Table 6 Data display table of integration findings and meta-inferences

Data display

• Overall severe depressive and stress symptoms, and extremely severe anxiety symptoms in the overall and qualitative samples. Extremely severe stress in the qualitative sample.

• Students experienced low mood, stress and anxiety related to catching COVID, social and peer isolation, online learning & clinical skills challenges, and difficulty accessing learning support.

• Flourishing levels of wellbeing in overall sample, and moderate levels in qualitative sample.

• Students supported their wellbeing through increased self-care, problem-solving, learning new skills, and seeking technical and emotional support.

• Moderate levels of resilience in overall and qualitative samples

• Students dealt with adversity through being proactive and drawing on or developing a range of coping strategies to manage challenges.

• Resilience moderated the relationship between student status and wellbeing

• In adversity students learnt to manage their learning better, prioritise their physical and mental wellbeing, and strengthen their resilience and personal growth.

• Higher depression predicted lower wellbeing

Data reduction and transformation

• Despite significant mental distress, students reported moderate to flourishing wellbeing and moderate resilience.

• Students faced substantial challenges during COVID-19 including mental distress and challenges to their learning.

• When resilience levels were high, international students experienced lower wellbeing than domestic students.

• Students drew on a range of personal, environmental and relational resources to cope with these challenges to their wellbeing and learning.

• Without access to the same supports as domestic students (e.g. family support), international students had to rely more on personal resources such as problem solving.

Data comparison and consolidation

• COVID-19 led to substantial student stress and adjustment due to social isolation and rapid changes to learning and acquisition of clinical skills.

• In the face of this adversity, students had high mental distress but also moderate levels of resilience and wellbeing.

• By drawing on a range of personal, environmental and relational resilience resources, students were able to navigate the adversity of COVID-19.

• Personal resources involved gratitude, self-awareness, cognitive self-regulation, cognitive flexibility, cognitive reframing, physical and psychological self-care, proactive problem solving, time management, active coping, stress management, and having a growth mindset.

• Environmental resources involved access to educational, technical, financial, and clinical skills support, and counselling and employment opportunities.

• Relational resources involved supportive relationships with family, peers and friends, educators, and counsellors.

Data integration and meta-inferences

• Faced with the unique challenges of a global pandemic, most nursing students maintained their wellbeing and resilience, even in the presence of high distress.

• Access to, and engagement with, personal, environmental and relational resilience resources served as protective factors for student wellbeing in this period of extraordinary challenge.