Socio-family Factors Predictive of Adaptative Coping Post COVID-19 Pandemic in Nursing Students from a Private University

Abstract Objective: To identify socio-academic and family functionality factors - communication, cohesion, and flexibility - as predictive stimuli of adaptive coping of nursing university students in the post-COVID-19 pandemic. Methods: A cross-sectional descriptive study with stratified random sampling, with participation by 416 Nursing students from a private university in Pereira (Colombia), who answered a self-completed sociodemographic characterization survey, the Olson et al., communication scale, FACES III scale to assess family cohesion and flexibility, and the Calixta Roy CAPS scale to assess coping and adaptation capacity. Binary logistic regression and Hosmer-Lemeshow goodness-of-fit were performed to determine predictors of success, using SPSS v.26. Results: The profiles of the participants showed a higher proportion of women (78.4%), ages between 21 and 30 years (57.5%), young people who study and work (60.1%), and those who have an academic session on Friday and Saturday (67.5%). Nursing students perceive that their families communicate efficiently and satisfactorily (85.8%), have strong cohesion with a tendency towards attachment (73.6%) and flexibility, show a tendency towards chaos (70.7%) and have adaptive coping (48.5%). The success predictors for adaptive coping were female sex (p=0.007), academic session Friday and Saturday (p=0.042), occupation, study, and work (p=0.026), socioeconomic strata 4.5 and 6 (p=0.041), good or very good communication (p=0.001), balanced family cohesion (p = 0.048), and balanced family flexibility (p=0.039). Conclusion: This study found that good family functionality and having adequate socioeconomic conditions were predictors of higher coping and adaptation capacity during the COVID-19 pandemic in the nursing students who participated in the study.

Fatores sociofamiliares preditores de enfrentamento adaptativo pós-pandemia COVID-19 nos estudantes de enfermagem de uma universidade privada Resumo Objetivo.Identifico os fatores socioacadêmicos e a funcionalidade familiar -comunicação, coesão e flexibilidade-, como estímulos preditivos do enfrentamento adaptativo de estudantes de Enfermagem no pós-pandemia de COVID-19.Métodos.Estudo descritivo transversal com amostragem aleatória estratificada.Participaram 416 estudantes de enfermagem de uma universidade privada da cidade de Pereira (Colômbia), respondendo a uma pesquisa autopreenchida de caracterização sociodemográfica e três escalas validadas: Comunicação de Olson et al., FACES III para avaliar a coesão e flexibilidade familiar e a escala CAPS de Calixta Roy, para avaliar a capacidade de enfrentamento e adaptação.Os preditores de sucesso foram analisados com regressão logística binária e Hosmer-Lemeshow, usando SPSS v. 26.Resultados.Os perfis dos participantes mostraram maior proporção de mulheres (78.4%), com idades compreendidas entre os 21 e os 30 anos (57.5%), jovens que estudam e trabalham (60.1%) e que cumprem o horário letivo de sexta-feira a sábado (67.5%).Os estudantes de enfermagem percebem que suas famílias se comunicam de forma eficiente e satisfatória (85.8%), têm forte coesão com tendência ao apego (73.6%) e flexibilidade, apresentam tendência ao caos (70.7%) e têm enfrentamento adaptativo (48.5%).Os preditores de sucesso para enfrentamento adaptativo foram: sexo feminino (p=0.007),jornada acadêmica sexta e sábado (p=0.042),ocupação, estudo e trabalho (p=0.026),estrato socioeconômico 4.5 e 6 (p=0.041),boa ou comunicação muito boa (p=0.001),coesão familiar equilibrada (p=0.048) e flexibilidade familiar equilibrada (p=0.039).Conclusão.Neste estudo, verificou-se que a boa funcionalidade familiar e ter condições socioeconômicas adequadas foram preditores de maior capacidade de enfrentamento e adaptação durante a pandemia de COVID-19 nos estudantes de enfermagem que participaram do estudo.Descritores: estudos transversais; COVID-19; Relações familiares; adaptação psicológica; estudantes de enfermagem; fatores socioeconômicos.Pandemic in Nursing Students from a Private University Introduction A s a result of constant social transference derived from the globalization of the economy, most social formations have incorporated customs, forms, and organizational models that have transformed the traditional notion of family.Since its origins, the family has been conceived as a social cell comprised by individuals with some degree of kinship, as the primary place where the social risks of its members are shared and managed; (1) the idea of family has gone through different moments, consistent with the historical-social development of the peoples, and in each one, the concept has been configured from the different disciplines, from the established hegemonic guidelines, (2) until it is currently read as a diverse, complex, dynamic reality that moves to the rhythm of the social order, with the multiplicity of conflicts and tensions that constitute it.. (3) In this sense, it must be considered that each family has its own dynamics and functionality, being that, as proposed by Palacio, (3) there are five issues that cross it, that are tied in the intimate space of the family and make its identification complex: sexuality, procreation, cohabitation, survival and coexistence; these issues, analyzed in numerous manuscripts within the context of the COVID-19 pandemic (4)(5)(6) force a concept of family as flexible as the institution itself.(9) Numerous authors have characterized the families during times of pandemic.Their writings highlight six analytical categories: (i) Coexistence: modification in family interactions, social interdependence; (7,8) (ii) Reinvention of lifestyles; (9) (iii) Resignification of values; (9,10) (iv) Affective communication: emotion management, expression of affection; (7)(8)(9)(10) (v) Support networks: spirituality enhancement, social and family support, (7,10) and (vi) Adaptation to the situation with change of limits, roles, and routines. (7,10)All these categories guide toward the importance of affective communication, family cohesion, flexibility in roles and responsibilities, as well as deployment of different coping mechanisms in subfamily systems, to survive and stay healthy. (8)thin this context, family health gains strength as one of the performance pillars of the Nursing profession; ethical, legal, and social commitment exists with the comprehensive care of the family.Several nursing theorists have approached the Luz Enith Velásquez Restrepo • Gladys Judith Basto Hernández María Nelcy Muñoz Astudillo family as a subject of care. (11)Considering the impact of the COVID-19 Pandemic on higher education in health, (12) and specifically in Nursing, (13) this study explored a-posteriori the coping and family adaptation mechanisms used by nursing students during the crisis period, for which elements were taken from Calixta Roy's Adaptation Model. (14)ccording to this Nursing theorist, the human system is a set of interdependent and connected parts in function of a whole and adaptation is a process and result through which these human systemscapable of thinking, feeling, and interacting -choose to integrate with their environment.Roy considers that people are in permanent interaction with their environment; all kinds of focal, residual, and contextual stimuli enter dynamically into the human adaptive system that trigger two central coping processes: the regulator (controls internal processes related with physical-physiological needs) and the cognator (regulates self-concept, role function, and interdependence).Depending on the responses triggered, the level of adaptation is assessed; to specifically identify individual nursing intervention needs, Roy differentiates five coping factors: F1: Recursive-centered; F2: Focused physical reactions; F3: Alert process; F4: Systematic processing, and F5: Know and relate. (14)king Calixta Roy's thought as a reference for understanding, the aim is to explore the strength of the relationship between coping and adaptation capacity by nursing students amid the crisis derived from the COVID-19 Pandemic, and the residual and contextual stimuli from their environment: from residual type: some socioacademic characteristics and, contextually, the family functionality.According to Callupe et al., (15) the level of family functioning predicts the degree of resilient coping.Said family functionality is studied from the perspective by David Olson et al., embodied in the Circumplex Model of Marital and Family Systems.(18)(19) The model is centered on the three principal dimensions of the family system: cohesion, flexibility, and communication.Cohesion refers to the support that family members give each other, the mutual commitment to the well-being of another, that is, how united or separated they are from the rest of the family. (16,17)Flexibility refers to the amount of change the family experiences regarding leadership, control, discipline, negotiation styles; that is how stability and change are balanced. (16,17)0) This initial evaluation is constituted as a starting point to facilitate greater levels of adaptation by strengthening family coping mechanisms.The aim of this study was to identify socio-academic and family functionality factors, like communication, cohesion, and flexibility, as predictive stimuli of adaptative coping by university nursing students, during post COVID-19 Pandemic.

Methods
Cross-sectional descriptive study conducted with a population of 1,360 nursing students from a private higher education institution in the city of Pereira in Risaralda, Colombia, in 2021.The sample was random stratified by academic semester, with 95% reliability and 4% precision error; under these conditions, the minimum sample size was 416 students.residence.All the variables were categorical and were dichotomized for the multivariate analysis.

Communication scale by Olson et al., created in
1982 by Barnes and Olson (17) and has been modified up to the 10-item version in a 1 to 5 Likert scale, formulated in positive, so that, the higher the score obtained, the higher the level of communication.
The psychometric properties for its application were analyzed in the Peruvian Institute of Psychological Guidance in 2016, where an internal consistency index of Cronbach's alpha α=0.887 was found. (19)he version used in this study was adapted for Latin America and validated in 2017 with Chilean adult population; a factorial solution of two constructs was found with internal consistencies of 0.895 and 0.854 for each construct. (18)This study reiterated the high reliability of this scale with a Cronbach's alpha of 0.90.

FACES III scale. This version evaluates cohesion and family flexibility
; it has 20 items, in a 1 -5 Likert scale.Odd items value cohesion and even items value flexibility.There are four cohesion levels: detached (disconnected), separate, connected (united) and entangled (amalgamated); the balanced levels are separate and connected.There are four flexibility levels: chaotic, flexible, structured, and rigid; the balanced levels are flexible and structured.The higher the score of the scales, the greater cohesion or flexibility.Proportions permit identifying needs for intervention. (17)Crossing cohesion and flexibility levels in a 4x4 table makes possible 16 family typologies according to functionality, of which four are extremely dysfunctional, eight are moderately functional [medium range] and four are balanced functional.)(23) For this study, application of FACESIII in nursing students showed high reliability, with Cronbach's alpha of 0.92.
The CAPs scale by Calixta Roy, validated for Colombia by Sarmiento et al. (24)  Ethical considerations.For data collection, sensitization was conducted with the selected students, after signing the informed consent, each scale was explained and instruments for self-completion were distributed.Participant anonymity and the right to withdraw from the process were preserved.Approval by the institutional ethics committee was obtained according to the Minutes of May 08, 2022.

Results
The

Communication
It is taken as an axiomatic assumption that all social relationships are built, acquire meaning and trajectory from the forms of interaction.
Communication permits families to construct their social world from the interactions and shared meanings among their members, during the time that they coexist and are maintained as a whole.According to the findings of this study, students perceive that communication between good and very good predominates in 85.8% of their families, which, in addition, is effective and satisfactory.Table 2 shows the proportional distribution of the scores obtained in the scale, the means, and the standard deviation (SD) per item.There is greater dispersion in items 9 and 5 that focus on everyday difficulties to achieve excellent communication when moods are altered.family members request it, support is offered, but not all participate in the decision making.Although there is an opening to share time with friends of family members, people prefer to interact with the closest relatives and enjoy family gatherings.Table 3 shows the frequencies of the scores obtained in the scale, the means, and standard deviation (SD) per perceived behavior.1.The cohesion scale shows tendency to attachment, when adding the united and amalgamated typologies (73.6%), while that of flexibility is inclined toward chaos, when joining the flexible and chaotic typologies (70.7%).16 family typologies emerge.The proportions found for each typology are registered in Table 5.The highest proportion corresponded to functional families (41.3%), followed by the middle range (37.5%) and, lastly, extreme dysfunctionality (21.2%).Coping and adaptation.As seen in Table 6, the factors with the highest percentage in high coping capacity were F1 Centered recursive, F4 Systematic processing, and F5 Know and relate.These findings permit characterizing creative families, who seek results based on their knowledge, have a methodical capacity to solve problems with concrete actions, and use effective social interaction strategies.In over half the students, adaptative coping was found at compensatory level.

Relation between sociodemographic variables and components of family dynamics
Significant relations were sought between the dichotomized sociodemographic variables (SD) and the family dynamics variables of communication, cohesion, flexibility, and adaptative coping.To dichotomize the variable of adaptative coping, the total score of the CAPs scale was used.The scale range used is from 0 to 99; in medium coping, scores are between 57 and 70.The midpoint corresponds to 63.A score above 63 was considered adaptive coping.shows satisfaction, listening capacity, expression of affection, interest in the other, mutual support within the family is reaffirmed as the principal component of family functionality for coping success during moments of crisis.It the study by Garcés et al., (8) family communication, in significant manner, was established as a predictor of perceived stress; offensive communication, linked to health concerns and problems in family life, increases high negative stress up to 37.9% of the total variance.In turn, Araújo et al., (25) found that a good level of communication among university adolescents and their parents predicts enjoyment and time spent on joint recreational activities.
Cohesion, in our study, showed balanced families, favorable for family functionality; in other contexts, it revealed variations, according with the specific conditions of the dynamics analyzed.The study by Lebow (26) highlighted the stable coexistence of the couple as a protective factor to control negative stress.Lacomba et al., (27) found relationships among family support, development of emotional regulation strategies, and resilience during moments of crisis.Robles et al., (28) exposed family conflicts related with mourning, violence, invasion of privacy, anxiety, stress, and economic hardship with direct impact on tuition financing and student academic performance.
Flexibility in our study scored for family balance, however, the means obtained in the items were very low and these favored the presence of families with extreme dysfunction.Several studies showed greater capacity to balance stability and change; Aponte et al., (29) observed that family members committed to decision making and obligations of household maintenance; Callupe et al., (15) found significant correlations among flexibility, emotional bonding, family functioning, and resilient coping.This work concludes that balanced family functionality, good family communication, cohesion, and family equilibrium, as well as good socioeconomic conditions predict adaptative coping in the nursing students who participated in the study during times of COVID-19 postpandemic.In this group it is necessary to strengthen family cohesion, seeking spaces for more frequent approaches when decisions are to be made involving the entire group and promoting participation by other close family members in joint activities.It is, likewise, important to strengthen family flexibility with respect to leadership, discipline, control, roles, and rules.
For professional nursing care, it is important to bear in mind that each family has a different Dynamic and specific way of coping with different stimuli; hence, family functionality should be examined in comprehensive manner, for which, Olson's Circumplex Model is a good theoreticalmethodological alternative.

Study limitations:
The Institution where the study was conducted is of private nature and the results are limited to the institutional situation observed.

Four
instruments were used to collect the information: Sociodemographic characterization survey that included 10 variables: age, sex, marital status, number of children, living with whom, household strata, occupation, semester in course, scheduled academic session (A: Monday to Thursday and B: Friday and Saturday), and department of Socio-family Factors Predictive of Adaptative Coping Post COVID-19 Pandemic in Nursing Students from a Private University

Figure 1 .
Figure 1.Cohesion and flexibility in families of 416 nursing students

Table 1 . Sociodemographic characterization of the 416 nursing students
B for Friday and Saturday and came to study from Valle del Cauca and Risaralda.Luz Enith Velásquez Restrepo • Gladys Judith Basto Hernández María Nelcy Muñoz Astudillo

Table 4 )
. Pandemic in Nursing Students from a Private University

Table 5 . Functionality levels and Family typologies in students
Socio-family Factors Predictive of Adaptative Coping Post COVID-19 Pandemic in Nursing Students from a Private University

Table 6 . Coping factors and levels of family adaptation (CAPs) in 416 university nursing students
* Nº items Scale 0 to 3