Comparison of the effect of parenting education through multimedia and social media on parenting stress of nurses in COVID Pandemic

doi:10.21203/rs.3.rs-2008677/v1

Introduction:

The prevalence of the COVID virus has increased nurses’ stress and has affected aspects of their lives such as nurses' relationships with their children. This study aimed to compare the effect of parenting education through multimedia and social media on nurses' parental stress in the COVID pandemic.

Methods

This quasi-experimental study was conducted in 2020 in the selected hospitals in Tehran, Iran. Hospitals were randomly assigned to experimental (multimedia and social media) and control groups (n = 20). Sixty female nurses with children aged 2–5 years were recruited by convenience sampling. Four DVDs, each containing 5 training sessions, were presented to nurses in the multimedia group for four weeks. In the social media group, educational materials were presented in the PowerPoint voiced and delivered to nurses with Rubika and WhatsApp messengers in 20 sessions over four weeks. There was no intervention in the control group. Data were collected using Parenting Stress Index before and two weeks after the intervention.

Results

There was no significant difference between nurses' parental stress scores in multimedia, social media, and control groups before the study (P = 0.956); while this difference was significant two weeks after the intervention (P < 0.0001). So that the nurses' parental stress score in the multimedia group decreased from 83.47 ± 15.46 to 71.16 ± 9.97 (P < 0.0001), in the social media group from 81.5 ± 15.34 to 51.11 ± 3.479 (P < 0.0001), and in the control group increased from 82.9 ± 15.23 to 82.30 ± 15.74 (P = 0.809). Parenting education was more effective in the social media group (P < 0.0001).

Conclusion

Parenting education with social media has a more impact on nurses' parental stress compared to multimedia. Therefore, using this method for psychological training is recommended to reduce nurses’ stress and improve their performance.

Stress

Parenting

Nurse

Multimedia

Social media

Pandemic

COVID

The outbreak of the COVID-19 virus has created an unprecedented situation for millions of families around the world (1). COVID-19 has brought new challenges to all aspects of the lives of parents and their children. Economic stress, physical and mental health concerns, home education challenges, and work-life balance can increase parental stress (2–4). Fear and anxiety caused by the possible infection have created a high and destructive psychological burden that can lead to mental disorders, immunodeficiency, and reducing the body's ability to fight disease in people in the community, including the treatment team (5). So, Huang and Zhao showed that the anxiety of health care workers was than others (6). Also, evidence showed that nurses experienced moderate to high levels of stress during the COVID pandemic (7). The nurses as the main element of care are more than 75% of the treatment team, and they are the first group at the forefront of the COVID pandemic. Therefore, they are more likely to develop psychological disorders, such as stress, and anxiety (8, 9). Evidence suggests that balancing nurses' personal and family lives are closely related to job variables (10). Parenting stress is a psychological disorder that occurs as a result of parents trying to overcome the duties and demands of parenthood. This type of stress needs to be distinguished from other stressful situations (11). Abidin proposed a conceptual theoretical model of parental stress in 1995. Parental stress is a type of stress experienced by parents and is due to the requirements of parenting and in most cases is very closely related to parental dysfunction (12). According to Abidin’s theory, the factors that trigger parental stress can be classified into several areas related to parents, children, and life events. Stressors in the child are related to the child's nature and behavioral factors, such as the degree of adaptability and regularity. Parents’ expectations and perceptions of the child and themselves as parents, parents' personality type, their performance, feel guilty, attachments and psychological disturbances, sense of competence as parents, and relationship with the spouse are trigger factors of parental stress. Environmental stressors are mostly summarized in spousal relationships, educational conflicts, health, social isolation, and job change (11). Meanwhile, empowering parents to manage their relationship with their children can significantly reduce this stress (13). Various factors affect parental stress, but their employment plays an important role in increasing this type of stress (14). Evidence showed that nursing occupation, female gender, history of COVID-19, and having a kindergarten child were the factors increasing parental stress (15). Hosseini et al. reported that stress in female nurses is more than in male nurses. It can be due to caring for children and housework by female nurses (16). On the other hand, Balali et al. found that about 40% of nurses gave moderate to low scores for playing the role of mother (17). Bashirian et al. mentioned that nurses experienced high levels of stress in their relationships with their children during the COVID pandemic (18). Evidence showed that nurses are very busy and usually do not have enough time to attend in-person classes (19, 20). On the other hand, the COVID pandemic has many economic, social, and cultural outcomes in all aspects of the life of the people worldwide, including education (21). Virtual training has received a lot of attention during the COVID pandemic (22, 23). The use of radio, podcasts, television, and online education are the best ways of virtual learning (24). Nowadays, distance learning such as e-learning (web-based technologies) and mobile-based education with features such as increasing the quality of learning, ease of access to a large volume of information, and reduction of educational costs are being replaced by traditional teaching methods (25). Distance learning methods can provide effective and adaptive solutions to improve care for psychological problems worldwide (26). Social media are web-based services that allow users who share common interests to share audio and video content (27). The advantages of these networks are increasing communication in the community, providing appropriate information, fast information transfer (28) increasing intergroup competition (29). and changing the behavior of individuals by creating new forms of cooperation between individuals (30, 31). Another method of distance learning is multimedia education. Providing information through multimedia education is one of the cheapest and most widely used methods worldwide. An educational multimedia message is the teacher-learner communication using words and images that lead to learning. In this method, the combination of words and pictures rather than using words alone facilitates learning (32). The majority of female nurses have maternal responsibilities, so psychological support, parenting education, and changing their lifestyle to reduce their parental stress are doubly important. Due to the limited evidence regarding the use of different educational methods to reduce nurses’ parental stress, especially in the COVID pandemic, this study aimed to compare the effect of parenting education through multimedia and social media on nurses' parental stress in the COVID pandemic.

Design

This quasi-experimental study was conducted in 2020. The entire study protocol was accessed at Aja University of Medical Sciences.

Participants and setting

This study of three groups (two experimental groups and one control group) was performed in four hospitals of an organization in Tehran, Iran. This organization has eight hospitals in Tehran. A researcher’s assistant placed the name of eight hospitals in a container. Before taking the name of the hospitals out of the container by the researcher’s assistant, the researchers decided that the name of the first, second, and third hospitals that is taken out consider for the multimedia, social media, and control groups, respectively. After sampling, the number of nurses in the second hospital was not enough, so the fourth hospital was also selected as a social media group according to the previous method. Sixty female nurses with children aged 2-5 years were recruited by the convenience method. The sample size was calculated with a 95% confidence interval, 90% test power, and based on the previous study (33), and considering a 10% probability of attrition, 20 nurses were recruited in each group.

One nurse from the multimedia group and two nurses from the social media group were excluded from the study due to COVID-19 disease and unwillingness to continue participating in the study. Finally, 19 nurses in the multimedia group, 18 nurses in the social media group, and 20 nurses in the control group were studied. Inclusion criteria included informed consent to participate in the study, not attending the same educational groups at the study time, not receiving simultaneous individual psychological treatment, not receiving psychiatric drugs in the mother and her children, having at least one child in the age group of 2-5 years, at least a bachelor's degree in nursing. Exclusion criteria included not responding to the two text messages of the researchers regarding reading educational content in the multimedia group, and not reading content in two sessions (not sending the phrase “Was studied”) for the social media group.

Data collection

The research tools were 1) demographic characteristics questionnaire (mother's age, spouse's age, mother's education level, number of children, child's age, child's gender, mother's shift work, history of using information resources in the field of parenting). 2) Parenting Stress Index (PSI-SF: Parenting Stress Index) developed by Abidin. This questionnaire has 36 items from 3 sub-scales: “parental distress”, “parent-child dysfunctional interaction”, and “difficult child characteristics”. The “parental distress” sub-scale (items 1 to 12) indicates the level of stress due to individual factors, and the degree of depression or conflict with the spouse due to the limitations that they have for raising a child. The “parent-child dysfunctional interaction” sub-scale (items 13-24) indicates dissatisfaction with the parent-child interaction in cases where the parent does not approve of the child. The “difficult child characteristics” sub-scale (items 25-36) measures the parent's perception of the child's self-regulatory ability. Scoring on a 5-point Likert scale ranges from (1) strongly disagree to (5) strongly agree (34). The range of scores in all three sub-scales is (12-60) and the total range of scores of the questionnaire is (36-180). The sum of the scores of the sub-scales shows the overall stress score, the higher the score, the more parenting stress. The previous study confirmed the validity and reliability (Cronbach's alpha coefficient: 0.92) of the PSI (35). Also, Iranian researchers confirmed the validity and reliability (Cronbach's alpha coefficient: 0.90) of this tool (34). Then, the demographic characteristics questionnaire and PSI were completed by all nurses.

Intervention

Firstly, the researchers prepared the educational content of reducing parenting stress. For this purpose, they searched valid electronic and print literature related to parenting stress. Also, one of the researchers referred to psychology and psychiatric nursing professors in the field of family and child. Then, the researchers prepared titles and educational content for a booklet related to parenting. Then, seven professors and specialists (Doctor of Clinical Psychology, Psychologist, Master of Psychiatric Nursing, Doctor of Nursing, and Doctor of Medical Education) confirmed the validity of the educational content. The final content consisted of two parts, parenting skills and lifestyle methods for mothers.

In the multimedia group, twenty educational sessions were prepared in voiced PowerPoint along with related images and it was recorded on Digital Versatile Discs (DVDs). The duration of each DVD included 5 training sessions of 90 minutes. One DVD was given to the nurses every week for one month. A total of 4 DVDs with a training duration of 6 hours were delivered to them. The researcher sent a weekly text message to the participants. It was a notification for studying the educational content. Also, the phone number of the researcher was provided to the nurses and their questions were answered.

In the social media group, the researcher installed an Iranian messenger called Rubica on the nurses’ smartphones and taught them how to work with it. The important features of this messenger include the possibility of installation on a smartphone, the possibility of exchanging messages and educational clips, movies and music, and a low-consumption Internet messenger. The researcher created a social group in the installed software so that everyone in the group could receive the content, and it was possible for everyone in that group to exchange opinions. She was the group admin. The researcher sent the educational materials in voiced PowerPoint (each 15-20 minutes) for four weeks. They were sent in the form of 5 training content per week at a specific time. Totally, 20 Power Points were sent by Rubica. The training content provided to both experimental groups was the same. Nurses could discuss any questions or ambiguities with the admin.

In the control group, no intervention was performed by the researchers. Two weeks after the intervention, the PSI was completed again by the nurses of the three groups (Figure 1). Intervention and data gathering was performed from September to December 2020.

Data analysis

The data analysis was performed using the SPSS software package (ver. 21), particularly descriptive (i.e., mean, SD, frequency, and percentage) and analytic tests, including paired t-test, Fisher’s exact test, Chi-Square test, Median test, Kruskal–Wallis, and one-way ANOVA. Kolmogorov-Smirnov test was utilized to check the normality of the data, considering the significance level of P>0.05. The statistical analyst was blinded to the control and intervention groups.

Ethical consideration

The Ethics Committee of Aja University of Medical Sciences approved this study (ID: IR.AJAUMS.REC.1398231). In the present study, the Helsinki Declaration was observed (36). The researcher explained the purpose and method of study to the nurses. Then, they signed the informed consent form that was approved by the ethics committee of Aja University of Medical Sciences. The nurses were allowed to voluntarily participate in the study, and withdraw whenever they liked. Nurses were assured that all information would be kept confidential. Researchers protected the participants from physical, psychological, and financial harm. The educational content was provided to the nurses in the control group after the study. In addition, the Committee on Publication Ethics principles were met.

Individual characteristics

The mean age of the nurses and their spouses was 34.24 ± 4.60 (26–44 years) and 37.58 ± 4.26 (28–47 years), respectively. The mean number of children was 1.62 ± 0.58 and all nurses had between 1–3 children. Also, the mean age of the first, second, and third children was 6.82 ± 4.05 (2–17 years), 2.14 ± 4.05 (0–9 years), and 0.12 ± 0.44 (less than a year), respectively. 55% of the first children and 30% of the second children were girls. 41.7% did not have a second child. 93.3% did not have a third child. 85% of the nurses had a bachelor's degree. 55% of the nurses worked the morning shift. 51.7% of the used the Internet as the main source for obtaining information (Table 1).

Table 1

Individual characteristics of nurses in multimedia, social media, and control groups
Variables			Groups			Test, value, df, P-value
Variables			Multimedia f (%)	Social network f (%)	Control f (%)	Test, value, df, P-value
Age (mean ± SD), y			39.9 ± 4.97	33 ± 4.27	34.80 ± 4.50	One-way ANOVA F = 1.085 df = 2 P = 0.345
Spouse's age (mean ± SD), y			37.35 ± 4.8	38.10 ± 4.8	37.30 ± 4.26	One-way ANOVA F = 0.215 df = 2 P = 0.807
First child age (mean ± SD), y			7.3 ± 4.55	5.7 ± 3.69	7.45 ± 3.85	Kruskal Wallis Value = 3.453 df = 2 P = 0.178
Second child age (mean ± SD), y			2.55 ± 2.44	1.7 ± 1.95	1.85 ± 2.07	Kruskal Wallis Value = 0.899 df = 2 P = 0.638
Third child age (mean ± SD), y			0.2 ± 0.61	0.1 ± 0.45	0.05 ± 0.22	Kruskal Wallis Value = 0.582 df = 2 P = 0.748
Number of children (mean ± SD)			1.75 ± 0.64	1.55 ± 0.60	1.55 ± 0.51	Kruskal Wallis Value = 1.324 df = 2 P = 0.516
Education status		Bachelor's degree	18(90)	14(70)	19(95)	Chi-Square Value = 5.49 df = 2 P = 0.064
Education status		Master's degree	2(10)	6(30)	1(5)	Chi-Square Value = 5.49 df = 2 P = 0.064
Shift work		Morning	13(65)	12(60)	8 (40)	Fisher's Exact Test Value = 10.535 P = 0.348
		Evening	0(0)	1(5)	1(5)
		Night	0(0)	2(10)	3(15)
		Morning & evening	2(10)	1(5)	3(15)
		Evening & night	4(20)	3(15)	1(5)
		In Rotation	1(5)	1(5)	4(20)
Child’ gender	First	Girl	12(60)	8(40)	13(65)	Chi-Square Value = 5.196 df = 4 P = 0.224
		Boy	7(30)	12(60)	7(35)
		Missing data	1(5)	0(0)	1 (1.7)
	Second	Girl	6(30)	6(30)	6(30)	Chi-Square Value = 3.06 df = 6 P = 0.911
		Boy	6 (30)	4(20)	6(30)
		No second child	7(35)	10(50)	8(40)
		Missing data	1(5)	0 (0)	0 (0)
	Third	Girl	1(5)	0(0)	0 (0)	Fisher's Exact Test Value = 2.285 P = 1
		Boy	1(5)	1(5)	1(5)
		No third child	18(90)	19(95)	19(95)
Information sources	Book		4(20)	7(35)	7(35)	Fisher's Exact Test value = 6.855 P = 0.545
	Magazine		0(0)	0(0)	1(5)
	Radio and TV		3(15)	2(10)	3(15)
	Internet		13(65)	9(45)	9(45)
	Other sources		0(0)	2(10)	0(0)
SD: standard deviation; df: degree of freedom

Parenting stress

The one-way ANOVA test showed that there was no significant difference between the total parenting stress score of nurses in the multimedia, social media, and control groups before the intervention (P = 0.956), while after the intervention, the difference was significant (P > 0.0001) (Table 2). The results of post-hoc tests showed that there was a significant difference between the total score of parenting stress in the multimedia, the social media, and the control groups two-by-two after the intervention (P > 0.05), so the total stress score in the social media group was lower than the multimedia group.

Table 2

Comparing the total parenting stress score of nurses before and two weeks after the intervention in three groups
Parenting stress Groups	Before intervention	After intervention	Value, df, P-value
Parenting stress Groups	Mean ± SD	Mean ± SD	Value, df, P-value
Multimedia	82.8 ± 15.35	71.16 ± 9.974	^*t = 4.577 df = 18 P < 0.0001
Social media	81.50 ± 18.44	51.11 ± 3.48	^*t = 8.762 df = 17 P > 0.0001
Control	82.9 ± 15.23	82.30 ± 1.74	^*t=-0.245 df = 19 P = 0.809
Value df P-value	^**F = 0.045 df = 2 P = 0.956	^**F = 37.796 df = 2 P < 0.0001
SD: standard deviation, df: degree of freedom; ^paired t-test, ^*one way ANOVA

The paired t-test showed that the mean parenting stress score in the multimedia and social media group decreased after the intervention (P > 0.0001), but this score did not change significantly in the control group (P = 0.809) (Table 2).

Also, the one-way ANOVA test showed that there was no significant difference in the scores of the sub-scale of parental distress (P = 0.176) and the sub-scale of parent-child dysfunctional interaction (P = 0.32) in the three groups before the intervention. In addition, the Kruskal-Wallis test showed that there was no significant difference in the sub-scale score of the difficult child in the three groups before the intervention (P = 0.858) (Table 3). While the Kruskal-Wallis test and the Median test showed that the total scores of the sub-scales of parental distress, parent-child dysfunctional interaction, and difficult child were significantly different in the three groups after the intervention (P < 0.0001) (Table 4).

Table 3

Comparison of scores of nurses' parenting stress sub-scales between three groups before the intervention
Sub-scale	Group	Mean ± SD	Mean Rank	Value, df, P-value
Parental distress	Multimedia	30.50 ± 7.71	-	*F = 1.792 df = 2 P = 0.176
	Social media	26.50 ± 6.84	-
	Control	29.25 ± 5.83	-
Parent-child dysfunctional interaction	Multimedia	25 ± 5.66	-	*F = 1.16 df = 2 P = 0.32
	Social media	27 ± 4.55	-
	Control	27.25 ± 5.07	-
Difficult child	Multimedia	27.30 ± 9.47	30.88	**Value = 0.305 df = 2 P = 0.858
	Social media	28 ± 9.87	31.8
	Control	26.40 ± 8.33	28.83
SD: standard deviation; * One-way ANOVA,** Kruskal Wallis

Table 4

Comparison of the sub-scales the total parenting stress of the subjects two weeks after the intervention between the test and control groups
Sub-scale	Group	Mean ± SD	Mean Rank	Median<	Medium≥	Test, Value, df, P-value
Parental distress	Multimedia	26.47 ± 6.95	35.24	12	7	Value = 33.507= df = 2 P < 0.0001 *Median = 24 Chi-Square = 26.506 df = 2 P < 0.0001
	Social media	16.22 ± 1.99	10.50	0	18
	Control	28.45 ± 6.38	39.73	16	4
Parent-child dysfunctional interaction	Multimedia	22.32 ± 5.26	25.66	7	12	Value = 18.593 df = 2 P < 0.0001 *Median = 22 Chi-Square = 21.733 df = 2 P < 0.0001
	Social media	20.22 ± 1.93	18.86	2	16
	Control	27.45 ± 5.6	41.30	17	3
Difficult child	Multimedia	22.37 ± 5.15	35.26	13	6	Value = 29.734 df = 2 P < 0.0001 *Median = 19 Chi-Square = 23.687 df = 2 P < 0.0001
	Social media	14.67 ± 14.67	11.53	0	18
	Control	26.40 ± 9.41	38.78	14	6
SD: standard deviation, df: degree of freedom; * Kruskal Wallis, ** Median's test

This study aimed to compare the effect of the educational program on empowering female nurses on parenting and lifestyle using multimedia and social media on their parenting stress. Before the intervention, there was no significant difference between the total score and dimensions of parenting stress in the experimental and control groups, and the groups were homogeneous in this respect. These results were consistent with other studies (37, 38). In the study of Mohammadi et al., the mean score of parental stress in the experimental and control groups before the study was 115.75 and 111.78, respectively (37) and in the study of Shiralinia et al. was 112.10 and 116.54, respectively (38) that were higher than this study. The target population of this study was different from their studies. This can indicate the difference in parenting stress scores in previous studies and the present study.

Two weeks after the intervention, the nurses' parenting stress in the experimental groups was lower than the control group. Also, the total score of parenting stress in the social media group was lower than in the multimedia group, which can indicate the more effect of social media education than multimedia education on parenting stress. In this study, in the multimedia teaching method, the interaction between the instructor and the learners was less, and the researcher sent weekly messages to the nurses in the multimedia group, but in the social media group, messages were sent daily. Also, multimedia training was provided by DVDs, so the nurses needed personal computer or laptop to study the educational content, which created time and place limitations for studying. While in the social media group, the educational content were delivered through the Rubika messenger, and the nurses were able to study through smartphones at any place and time. Since educational content was provided weekly in the multimedia group and daily in the social media group, the nurses in the social media group received a smaller amount of educational content at each stage probably created more motivation to study. These results are consistent with other studies (1, 39, 40). Riegler et al. reported that remote parenting psychiatric interventions reduced depression, parental stress, and disorder family functioning in families of military veterans during the COVID-19 pandemic (1). This study and Riegler's study were both conducted during the COVID-19 pandemic and using the virtual education method. Riegler used Online Parenting Pro-Tips and web-based education to train child development and positive parenting by video conference. The training took place for two weeks and in 6 sessions. Of course, in live webinar training, there is more possibility of interaction between the instructor and the learners, but this teaching method requires a live video conference and internet with a suitable bandwidth. While in the present study, multimedia and social media training methods were used, which requires fewer facilities and costs than online training. Ngai et al. showed that the mothers who received behavioral therapy by telephone, compared to mothers who only received usual postpartum care at six weeks had significantly lower levels of parenting stress (40). Their study is also different from the present study in the terms of target population and educational method. Zahedpasha et al. showed training program based on virtual participation was effective on stress and anxiety of parents of premature infants hospitalized in neonatal intensive care units. They used virtual education and telegram application groups for four days and in different groups at different times. The training program was conducted in groups of 2–10 parents (mother and father). Their study is different from this study in terms of the target population and educational content.

This study showed that the nurses’ parenting stress in the multimedia group decreased significantly after the intervention. Also, there was a significant difference between the mean scores of the sub-scales of “parental distress”, “parent-child dysfunctional interaction”, and “difficult child characteristics” after the intervention compared to before the intervention. Also, this study showed that in the social media group, parenting stress and its sub-scales decreased significantly after the intervention. The nurses had the opportunity to study the educational content at any time and place and could share their experiences with other members of the group and the instructor. Evidence indicated that the capacity of social networks can be used at many individual and social levels for education, changing ideas, identifying problems and determining their solutions, establishing social relations, managing organizational affairs, public policymaking, and guiding people in the path of achieving goals (41). Education through social networks is multimodal and does not depend on time and place. Transferring information in this way is easy and facilitates the teaching and learning process (42).

One of the limitations of this study was the reluctance of some nurses to install Rubika software on smartphones. To control this limitation, the researcher explained the objectives of the study to them and encouraged them to install the software and participate in the study.

This study showed that teaching parenting skills and lifestyles through multimedia and social media to female nurses leads to a reduction in mothers’ parenting stress. Education based on social media was more effective in reducing the parenting stress of nurses than the multimedia method. Probably, the reasons for this finding were the greater interaction between the instructor and the learners, the possibility of benefiting from education at any time and place and sending educational content with less volume in the social media group. Since nursing is one of the most stressful jobs and female nurses have multiple tasks and maternal responsibilities, providing psychological support, empowering nurses on parenting and healthy lifestyle, and providing essential training to reduce their parenting stress, especially during the COVID-19 pandemic is necessary. To carry out interventions in the nurses, the cost of the intervention, the novelty of the interventions, and the working conditions of the nurses should be taken into consideration. Therefore, it is suggested to use multimedia training methods and especially social media to empower nurses on parenting and healthy lifestyle and reduce their parenting stress. Also, to interact as much as possible between the participants with the instructor and with each other, more studies should be conducted regarding the comparison of new non-attendance training methods such as online classes and webinars.

DVDs: Digital Versatile Discs

Acknowledgment

We here by express our gratitude to all the participants in the study, the managers, and officials of the studied hospitals who have helped us to conduct this study.

Authors' contributions

MA involved in planning, data collection, interpretation, and writing the paper. SA involved in the study conception, plalannin, interpretation, and critically revising the paper. ZF contributed to data analysis, interpretation, and critically revising the paper. MK involved in the study conception, planning, and critically revising the paper.

Funding

This article is taken from the Master's Thesis of Psychiatric Nursing, which was approved by Aja University of Medical Sciences on 24 December 2019 (ID: 594276). Funders played no role in the conceptualization, design, drafting and approval of the manuscript.

Availability of data and materials

The datasets used and analyzed during the present study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

The Ethics Committee of Aja University of Medical Sciences approved this study (ID: IR.AJAUMS.REC.1398231). In the present study, the Helsinki Declaration was observed and followed. The researcher explained the purpose and method of study to the nurses. Then, all the participants signed the informed consent form that was approved by the ethics committee of Aja University of Medical Sciences. The nurses were allowed to voluntarily participate in the study, and withdraw whenever they liked. Nurses were assured that all information would be kept confidential. Researchers protected the participants from physical, psychological, and financial harm. The educational content was provided to the nurses in the control group after the study.

Consent for publication

Not applicable.

Competing interests

The authors declared no conflicts of interest regarding article publication.

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No competing interests reported.

Comparison of the effect of parenting education through multimedia and social media on parenting stress of nurses in COVID Pandemic

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