1.4
d.	Social Media	5	7.1
e.	Academics	1	1.4

The data presented in the table 1 shows that majority of the Students are females, studying in second year GNM, more number of students are from Karnataka and belongs to rural area. Majority of the students got there source of information about corona virus from TV media.

SECTION II: LEVEL OF ANXIETY AND ATTITUDE OF GNM STUDENTS IN RETURNING BACK TO SCHOOL AFTER LOCKDOWN DUE TO COVID -19 PANDEMIC.

Table: II - Frequency and Percentage distribution of the level of Anxiety of GNM Students in returning back to School after lockdown due to Covid - 19 pandemic. N = 70

Sl. No	Attitude level	Frequency(f)	Percentage %
a.	No anxiety	1	1.4
b.	Mild anxiety	30	42.9
c.	Moderate anxiety	23	32.9
d.	Severe anxiety	16	22.9
	Total	70	100

The data presented in the table: II shows that among 70 samples has 1.4% no anxiety, 42.9% Mild Anxiety, 32.9% Moderate Anxiety and 22.9% Severe Anxiety

SECTION III: ASSOCIATION OF THE LEVEL OF ANXIETY OF GNM STUDENTS WITH THEIR DEMOGRAPHIC VARIABLES:

Table: VI - Association of the level of Anxiety of GNM Students with their personal variables. N= 70

Sl. No	Variables	Below Median	Above Median	Chi square	Df	P value	Inference
1.	Gender
a.	Male	30	32	0.007	1	0.932	NS
b.	Female	4	4	0.007	1	0.932	NS
2.	Year of Course
a.	I Year	12	8	2.129	2	0.345	NS
b.	II Year	10	16
c.	III Year	12	12
3.	Native State
a.	Karnataka	32	27	4.825	1	0.028	S
b.	Tamilnadu	2	9	4.825	1	0.028	S
4.	Area of Living
a.	Rural	26	31	1.075	1	0.300	NS
b.	Urban	8	5	1.075	1	0.300	NS
5.	Source of information
a.	TV media	27	32	7.373	4	0.117	NS
b.	Newspaper	2	2
c.	Internet	0	1
d.	Social Media	5	0
e.	Academics	0	1

Table: VII - Association of the level of Attitude of GNM Students with their personal variables. N= 70

Sl. No	Variables	Below Median	Above Median	Chi square	Df	P value	Inference
1.	Gender
a.	Male	30	32	0.337	1	0.562	NS
b.	Female	3	5	0.337	1	0.562	NS
2.	Year of Course
a.	I Year	7	13	2.400	2	0.301	NS
b.	II Year	12	14
c.	III Year	14	10
3.	Native State
a.	Karnataka	26	33	1.425	1	0.233	NS
b.	Tamilnadu	7	4	1.425	1	0.233	NS
4.	Area of Living
a.	Rural	28	29	0.483	1	0.487	NS
b.	Urban	5	8	0.483	1	0.487	NS
5.	Source of information
a.	TV media	28	31	3.134	4	0.536	NS
b.	Newspaper	1	3
c.	Internet	1	0
d.	Social Media	3	2
e.	Academics	0	1

The data presented in the table: VI- shows that among 70 samples there was significant association between anxiety and their personal variables such as native state, however it is found that there is no significant association between anxiety and their personal variable such as gender, year of course, area of living and source of information.

The data presented in the table: VII - shows that among 70 samples there was no significant association between Attitude and their personal variable such as gender, year of course, native state, area of living and source of information.

SECTION IV: Correlation between level of Anxiety and Attitude of GNM Students in returning back to School after lockdown due to Covid 19 pandemic:

Table: VIII- Correlation between level of Anxiety and Attitude of GNM Students. N= 70

Varia-bles

Mean

Pearson’s R Value

(p value)

Spearman Correlation value

(p value)

Remarks

Anxiety

35.10

10.968

0.713 (0.0001)

0.701

(0.0001)

High positive correlation

Attitude

34.94

8.214

The data presented in the table: VIII - shows that among 70 samples has High Positive Correlation 0.701 (0.0001) between level of Anxiety and Attitude.

CONCLUSION:

The study finding suggest that there is a anxiety among the students in returning back to school. So that there should be proper Covid-19 safety measures should be taken according to guidelines and individual counselling should be arranged if necessary. Psychological support-oriented programme should be arranged by government or non-governmental agencies. Parents should be encouraged by providing pandemic response and recovery support from the government, to create a friendly and positive family environment for students without imposing pressure on future academic and working career. We believe that providing psychological support and assurance can help in overcome anxiety and perform better in their studies

RECOMMENDATION:

1. A replication of present study can be conducted with a larger population to generalize the findings.

2. A similar study can be conducted in different settings

3. A comparative study can be conducted between different students

REFERENCE:

1. http//:livemedicine.com/worst-epidemics-and-pandemics-in-history.html

2. http//:www.merriam-webster.com

3. https://coronavirus.jhu.edu/map.html (accessed on May 1st,2020)

4. Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ. 2020;368:m408-m.

5. A study to assess the perceived stress and coping strategies among B.Sc. nursing students of selected colleges in Pune during COVID-19 pandemic lockdown. International Journal of Science & Healthcare Research. 2020; 5(2): 280-288.

6. www.ncbi.nlm,nih,gov.A qualitative study on the psychological experience of caregivers of COVID -19 patients

7. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.html

8. Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, et al. (2020) Mental health problems and social media exposure during COVID-19 outbreak. PLoS ONE 15(4): e0231924.

9. https://www.indiatoday.in/education-today/featurephilia/story/how-is-the-covid-19-pandemic-affecting-education-all-over-the-world-1664380-2020-04-07]

10. Limcaoco G S R, Mateos M E, Fernández M J, Roncero C. Anxiety, worry and perceived stress in the world due to the COVID-19 pandemic, March 2020. Preliminary results. Biomedical Research Institute of Salamanca.

11. Doihttps://doi.org/10.1101/2020.04.03.20043992

Received on 03.11.2020 Modified on 28.11.2020

Int. J. Nur. Edu. and Research. 2021; 9(1):27-32.

DOI: 10.5958/2454-2660.2021.00007.7

Variable	Number of Items	Maximum Score	Mean	Mean %	Median	SD
Anxiety scores	15	60	35.23	58.5	34	11.3

Sl. No	Attitude level	Frequency (f)	Percentage %
a.	Unfavorable Attitude	8	11.4
b.	Moderately Favorable Attitude	31	44.3
c.	Favorable Attitude	31	44.3
	Total	70	100

3Principal, Community Health Nursing Department, JSS School of Nursing, Chamarajanagara.

SETTING OF THE STUDY:

³Principal, Community Health Nursing Department, JSS School of Nursing, Chamarajanagara.