INTRODUCTION
The lockdown strategy adopted to contain the spread of the COVID-19 pandemic has unprecedentedly affected the world of work and study. According to United Nations, 1.75 billion learners ranging from children to students in professional courses were affected by the COVID-19 pandemic.[1] Academic facilities around the globe shifted their operations to online learning due to the pandemic.[1] The massive unplanned transition from traditional learning to an exclusively online learning setup has posed challenges to teachers and students alike.[2,3]
In comparison to general education, the development and implementation of online learning programs for students of healthcare professions were more challenging.[3] For students who are trained for direct patient care, learning complex practical skills and procedures in an online platform are very demanding.[4,5] Undergraduate nursing students who are learning several basic concepts of patient care need experiential learning.[6] The experiences of nursing students, in this abrupt transition, can give valuable insights to improve the online delivery of classes. We undertook this study to describe nursing students’ perceptions and experiences about online learning during the COVID-19 pandemic. We also aimed to understand the challenges faced by students in attending online classes.
MATERIALS AND METHODS
A cross-sectional descriptive survey was conducted to find out the perceptions and experiences of online classes during the COVID-19 pandemic. The study was conducted in February 2021.
Sample
The study was conducted among the nursing students at the College of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, India, which is the apex center for mental health and neuroscience education in the country. The College has a total of 328 undergraduate nursing students. A total of 225 students which included 76 second years, 77 third years, and 72 fourth years were contacted for participation in the survey.
Consent emails were sent to the coordinators of the respective batches, explaining the objectives and purpose of the study. The Google forms questionnaire, which was used for the study was first sent to the representatives of the participant batches and subsequently shared among the students.
Ethical considerations
The study protocol was approved by the scientific review board and ethics committee. As the data collection was carried out through the internet, participants provided informed consent by clicking a button after having read all relevant information. The anonymity of statements in the transcripts as well as the confidentiality and security of the data were ensured.
Tools and techniques
The survey instrument used was a self-administered questionnaire. It was prepared as a Google form questionnaire as this minimizes the contact with individuals for data collection. The questionnaire was constructed based on the review of the literature and the opinion of the subject experts. The survey contained an introductory paragraph that informed participants of the study’s aims, the confidentiality of their responses, and the freedom to decline to answer any question or to withdraw from the study altogether. It consisted of three major sections. The first section was the demographic characteristics. The second section had seven questions related to the experience of online theory classes and two questions related to online practical classes. The respondents were provided statements related to the online classes and they had to agree or disagree with those statements. In this section, the students were asked to rate the effectiveness of demonstrating practical procedures through online sessions on a linear scale. The linear scale is composed of a line with equally spaced markings from 0 to 10 with word descriptors (not at all effective and fully effective) at both ends. The higher the score, the greater was the effectiveness of the online practical sessions.
The third section comprised of an open-ended question regarding the challenges that the participants faced during the online classes. Open-ended questions were designed to elicit descriptive feedback in the participants’ own words.
The questionnaire was reviewed and validated by three nurse educators. The experts conducted their review independently and the tool was modified based on their feedback.
RESULTS
The online questionnaire was completed by 120 students. The response rate was 53.33%. The demographic details of the sample are discussed in Table 1. The age of the sample ranged from 18 to 24 years with a mean of 20.1 (S.D 2.2) years. The majority of the students were females and were in their second year of professional nursing education.
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Table 1: Sociodemographic profile of the students
The perception of students about online theory and practical classes is depicted in [Table 2]. Majority of them (73.3%) preferred traditional in-person learning over an online mode of education. On a scale of 0–10, the mean score for the effectiveness of learning practical procedures through online sessions was 4.7 (S.D 2.3).
Table 2: Perception of nursing students about online theory and practical classes
The open-ended questions received several responses that explained the difficulties faced by students. The responses of the students are summarised in Table 3. The highest challenge experienced by the students was related to connectivity issues.
Table 3: Difficulties faced during the period of online classes
DISCUSSION
The COVID-19 pandemic has made online education mainstream and a possible alternative for in-person education. Professional training including medical and nursing education shifted to online or hybrid modes depending on the intensity of the pandemic in a given time and place. The present study was conducted to understand the experiences and perceptions of undergraduate nursing students about online classes during the COVID-19 pandemic.
The majority of the participants preferred traditional in-class learning over online classes even though online modes of learning met their expectations. This finding corroborates with studies conducted among students of other health professions.[7,8]
Medical students, pharmacy students,[4] and nursing students[5] from other countries have expressed varying degrees of acceptance to the online mode of education. Evaluation of the barriers and facilitators for medical and nursing education for international students from low- and middle-income countries has shown that only 36.5% of students were satisfied with the online mode of education.[9] Online education has raised concerns of affecting the quality of medical education negatively, by affecting clinical learning.[10]
In the present study, half of the participants opined that online courses provide flexibility for their schedules. As the preparation needed to attend online classes was very less in comparison to traditional classes which need a physical presence in the class, students experienced flexibility in their schedule. The majority of the participants felt that the online classes were well organized and scheduled. Most of them also expressed satisfaction about online classes meeting their expectations. Similar findings are observed in other studies as well.[11,12,13]
A mixed response was observed regarding the acceptability of online classes for learning psychomotor skills. Half of the respondents were confident that they would be able to practically use the skills they learned through online classes, whereas the other half disagreed on it. Similarly only half of the respondents opined that the videos of practical procedures viewed online were comprehensive and helpful. Even though researchers advocate teaching psychomotor skills through the online mode in the current context,[14] the present study exposes the need to modify the teaching–learning process to ensure student engagement in learning psychomotor skills.
The major challenge faced by nursing students in online classes was bandwidth and connectivity issues. This is a very commonly reported challenge in online education.[4] The majority of the participants in this study belonged to rural domiciles, and they attended the online classes from their homes. The lack of reliable internet sources and internet connectivity in rural areas was a major hurdle faced by the students.[15]
Several participants had fears about the negative impact of online classes on health. As nursing students are aware of the general health issues related to long screen hours and immobility, they are concerned about the influence that online classes can have on their health. Difficulty in concentrating and attending classes throughout the day was another major challenge faced by them. Some students may lack the qualities for attending online classes, which is different from in-person classes. It requires constant attention and motivation to keep oneself engaged in the classes. Hence, it can be challenging for students who do not possess these qualities to keep themself glued to the online classes throughout the day.
One of the major limitations of the study is that the sample size was small. As the method used for the study was a survey, the findings are limited by reliance on self-reporting. Additionally, it is potentially biased due to the nonresponders. In the survey tool, the participants were given the option of a dichotomous response for the statements about online classes. Hence, unlike a Likert scale, the grade of their agreement or disagreement with the statements was not measured in this study. Future studies can use focus-group discussions to obtain an in-depth understanding of the students’ experiences about online classes.
CONCLUSION
Nursing students have mixed responses regarding the acceptability of online form of nursing education. The usage of online classes for delivering skill-based teaching needs further refinement. Education should be always tailored to student preferences.[13] Hence online education needs to be made user-friendly by addressing the challenges faced by students. These classes need to be supplemented with programs that can enhance practical learning abilities.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
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