Knowledge, Attitudes and Behavior of Nursing Students Towards the Covid-19 Pandemic In Indonesia

Coronavirus disease 2019 (COVID-19) is an emerging respirat caused by the new coronavirus and was first detected in December 2019 in Wuhan, China. As a prospective nurse professional who will engage with patients or partners for counseling about pregnancy decision provide health education. During this pandemic period, there was no research that identified the knowledge, attitudes and behavior of students towards the 2019 coronavirus in Indonesia. The purpose of this study is to find out the description of the knowledge, attitudes, and behavior nursing students against COVID-19 in Indonesia. This cross was conducted from May June 2020. The data was collected online by relying on the writer's network with nursing lecturers in Indonesia and posting to several groups on social media. The inclusion criteria were (i) being a nursing student with Indonesian nationality; (ii) acknowledges the consent given prior to the completion of the survey. A developed questionnaire of knowledge, attitudes and practices towards COVID used. The majority of participants included in the study (> 80%) had a high level of caution regarding droplets and air isolation during the COVID outbreak which indicates that most participants had a positive attitude towards COVID-19. More than 80% of participants agreed that COVID will finally be brought under control and belief that Indonesia can win the battle against the COVID-19. This study can be used as a reference in developing policies for nursing institutions during the 2019 coronavirus pandemic in Indonesia. This open access article is under the CC–BY-SA license. , Sikap, Dan Perilaku Mahasiswa

is an emerging respirat caused by the new coronavirus and was first detected in December 2019 in Wuhan, China. As a prospective nurse professional who will engage with patients or partners for counseling about pregnancy decision provide health education. During this pandemic period, there was no research that identified the knowledge, attitudes and behavior of students towards the 2019 coronavirus in Indonesia. The purpose of this study is to find out the description of the knowledge, attitudes, and behavior nursing students against COVID-19 in Indonesia. This cross was conducted from May June 2020. The data was collected online by relying on the writer's network with nursing lecturers in Indonesia and posting to several groups on social media. The inclusion criteria were (i) being a nursing student with Indonesian nationality; (ii) acknowledges the consent given prior to the completion of the survey. A developed questionnaire of knowledge, attitudes and practices towards COVID used. The majority of participants included in the study (> 80%) had a high level of caution regarding droplets and air isolation during the COVID outbreak which indicates that most participants had a positive attitude towards COVID-19. More than 80% of participants agreed that COVID will finally be brought under control and belief that Indonesia can win the battle against the COVID-19. is an emerging respiratory disease caused by the new coronavirus and was first detected in December 2019 in Wuhan, China. As a prospective nurse professional who will engage with patients or partners for counseling about pregnancy decision-making and ring this pandemic period, there was no research that identified the knowledge, attitudes and behavior of students towards the 2019 coronavirus in Indonesia. The purpose of this study is to find out the description of the knowledge, attitudes, and behavior of 19 in Indonesia. This cross-sectional survey was conducted from May June 2020. The data was collected online by relying on the writer's network with nursing lecturers in Indonesia and edia. The inclusion criteria were (i) being a nursing student with Indonesian nationality; (ii) acknowledges the consent given prior to the completion of the survey. A developed questionnaire of knowledge, attitudes and practices towards COVID-19 was The majority of participants included in the study (> 80%) had a high level of caution regarding droplets and air isolation during the COVID-19 outbreak which indicates that most participants had a positive attitude icipants agreed that COVID-19 will finally be brought under control and belief that

INTRODUCTION
Coronavirus disease 2019 (COVID-19) is an emerging respiratory disease caused by the new coronavirus and was first detected in December 2019 in Wuhan, China. It is highly contagious, and its main clinical symptoms include fever, dry cough, fatigue, myalgia and dyspnea. In China, 18.5% of patients with COVID-19 progress to a severe stage characterized by acute respiratory distress syndrome, septic shock, intractable metabolic acidosis, and bleeding and coagulation dysfunction (The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team, 2020). Empirical clinical data show that the overall case fatality rate for COVID-19 is 2.3% in China, significantly lower than SARS (9.5%), MERS (34.4%), and H7N9 (39.0%) (Chen et al. 2020;Munster et al. 2020;WHO 2020).
The ongoing COVID-19 epidemic has spread at an extremely fast pace, and as of February 15, 2020, the virus has reached 26 countries in total, resulting in 51,857 laboratory confirmed infections and 1669 deaths, with nearly all infections and deaths occurring in China ( 2020). In response to this serious situation, the World Health Organization (WHO) declared it a public health emergency of international concern on January 30 and called for collaborative efforts of all countries to prevent the rapid spread of COVID-19 (WHO 2020). In Indonesia, as of 12 April 2020, the Government of the Republic of Indonesia has reported 4,241 confirmed cases in at least 17 provinces and 373 deaths related to 2019 -nCoV, while 359 patients have recovered from the disease. The Ministry of Health of the Republic of Indonesia (MoH) has taken action to step up response efforts for 2019-nCoV, responding to initial guidelines from WHO on the new coronavirus. Since 17 March 2020, the Government of Indonesia has issued a policy for all institutions to work and learn from home to control 2019-nCoV transmission.
Nursing is an integral part of health services which is the first line of health services (ANA, 1980). In Indonesia, nursing education is currently experiencing rapid development, marked by an increase in nursing education providers, an increase in graduate nursing graduates and an increase in the quality of nursing lecturer education levels (APNI, 2015). Nursing education is different from other scientific education, where students are not only required to have accurate knowledge but also have the skills to apply their knowledge through nursing actions, so that practicum becomes an important part of nursing education (Flood and Commendador 2016).
Knowledge, attitudes and practices (KAP) of corona virus 2019 including information and communication, knowledge, causes and symptoms, prevention, care and seeking care, risks (WHO, 2016a) As a prospective professional nurse who will engage with patients or partners for counseling about pregnancy decision-making and providing health education This open access article is under the CC-BY-SA license.
19) is an emerging respiratory disease caused by the new coronavirus and was first detected in December 2019 in Wuhan, China. It is highly contagious, and its main clinical symptoms include fever, dry ina, 18.5% of 19 progress to a severe stage characterized by acute respiratory distress syndrome, septic shock, intractable metabolic acidosis, and bleeding and coagulation dysfunction (The Novel Coronavirus Pneumonia Epidemiology Team, 2020). Empirical clinical data show that the overall case fatality rate for 19 is 2.3% in China, significantly lower than SARS (9.5%), MERS (34.4%), and H7N9 (39.0%) (Chen et al. 2020;19 epidemic has spread at an extremely fast pace, and as of February 15, 2020, the virus has reached 26 countries in total, resulting in 51,857 laboratory confirmed infections and 1669 deaths, with nearly all infections and deaths occurring in China (WHO 2020). In response to this serious situation, the World Health Organization (WHO) declared it a public health emergency of international concern on January 30 and called for collaborative efforts of all countries to prevent the rapid (WHO 2020). In Indonesia, as of 12 April 2020, the Government of the Republic of Indonesia has reported 4,241 confirmed cases in at least 17 provinces and nCoV, while 359 patients have f Health of the Republic of Indonesia (MoH) has taken action to step up nCoV, responding to initial guidelines from WHO on the new coronavirus. Since 17 March 2020, the Government of Indonesia has issued a ons to work and learn from home to Nursing is an integral part of health services which is the first line of health services (ANA, 1980). In Indonesia, nursing education is currently experiencing rapid development, an increase in nursing education providers, an increase in graduate nursing graduates and an increase in the quality of nursing lecturer education levels (APNI, 2015). Nursing education is different from other scientific only required to have accurate knowledge but also have the skills to apply their knowledge through nursing actions, so that practicum becomes an important part of nursing education (Flood and orona virus-2019 including information and communication, knowledge, causes and symptoms, prevention, care and seeking care, risks (WHO, 2016a) As a prospective professional nurse who will engage with patients or partners for counseling about making and providing health education (Gerdts et al. 2016;Gundacker and Rodriguez 2016).
Maintaining adequate knowledge, attitudes, and practices for nursing students is very important in both endemic and non endemic fields (Harapan et al. 2017;Zam and Bartoloni 2016). Their lack of knowledge will contribute significantly to their attitudes towards disease and has the potential to affect the quality of future patient care (Ali et al. 2017). During this pandemin period, there was no that identified the knowledge, attitudes and behavior of students towards the 2019 corona virus in Indonesia. Identifying knowledge, attitudes and practices towards the corona virus in nursing students is very important as input in policy making i n this pandemic, especially for nursing institutions in Indonesia. The purpose of this study was to describe the knowledge, attitudes and behavior of nursing students towards the 2019 corona virus in Indonesia.

Research design
This cross-sectional survey was conducted from May June 2020. The data was collected online because it was not possible to conduct a national community survey during this pandemic period. The online survey was conducted by relying on the writer's network with nursing lecturers in Indonesia and posting to several groups on social media. Ethical permission to conduct research will be processed before data collection. Participants must answer yes-no questions to confirm their willingness to part voluntarily. After confirming the questions, participants were directed to complete the survey independently. The time of this research was conducted from April to May 2020.

Sample
The sample in this study were nursing students in Indonesia. The i nclusion criteria were (i) being a nursing student with Indonesian nationality; (ii) acknowledges the consent given prior to the completion of the survey. Participation is anonymous, and voluntary. The sampling technique was carried out by convenience samp number of samples recruited is around 1000 students throughout Indonesia.

Instrument
The questionnaire consisted of two parts: demographics and KAP. Demographic variables include age, gender, marital status, education, occupation, and current residence.
The COVID-19 knowledge questionnaire was developed by Zhong (2020). The questionnaire has 12 questions (  (Gerdts et al. 2016;Gundacker and Rodriguez 2016). Maintaining adequate knowledge, attitudes, and practices for nursing students is very important in both endemic and nonendemic fields (Harapan et al. 2017;Zammarchi, Spinicci, and Bartoloni 2016). Their lack of knowledge will contribute significantly to their attitudes towards disease and has the potential to affect the quality of future patient care (Ali et al. 2017). During this pandemin period, there was no research that identified the knowledge, attitudes and behavior of students towards the 2019 corona virus in Indonesia. Identifying knowledge, attitudes and practices towards the corona virus in nursing students is very important as input in n this pandemic, especially for nursing institutions in Indonesia. The purpose of this study was to describe the knowledge, attitudes and behavior of nursing students towards the 2019 corona virus in Indonesia.
sectional survey was conducted from May-June 2020. The data was collected online because it was not possible to conduct a national community-based sampling survey during this pandemic period. The online survey was ter's network with nursing lecturers in Indonesia and posting to several groups on social media. Ethical permission to conduct research will be processed before data collection. Participants must answer no questions to confirm their willingness to participate voluntarily. After confirming the questions, participants were directed to complete the survey independently. The time of this research was conducted from April to May 2020.
The sample in this study were nursing students in nclusion criteria were (i) being a nursing student with Indonesian nationality; (ii) acknowledges the consent given prior to the completion of the survey. Participation is anonymous, and voluntary. The sampling technique was carried out by convenience sampling. The number of samples recruited is around 1000 students The questionnaire consisted of two parts: demographics phic variables include age, gender, marital status, education, occupation, and current residence.
19 knowledge questionnaire was developed by Zhong (2020). The questionnaire has 12 questions (Table  1) Aminah; Eli Amaliyah transmission routes (K5-K7), and 5 regarding prevention and control (K8-K12) of COVID-19. These questions are answered correctly / incorrectly with an additional "I don't know" option. Correct answer is given 1 point and wrong / unknown answer is given 0 points. The total knowledge score ranges from 0 to 12, with higher scores indicating better COVID-19 knowledge. The Cronbach alpha coefficient of the knowledge questionnaire was 0.71 in our sample, indicating acceptable internal consistency (Zhong et al. 2020). Attitudes towards COVID-19 were measured by 2 questions regarding agreement on the ultimate control of COVID-19 and confidence in winning the battle against COVID-19. The respondent's practice assessment consisted of 2 behaviors: going to a crowded place and wearing a mask when going out in the last few days.

Data collection procedure
The research was conducted after obtaining permission and recommendations from the Chairperson of Univeristas Sultan Ageng Tirtayasa Program Diploma 3 in Nursing and the Head of the Serang City Health Office, where the researcher conducted the research. Ethical clearance was obtained from KEPK STIKep PPNI Jawa Barat. As an ethical consideration, the researcher ensures that respondents are protected by fulfilling ethical principles (Polit & Hungler, 2006). Anonymous data is collected during the entire google process. Data is stored on separate servers that only the data manager can access. The data is converted using a codebook. After the data collection step, the data is exported, extracted.

Data analysis
The frequency with which answers to correct knowledge and various attitudes and practices are explained. Scores of knowledge and attitudes and practices of different people according to demographic characteristics were compared by independent sample t test, one-way analysis of variance (ANOVA), or the appropriate Chi-square test. Multivariable linear regression analysis using all demographic variables as independent variables and knowledge scores as outcome variables was performed to identify the factors associated with knowledge. Similarly, binary logistic regression analysis was used to identify factors associated with attitudes and practices. The factors were selected by stepwise backwards. Nonstandard regression coefficient (β ) and odds ratio (OR) and 95% confidence interval (CI) were used to measure the relationship between variables and KAP. Data analysis was performed using SPSS version 17.0. The level of statistical significance was set at p <0.05 (two-sided).

RESULTS
The response rate was 91.7%; There were no significant differences between respondents and non-respondents in terms of education level (p = 0.4), gender (p = 0.3), and mean age (p = 0.5). The majority were women (98.6%), aged 18-19 years (mean ± SD, 19.736 ± 1.61 years), and the majority were diploma III programs. Many of them get their information from the internet (69%). D3 students are easier than S1 (Table 1). The total score of student knowledge was 8.66 (6-12), this shows that the attitude of students towards droplets and airborne precautions during the COVID-19 outbreak was positive. There was no statistically significant difference in the total knowledge score between D3 and S1 students (p = 0.586). While the total score of student attitudes is 9.47 (0-12), this shows that the attitude of students towards droplets and airborne precautions during the COVID-19 outbreak is good. There was no statistically significant difference in the total score of attitudes between D3 and S1 students (p = 0.330). The total score for the student package was 1.32 (1-2), this shows that the practice of students against droplets and airborne precautions during the COVID-19 outbreak was positive. There was no statistically significant difference in the total score of attitudes between D3 and S1 students (p = 0.590). 1.32 ± 0.669 (0-10) 0.590 In this survey, more than 80% of D3 and S1 students answered correctly that the main clinical symptoms of COVID-19 are fever, fatigue, dry cough, and myalgia. The difference with colds, nasal congestion, runny nose and sneezing are less common in people infected with COVID-19. About 78-80% answered correctly that there is currently no effective cure for COVID-19 but symptomatic treatment and early support can help most patients recover from infection. About 87% -89% answered correctly that hospital wards should be informed before admitting to patients who need drip and drip prevention (Table 3). Regarding attitudes, around 89% -96% of both D3 and S1 students agree that COVID-19 can finally be controlled and are confident that Indonesia can win the battle against COVID-19 (Table 4). Table 4 Nursing student attitude of the covid 19 in Indonesia among student (n=362)

Items
Number of agreed answer Nursing Diploma Undergraduate Nursing Do you agree that COVID-19 will finally be brought under control? 95.1% 94.7% Do you have the belief that indonesia can win the battle against the COVID-19? 96.6% 89.5% The practice of nursing students in preventing COVID-19 in not avoiding crowded places is still low, only around 30%, while the use of masks is almost 100% (Table 5).  (Table 6).

DISCUSSION
The majority of participants included in the study had a high level of caution regarding droplets and air isolation during the COVID-19 outbreak which indicates that most participants had a positive attitude towards COVID-19. More than 80% participants agreed that COVID-19 will finally be brought under control and belief that indonesia can win the battle against the COVID-19. Meanwhile, the practice of nursing students against droplets and airborne universal precautions during the COVID-19 outbreak was somehow problems. In addition, they wear masks when left the house but still engange in activity involve many people. Attitudes and practices of COVID-19 prevention and control are important for maintaining safety and learning later when being a nurse in giving the best quality of service by caring for patients and protecting themselves from COVID-19 infection.
Despite their good practices against droplets and airborne prevention during the COVID-19 outbreak, very few are not crowding. Many students have a high perception of the risk of contracting COVID-19. Considering that students cannot practice self-isolation; they are also at greater risk of catching COVID-19 and possibly spreading the infection to their patients. The availability of personal protective equipment in some area is a major issue as supply problems correlate with the development of disease outbreaks. Our findings point to the need for a comprehensive health education and policy plan aimed at increasing the awareness of future health workers to defend and protect themselves as well as people from infection.
Attitude ratings are substantially linked to practice ratings. Nursing student with a good mindset is engaged in further dripping and air insulation precautions during the outbreak of COVID-19. Previous research indicated that attitudes are related to practice, indicating that health care workers with higher attitude scores are more likely to practice SARS-CoV-2 prevention (Papagiannis, 2020). Previous research has reported mixed results on the behaviors and procedures of health workers to Ebola and Zika viruses. Oladimeji et al., in particular, have expressed a good understanding of the Ebola virus, but without a degree of good practice among Nigerian health workers. Attitude and experience surveys are commonly used to detect personality variations and patterns that can help execute effective strategies. Our study was performed early in the epidemic of the disease and can thus help to set priorities for a global public health plan to handle the most dangerous and unsafe practices. Factors that can affect attitudes and practices towards COVID-19 need to be fully understood and identified.

STUDY LIMITTAION
There are a lot of drawbacks to our research. We agree that the nature of the study does not favor the geographical sample of participants. Convenience sampling has limitations on population bias, which can restrict the interpretation of the results of the target sample. In addition. this research offers a questionnaire-based analysis and thus there is a potential for bias in depth. Another possible limitation in our sample could be that the gender of the respondents is overwhelmingly female.

CONCLUSION
Our research highlights the optimistic attitudes and best practices of nursing students towards prevention of droplets and airborne precautions during the outbreak of COVID-19. Tailor-made educational programs and targeted monitoring in order to perform and sustain nursing practices should be compulsory.