Pandemic Pedagogy: Perception of Nursing students’: A cross-sectional study

What is already known about the topic?

What does this paper add?

Introduction

The outbreak of COVID-19 hampered educational activities worldwide. Educational institutions in most countries had to engage in remote teaching learning from face-to-face teaching during and after the lockdown. When the COVID-19 crisis would end in uncertainty and colleges started functioning as before, it led to continuing e-learning in many parts of the world indefinitely until the pandemic came under control.

What we experienced during COVID-19 was unprecedented. Nursing institutions faced a unique challenge as they had a significant role in bringing up the next generation of care providers (Dewart et al., 2020). The COVID-19 pandemic has pushed us towards remote learning from traditional classroom learning (Hodges et al., 2020). The sudden shift from face-to-face classes to remote learning due to the pandemic posed challenges for teachers and students due to the technology and its accessibility. Nursing education focuses on the development of knowledge and clinical competency for providing quality care to patients. During the course of study, theory and practicums go hand-in-hand for students, bridging the gap between theory and practice. Students acquire their clinical skills by practicing in both laboratories and hospitals. Clinical experiences are vital for developing technical expertise and enhancing procedural skills in nursing. Nursing education emphasizes the significance of both technical skills and critical thinking in nursing practice and clinical judgement. Therefore, while clinical experiences contribute to skill development, critical thinking remains an integral aspect of nursing education and practice for effective problem-solving and decision-making. As the government declared the closure of educational institutions due to the pandemic, students had to move to their homes without knowing about their return to the colleges. Both students and teachers assumed that they would return at the earliest, but the pandemic kept them in their homes for more than six months.

All the nursing schools in India quickly moved on to emergency remote teaching from face-to-face classes. The institutions adopted synchronous and asynchronous technology based on convenience and availability. The synchronous technology included live interactions between teachers and students during online classes, whereas the asynchronous technology had a time gap between the instructor and its recipient (Finkelstein, 2006). Implementing emergency remote teaching helped students continue learning outside educational institutions, keeping students and teachers safe in their homes. During this phase, students might have had varied experiences and faced various challenges due to changes in the learning environment. In India before the pandemic, most of the teaching-learning activities occurred either in formal classrooms or laboratories under the teacher’s constant mentoring, whereas in the mode of emergency remote teaching, the students had to take responsibility for learning themselves.

In 2021, Dvořáková et al. conducted a study on how university students perceived remote learning during the first wave of the COVID pandemic. The study included 68 undergraduates and 31 postgraduates students who were surveyed online through MS forms. Out of 99 participants, the average satisfaction score for emergency remote teaching was 4.07 out of 5. Eighty percent of students revealed that during remote learning students missed the opportunities for classroom discussions and interaction with classmates and teachers. Regarding their stress level during remote learning, 48% expressed that they were partly stressed, and 19% expressed being more stressed than in regular face-to-face teaching.

Emergency remote teaching or pandemic pedagogy in nursing and other professions has not been much extensively explored. The objective of the study was to assess the perceptions of the undergraduate students of nursing on pandemic pedagogy and identify the challenges they faced in remote learning.

Methods

Sample size and sampling technique

A complete enumeration of all the nursing institutions deemed to be universities in southern India was the sampling technique considered in the study. However, out of 13 nursing institutions of the Deemed Universities in the selected geographical area, three nursing colleges agreed to participate in the study. The online survey questionnaire was sent to all the students of the three colleges, and they were requested to participate in the study if they were willing to Figure 1 depicts the schematic flow chart representation of the sample selection.

Figure 1. A schematic flow chart representing sample selection.

Results

Discussion

This study explores undergraduate nursing students’ perceptions of remote learning during the COVID-19 pandemic. The sudden shift to remote learning presented challenges for teachers and students unprepared for this transition. Remote teaching-only classes may affect student performance, especially for those who are already struggling academically. Face-to-face instruction enables the academic performance of students more than remote teaching learning (Xu & Jaggars, 2014). The present study reveals that 81.4% of the participants (72.8% A and 8.6% SA) agreed that the remote instructions helped to accomplish the learning objectives. However, 64.6% of the students were concerned about their lack of in-depth understanding of the subject. The majority of students (43.3% D, 15.3% SD) disagreed that remote instruction helped them concentrate better than face-to-face teaching. Additionally, they found remote instruction less interactive than classroom learning (47.4% D, 15.2% SD). Half of the participants (51.0%) perceived no difference between remote and face-to-face classroom learning, as both helped them to understand the course concepts in the same manner.

In the present study, there was a mixed response from the participants on the aspect of opportunity to communicate with classmates well during this pandemic time similar to what happened in the classroom (43.6% A, 36.9% D). Most of them (57.4 % A, 8.5% SA) agreed that they never got a sense of isolation while attending the remote classes away from the regular classroom and 63% agreed that the opportunities for extracurricular activities were greater in the regular classroom learning. Bali and Liu (2018) explored higher education students’ perceptions and indicated that social presence, social interaction, and satisfaction were higher in face-to-face learning than in remote learning. However, a few students preferred remote learning, as the technology led them to be innovative. The student engagement remains a challenge in the remote learning.

Engaging students and enhancing student-learning may not be as effective in remote learning as in classroom learning. The students may not be able to discuss and have doubts that arise during the remote classes cleared (Alturise, 2020). In the present study, the students perceived that they were kept active throughout the class (71.4% A, 10.3% SA) with the use of learner engagement applications (59.2% A, 12.7% SA).

Remote learning would hinder the acquisition of clinical skills. A study conducted among dental students and staff reported that the closure of teaching clinics affected students’ clinical competence (Loch et al., 2020). In the present study, most students felt that they were not confident in performing the clinical skills as they were away from the institution for a longer time (20.6% SA and 62.4% A). They also reported that the inability to incorporate the theory into the practice hindered their learning (15.7% SA, 68.6% A) and development of the clinical decision-making skills (15.2% SA, 68.6% A). Nearly half of them (49%) agreed that a virtual demonstration of nursing procedures helped them to develop clinical skills as in regular teaching. The students agreed that being away from the clinical setting for a long time affected their clinical skills (59%) and felt they were not confident in performing the procedures that they missed to practice (62.4%).

Due to the abrupt shift from face-to-face to remote teaching-learning education, there were concerns about the availability of technology in terms of the devices used for attending remote instruction, internet access, and skills in the use of technology. The type of devices used by students for remote learning varied based on their socioeconomic status. The researchers found that when students expected to use electronic devices for remote instruction, classwork, online reading, and assignments, the problem with the technology caused stress and affected the academic performance of the students (Gonzales et al., 2020). The data from the present study revealed that 70% of the participants agreed that the software used for remote learning was user-friendly and 69% of them agreed that the teachers’ technical skills helped them to have uninterrupted classes. However, 53% of them perceived that unfamiliarity with the use of technology made remote learning difficult. Along with technical issues, there were major challenges such as network issues (52% A and 34.5% SA), electricity issues and bad weather during remote learning. One of the significant factors that favoured remote learning was the availability of teaching-learning material and the recordings of the classes on the same platform (72%).

A study conducted among 804 medical students from Poland reported various advantages and disadvantages of remote learning. The majority (73%) of students enjoyed remote learning. Learning at the students’ own pace (64%), ability to stay at home (69%), continuous access to online material (69%), and a comfortable environment were reported as the advantages of remote learning whereas, a lack of patient interaction (70%) and technology-related problems (54%) were the disadvantages that the medical students faced. Remote learning was considered less effective in honing skills and social competencies (p<0.001) than face-to-face learning whereas there was no difference in knowledge gain (p=0.46). However, the students were less active during remote teaching than during traditional classes (Bączek et al., 2020). In the present study, 71.5% of them expressed that remote instruction timings were more convenient than classroom learning. Mukhtar et al. (n.d.), reported that remote learning encouraged student-centered learning. They could learn asynchronously at any time of the day and become self-directed learners. In the present study, most of them (65%) agreed that their self-directed learning skills had improved. They also perceived that, they needed to be more accountable (74.2%) and responsible (72.6%) to achieve learning outcomes during the pandemic pedagogy.

As per the responses from the student nurses who participated in the present study, 61.5% agreed that the remote classes provided enough opportunity to clarify their doubts with the teacher and they even agreed (70.7%) that the teachers did motivate them to be away from the institution. The majority of the (56.2%) participants agreed that the teachers were able to give attention to the individual students as in the physical classroom. More than half of them (53%) perceived that being away from the institution for a longer duration and attending classes remotely was a stressful situation for them. They perceived that being away from regular classes affected their overall development (57.6%). Even though they perceived it as a stressful situation, the majority (61.9%) agreed that the instructions given during the remote classes were as clear as those in the physical classroom. Most of the participants (66%) agreed that the remote teaching mode provided an adequate opportunity for instructor feedback for the students as in the physical classes.

Remote teaching and learning in many countries face challenges in regard to accessibility. Students living in remote areas often encounter problems with connectivity. The English language education program in Indonesia found that the availability and sustainability of internet connections, accessibility of teaching materials, and compatibility of devices were major obstacles to remote learning. To increase student participation in remote learning, it is important to have more user-friendly platforms available (Agung & Surtikanti, 2020). According to a study by Baloran (2020), due to poor internet connectivity, college students refused to have a blended online learning approach during the COVID-19 pandemic. The majority of students (61.78%) preferred learning inside the classroom rather than remotely. This finding was also supported by Hassan Ja’ashan (2015). Subedi et al. (2020) reported that 63.2% of students were affected because of electricity and 63.6% because of internet problems, only 64.4% of the students had internet access for their remote classes. Khalil et al. (2020) reported that poor internet connectivity and the utility of online tools were the challenges of remote learning. In the present study, 86.2% of students reported that connectivity issues (34.5% SA and 51.7% A) were a major concern during classes, especially in rural areas. A study conducted to explore the challenges to remote medical education during the COVID-19 pandemic reported that pandemic related stress, and issues related to the online experience, communication, and time management were the challenges faced (Rajab et al., 2020). The challenges faced by teachers may influence students’ remote learning. A qualitative study conducted among teachers in India reported that the home environment with family interruptions, external distractors, lack of basic facilities, lack of support from the institution on training and support for the use of technology, and lack of technical knowledge were the barriers faced by teachers during remote teaching (Joshi et al., 2020). The present study also reported several challenges such as poor internet connectivity, inability to understand the concepts, lack of peer support, lack of opportunity for group study, and lack of opportunity for clinical practice.

The COVID-19 pandemic had a psychological and emotional impact and affected students’ mental health (Lee, 2020). Students in institutions of higher education, including nursing, experienced moderate to severe stress and anxiety in virtual classrooms during the COVID-19 pandemic (AlAteeq et al., 2020; Gallego-Gómez et al., 2020; Sheroun et al., 2020). The findings of the present study also support this, where 52.9% agreed and 19% strongly agreed that they were stressed by being away from the institution for a long time and attending classes remotely. Providing high-quality remote teaching learning using a stable educational framework and encouraging students may help lower their anxiety (Savitsky et al., 2020). The perceptions of the students from a university of higher education from India reported that remote learning helped them continue their learning and complete the syllabus. As the students were not accustomed to learning with cell phones or computers, it led to a lack of interest and attention during the remote classes. The students were unable to attend a few classes when the data limit was exceeded for the day (Mishra et al., 2020).

The students discovered that having access to recorded classes during remote learning improved their understanding, while difficult concepts made it harder to follow (Khalil et al., 2020). According to Deepika (2020), it is crucial for both students and teachers to have quality and timely interactions, technical support, structured remote modules, and practical class facilities for satisfactory remote instruction. Most of the students (66.2%) agreed that they had an opportunity for instructor feedback during remote teaching.

The present study findings revealed that among the student nurses who participated, 62% agreed and 29% of them strongly agreed that remote learning was safer amidst the COVID pandemic and 53% of them agreed that remote classes were interesting, and that they enjoyed learning.

This study has several strengths. First, the study tried to explore how nursing students perceived remote learning during the COVID-19 pandemic. This gives information to nursing education institutions to understand the views of the students. Second, the challenges identified allow universities to overcome these factors and deliver quality nursing education. Third, since the study was conducted in multicentre with a large number, generalizability of the findings to all nursing institutions in India is possible. Nonetheless, this study also has a few limitations. First, since it was a cross-sectional study detailed information on the challenges could not be explored. Second, since the study has not been focused on assessing learning, it would not help improve the assessment methods.

The implications of the study are as follows. First, the emergency remote teaching-learning was the first experience for the students as well as the teachers and this study explored the student’s perceptions of this pandemic pedagogy. Second, various challenges that hindered the learning of students need to be deliberated by institutions and the government so that we can prepare well for such pandemics in the future.

Conclusions

This study on nursing students’ perceptions of pandemic pedagogy offers valuable insights into the challenges and experiences faced during remote teaching and learning during the COVID-19 pandemic. The results from the present study conclude that an abrupt shift to remote learning during the COVID-19 pandemic led to disruption in teaching and learning activities. Students perceived various challenges during remote learning, especially in gaining clinical skills. Exploring students’ perceptions highlights the need for flexible and innovative approaches, integrating digital technologies, and emphasizing student engagement. As the healthcare landscape rapidly evolves, nursing education must continue to evolve as well, incorporating lessons from the pandemic era. The experiences shared in the study emphasize the importance of fostering resilience, adaptability, and technological proficiency among nursing students. These findings have broader implications for nursing education beyond the pandemic, guiding the development of future-ready curricula that prepare nurses to navigate complex healthcare scenarios with confidence.

Data availability