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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 23  |  Issue : 1  |  Page : 67-75

Perception of Indian nursing students about e-learning during COVID-19 pandemic: A cross-sectional study


1 Nursing Tutor, College of Nursing, AIIMS, Patna, India
2 Stroke Team Coordinator, Neurology Nursing Coordinator, PGIMER, Chandigarh, India
3 Assistant Professor, Manikaka Topawala Institute of Nursing –CHARUSAT, Anand, Gujarat, India
4 Nursing Officer, NIMHANS, Banglore, India

Date of Submission23-Jul-2021
Date of Decision23-Mar-2022
Date of Acceptance23-Mar-2022
Date of Web Publication28-Apr-2022

Correspondence Address:
Ms. Shelly Dhawan
AIIMS, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcn.ijcn_71_21

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  Abstract 

COVID-19 pandemic led to abrupt disruption in the routine functioning of nursing education, which resulted in a sudden transition from on-campus face-to-face learning to e-learning approaches. The fast advancement of science and technology insists educational institutions think about different ways of teaching and learning in both formal and informal environments. The purpose of this study was to investigate the nursing student's perceptions regarding e-learning. This cross-sectional study was conducted by using non-probability sampling technique. Data from 835 graduate and post-graduate nursing students across the nation were collected through 20 items web-based questionnaire to sort information regarding their perception towards benefits and limitations of e-learning, challenges encountered and required modifications in teaching–learning techniques through online platform. Findings of this study suggested that nursing students find e-learning beneficial in terms of saving time to travel and their ability to communicate. Students perceived this technique limited as far as problem-solving techniques, clinical skills, teamwork etc., are concerned. In this study, 42.4% and 38.9% of students agreed and strongly agreed respectively that utilisation of excessive data and connectivity is one of the encountered challenges while learning through e-platforms. 64.6% of students stated their preference to learn some part of the syllabus through online mode even after pandemic. A well-planned e-learning method can deliver numerous benefits but student retention in virtual/e-learning can be a barrier to the growth of technology depended teaching–learning. The future of nursing education should include a combination of technology-based and traditional learning.

Keywords: Coronavirus disease 2019, e-learning, nursing students, pandemic


How to cite this article:
Dhawan S, Kumar M, Joshi B, Singh A. Perception of Indian nursing students about e-learning during COVID-19 pandemic: A cross-sectional study. Indian J Cont Nsg Edn 2022;23:67-75

How to cite this URL:
Dhawan S, Kumar M, Joshi B, Singh A. Perception of Indian nursing students about e-learning during COVID-19 pandemic: A cross-sectional study. Indian J Cont Nsg Edn [serial online] 2022 [cited 2022 Aug 20];23:67-75. Available from: https://www.ijcne.org/text.asp?2022/23/1/67/349906


  Introduction Top


The COVID-19 pandemic has been associated with a variety of public health morbidity and mortality trajectories, affecting the physical as well as psychosocial health of the individual in different parts of the world. The announcement of COVID-19, a public health emergency by the World Health Organization forced a majority of countries to follow social distancing norms to limit the virus spread. Thus, to prevent gathering and following social distancing norms, various colleges and institutions have been closed without any further notice. With advancements in information technology like e-learning, education has been continued in various disciplines including nursing, especially at a difficult time of the COVID-19 pandemic crisis.

The pandemic leads to never pretend disruption in the routine functioning of nursing education resulted in a sudden transition from on-campus face-to-face learning to e-learning approaches, which is challenging for both faculty and students as it requires much planning over a short period.[1] At this pandemic time, when health care is suffering from a serious shortage of nurses, educating the student nurses during pandemic through e-learning is more important than ever before. Globally, many nursing institutions are offering e-learning courses for nursing students.

The concept of e-learning is not new as it has been a part of many academic courses for a long time. The success of the e-learning method is dependent on the learner's ability, their interest in technology use.[2] Students' and educators' perception regarding e-platforms as teaching–learning method is extremely important to make it interesting and feasible. Undoubtedly, technology-based learning has captured the nursing education worldwide and made learning more convenient.[3]

Although there is no standard or recognised definition of e-learning for research purposes, it can be defined as a wider concept that involves any educational intervention mediated electronically through the internet and does not require learners to be present at a specific location.[4]

India is the second-largest user of information technology as part of teaching–learning methods after the USA.[5] Many nursing educationalists believe that in future the nursing education will find no room to avoid the utilisation of information technology with the integration of the traditional approach of teaching and learning. E-learning holds a wide variety of advantages for learners by providing a time-efficient and flexible schedule which attracts the learner's acceptance.[6],[7] Escalation of COVID-19 pandemic to global public health emergency has urged nursing institutions to consider e-learning and simulation instructions as an alternative to clinical and traditional nursing practices to avoid social interaction of students.[8]

The popularity of e-learning in nursing education is increasing rapidly and the impact of the pandemic on nursing education is noticeable; thus, there is a need to understand nursing students' perceptions about e-learning during this pandemic.[9]

The purpose of this study was to investigate the nursing students' perceptions regarding e-learning and specifically to seek answers to the following:

Objectives of the study were

  • To assess the perception regarding benefits and limitations of e-learning during COVID-19 pandemic among nursing students
  • To assess the challenges encountered by nursing students while learning through e-platform during COVID-19 pandemic
  • To assess the perception regarding required modifications in e-learning techniques among nursing students
  • To find out the association between the perception of nursing students with their socio-demographic characteristics.



  Methodology Top


A descriptive cross-sectional study was conducted to collect data from 835 (undergraduate and post-graduate) students studying at various nursing institutions across India. The sample size could not be estimated due to non-availability of the previous study related to this research project. This pandemic happened suddenly and there was abrupt transition to online teaching–learning from traditional classroom teaching. There was a scarcity of enough evidence related to the current topic. This study aimed to enrol maximum number of participants (nursing students) from all over the country and all the possible efforts were made by researchers with regard to that. For this study, a total of 1285 students were approached through a web based link, out of which 835 responded. Hence, the response rate was 64.9%. Non-probability (convenient) sampling was used to choose nursing institutions and students. Participants were approached by using researchers' contacts with faculty members working in various nursing institutions. In order to collect data from maximum number of subjects, web-based link was shared with faculty members which was further shared by them with their students. Repeated gentle reminders were given to the faculty members to share link with maximum number of students.

Data regarding socio-demographic characteristics, nursing students' perceptions regarding benefits and limitations of e-learning, challenges encountered while learning through e-platforms during pandemic and modifications required to improve learning through online mode were collected by using socio-demographic profile (6 items) consisted of personal information of nursing students i.e., age, enrolled course, class, type of institution, formal training in using computers and possession of electronic gadgets with internet facility and Likert scale. Tools were developed by the researchers and validated. After making final corrections, the tool was administered to 50 students and data were used to assess the reliability. It was established by split-half method (Cronbach's alpha-0.73). This Likert scale is consisted of 14 items which are further divided into four domains. Each item score ranges from 1 to 5, where 1 refers to strongly disagree, 2 refers to disagree, 3 refers to neutral, 4 refers to agree and 5 refers to strongly agree. First domain is perception regarding benefits of e-learning (3 items) – total score ranges from 3 to 15, score 9 refers to overall neutral response, higher the score, more are the perceived benefits of e-learning. Second domain is perception regarding limitations of e-learning (6 items) – total score ranges from 6 to 30, score 18 refers to overall neutral response, higher the score, more are the perceived limitations of e-learning. Third domain is perceptions regarding challenges encountered while attending e-classes during lockdown (2 items) – total score ranges from 2 to 10, score 6 refers to overall neutral response, higher the score, more are the perceived challenges encountered while learning through e-platforms. Fourth domain is perception towards required pre-requisites and modifications (3 items) – total score ranges from 3 to 15, score 9 refers to the overall neutral response. Higher the score, higher is the perception towards required pre-requisites and modifications. Descriptive and inferential statistics was applied by using mean, median, SD, frequency distribution and independent t-test, ANOVA, post hoc test, respectively.

Ethical permission was taken from institutional review board of Manikaka Topiwala Institute of Nursing, Gujarat, India. Participating in the e survey was considered consent to participate in the study.


  Results Top


Socio-demographic profile

The socio-demographic finding of the students revealed that 61.3% of the students were between the age group of 18–22 years and only 5.9% were more than 27 years of age. Most of the students (65%) were pursuing Graduation from government institutions (56.3%). In this study, 31.9% of the students had formal training in computers but most (97%) of them had smartphone/laptop with an internet facility [Table 1].
Table 1: Sociodemographic characteristics of nursing students

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Findings related to overall mean score and standard deviation

[Table 2] represents that the overall mean score and standard deviation of perceived benefits of e-learning by nursing students is 9.9 ± 2.5, which is slightly higher than overall neutral response.[9] This suggests that students have not found e-learning much beneficial. Data also revealed that nursing students' perceptions regarding limitations of e-learning are 23.2 ± 3.2, which is higher than the overall neutral response. This finding shows that students invariably perceive e-teaching learning methods limited in nature as far as clinical expertise, confidence, teamwork, etc., are concerned. Data also show that perception regarding challenges encountered during learning through e-platform is 7.7 ± 1.3 which is again higher than the overall neutral score of six. This finding shows that learning through e-platforms poses many challenges to students. This table also represents mean and SD of perceptions of nursing students regarding modifications required to improve e-teaching learning methods (10.8 ± 1.6). This is higher than overall neutral response of score nine.
Table 2: Mean score of nursing students' perceptions towards benefits and limitations of e - learning, challenges encountered and required pre-requisites and modifications

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Findings related to association

[Table 3]a and [Table 3]b represents the association and post hoc test of nursing students' perceptions regarding benefits and limitations of e-learning, challenges encountered and required pre-requisites and modifications with selected variables.
Table 3:

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[Table 3]b represents post hoc test for the association of nursing students perceptions regarding benefits and limitations of e-learning, challenges encountered and required pre-requisites and modifications with selected variables n = 835.

[Table 4] represents frequency (percentage) distribution of nursing students' perceptions towards benefits, limitations of e-learning encountered challenges, required pre-requisites and modification.
Table 4: Frequency (percentage) distribution of perceptions of Indian nursing students regarding benefits, limitations, challenges and required prerequisites of E-learning

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As shown in [Table 3], data revealed that nursing students getting education from private nursing institutions find e-learning more beneficial (10.4) as compared to students from government colleges (9.5) with statistically significant P = 0.001. Furthermore, students who were doing MSc Nursing perceive more benefits (10.2) as compared to undergraduate students (9.7) with a P = 0.01. Students who have already received formal training in computers reported more benefits (10.4) as compared to the students who did not receive any training (9.6) with a P = 0.0001. Data represent that nursing students' perception regarding benefits, limitations, required pre-requisites and modifications was significantly associated with their age and enroled class.

There was no statistically significant association found between perceived limitations of e-learning by nursing students with their selected socio-demographic variables such as type of institution, enroled course, formal training in computers and smartphone/laptop with internet facility.

Interestingly, students who had received formal training in computers perceived more challenges (7.8) while learning through e-platforms as compared to other students (7.6) with P = 0.02. The reason could be that students who already had computer training in past might have expected not to encounter problems during e-learning but when issues were faced, they perceived it more as compared to the students who expected to encounter difficulties while e-learning, since they have not received any formal training in computers. There was no significant association found between perception regarding encountered challenges with age and enroled class.

Furthermore, students from private institutions (11.3), pursuing post-graduation (11.1) and had formal training in computers in past (11.2) were more interested in improving e-learning by inculcating modifications with a P = 0.0001 as compared to students from government institutions (10.5), pursuing graduation (10.7) and with no formal training (10.7).

[Table 3]b (provided in hyper-link) represents post hoc test for the association of nursing students' perceptions regarding benefits and limitations of e-learning, challenges encountered and required pre-requisites and modifications with age and enrolled class. Data revealed that nursing students whose age lies between 18 and 22 years perceived significantly higher benefits (10.0) as compared to students between the age group of 23–26 years (9.5) with a P = 0.003. Again, students whose age was more than 27 years perceived benefits (10.8) even more than 18–22 years with a P = 0.05. Findings also showed that students with age 27 years or more perceived significantly less limitations (21.5) of e-learning than the age group of 18–22 years (23.2) and 23–26 years (23.3) with a P = 0.001 and 0.0001, respectively. Data also revealed that students with age more than 27 years more were interested in recommending required modifications in e-platforms to enhance learning (11.3) than the age group of 23–26 years (10.7) with a P = 0.02.

Data also show that 1st year students found e-learning significantly more beneficial (10.6) as compared to 2nd year (9.9), 3rd year (9.5) and 4th year (9.6) with P = 0.002, 0.0001 and 0.0001 respectively. In addition, 2nd year students perceived less limitations (22.8) as compared to 3rd year (23.7) with a P = 0.004.

Findings related to frequency distribution of nursing students' perceptions

As shown in [Table 4], data showed that 43.6% of nursing students agreed that e-learning saves their time which was earlier consumed to travel to institute. Approximately half of the participants (48%) agreed that e-platforms limit their understanding of problem-solving techniques. More than half of the participants (51%) agreed that loss of contact with patients during this pandemic make them feel less confident as far as their clinical practices are concerned. 58.2% of the participants feel that loss of patient's feedback is another limitation of e-leaning. Again, more than half of the participants (55.6%) agreed that this e-learning platform will compromise the quality nursing force.

Data revealed that 47.1% of participants showed their agreement to the fact that in the beginning, they had to utilise a lot of time to grasp e-platform techniques. Another encountered challenge agreed by 42.4% of nursing students was network issue and excessive internet data utilisation. A total of 57.2% of participants agreed that successful implementation of e-learning requires sincere efforts. Most of the participants 64.6% showed agreement that some portion of the syllabus should be offered through online mode even after pandemic.


  Discussion Top


In the light of the never-before-seen restrictions and social distancing norms, a sudden transition of nursing education from the traditional approach to e-learning has created a big challenge for nursing students.

This study shared the perception of nursing students about e-learning during the COVID-19 pandemic by obtaining information from a good number of participants (835) across nationwide nursing institutions. The focus of this study is to observe how information technology affects nursing education and is conducted during the complete lockdown and social restriction period of the month between May and June 2020.

Data revealed that formal training in computers was taken by only 68.1% of study participants that shows an urgent need to include formal induction training of technological aspects in the nursing curriculum. The need for formal training for e-education can be validated by the findings of the study conducted by O'Neil, Fisher and New bold (2009), which showed that e-learning is using technology to enhance teachings inside and outside the traditional classroom.[10] Information technology has revolutionised educators' ability to facilitate learning while sitting far from their students.[11] Several researchers have reported beneficial and limited outcomes of e-learning in nursing education in terms of achievement, satisfaction, outlook and desire for learning.[11],[12]

With new technological advancements in health care academics being introduced every day, e-simulations are the next step to be incorporated into the practical classes and to provide real-time virtual experience for student nurses to explore the clinical practice.

Student's engagement and interest in learning is a foremost important factor of any effective teaching method. The integration of information technology into the nursing curriculum provides strategies to boost the active participation of students in the learning process.[13]

A total of 35.2% of the study students reportedly agreed that they were more comfortable responding to their queries as compared to classroom teaching–learning whereas 38.7% agreed that their communication skills and language have been improved with e-learning as a method of learning.

In traditional classroom teaching, students are required to travel to their institutions which results in wastage of time and energy, while in e-learning mode students do not require to leave their homes to participate in teaching–learning process. The present study's findings showed that 43.6% of students agreed and 18.2% strongly agreed with the fact that e-learning saves time that was earlier consumed to travel to the institute. This is in line with the findings of the study conducted by Bloom and Hough, which represented that nursing students were highly satisfied with the use of technology in learning as they were not restricted by physical presence Hence, e-learning offers an attractive invitation for learners to use technology in education.[14]

A well-planned e-learning method can deliver numerous benefits, including providing courses with flexible convenient timing as per students/faculty requirements and improving the quality and speed of information exchange.

Nevertheless, limitations of e-learning were also reported by Boston et al. that student retention in virtual/e-learning is lower in comparison to face-to-face classroom teaching.[15] This remains a barrier to the growth of technology depended teaching–learning.

One of the perceived and widely reported limitations of e-learning is the absence of peer support and group discussions that may limit the understanding of concepts and problem-solving among students. In the present study, 48% of participants agreed to experience isolation due to a lack of peer support group. Even the students' feedback about clinical practices with e-learning simulation was found to be compromised as most (58.2%) of the participant's frequent patient feedback was missed which was a subsidiary to appraise their progress.

Another limitation can be seen in the form of the absence of clinical supervision and real-time patients care evaluation in the clinical area for student nurses. Thus, e-learning affects nursing education because of a lack of opportunities for hands-on practice. This is reflected in this study as 29.3% strongly agreed and 51% agreed that due to lack of hands-on practice they feel less confident in the clinical skills and to become a competent nurse.

The present study findings depicted that the response of students suggested that e-learning can enhance learning experience, but it has to be provided accurately by keeping students' problems and comfort ahead. Students' responses identified obstacles like the use of excess internet data and poor internet connectivity, difficulty for beginners to grasp e-learning techniques.

Nursing educators must be motivated and willing to utilise information technology for nursing education. Study participants' response also indicated several constraints for full-time use of e-learning, as lack of training for students and faculty to use information technology, computers and limited availability of high-speed internet connections.

The majority of participants were agreed with the statement that sincere efforts to implement e-learning should be taken by authorities and educators since it has been globally accepted as the primary method of learning. The future of nursing education should include a combination of technology-based and traditional learning in the syllabus and learning should be offered on virtual/online teaching mode in the future too.[16]

The major challenges faced during e-learning by students are found to be limited feedback, lack of competence in information technology, internet access issues and organisational barriers.[6],[8]

Many educationalists depicted common benefits of e-learning areas as self-paced, cost-effective, time-efficient and environmentally friendly learning.[9],[11] Therefore, future e-learning education programs should be improved in terms of computer training, data network, e-learning feedback and designed to improve learner's satisfaction.


  Conclusion Top


Overall findings of this study are positive and in favour of introducing e-learning as an integral part of the curriculum. More data are required to prove the superiority of e-learning processes over classroom traditional learning. Education is a process of developing an attitude to learning. It is a process of creating new knowledge and finally, it is also acquiring certain human and ethical values while involving in the reading-learning process. Possibilities to do all three virtually without attending traditional learning from classrooms is a debatable subject and may require more shreds of evidence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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