INTRODUCTION:
The world is facing
unprecedented challenges in the face of a global pandemic. The fast progression
of the COVID-19 led to be considered on 13 March 2020 by the WHO as a pandemic
disease. (WHO, 2020a; WHO, 2020b) As the disease had infected
many persons in most countries in an international pattern. The world
faced a serious public health emergency. The main public health recommendation
was to remain at home and stay safe within it. (Remuzzi
and Remuzzi, 2020; Torri et al., 2020; (Jackson et al.,
2020)
This health crisis
impacted not only the area of health but all systems and communities. COVID-19
has also already disrupted universities and academic institutions including
nursing institutes. (Dewart et
al., 2020).
In many countries, the health authorities preferred to suspend the presence of
nursing students in health care facilities. (Jackson et al., 2020; UNESCO,
2020) The question was how to continue to educate nurses in a society facing
social distancing, isolation, and quarantine measures. Ethically weighing the
value of education against the risk and strain to the learner personally and
professionally should be considered. (Dewart et
al. 2020)
Multiple solutions
have been suggested for education, all of which are based on distance learning.
As a result of constrictions, the world experiencing in all sectors including
education specially applied sciences which was the most affected, many
countries including Kuwait adopted distance learning as a favorite option to
complete the academic year 2019/2020. The professors, educators and experts in
traditional education arts, have obliged to deal with distance e-learning,
although the majority of them were not ready for this process. Also, students
faced the problem of change from face-to-face learning, to distance e-learning.
(Ramos-Morcillo et al., 2020)
Although distance learning is not new concept
in many countries, it was not considered as a main teaching resource in Kuwait.
Thus, many challenges emerged as a result for administrative and teaching
staff, but more to the students. It is important to know how students
participated in this experience, and how successful was the effort, from their
point of view. It is essential to know how students react to this
experience, content, styles used and their personal aspect and their acceptance
for the new education technology. The aim of the present study is to describe
nursing student’s perception of different domains of distance education
Subjects and Methods:
Settings:
Nursing
institute is one of the structures of the public Authority for Applied
Education and Training in Kuwait. Nursing student should pass through a
preparatory course and 3 academic years. The total number of nursing students
in the academic years during 2019/2020 was 420. All of them were invited to participate
in the present study after performing their examination though an online
questionnaire.
Study design:
An
observational cross-sectional study design was adopted for this study. Data of
this study was collected through an online specially designed questionnaire
that was sent to all registered nursing students during the academic year
2019/2020. This questionnaire consisted of several sections. The first section
dealt with general characteristics, including age, sex, marital state, academic
years, presence of job beside studying. The second
section include 6 domains related to perception of distance learning: experience
in general (7 items), course structure and contents (8 items), examination and
evaluation (7 items), ease and speed (3 items), multimedia (5 items) and
interactivity (4 items). Each item has 5 responses starting from 4 for the
highest positive perception and 0 for lowest negative perception. Total score
for each domain was transformed into percentage score calculated sum of items
scores multiplies by 100 / number of items under the specific domain. The sum
was treated to yield a range of 100% with a minimum of zero and a maximum of
100. A pilot study was carried out on 10 nursing students. All the necessary
approvals for carrying out the research were obtained.
Statistical
analysis:
Descriptive
(count, percentage, minimum, maximum, arithmetic mean, median and standard
deviation) and analytic measures (One way ANOVA) were performed. The level of
significance selected for this study was P ≤ 0.05. The questionnaire was tested for its
reliability. Crunbach’s alph
were 0.80, 0.79, 0.63, 0.93, 0.88 and 0.78 for the studied 6 domains.
RESULTS:
Recruitment effort
resulted in participation of 149 nursing students. After data entry, 3 questionnaires
were deleted due to incompleteness. The final analysis was performed on 146
nursing students. Table 1 shows the general characteristics of the
participating students. Their age ranged from 18 to 35 years with a mean 24.9 ±
3.7 years old. Males constituted 44.5% versus 55.5% for females. Just above
half of them were single (56.2%) with 34.2% were married and 9.6 divorced. A
fifth of them had an additional job beside their study. Regarding their
academic year, 17.1%, 22.6% and 60.3% were in the first, second and third year
respectively. The higher percentage of them lived in Jahra
(38.4%) and the least percentage was in Ahmedi and Mubaral Al-Kabeer (8.2%)
The mean percentage
score for each domain of nursing student perception of distance learning was
presented in table 2 and figure 1. The highest positive perception score was
related to course structure and contents (67.6%) and evaluation and examination
(67.7%). The least score was recorded for the multimedia (51.0%) and ease and
speed of the course (54.3%), with a significant difference (F = 16.46, p <
0.001).
DISCUSSION:
As COVID-19 became a
pandemic and lockdown started worldwide, most of the academic facilities
converted to use online learning as an alternative during this period to ensure
the safety of staff and students. (Harvard Medical School, 2020) The educational establishments
in Kuwait is not different including Nursing Institute. Thus, the
educational system is shifting toward a new entirely system of online teaching
and examination. (Sandhu and de Wolf, 2020) As we experienced a massive
transition to online learning, it was extremely important to study the effects
of online learning using several parameters on nursing students especially, it
is known that practical courses need on-ground interaction for the purpose of
practice, on the contrary, basic science courses are more flexible to be
converted to online as it needs a minimal real-time interaction between the
lecturer and the students. Identifying the weak domains of the online nursing
curriculum was the main outcome. Thus, improvement of the whole nursing
curriculum was the ultimate goal of the study. (Keane, 2020).
The
current study revealed that, the scoring of different domains of nursing
curriculum ranged from 51.03% for the quality and integration of multimedia to
67.74% for examination and evaluation of the course as well as 67.59% for the
course structure and content. This reveals that nursing students were just
fairly or moderately satisfied with online nursing course. Some studies (Jwayyed etal., 2011;
Lewis et al., 2001) revealed negative results for the use of distance teaching
while other studies showed an equal or superior learning outcomes of online learning
as compared with traditional learning methods. (Rosenberg et al., 2003;
Chumley-Jones et al., 2002) Nearly 90% of students, needed
at least some in-person instruction. (Brockman et al., 2020) Also, Kay et al.
(2018) found that half of the studied students prioritized both physical (in
person) and virtual (online) access to the lab work. However, Salter and
Gardner (2016) found that most students prefer in-person labs over online labs.
Experience
of nurses about on-line learning may be an important factor for this low
rating; as this was the first on-line course. This is congruent with other
authors who revealed that most the students were not pleased with their online
experience especially those with first-time online experience who showed worse
results compared with experienced students. (Freeze et al., 2010; Sindiani et al., 2020) Another study found that e-learning
readiness influenced students' satisfaction. Increased satisfaction might be
related to increased self-efficacy in e-learning. ( Sandhu
and de Wolf, 2020).
The results of the
current study revealed that course structure and content was one of the highest
scored domains (67.59%). Similar results were demonstrated in other online
courses. In one study participants expressed high satisfaction with the content
structure of the course. They declared that the course was highly educational, the
rich and relevant information. (Mącznik
et al., 2015).
There are four interactions that online
teachers should consider: students’ interaction with resources, interaction with the instructor,
interaction with the peer, and interaction with self. (Hirumi, 2009; Moore, 1989) These
interactions have been found crucial for meaningful learning experiences and
effectiveness in online learning. (Swan, 2002) In
this study, interactivity domain scored less than 60 percent (58.73%)
indicating low satisfaction with interactivity while learning through on-line
approach. Salter and Gardner (2016) found that students felt more involved and
bound in the learning process when face to face physically interact with an educators. On the other hand, some previous studies reported
increased gains of knowledge and higher satisfaction with learner and more
interactivity in e-education. (Liberati et al., 2009;
Pace et al. 2012)
The
current study also revealed that the ease and speed curriculum domain scored
only 54.34%. Asynchronous interaction was the main approach used for this
on-line course. Synchronous online
interactions, however, can be effective in discussing topics with some
preparation work, creating social presence among members as well as planning
tasks that need real-time feedback. (Rhim and
Han, 2020; Braun and Kearns, 2008).
Research
on the use of web-based technologies in nursing is at its infancy, which
impacted on the present results in several respects. COVID-19 changed the world, it helps us to discover a new way of learning by
setting up the borders for a new era of online learning keeping the progress of
the teaching process is of high value during this critical situation with
maintaining students and lecturers’ health as our priority. (Sindiani et al., 2020) The nurses training programs have
been designed to equip nurses with competencies in providing safe and effective
nursing care of high standard in a variety of settings.
The use of
convenience sampling technique and cross-sectional design that is based on a
questionnaire are the main limitations of the current
study which may affect the generalizability of the findings. Further research
studies are recommended using a more representative sample of nursing students
from all over Kuwait, applying a longitudinal design that is based on a valid
and reliable tool to help improving the external validity of the results.
Acknowledgement:
The author would like to thank Dr. Nadia A Atitt-Allh (Professor of Maternity and Gynecological
Nursing, Nursing College, Ain Shams University, Egypt) for her help and support
throughout this work.
Conflicts
of interest: No conflict of interest.
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