Journal of Pediatric Nursing 66 (2022) 15–22

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Journal of Pediatric Nursing

journal homepage: www.pediatricnursing.org

In the eyes of adolescents, is the pandemic an obstacle or a gain?

A qualitative study based on the ecological theory
Sureyya Sarvan, Leyla Muslu ⁎
Akdeniz University, Faculty of Nursing, Dumlupinar Boulevard, Campus, 07058, Konyaaltı, Antalya, Turkey

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: This study was conducted to find out how the COVID-19 pandemic affects the lives of adolescents and
Received 21 December 2021 their expectations about the future.
Revised 10 May 2022 Methods: Data for the study was collected using a descriptive qualitative research design. The sample included 24
Accepted 11 May 2022 adolescents between the ages of 15 and 17, who were recruited according to the purposive sampling method. The
research questions and results were structured according to the Bronfenbrenner's Ecological Theory. Data were
Keywords:
collected until saturation was achieved. NVivo 12 program was used to organize the data. The transcribed data
Adolescent
COVID-19
were analyzed using the inductive thematic analysis method.
Ecological theory Findings: According to the adolescents' views on the pandemic, were identified twelve sub-themes connected to
Qualitative study four main themes and twenty-four metaphor themes in accordance with the Ecological Theory. These were
(a) Microenvironments, (b) Education and social life, (c) Ecological lifestyle, (d) Future expectations, and
(e) metaphor themes about COVID-19. Moreover, adolescents reported negative opinions on all metaphors.
Implications for practice: The restrictions applied as measures of control to the global pandemic mostly nega-
tively affected the family and peer relations of adolescents, their academic and social lives, and their expectations
about the future. This study demonstrates that it is possible to monitor the psychosocial development of adoles-
cents according to the Ecological Theory.
Implications for research: Similar studies may be conducted based on the Ecological Theory to evaluate the devel-
opment of adolescents after the pandemic.
© 2022 Elsevier Inc. All rights reserved.

Starting from 2019 the coronavirus SARS-CoV-2 infection (Cinesi were imprisoned. Moreover, they were disappointed in their opposite-
Gómez et al., 2020), which causes the disease called COVID-19, has sex friendships and received less support from their friends (Chen
caused a global pandemic (WHO, 2020). While this disease has directly et al., 2020; Rogers et al., 2021). They also indicated that they were con-
affected the elderly due to respiratory infections (Cinesi Gómez et al., fused about the future and felt helpless (Ellis et al., 2020; Rogers et al.,
2020; Zhang et al., 2020), it has indirectly affected children and adoles- 2021).
cents (Bahn, 2020; Szabo et al., 2020). Studies show that adolescents are In this study, Urie Bronfenbrenner's ecological theory was used as
in danger of experiencing adverse consequences for both mental and the conceptual framework to identify adolescents' experiences with
physical health as a result of the pandemic (Brown et al., 2019; Leser the Covid 19 pandemic. The Ecological Theory focuses on all the rela-
et al., 2019). With the closure of schools combined with additional tionships that affect the growth and development of the child, which
socio-behavioral measures (social distancing, quarantine etc.), the life- is positioned at the center. During the pandemic, the lives of children
style of adolescents was interrupted (Margaritis et al., 2020; were affected in many ways.
Vanderloo et al., 2020). During this process, studies indicated that ado-
lescents' leisure activities such as sports and games decreased (Guan The ecological theory
et al., 2020; Zenic et al., 2020) and their sleep patterns were disturbed
(Bates et al., 2020). Adolescents reported that their negative emotions Urie Bronfenbrenner asserts that human development is strongly
increased, their positive emotions decreased, their close relationships shaped by the conditions and events that occur in the historical period
with their families limited their personal space and they felt like they in which the person lives and discusses the development of the child
in five interwoven systems (Bronfenbrenner, 1979; Bronfenbrenner &
⁎ Corresponding author.
Evans, 2000; Bronfenbrenner & Morris, 2006). These five systems are
E-mail addresses: ssarvan@akdeniz.edu.tr (S. Sarvan), leylamuslu@akdeniz.edu.tr defined as the microsystem, mesosystem, exosystem, macrosystem
(L. Muslu). and the chronosystem. Since these five systems are interrelated, the

https://doi.org/10.1016/j.pedn.2022.05.012
0882-5963/© 2022 Elsevier Inc. All rights reserved.
S. Sarvan and L. Muslu Journal of Pediatric Nursing 66 (2022) 15–22

impact of one system on a child's development depends on its relation- by the same researcher with online cameras turned on. The adolescents
ship to other systems. The framework of the theory consists of four com- were asked to fill out a personal information form by the same re-
ponents: Namely, process, person, context, and time (Bronfenbrenner, searcher before starting the interviews. The interviews lasted an aver-
1979; Bronfenbrenner & Evans, 2000; Edinete & Tudge, 2013). In other age of 30 min in the adolescent's home and in a room of their choice.
words, the two-way relationship between the child and its environment The interviews were digitally recorded in computer with the consent
focuses on the time, the individual characteristics of the child, and the of the participants and transcribed verbatim.
quality of the interaction with the closest people.
As some studies indicate that curfews, long-term school closures, Ethical considerations
and staying at home with their families during the pandemic may
have a detrimental effect on the physical and psychological health of ad- Approval for the study was obtained from the Ministry of Health Sci-
olescents (Brooks et al., 2020; Wang et al., 2020), the present study was entific Research Platform (Turkey). Ethics committee approval was ob-
conducted to reveal how the COVID-19 pandemic affects the lives and tained from the University Clinical Research Ethics Committee. Before
future expectations of adolescents in Turkey. The research questions data collection, written and verbal consent was obtained from the par-
were based on the Ecological Theory (Bronfenbrenner, 1979; ticipants and their parents, and they were fully informed about the
Bronfenbrenner & Evans, 2000). This article is focused solely on aims and procedures of the study and the necessity of voice recording.
reporting the interview findings regarding the experiences of adoles- The researchers declared that participants' identities and voice record-
cents during the COVID-19 pandemic. ings would be kept confidential and that their subjective data would
be used only for scientific purposes. To ensure anonymity, each adoles-
Method cent was given a unique number between 1 and 24. Participants were
informed that they had the right to withdraw at any time up to the
Design and setting point of data analysis.

This study was conducted using a descriptive qualitative research Data analysis
design (Bradshaw et al., 2017). The authors considered and followed
the Consolidated Criteria for Reporting Qualitative Research (COREQ), Bronfenbrenner's Ecological Theory was used as a framework for
which was designed to encourage clear and comprehensive reporting identifying themes that describe what adolescents are going through
of qualitative work (Tong et al., 2007). during the COVID-19 pandemic. The authors transcribed the interview
data verbatim, then checked all transcripts and compared them with
Participants the original computer recordings (Lindgren et al., 2020). The content
of the text was coded independently by two researchers. The re-
The sample of the study was designated according to the purposeful searchers used the systems of the ecological theory as the framework
sampling method (Patton, 2015). Participants consist of 24 adolescents when coding the data. Later, the two researchers came together to com-
between the ages of 15 and 17 living in Antalya, which is a city located in pare the inconsistencies, similarities and associations in the codes and
the southern region of Turkey. The snowball sampling technique was discussed them throughout the analysis process to reach a consensus.
used to recruit participants. This is a common sampling technique in Finally, main and sub-themes were identified according to the ecologi-
qualitative research, where the researcher does not directly recruit par- cal theory. The themes identified were reviewed by two independent
ticipants, but contacts others through a few participants (Parker et al., researchers (qualitative research specialist and pediatric nursing spe-
2019). The e-mails of the adolescents were obtained from a family cialist) and the validity, reliability, transparency and rigor of the the-
health center located in the city center. Adolescents who were eligible matic content analysis were verified (Maher et al., 2018). In addition,
for the study were invited to participate by an e-mail. Three adolescents kappa analysis was performed for internal reliability (0.860), and it
who responded positively to the email were recruited, and they were was seen that there was a good level of agreement between the coders
asked to forward the same email to their peers. Recruitment was (Landis & Koch, 1977). NVivo 12 program helped organize the data
stopped when names began to recur and data saturation was reached. analysis and the analysis of the data was inductive.
The criteria for inclusion in the study were: (a) being between the
ages of 15 and 17; (b) being able to communicate in Turkish; Validity, reliability and rigor
(c) participating voluntarily; and (d) obtaining parental consent.
To ensure that the process was reliable, the researchers followed
Data collection four criteria; credibility transferability, dependability, and confirmabil-
ity (Maher et al., 2018). To ensure rigor in this research, all qualitative
A data collection strategy based on individual (N = 24) and online interviews were conducted by the authors. The adolescents and the au-
interviews was applied to obtain participants' in-depth perceptions thor did not meet before the data collection interviews. Before starting
and experiences of the COVID 19 pandemic (Grove & Gray, 2018). The the analysis, the coders identified and expressed any personal experi-
interviews were conducted between October–December 2020 using ences, biases, and assumptions that could affect the data analysis
semi-structured and open-ended questions. Seven semi-structured (Creswell & Creswell, 2017). Great emphasis was placed on using a sys-
questions about COVID-19 were designed: How adolescents define tematic approach during coding to increase the reliability of the the-
COVID-19; how the epidemic affects their social life, school life, and matic analysis. The researchers contributed to all phases of the
family life; whether they experience anxiety and fear about COVID-19; analysis to increase internal validity. The themes were supplemented
how they cope with this anxiety and fear; how the epidemic will affect with quotations from different adolescents to increase confirmability.
their future and their expectations about life and the metaphors they
produce about the disease. Potential sources of bias were minimized Results
by seeking expert opinion to evaluate the meaning, purpose, and
scope of the qualitative interview questions. In addition, a personal in- The adolescents consisted of 13 females and 11 males aged 15–17
formation form containing the descriptive characteristics of adoles- years. Their average age was 16.4 years (standard deviation: 1.25).
cents, prepared by the researchers in line with the literature, was used About half of the parents of the adolescents had a university degree,
(Buzzi et al., 2020; Fegert et al., 2020; Liang et al., 2020; Masten & about half of them had a medium income, and most of the adolescents
Motti-Stefanidi, 2020). Adolescents were interviewed privately once had a sibling. Moreover, more than half of the adolescents did not take

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S. Sarvan and L. Muslu Journal of Pediatric Nursing 66 (2022) 15–22

vitamins and mineral supplements, most of them refrained from going Table 2
out during the pandemic, and half of them got information about Themes and sub-themes of study.

COVID-19 from the internet. The demographic characteristics of the ad- Themes Sub-themes
olescents are detailed in Table 1. Microenvironments • The fear of death
• Coping with COVID-19
Themes • Family interaction
• Self-discovery
Education and social life • Change in academic life
Qualitative data were synthesized and four main themes and eigh-
• Restriction of social life
teen sub-themes (Table 2), as well as twenty-four metaphor themes Ecological lifestyle • The value of life
(Fig. 1) were identified. The opinions mentioned by adolescents regard- • Nature's reaction
ing the pandemic were allocated to the following main themes: • Collapse of the economy
(a) Microenvironments, (b) Education and social life, (c) Ecological life- • Lockdown of life
• Concern for future
style, (d) Future expectations, and (e) Metaphors about COVID-19. Future expectations
• Hope

Main theme 1: microenvironments

Sub-theme 1: The fear of death.
The adolescent's microenvironment corresponds to the micro- Adolescents shared their fears about this period. They expressed that
system of the Ecological Theory. The microsystem, which has the they were afraid of death, especially for their family and close friends
greatest impact on the development of the individual, basically includes and also for themselves.
the family and friend groups. According to the Ecological Theory, the ad- ‘I fear of my family, loved ones, friends or myself being infected with
olescent is in the center of this system and the daily life interactions and covid, sometimes I fear I will lose someone I love very much (P13).
experiences of the adolescent enable his/her development and self- ‘I fear because so many people are dying. I am afraid of being sick and
discovery. The influence of the microsystem on the development of not being able to breathe’ (P22).
the adolescent also shapes his/her relationships with other systems Sub-theme 2: Coping with COVID-19.
(Bronfenbrenner, 1999; Bronfenbrenner & Evans, 2000). In this study, The interviews implied that adolescents have developed some posi-
adolescents reported that they discovered themselves while experienc- tive and negative coping methods during this period.
ing complex emotions such as fear and coping, impairment, and ‘I am trying to protect myself from the virus. Washing my hands, having
strengthening of family interactions. a mask on my face and observing social distance make me relax.’ (P15).
The first main theme consists of four sub-themes: the fear of death, ‘I try to lock myself in the room and ensure my isolation’ (P18).
coping with COVID-19, family interaction, and self-discovery. Each sub- Sub-theme 3: Family interaction.
theme represents different aspects of change in the adolescent, family, Adolescents shared their positive and negative experiences regard-
and immediate environment. ing family relationships.
‘We had a long time together as a family, albeit unintentionally. This
Table 1 strengthened our family ties’ (P1).
Socio-demographic characteristics of adolescents. ‘Everyone in my family has found new pursuits to spend their free time
on. When the stress of work and school did not affect our home life, I started
Adolescents Number (n) Percent (%)
to get on better with my family’ (P21).
Age ‘Fights increased because we were always together with our family’
Average age 16.4 ± 1.25
Sex
(P14).
Female 13 54,3 Sub-theme 4: Self-discovery.
Male 11 45.7
Mother'’s education status
Illiterate 2 8.4
Primary 5 20.8
High school 5 20.8
University 12 50
Father'’s education status
Illiterate 1 4.2
Primary 3 12.5
High school 5 20.8
University 15 62.5
Family income situation
Income more than expenditure 8 33.3
Income equal to expenditure 14 58.4
Income less than expenditure 2 8.3
Number of siblings
0 (only child) 3 12.5
1 17 70.8
3 4 16.7
Taking vitamins and mineral supplements
Yes 9 37.5
No 15 62.5
Going out during the pandemic
Once a week 4 16.7
Never 20 83.3
Information resource about COVID-19
Television 7 29.2
Internet 13 54.1
Television and internet 4 16.7
Information time
Average time 38.3 ± 39.14
Fig. 1. Metaphors about COVID-19.

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S. Sarvan and L. Muslu Journal of Pediatric Nursing 66 (2022) 15–22

In our research, one adolescent indicated that social isolation ‘A great massacre that engulfed the world, a plan based on the economic
allowed them to discover themselves. collapse that I think was done on purpose’ (P17).
‘I think absolutely, because I had a long time to discover myself, so the ‘COVID-19 is affecting the world in many ways right now…economi-
me of three months ago and the me of now cannot be the same’(P24). cally, legally, and psychologically’ (P 24).
Sub-theme 4: Lockdown of life.
Main theme 2: education and social life Adolescents stated that the restrictions in social life stopped them
from living their lives, and this caused uncertainty.
The interruption of the interaction between systems of the Ecologi- ‘I cannot go outside. My body is not aware that it is alive’ (P21).
cal Theory due to the restrictions applied during the pandemic ad- ‘After all, the whole world is locked down’ (P7).
versely affected the academic life, friendships, hobbies and leisure
activities of the adolescents. Main theme 4: future expectations
Sub-theme 1: Change in academic life.
When the opinions of adolescents on the pandemic were The fact that the pandemic is global and affects all areas of life has
questioned, it was found that online education was new to most stu- also had a great impact on the chronosystem, the last system of the Eco-
dents, and most of them reported negative opinions especially about logical Theory. This study demonstrated that despite the uncertainty
this sudden transition. Their opinions on this theme are given below: and worry experienced by the adolescents about their future, they
‘My school life and my preparation for university were interrupted, so I were still hopeful.
was psychologically affected; I was extremely stressed’ (P13). Sub-theme 1: Concern for the future
‘It was far more difficult to adapt to lessons from home. So when I was at Some adolescents expressed their concerns about the future due to
school, I understood better’ (P16). uncertainties.
Sub-theme 2: Restriction of social life. ‘I will never forget that we are going through a difficult time; it will
Most of the adolescents mentioned that their social life was limited, affect my future’ (P19).
and they could not pursue leisure activities. ‘I think it will be a lost year and affect my future by taking a year from
‘A negative experience where my freedom was restricted... I can't go to my life’ (P20).
basketball practice that I normally go to regularly and I can't spend time ‘I don't know at all what awaits us in the future; maybe that's what I'm
outside with my friends’ (P18). most afraid of...It takes a lot of things from the world...’ (P9).
‘When we went out, we did not cuddle or even kiss when we said Sub-theme 2: Hope
goodbye to our friends’ (P2). Some adolescents had optimistic outlooks. They expressed that they
‘I do not leave the house and my social life has completely turned to the were hopeful and that this period would lead to new opportunities.
virtual world’ (P4). ‘The number of people in the world is decreasing. In the future, job op-
portunities will increase’ (P12).
Main theme 3: ecological lifestyle ‘The fact that countries help each other shows that their relations can
improve in the future” (P15).
The meaning of ecological life for the individual is to lead a respectful
life in harmony with nature and environment. Although the compo- Main theme 5: metaphors about COVID-19
nents in the macro and exosystem of the ecological theory do not di-
rectly affect the development of the child, they determine the The metaphors produced by the adolescents participating in the
environment in which the child lives and create an indirect effect on study related to COVID-19 are listed in Fig. 1. Although adolescents re-
his/her development (Bronfenbrenner, 1995). ported both positive and negative opinions about the pandemic, they
The changes caused by the pandemic in the exosystem and all produced negative metaphors. Metaphors are classified as the ani-
macrosystem of the Ecological Theory have created changes in the mal, plant, technology, object, abstract concept, nature and the other.
values of the adolescents, who are positioned at the center of the theory. Some opinions on metaphor groups are given below:
Sub-theme 1: The value of life. Animal.
Adolescents commented that they understood the importance of One adolescent produced the metaphor of Cerberus and explained
their daily life cycle during the period of restrictions. the reason as ‘I liken it to Cerberus, the hound of Hades in Greek mythol-
‘When everything is over, I will live with the awareness of how impor- ogy, as if it were an animal’ (P2). One adolescent used the metaphor of
tant and valuable most of the activities I do in my daily life (taking the sub- the sea urchin. The participant explained this as ‘because it looks like
way, traveling, etc.) are actually… Walking outside without fear, even sea urchin, both of them are harmful, prickly on the outside, rough’
going to the market is very valuable for me’ (P13). (P14). One participant produced the chameleon and expressed it as
‘I realized that most of the expenses we make in our daily life are unnec- ‘I liken it to the chameleon, because it constantly changes color, that
essary, that the plans made are not always valid, and that we can live in a is, it mutates’ (P20).
much more minimalist way’ (P5). Plant.
Sub-theme 2: Nature's reaction. One participant produced the baobab metaphor and explained this
The fact that the pandemic is on a global scale and has lasted for a as ‘I used to liken it to the baobab plant. From what I read in The Little
long time has led adolescents to question COVID-19 and search for a Prince, it wouldn't be a problem if it was cut while it was a sapling,
cause-and-effect relationship. They expressed their opinions on this but I think people were careless and allowed it to grow. I think if no
issue. measures are taken, it will be the plant that will cover the entire planet’
‘I think we pay a price for being unconscious people, for harming nature, (P21). Another adolescent produced the metaphor of the cactus and
animals, and the environment, and for using all-natural resources too said ‘I would liken it to a cactus. I liken the COVID-19 virus to a cactus
wastefully’ (P13). because it hurts anyone who touches it’ (P5).
‘It is nature's response to the growth of the human population, to our Technology.
chaotic and incessant One adolescent used the terminator metaphor. When asked why,
population increase’ (P4). the participant said, ‘They are both programmed to murder their own
Sub-theme 3: Collapse of the economy. world’ (P3). Another adolescent produced a metaphor that linked
Adolescents expressed the negative effects and causes of the pan- COVID-19 with the final level monster (of a video game) and expressed
demic on the economy. this as ‘Level end boss’ (P10).

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S. Sarvan and L. Muslu Journal of Pediatric Nursing 66 (2022) 15–22

Object. interactions, they develop in these environments are important

One adolescent, used the black mirror metaphor about COVID-19 microsystems (Bronfenbrenner, 1979).
and stated, ‘We made the world this way’ (P13). In our study, most of the adolescents mentioned about their anxi-
eties and expressed their fear of death for themselves and their loved
Abstract concept ones. It was demonstrated in the literature that the pandemic has cre-
ated many new stressors due to sudden and unprecedented changes
One participant explained using the punishment metaphor and in adolescents' lives, accelerating the already increasing risk of anxiety
said, ‘It is a frightening and annoying situation that makes you de- and depression (Chahal et al., 2021; Crescentini et al., 2020; Loades
pressed, as if we are experiencing the consequences of all evils’ (P11). et al., 2020; Racine et al., 2020; Whittle et al., 2020). Parental health,
Nature. fear of death, separation from friends and closure of schools increase
One participant made a connection between COVID-19 and the sun. the feeling of insecurity in adolescents. In a study, it was found that
The participant said, ‘It looks like the sun, because nobody wants to get being infected by someone from the family or outside the family during
too close to the sun (in order not to get burned). But at the same time, its the COVID-19 pandemic was a risk factor, while living with a family
light is strong enough to cover the whole earth’ (P16). with a stable financial income was among the protective factors against
Other. anxiety (Cao et al., 2020). In another study, it was demonstrated that the
One participant used the metaphor of acne. When asked why, the fear levels of young people about COVID-19 were significantly higher
participant explained that ‘it is very unpleasant and undesirable’ (P6). than those of adults (Kocak et al., 2021). “Stay at home” orders, social
distancing rules, school closures and other measures mandated by the
Discussion government have disrupted the sense of normalcy. These led to feelings
of isolation, fear, and anxiety among adolescents who develop a sense of
This study was conducted on the basis of Urie Bronfenbrenner's Eco- autonomy and often depend on their social connections to form an un-
logical Theory in order to determine the psychosocial effects of the derstanding of themselves (Steinberg & Morris, 2001). These findings
COVID-19 pandemic on adolescents. No study was found in the litera- support the findings of our study.
ture based on this theory. Since this study is based on the Ecological Adolescents who expressed their fear about COVID-19 in our study
Theory, it may contribute to the literature as it reveals not only the also mentioned their opinions on ways of coping. Similarly, in a study
views of adolescents on their microenvironment but also on other sys- conducted in three different countries, it was demonstrated that adoles-
tems that affect them. (Fig. 2). Moreover, the metaphors produced by cents used various coping strategies during the COVID-19 pandemic,
adolescents regarding the pandemic were also included in the study. such as accepting what is happening, emphasizing the advantages of
being at home, and acting as if nothing happened (Orgilés et al.,
Main theme 1: microenvironments 2021). In another study, it was found that adolescents made an effort
to respect the rules in force, planned their daily routines, and used var-
This system covers the pattern of activities, social roles and interper- ious coping strategies such as doing different activities than before, like
sonal relationships experienced by the adolescent developing in a face- cooking, playing video games, reading books, and playing board games
to-face environment with certain physical, social and symbolic charac- (Pigaiani et al., 2020).
teristics. Closed environments such as the home, the peer group, and In our study, the theme of interaction within the family emerged as
the school where the developing individuals live and the direct another sub-theme. Adolescents shared their positive and negative

•Restricon of social
life
•Change in peer
relaonships
•Change in academic Mesosystem
life •Collapse of the
•Self-discovery economy Macrosystem
•Family interacon •Change in •Lockdown of life
•Coping with Covid-19 connecons •Nature's reacon
between •The value of
•The fear of death life
systems
•Worry about family
members geng sick

Microsystem
Exosystem

Chronosystem
Concern for future, hope

Fig. 2. Potential changes in the lives of adolescents according to Ecological Theory.

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S. Sarvan and L. Muslu Journal of Pediatric Nursing 66 (2022) 15–22

experiences about family relationships. In a similar study, it was found Main theme 4: future expectations
that adolescents felt it difficult to stay at home and fighting emerged
(Pigaiani et al., 2020), while in another study, it was demonstrated In our study, the opinions of adolescents implied that the COVID-19
that the quality of parent-child relationship and family satisfaction de- pandemic will affect their expectations and plans for the future. Al-
creased (Hussong et al., 2022). These studies indicate that during the though the adolescents expressed that they were uncertain and worried
pandemic, significant changes have occurred in the microsystem of ad- about the future, it was inferred from some of their statements that they
olescents and in their family and friend relationships. It seems that these were also hopeful. In a study conducted with adolescents in Italy, partic-
changes have had an impact on the psychosocial development of ado- ipants mostly talked about feelings of uncertainty about the near future.
lescents. In this study, about a quarter of the participants stated that they were
disappointed, and thought that the summer would be sad, boring or
Main theme 2: education and social life scary. Only about one-tenth of the adolescents expected that the sum-
mer would still be interesting and entertaining and stated that they
In our research, most of the adolescents reported that they experi- were hopeful (Commodari & La Rosa, 2020).
enced unhappiness and uncertainty due to the change in their academic The fifth and final level of Bronfenbrenner's Ecological Theory, the
life caused by the ongoing COVID-19 pandemic and that their social chronosystem, consists of all environmental changes that occur
lives were restricted. Similarly, in a study conducted in India, it was throughout the lifespan and affect development, including transitions
demonstrated that limited classroom interaction and an inefficient and historical events that occur in life (Bronfenbrenner & Evans,
schedule significantly affected the satisfaction levels among students. 2000). The Covid-19 pandemic has caused disruptions in the
In addition, it was found that half of the students could not use their chronosystem by affecting both the period in which adolescents live
time well during the quarantine period, and their sleep habits, daily ex- and their plans and expectations about the future. Psychosocial devel-
ercise routines, social interactions, and health status were significantly opment in adolescence, which is the transition period from childhood
affected (Chaturvedi et al., 2021). In another study conducted in the to adulthood, requires the adolescent to develop a realistic and positive
United States, three-quarters of adolescents expressed that the worst self-image and identity (Tsang et al., 2012). The acquisition of identity is
situation during the pandemic was limited social opportunities the most important psychosocial aspect of adolescence (Chávez, 2016).
Cockerham et al., 2021). There is reason to believe that changes in the chronosystem will affect
The mesosystem of the Ecological Theory refers to the connections the identity acquisition process of adolescents (van Doeselaar et al.,
and processes that occur between two or more microsystems. It is also 2018). As can be inferred from the views of adolescents, a change in a
defined as a relationship that bridges two micro-systems in the life of system affects all systems just like a chess piece. In order for the devel-
the developing individual. School-family and peer group-family rela- opment of adolescence to be completed in a healthy way, it is necessary
tionships are included in this system Bronfenbrenner, 1979). One of to complete the development of each system and solve its problems.
the most specific changes in the adolescence period is the shift of the Otherwise, problems may be carried to young adulthood or adulthood.
center around which the adolescent's world revolves, from the family
to the peer group. Adolescents must orient towards peers to a greater Main theme 5: metaphors about COVID-19
extent than at previous developmental stages in order to achieve inde-
pendence from their parents. Peer orientation is an important and An important finding of this study is that all participants produced
healthy new stage in the development of children (Brown & Larson, negative metaphors (Fig. 1). As can be seen in Fig. 1, some metaphors
2009). Since the relationship (school, peer) of more than one look positive, but it is inferred from their comments that their opinions
microsystem defined by the ecological theory takes place online during on the metaphors are negative. Similarly, in one study in South Africa,
the COVID-19 pandemic, various disruptions are experienced in these adolescents found themselves “on hold” and “stuck” (Gittings et al.,
systems. Since schools represent the area where adolescents socialize 2021). In another study in Italy, adolescents expressed their situation
most frequently, closing schools and social areas and banning face-to- “as if in a prison, locked between walls and screaming”, “as if it were
face meetings have unfortunately been important changes that have af- winter or autumn” (Commodari & La Rosa, 2020).
fected the development of adolescents. Adolescence is a period during which abstract thinking develops.
The development of abstract thinking can enable adolescents to solve
Main theme 3: ecological lifestyle problems they face. However, this study implied that the long duration
of the pandemic and the negative opinions of adolescents about it may
In our study, adolescents questioned the meaning of life during the have adversely affected their cognitive, psychosocial and emotional de-
pandemic and expressed the reaction of nature, the collapse of the econ- velopment processes. It is even possible that traces of these negative
omy, and the restriction of life. All these sudden changes in the emotions may extend into young adulthood and adulthood (Sanders,
macrosystem surrounding adolescents have caused them to question 2013).
both themselves and the factors in the macrosystem. Since the COVID-
19 pandemic was announced, there has been an unprecedented change Implications for pediatric nursing practice
in the way we organize ourselves socially and in our daily routines. A
sudden withdrawal from school, social life, and outdoor activities have The findings of the study may help pediatric nurses to be aware of
greatly affected adolescents. In a study conducted in Germany, it was potential problems experienced by adolescents. They may plan inter-
shown that children and adolescents felt a significant burden due to ventions to support adolescents socially and developmentally regarding
quarantine, social distance, and education at home. The study demon- these problems. Moreover, they may prepare training that will increase
strated that adolescents' vitality decreased during this period, and that the awareness of adolescents and families about the negative effects of
their tension and depression levels, and emotional fragility increased the pandemic. They may also use the ecological theory to monitor the
(Ravens-Sieberer et al., 2021). development of children and adolescents.
In our study, adolescents also mentioned the “lockdown of life” due
to restrictions. Similarly, in another study on adolescents and youth in Limitations
South Africa, participants described their situation as “on hold” and
“stuck”, and expressed their unfolding anxiety, frustration, and feelings Due to physical restrictions during the pandemic face-to-face inter-
of purposelessness (Gittings et al., 2021). These studies are all in line views could not be held with adolescents. Therefore contextual data
with our study. could not be collected by the researchers regarding the area where the

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participants were located. This also resulted in the exclusion of partici- Bronfenbrenner, U., & Morris, P. A. (2006). The bioecological model of human develop-
ment. In R. M. Lerner, & W. Damon (Eds.), Handbook of child psychology: Theoretical
pants who had little or no access to the technology used on the online models of human development (pp. 793–828). John Wiley & Sons Inc.
platform. Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin,
G. J. (2020). The psychological impact of quarantine and how to reduce it: Rapid re-
view of the evidence. Lancet, 395(10227), 912–920. https://doi.org/10.1016/S0140-
Conclusion 6736(20)30460-8.
Brown, B., & Larson, J. (2009). Peer relationships in adolescence. In R. M. Lerner, & L.
The impact of the COVID-19 pandemic around the world is not over Steinberg (Eds.), Handbook of child adolescent psychology (pp. 74–103). Hoboken,
NJ: Wiley.
yet and will likely continue for the next few years. Like all other coun- Brown, M. R. G., Agyapong, V., Greenshaw, A. J., Cribben, I., Brett-MacLean, P., Drolet, J.,
tries in the world, Turkey is trying to control the pandemic by taking im- McDonald-Harker, C., Omeje, J., Mankowsi, M., Noble, S., Kitching, D., & Silverstone,
portant steps to return to normal life. Researchers are conducting P. H. (2019). After the Fort McMurray wildfire there are significant increases in men-
tal health symptoms in grade 7–12 students compared to controls. BMC Psychiatry, 19
research on how macro-level events such as the COVID-19 pandemic (1), 18. https://doi.org/10.1186/s12888-018-2007-1.
will affect the development of children and young people. We assert Buzzi, C., Tucci, M., Ciprandi, R., Brambilla, I., Caimmi, S., Ciprandi, G., & Marseglia, G. L.
that the Ecological Theory can guide the research on adolescents by pro- (2020). The psycho-social effects of COVID-19 on Italian adolescents’ attitudes and
behaviors. Italian Journal of Pediatrics, 46(1), 1–7. https://doi.org/10.1186/s13052-
viding a framework for determining the development of children and
020-00833-4.
adolescents in systems that have cascaded or intertwined in progress Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., & Zheng, J. (2020). The psychological
of time. Consideration of these systems demonstrate that we should impact of the COVID-19 epidemic on college students in China. Psychiatry Research,
pay attention to the factors that can affect the development of adoles- 287(112934), 1–5. https://doi.org/10.1016/j.psychres.2020.112934.
Chahal, R., Kirshenbaum, J. S., Miller, J. G., Ho, T. C., & Gotlib, I. H. (2021). Higher executive
cents or strengthen them during the global pandemic. Moreover, the control network coherence buffers against puberty-related increases in internalizing
Ecological Theory allows the experience of adolescents (with factors symptoms during the COVID-19 pandemic. Biological Psychiatry: Cognitive
such as the family, friends, society, time) to be comprehensively ad- Neuroscience and Neuroimaging, 6(1), 79–88. https://doi.org/10.1016/j.bpsc.2020.08.
010.
dressed. The authors hope that the findings obtained from this study
Chaturvedi, K., Vishwakarma, D. K., & Singh, N. (2021). COVID-19 and its impact on edu-
will guide future researchers. cation, social life and mental health of students: A survey. Children and Youth Services
Review, 121(105866), 1–6. https://doi.org/10.1016/j.childyouth.2020.105866.
Chávez, R. (2016). Psychosocial development factors associated with occupational and
Author contributions vocational identity between infancy and adolescence. Adolescent Research Review, 1
(4), 307–327. https://doi.org/10.1007/s40894-016-0027-y.
Conception and design: LM, SS. Chen, P., Mao, L., Nassis, G. P., Harmer, P., Ainsworth, B. E., & Li, F. (2020). Coronavirus dis-
ease (COVID-19): The need to maintain regular physical activity while taking precau-
Data collection: SS, LM.
tions. Journal of Sport and Health Science, 9(2), 103–104. https://doi.org/10.1016/j.
Analysis and interpretation: LM, SS. jshs.2020.02.001.
Writing the manuscript: SS, LM. Cinesi Gómez, C., Peñuelas Rodríguez, Ó., Luján Torné, M., Egea Santaolalla, C., Masa
Critical revision of the manuscript: SS, LM. Jiménez, J. F., García Fernández, J., ... Ferrando Ortola, C. (2020). Clinical consensus
recommendations regarding non-invasive respiratory support in the adult patient
All authors approved the final version for submission. with acute respiratory failure secondary to SARS-CoV-2 infection. Medicina Intensiva
(English Edition), 44(7), 429–438. https://doi.org/10.1016/j.medin.2020.03.005.
Cockerham, D., Lin, L., Ndolo, S., & Schwartz, M. (2021). Voices of the students: Adolescent
Funding statement well-being and social interactions during the emergent shift to online learning envi-
ronments. Education and Information Technologies, 26(6), 7523–7541. https://doi.org/
No funding. 10.1007/s10639-021-10601-4.
Commodari, E., & La Rosa, V. L. (2020). Adolescents in quarantine during COVID-19 pan-
demic in Italy: Perceived health risk, beliefs, psychological experiences and expecta-
Declaration of Competing Interest tions for the future. Frontiers in Psychology, 11(559951), 1–11. https://doi.org/10.
3389/fpsyg.2020.559951.
Crescentini, C., Feruglio, S., Matiz, A., Paschetto, A., Vidal, E., Cogo, P., & Fabbro, F. (2020).
No conflict of interest has been declared by the authors. Stuck outside and inside: An exploratory study on the effects of the COVID-19 out-
break on Italian parents and children’s internalizing symptoms. Frontiers in
Acknowledgments Psychology, 11(586074), 1–14. https://doi.org/10.3389/fpsyg.2020.586074.
Creswell, J. W., & Creswell, J. D. (2017). Research Design: Qualitative, Quantitative, and
Mixed Methods Approaches. Sage (publications).
The researchers would like to thank the 24 adolescent who partici- van Doeselaar, L., Klimstra, T. A., Denissen, J. J. A., Branje, S., & Meeus, W. (2018). The role
pated in the study. of identity commitments in depressive symptoms and stressful life events in adoles-
cence and young adulthood. Developmental Psychology, 54(5), 950–962. https://doi.
org/10.1037/dev0000479.
References Edinete, M. R., & Tudge, J. (2013). Urie Bronfenbrenner’s theory of human development:
Its evolution from ecology to bioecology. Journal of Family Theory & Review, 5(4),
Bahn, G. H. (2020). Coronavirus disease 2019, school closures, and children’s mental 243–258. https://doi.org/10.1111/jftr.12022.
health. Journal Korean Academy Child Adolescent Psychiatry, 31(2), 74–79. https:// Ellis, W. E., Dumas, T., & Forbes, L. M. (2020). Physically isolated but socially connected:
doi.org/10.5765/jkacap.200010. Psychological adjustment and stress among adolescents during the initial COVID-19
Bates, L. C., Zieff, G., Stanford, K., Moore, J. B., Kerr, Z. Y., Hanson, E. D., ... Stoner, L. (2020). crisis. Canadian Journal of Behavioural Science, 52(3), 177–187. https://doi.org/10.
COVID-19 impact on behaviors across the 24-hour day in children and adolescents: 1037/cbs0000215.
Physical activity, sedentary behavior, and sleep. Children, 7(9), 138. https://doi.org/ Fegert, J. M., Vitiello, B., Plener, P. L., & Clemens, V. (2020). Challenges and burden of the
10.3390/children7090138. coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: A
Bradshaw, C., Atkinson, S., & Doody, O. (2017). Employing a qualitative description ap- narrative review to highlight clinical and research needs in the acute phase and the
proach in health care research. Global Qualitative Nursing Research, 4, 1–8. https:// long return to normality. Child and Adolescent Psychiatry and Mental Health, 14(20),
doi.org/10.1177/2333393617742282. 1–11. https://doi.org/10.1186/s13034-020-00329-3.
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and Gittings, L., Toska, E., Medley, S., Cluver, L., Logie, C. H., Ralayo, N., ... Mbithi-Dikgole, J.
design. Harvard university press. (2021). ‘Now my life is stuck!’: Experiences of adolescents and young people during
Bronfenbrenner, U. (1995). Developmental ecology through space and time: A future per- COVID-19 lockdown in South Africa. Global Public Health, 16(6), 947–963. https://doi.
spective. In P. Moen, G. H. ElderJr., & K. Luscher (Eds.), Examining lives in context: Per- org/10.1080/17441692.2021.1899262.
spectives on the ecology of human development (pp. 619–647). American Psychological Grove, S., & Gray, J. (2018). Understanding nursing research. Building an evidence-based
Association. https://doi.org/10.1037/10176-018. practice (7th ed.). Amsterdam, Netherlands: Elsevier - Health Sciences Division.
Bronfenbrenner, U. (1999). Environments in developmental perspective: Theoretical and Guan, H., Okely, A. D., Aguilar-Farias, N., del Pozo Cruz, B., Draper, C. E., El Hamdouchi, A., ...
operational models. In S. L. Friedman, & T. D. Wachs (Eds.), Measuring environment Veldman, S. L. (2020). Promoting healthy movement behaviours among children dur-
across the life span: Emerging methods and concepts (pp. 3–28). American Psychologi- ing the COVID-19 pandemic. The Lancet Child & Adolescent Health, 4(6), 416–418.
cal Association. https://doi.org/10.1037/10317-001. https://doi.org/10.1016/S2352-4642(20)30131-0.
Bronfenbrenner, U., & Evans, G. W. (2000). Developmental science in the 21st century: Hussong, A., Midgette, A., Richards, A., Petrie, R., Coffman, J., & Thomas, T. (2022). COVID-
Emerging questions, theoretical models, research designs and empirical findings. 19 life events spill-over on family functioning and adolescent adjustment. Journal of
Social Development, 9(1), 112–115. https://doi.org/10.1111/1467-9507.00114. Early Adolescence, 42(3), 359–388. https://doi.org/10.1177/02724316211036744.

21
S. Sarvan and L. Muslu Journal of Pediatric Nursing 66 (2022) 15–22

Kocak, O., Kocak, Ö. E., & Younis, M. Z. (2021). The psychological consequences of COVID- Ravens-Sieberer, U., Kaman, A., Erhart, M., Devine, J., Schlack, R., & Otto, C. (2021). Impact
19 fear and the moderator effects of individuals’ underlying illness and witnessing in- of the COVID-19 pandemic on quality of life and mental health in children and ado-
fected friends and family. International Journal of Environmental Research and Public lescents in Germany. European Child & Adolescent Psychiatry, 25, 1–11. https://doi.
Health, 18(1836), 1–15. https://doi.org/10.3390/ijerph18041836. org/10.1007/s00787-021-01726-5.
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical Rogers, A. A., Thao, T., & Ockey, S. (2021). Adolescents’ perceived socio-emotional impact
data. Biometrics, 33(1), 159–174. of COVID-19 and implications for mental health: Results from a US-based mixed-
Leser, K. A., Looper-Coats, J., & Roszak, A. (2019). Emergency preparedness plans and per- methods study. Journal of Adolescent Health, 68(1), 43–52. https://doi.org/10.1016/j.
ceptions among a sample of United States childcare providers. Disaster Medicine and jadohealth.2020.09.039.
Public Health Preparedness, 13(4), 704–708. https://doi.org/10.1017/dmp.2018.145. Sanders, R. A. (2013). Adolescent psychosocial, social, and cognitive development.
Liang, L., Ren, H., Cao, R., Hu, Y., Qin, Z., Li, C., & Mei, S. (2020). The effect of COVID-19 on Pediatrics in Review, 34(8), 354–358. https://doi.org/10.1542/pir.34-8-354.
youth mental health. The Psychiatric Quarterly, 91(3), 841–852. https://doi.org/10. Steinberg, L., & Morris, A. S. (2001). Adolescent development. Annual Review of
1007/s11126-020-09744-3. Psychology, 52(1), 83–110. https://doi.org/10.1146/annurev.psych.52.1.83.
Lindgren, B. M., Lundman, B., & Graneheim, U. H. (2020). Abstraction and interpretation Szabo, T. G., Richling, S., Embry, D. D., Biglan, A., & Wilson, K. G. (2020). From helpless to
during the qualitative content analysis process. International Journal of Nursing hero: Promoting values-based behavior and positive family interaction in the midst
Studies, 108(103632), 1–6. https://doi.org/10.1016/j.ijnurstu.2020.103632. of COVID-19. Behavior Analysis in Practice, 13(3), 568–576. https://doi.org/10.1007/
Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., ... s40617-020-00431-0.
Crawley, E. (2020). Rapid systematic review: The impact of social isolation and lone-
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative re-
liness on the mental health of children and adolescents in the context of COVID-19.
search (COREQ): A 32-item checklist for interviews and focus groups. International
Journal of the American Academy of Child & Adolescent Psychiatry, 59(11),
Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/
1218–1239. https://doi.org/10.1016/j.jaac.2020.05.009.
mzm042.
Maher, C., Hadfield, M., Hutchings, M., & de Eyto, A. (2018). Ensuring rigor in qualitative
Tsang, S. K., Hui, E. K., & Law, B. C. (2012). Positive identity as a positive youth develop-
data analysis: A design research approach to coding combining NVivo with tradi-
ment construct: A conceptual review. The Scientific World Journal, 2012, 1–8.
tional material methods. International Journal of Qualitative Methods, 17(1), 1–13.
https://doi.org/10.1100/2012/529691.
https://doi.org/10.1177/1609406918786362.
Vanderloo, L. M., Carsley, S., Aglipay, M., Cost, K. T., Maguire, J., & Birken, C. S. (2020). Ap-
Margaritis, I., Houdart, S., El Ouadrhiri, Y., Bigard, X., Vuillemin, A., & Duché, P. (2020).
plying harm reduction principles to address screen time in young children amidst the
How to deal with COVID-19 epidemic-related lockdown physical inactivity and sed-
COVID-19 pandemic. Journal of Developmental & Behavioral Pediatrics, 41(5),
entary increase in youth? Adaptation of Anses’ benchmarks. Archives of Public Health,
335–336. https://doi.org/10.1097/DBP.0000000000000825.
78(52), 1–6. https://doi.org/10.1186/s13690-020-00432-z.
Masten, A. S., & Motti-Stefanidi, F. (2020). Multisystem resilience for children and youth Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psycho-
in disaster: Reflections in the context of COVID-19. Adversity and Resilience Science, logical responses and associated factors during the initial stage of the 2019 Coronavi-
1(2), 95–106. https://doi.org/10.1007/s42844-020-00010-w. rus disease (COVID-19) epidemic among the general population in China.
Orgilés, M., Morales, A., Delvecchio, E., Francisco, R., Mazzeschi, C., Pedro, M., & Espada, J. P. International Journal of Environmental Research and Public Health, 17(5), 1729.
(2021). Coping behaviors and psychological disturbances in youth affected by the https://doi.org/10.3390/ijerph17051729.
COVID-19 health crisis. Frontiers in Psychology, 12(845), 1–9. https://doi.org/10. Whittle, S., Bray, K. O., Lin, S., & Schwartz, O. (2020). Parenting and child and adolescent
3389/fpsyg.2021.565657. mental health during the COVID-19 pandemic. PsyArXiv., 1–42. https://doi.org/10.
Parker, C., Scott, S., & Geddes, A. (2019). Snowball sampling. SAGE research methods founda- 31234/osf.io/ag2r7. http://doi.org/10.31234/osf.io/ag2r7.
tions. London, UK: Sage Publication. https://doi.org/10.4135/9781526421036831710. World Health Organization (WHO) (2020). Coronavirus disease (COVID-19) out-break. Ge-
Patton, M. Q. (2015). Qualitative research and evaluation methods (4th ed.). Los Angeles: neva, Switzerland: WHO Retrieved fromhttps://apps.who.int/iris/bitstream/handle/
Sage, USA. 10665/332197/WHO-2019-nCoV-FAQ-Virus_origin-2020.1-eng.pdf.
Pigaiani, Y., Zoccante, L., Zocca, A., Arzenton, A., Menegolli, M., Fadel, S., Ruggeri, M., & Zenic, N., Taiar, R., Gilic, B., Blazevic, M., Maric, D., Pojskic, H., & Sekulic, D. (2020). Levels
Colizzi, M. (2020). Adolescent lifestyle behaviors, coping strategies and subjective and changes of physical activity in adolescents during the COVID-19 pandemic: Con-
wellbeing during the COVID-19 pandemic: An online student survey. Healthcare, 8 textualizing urban vs Rural living environment. Applied Sciences, 10(11), 3997.
(472), 1–12. https://doi.org/10.3390/healthcare8040472. https://doi.org/10.3390/app10113997.
Racine, N., Cooke, J. E., Eirich, R., Korczak, D. J., McArthur, B., & Madigan, S. (2020). Child Zhang, L., Wang, D. C., Huang, Q., & Wang, X. (2020). Significance of clinical phenomes of
and adolescent mental illness during COVID-19: A rapid review. Psychiatry patients with COVID-19 infection: A learning from 3795 patients in 80 reports.
Research, 292, Article 113307. https://doi.org/10.1016/j.psychres.2020.113307. Clinical and Translational Medicine, 10(1), 28–35. https://doi.org/10.1002/ctm2.17.

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