Intr0duction:
Since COVID-19 has been defined as a pandemic disease and
lockdown started worldwide, and to ensure safety of students and educators, most
of the educational institutes have been converted to distance learning. (Harvard
Medical School, 2020) The educational
establishment in Kuwait is not different including Nursing Institute. Thus, the
educational system is shifting toward a new 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 on nursing students knowing that practical courses need direct
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.
E-learning has been defined as “an
educational method that facilitates learning by the application of information
technology and communication providing an opportunity for learners to have
access to all the required education programs”. (Golband
et al., 2014) Although distance learning is not a 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. To develop an e-learning experience,
it is necessary to have good knowledge regarding specific elements of
e-learning, educational methods and individual characteristics of the
attendants. The aim of the present study is to identify personal factors that
could affect perception of distance learning of nursing course among nursing
students during Covid-19 pandemic
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 two 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 points Likert-scale (responses) starting from 4 for
the highest positive perception and 0 for lowest negative perception. High
score indicated positive perception of the domain of distance learning.
Total score for each domain was transformed into
percentage score calculated as sum of items scores multiplied 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. For each domain, as well as
the total, score less than 75% was considered as negative perception whereas
score ≥ 75% was considered as positive perception.
A pilot study was carried out on 10 nursing students. All
the necessary approvals for carrying out the research were obtained.
Statistical analysis:
The questionnaire was tested for its
reliability. Crunbach’s alpha were 0.80, 0.79, 0.63,
0.93, 0.88 and 0.78 for the studied 6 domains. Simple descriptive statistics as
number and percentage distribution for categorical variables and mean with the
standard deviation for the age were used. To detect association between domain
score (high and low) and personal factors, analysis was initially carried out
based on a series of univariate comparisons using Chi-square test. In order to
control simultaneously for possible confounding effect of the variables, multiple
logistic regression was used for the final analysis whereas the association
between personal factors and outcome of interest (low score) was expressed in
terms of odds ratios (OR) together with their 95% confidence intervals (95%
CI).
RESULTS:
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%) and 43.8% ever married. 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.
Table 2 shows the distribution of participating nursing
students according to their sociodemographic characteristics and their
curriculum domains perception scores.
Regarding first domain (experience in general), student
in the age group ≥ 25 years were more liable to have negative perception
(64.1%) compared with those with positive perception (31.0%) significantly (p = 0.002).
Also, a lower proportion of students who practiced a job beside the study had
negative perception (16.2%) than those with positive perception (34.5%)
significantly (p = 0.03).
As regards the second domain (examination and
evaluation), the majority of students with positive perception were in the
third academic year (86.7%) as compared with those with negative perception
(48.5%) significantly (p < 0.001). The same pattern was observer for the
third domain (course structure and contents) (84.5% versus 44.3%. p < 0.001)
For the fourth domain (ease and speed), 66.7% of students
with negative perception were female as compared with 34.0% in the positive perception
group significantly, p < 0.001.
The fifth (multimedia) and sixth (interactivity) domains
as well as the overall score showed the same pattern whereas students in the
age group ≥ 25 years old were associated with negative perception
significantly (p < 0.001, 0.01 and 0.01 respectively) while those who have
another job beside their study were associated with positive perception (p =
0.05, 0.05 and 0.03 respectively)
Table 3 shows the adjusted odd ratio and its 95%
confidence limits of significant predictors of negative perception of the curriculum
domains. Overall, older age of students was proved to be significantly
associated with negative perception (OR = 1.17, CIs: 1.20 – 1.34), whereas having
a job beside study was significant a protective factor against negative perception
(OR = 0.20, CIs: 0.07 – 0.60).
Analysis of associated factors with individual domains
showed that the age was a risk factor for negative perception in the first,
fifth and sixth domains (OR = 1.20, CIs: 1.06 – 1.36), (OR = 1.21, CIs: 1.10 –
1.37) and (OR = 1.21, CIs: 1.10 – 1.38). Being a female student was associated
with negative perception regarding the fourth domain (OR = 3.88, CIs: 1.88 –
8.00). Having a job beside the study was significantly protective against negative
perception in the first, fifth and sixth domains (OR = 0.21, CIs: 0.08 – 0.61),
(OR = 0.23, CIs: 0.08 – 0.65) and (OR = 0.16, CIs: 0.06 – 0.47). Also, being in
the third academic year was a protective factor against negative perception as
compared with being in the first year in the second (OR = 0.31, CIs: 0.11 –
0.91) and third (OR = 0.25, CIs: 0.09 – 0.69) domains.
DISCUSSION:
With the wide use of technology in today’s
learning environment, we should not anymore be concerned with finding out which
is better, face-to-face or technology-enhanced instruction. Our primary goal
should be whether students really learn with the intervention of online
learning tools and the variables that contribute to the success of online
learning process. (Kira and Saade,
2006) The current study revealed that there is a variety of preferences on the
different domains of a nursing on-line curriculum. Since there are multiple
user control features in the interactive on-line methods, it remains clear that
multiple parameters will interact to affect the perception of the participants
about the quality and effectiveness of such type of learning. Consistent with
other studies; this study about the detailed domains of a nursing on-line
curriculum revealed that sociodemographic characteristics of nursing students
play an important role about quality of on-line learning.(Sindiani
et al., 2020; Pei and Wu, 2019)
The results of the current study revealed
that younger nursing students tended to significantly score high (positive
perception) for the overall evaluation of the nursing curriculum as well as the
“course expectation in general”, “multimedia” and “interactivity” domains.
Younger people tend to be more proactive in using technologies in their
learning, which is most likely due to their earlier contact with technology and
also to the way they perceive the technology as an instrument both for
entertainment and learning. (Forsyth et al., 2018) Also, younger age students
might have been exposed to digital technological learning during their high
school while the older ones could not catch such opportunity. The findings of
the current study are inconsistent with other studies that did not find a
significant difference between age and overall on-line courses. (Colorado and Eberle, 2010; Marti´nez-Caro et
al., 2011) The observed differences between this study from one side and the
other studies dealing with the impact of age on on-line learning might be
attributed to different study designs, outcome measures, used technologies, and
different fields of training courses and populations.
Although the sum of all the learning domains
did not differ significantly between male and female students, yet males had
significantly higher scores on the “pace and speed domain”. Reviewing the
literature revealed inconsistent results. Some studies showed that male
students had more positively perception towards e-learning than female
students, (Liaw and Huang, 2011) while others reported
that females were more liable to deal with communication technologies and
accept information than males. (Egbo et al., 2011)
However, some other studies did not show significant difference between
attitude scores for male and female. Suri and Sharma (2013) in his study,
reported that no gender difference regarding the perception of e-learning which
goes with many recent studies which showed that the gap between male and female
in this issue is narrowing. (Bhattacharjee, 2021)
The current findings revealed that no overall
significant differences were related to the academic year of the nurse
students. However, some individual domains specifically “structure and content”
and “examination and evaluation” were significant predictors of high score for
the students in the third academic year (most senior students) compared with
those in the first academic year (most junior students). This is inconsistent
with another study that revealed a better students’ perceptions of e-learning
in university education among junior students. (Yacoba
et al., 2012) However, the later students experienced using e-learning in
secondary schools, while senior nursing students of the current study may tend
to have been employed. Few references dealt with the impact of employment of nursing
students on on-line learning curriculum. The current study revealed that
working student nurses tended to have a high score on the overall curriculum as
well as “course expectations in general”, “multimedia” and “interactivity”
domains of the curriculum. This confirms the results shown in other studies
that used different sample population and different learning contents. (Forsyth
et al., 2018) Multiple reasons can explain this finding. The employed students
have a greater need of distance education and it would respond to their needs
in greater extent than to the needs of unemployed students as they have both
more social and personal commitments. Also, the flexible conditions that online
distance education creates for combining studying with work and personal
engagements. (Forsyth et al., 2018)
It seems reasonable to develop an e-learning
nursing or other curricula by considering the significant sociodemographic
factors affecting on-line learning revealed by this study. Thus, age,
employment, academic year as well as gender should be taken into account to
have a successful and effective e-learning program. One limitation of the study
is the cross-sectional design that is based on an on-line questionnaire with
the low response rate that may affect generalization of the findings. Another
limitation is concerned with the predictor variables of nursing student
perception of distance learning, as only personal factors were studied. Further
research studies are recommended to include more factors that could be
associated.
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