Perception of undergraduate nursing students regarding e-learning during COVID-19 pandemic in West Bengal

INTRODUCTION

E- learning as the “e” implies for “electronic” includes all form of educational activities carried out by individuals or group, while working online or off line and synchronously or asynchronously via standalone or networked computers and other electronic devices.¹ The educational system has vastly affected due to COVID 19 pandemic situation along with the effect on human life over 3.91 crore people across the globe. UNESCO highlighted that in India, around 32 crores college students are suffering with their learning process due to this pandemic.²

Although there is indefinite number of processes in education system, most of the institutions adopted of face-to-face lectures- discussion with online teaching learning process during this pandemic. But student and teachers are still in dilemmas with questions in mind, that whether this process can achieve the objectives of university curriculum or not. COVID 19 pandemics have already changed the landscape of education and nursing education as well.3Thus, to remain relevant, universities will need to work on reinventing their learning environments which must facilitate expansion of digitalisation and complement student-teacher and teaching staff relationships.^2,3

Need for the study

James M. Marshal established that people remember only 10% of what they read, 20% of what they hear, 30% of what is visible to them and 50% of what they hear and see. With the advent of technologies which combines images, texts and audio all in one learner can make the percentage even higher than 50%.⁴ Studies by Coopasami et al and Ali et al reported much earlier this pandemic that, nursing students are psychological ready for e-Learning although technological and equipment readiness among them was lacking.^5,6 America Nurses Association (ANA) suggested in 2010 that, online, virtual, simulated and competency-based learning should be attempted in educational institutions to expand opportunities to students and increase efficiency of nursing students.⁷

Existing literature shows that nursing students found this pandemic moderately stressful.⁷ This was further triggered by students’ personal problems such as older students with family responsibilities, poor technological accessibility, poor performance in online exam; although passing an online exam enhances nurses’ attitude towards e-learning.^6-9 In this context teachers are ready to find out the outcome of the online teaching in each and every corner. Keeping these in mind perception of nursing students on e-learning need to be understood, so that their learning experience can be improved in the next academic year due to uncertain of future in the short-term control of COVID-19.¹¹

Objectives of the study was to identify the perception of the undergraduate nursing students towards e-learning during Covid-19 pandemic and to find out the association of undergraduate nursing student’s perception with reference to selected background information.

METHODS

A descriptive cross-sectional web-based survey was conducted among undergraduate nursing students from 1st year to 4th year of various college of nursing, Kolkata, from September 2020 to October 2020. A Snowball sampling technique was employed to enrol survey participants. Undergraduate nursing students of B.Sc. Nursing course from 1st to 4th year were included. Participation in the study was fully voluntary and non-commercial. In the pandemic situation as we were unable to approach individual nursing colleges for participation. Thus, the link of the questionnaire was sent mainly through E-mails, WhatsApp to the contacts of the investigators from the different geographic areas of West Bengal and then the primary contact was asked to share the link to their batchmates. The link consisted of an online structured questionnaire for gathering basic details of the participants and a likert scale developed by using Google forms, along with consent form. Through this, the link was forwarded to nursing students apart from the first point of contact and so on. On receiving and clicking the link, the participants were automatically directed to the information about the study and informed consent. After they agreed to take the survey, they filled up their details and so on. Though estimation of sample size is necessary, but in the present study we did not restricted the number of participants; as we required large number of samples from different colleges in an around West Bengal, India. Approval was obtained and necessary permissions were taken from the authorities of a private nursing college from where the author belongs.

Instrument and scoring system A structured questionnaire related to background information of participants and Likert scale with 25 items on perception of nursing students towards e-learning was developed and validated by seven experts and thereafter readability of the tool was checked by 4 experts and 4 nursing students. Then a pilot web survey was conducted among 10 randomly selected nursing students. All these participants were excluded from the final survey. The 6-point Likert scale showed reliability coefficient (Cronbach’s alpha) 0.83 resembling a reliable tool.

The Likert scale had items from the areas as, 1)Perceived advantages and disadvantages of E-learning (item number 1, 3, 4, 5, 6, 7, 11, 19, 23), perceived professional issues (item number 8, 12, 13, 14, 17, 20, 22, 24, 25), perceived personal issues related to e-learning (item number 9, 10, 15, 18, 21,23) and logistic concerns in item number 2,16. The participants had to rate the items on how they perceived e- learning. The range of responses and scores was; Strongly disagree (0), disagree (1), somewhat disagree (2), somewhat agree (3), agree (4), and strongly agree (5). Total scores ranged from 0 to 125 with higher scores reflected positive perception. Reverse scoring was done for items 10, 12, 15, 21, 23, 25.

Data analysis

The collected data were stored in Google drive and protected by username and password. Descriptive statistics were calculated to summarize demographics and key variables. Inferential statistics were applied. The chi-square test was applied to examine the level of association among variables. The data were coded and entered in Microsoft excel sheet and analysed. Collected data were analysed using SPSS 20.0 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). P<0.05 was considered statistically significant.

RESULTS

An online (Google) survey was conducted related to awareness among the Indian population during COVID19 pandemic. A total of 351 samples were responded and all participants were from Indian origin and above 17 years of age. 11 respondents were excluded because of incompleteness of their response about questionnaire and finally 327 responses were analysed. The study, by default included all individuals who understood English, had access to the internet and was willing to participate in the study. A descriptive statistics-based analysis was conducted to illustrate the background data. The frequency of percentage distribution of background data of undergraduate students depicts that, majority 66.4% belonged to the age group of 21-23 years, used internet daily before lockdown (80.7%).

The respondents were mostly 4th year (39.1%) and 3rd year (28.4%) students, 75.2% students never had an earlier experience of e-learning. Though 69.7% of students were aware of availability of institutional internet access, e-journals and computer lab only 37.9% have used those facilities before lockdown. Majority of students attended e-learning sessions through smart phone (96.94%) and 92.4% had the ownership of the gadget they used. The perception score among undergraduate students ranged from 68-123 with Mean(SD) of 104.49 (8.19). Majority of the respondents (70.95%) had indifferent perception towards e-learning.

Question wise analysis of responses represented in the Table 3 revealed that, Majority agreed that e-learning helped them to understand theoretical sessions (70.03%), and (78.59%) agreed willingness to attend webinars in future. The respondents of 83.79% agreed that have missed their interactions with patients and thus 80.43% agreed to prefer traditional classroom session over e-learning. 32.72% disagreed that e-learning is easier to understand demonstration sessions.

Almost 50.46% reported feeling of being overloaded and eye strain (77.06%) after e-learning, 70.03% agreed that peer group discussion is difficult in e-learning session. 64.84% agreed that doubts are cleared better in classroom, 53.52% felt anxious when they heard that e-learning sessions will be conducted, 58.41% agreed that they felt anxious about completion of syllabus. Around 57.19% of participants responded that they feel special training of teachers are required for e-learning, 84.71% believed that technological interruption caused disturbances during learning. Undergraduate nursing student’s perception didn’t have any significant association in terms of current year of academic study, previous experience of e-learning, institutional availability of e-learning facilities or its previous access, type of gadget used for e-learning.

Although, gadgets used in learning session was significantly associated with perception towards e-learning. Thus, the findings from the current study indicated that, although students attended to the e-learning sessions during the pandemic but they still prefer over traditional teaching sessions over e-learning as represented by their indifferent attitude and individual responses against each question.

*significant at p<0.05.

DISCUSSION

In this current study 66.4% belonged to the age group of 21-23 yrs., used internet daily before lockdown (80.7%). Most of the respondents (75.2%) never had an earlier experience of e-learning. Though 69.7% of students were aware of availability of institutional internet access, e-journals and computer lab only 37.9% have used those facilities before lockdown. Majority of students attended e-learning sessions through smart phone (96.94%) and 92.4% had the ownership of the gadget they used. This is similar with globally reported findings which revealed that students preferred mobile because student-teacher interaction through was felt to be easier as compared to other devices and learning can happen anytime and anywhere.^13,16-18

Majority of the respondents (70.95%) had indifferent perception towards e-learning whereas Abbasi et al found negative perception among medical students in this regard.¹³

In this study 78.59% agreed to attend webinars in future. Similar interest among registered nurses was reported by Opeyemi et al.¹⁴ Majority of the respondents agreed that e-learning helped them to understand theoretical sessions (70.03%), 83.79% agreed that have missed their interactions with patients and thus 80.43% agreed to prefer traditional classroom session over e-learning. 32.72% disagreed that e-learning is easier to understand demonstration sessions. This finding is congruent with studies conducted in countries like Malaysia, China, Singapore etc. are the places where students reported e-learning as less appealing due to practical constraints of learning in the lab/clinical environment.^20-22

Participants reported anxiousness (53.52%) when they heard that e-learning sessions will be conducted, 58.41% agreed that they felt anxious about completion of syllabus. Similar dilemmas were reported by nursing students globally.^6-9 Almost 50.46% reported feeling of being overloaded and eye strain (77.06%) after e-learning. Similar Digital Eye Strain (DES) due to e-learning among children has been reported by Mohan and collegues.¹⁵ 70.03% agreed that peer group discussion is difficult in e-learning session. 64.84% agreed that doubts are cleared better in classroom. There is paucity of data of similar nature till date as very few studies have addressed the perception of nursing students. The current study is having comparatively large sample size in this regard and unique in Indian scenario. Due to the limited resource availability, we were unable to involve nursing students all over the country. Further should be carried out to find the factors influencing nursing students’ perceptions towards e-learning and also studies exploring nursing faculties experience of e-learning need to be considered.

Limitations

The study is limited to the undergraduate nursing students of West Bengal which by default consisted of only female candidates thus gender-based variations couldn’t be assessed. Hence, the findings cannot be generalized.

CONCLUSION

It can be said that this pandemic has thrown a challenge to the educational technology reminding the theory of “Survival of the fittest”. Nursing faculties needs to address the perceptions of the students so that the best possible teaching method can be utilized in near future as per their needs.

ACKNOWLEDGEMENTS

Authors would like to thank all the undergraduate nursing students for their voluntary participation and also express their gratitude towards seven experts for their support in the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Chitra A, Raj M. E-Learning. J Applied Advanced Res. 2018;3:11-3.
2. 2. UNESCO. 2020 State of education report for India. New Delhi. 2020.
3. 3. Schleicher A. The Impact of covid-19 on education insights from education at a glance. OECD. 2020: 1-31.
4. 4. Marshall J. Learning with technology. Evidence that technology can, and does, support learning. 2002;6:24-76.
5. 5. Coopasami M, Knight S, Pete M. e-Learning readiness amongst nursing students at the Durban University of Technology. Health SA Gesondheid. 2017;22:300-6.
6. 6. Ali W. Nursing students readiness for e-learning experience. Gynecol Obstet. 2016;6:1-5.
7. 7. Aslan H, Pekince H. Nursing students' views on the COVID-19 pandemic and their percieved stress levels. Perspect Psychiatr Care. 2020;8:1-7.
8. 8. Borhani F, Vatanparast M, Zadeh AA, Ranjbar H, Pour RS. Virtual education effect on cognitive learning and attitude of nursing students towards it. Iran J Nurs Midwifery Res. 2011;16(4):321-24.
9. 9. Morcillo AJ, Costa C, García JE, Martínez M. Experiences of nursing students during the abrupt change from face-to-face to e-learning education during the first month of confinement due to COVID-19 in Spain. Int J Environ Res Public Health. 2020;17(15):5519-24.
10. 10. Gómez JI, Cano M, Martínez A, Balanza S, González MT, Simonelli AJ, et al. The COVID-19 pandemic and its impact on homebound nursing students. Int J Environ Res Public Health. 2020;17(20):7383-6.
11. 11. Opeyemi OZ, Adeyemi AA, Olajuwon TD. Perception of nursing students towards online learning: a case study of Lau tech open and distance learning centre, Ogbomoso, Oyo State, Nigeria. Galore Int J Health Sci Res. 2019;4(4):23-30.
12. 12. Maheshwari S, Zheleva B, Rajasekhar V, Batra B. E-Teaching in pediatric cardiology: a paradigm shift. Ann Pediatr Cardiol. 2015;8(1):10-3.
13. 13. Elbasuony MMM, Gangadharan P, Janula R, Shylaja J, Gaber FA. Undergraduate nursing students’ perception and usage of E-learning and blackboard learning system. Middle East J Nursing. 2018;12(2):3-13.
14. 14. Abbasi S, Ayoob T, Malik A, Memon SI. Perceptions of students regarding E-learning during Covid-19 at a private medical college. Pak J Med Sci. 2020;36:57-61.
15. 15. Mohan A, Sen P, Shah C, Jain E, Jain S. Prevalence and risk factor assessment of digital eye strain among children using online e-learning during the COVID19 pandemic: digital eye strain among kids (DESK study-1). Indian J Ophthalmol. 2021;69:140-4
16. 16. Yilmaz O. E-Learning: Students input for using mobile devices in science instructional settings. Edu Learn. 2016;5:182-4.
17. 17. Roberts N, Rees M. Student use of mobile devices in university lectures. Aus J Educ Technol. 2014;30:4-6.
18. 18. Martinez IG, Sanchiz DC, Batanero JMF, Rosa ALDL. Using mobile devices for improving learning outcomes and teachers’ professionalization. sustainability. 2019;11:6917-9.
19. 19. Murphy A, Farley H, Lane M, Baig A, Carter B. Mobile learning anytime, anywhere: What are our students doing? Australas J Inf Syst. 2014;18(3):98-103.
20. 20. Bao W. COVID -19 and online teaching in higher education: a case study of Peking University. In: Hum. Behav. Emerging Technol: 2020.
21. 21. O'Flaherty JA, Laws TA. Nursing student's evaluation of a virtual classroom experience in support of their learning Bioscience. Nurse Educ Pract. 2014;14(6):654-9.
22. 22. Mahajan MV, Kalpana R. A study of students’ perception about e-learning. Indian J Clin Anat Physiol. 2018;5(4):501-7.
23. 23. Ali NS, Carlton KH, Ryan M. Students’ perceptions of online learning implications for teaching. Nurse Educator. 2004;29(3):111-5.
24. 24. Linjawi AI, Alfadda LS. Students’ perception, attitudes, and readiness toward online learning in dental education in Saudi Arabia: a cohort study. Adv Med Edu Practice. 2018;9:855-63.
25. 25. Gallagher LS, Reilly J, Killion CM. Nursing student perceptions of community in online learning. Contemporary Nurse. 2009;32(2):133-46.
26. 26. Gerkin KL, Taylor TH, Weatherby FM. The perception of learning and satisfaction of nurses in the online environment. J Nurses Staff Development. 2009;25(1):8-13.
27. 27. Smart KL, Cappel JJ. Students’ perceptions of online learning: a comparative study. Journal of Information Technology Education. 2006;6:201-10.