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

Coronavirus disease 2019 pandemic impacted across the globe disrupting all sectors including the higher education universities. Nursing institutions faced various challenges due to the pandemic restrictions, of which the abrupt shift of implementing the curriculum to online mode posed a major challenge to both the teachers and the students. To assess nursing students’ perception of pandemic pedagogy and the challenges faced in online teaching-learning, this cross-sectional survey was conducted among 982 undergraduate nursing students from three Deemed to be University nursing institutions of Southern India. Institutional Ethics Committee approval (IEC 444/2020), permission from the heads of the institutions and study participant’s consent was obtained. Data was collected using an online survey questionnaire which had three domains, including student-related (19 items), teacher-related(5 items), and physical learning environment-related factors (11 items). The reliability was established using Cronbach’s Alpha (0.86). Explored the favouring, hindering factors and challenges faced during the emergency remote teaching with open-ended items. The overall mean score of perceptions on pandemic pedagogy was 89.03±10.03. Sixty-three percent of students had a total perception score above 87 which indicates that they preferred online learning during the pandemic whereas 45% preferred classroom learning. There was a significant difference in the total perception scores and the years of study( F (3, 978) = 4.96, p = 0.002). The factors favouring online learning were, an opportunity to view the recorded classes even after the live classes’ (n=165), and ‘more time to spend for learning activities’ (n=152). Factors that hindered the learning or the challenges faced were poor network connectivity (n=451), and lack of opportunity for group study (n=326). Students favoured online learning during the pandemic; however, there were several challenges. The educational institutions need to prepare themselves to overcome this and focus on a blended learning curriculum.


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 faceto-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 REVISED Amendments from Version 2 As suggested by the reviewer, a few grammatical errors were rectified, and the rearrangement of the discussion section of the paper was considered as per the reviewers' suggestions.A few modifications in the introduction and methodology were also considered for the better readability of the manuscript.We made a slight change in figure to get more clarity as suggested by the reviewer to include the number of institutions replied but, declined to participate.
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, Dvo ráková 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.

Design and sample
This cross-sectional survey was conducted among undergraduate nursing students studying in the deemed to be university nursing institutions of southern India, under the University Grants Commission of India.

Setting and data collection
Investigators obtained approval from the Institutional Ethics Committee (IEC 444/2020) for conducting the study and permission from the heads of the institutions.The study was registered under the clinical trial registry of India (CTRI/2020/08/027047).
All the deemed to be universities nursing institutions (13 institutions) of southern India were approached and included only those three nursing institutions permitted to conduct the study.Students undergoing a four-year undergraduate nursing degree programme were included in the study.The students were sent home from the institutions under lockdown, and all three nursing institutions moved on to emergency remote teaching.Since the institutions did not have remote teaching before the pandemic, it was a sudden change for both teachers and students.Initially, teachers themselves explored various platforms and later they were oriented to remote teaching platforms such as Microsoft teams, Impartus and Edmodo by the institutions.The nursing institutions offered approximately three to five hours of remote instruction during the pandemic.
An online survey with a written consent form was sent to all the participants via Google Form to their contact details submitted to the institution.The students consented to participate in the study after reading the participant information sheet provided in the form.

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.

Demographic
A demographic questionnaire was used to collect the information on age, year of study, area of residence, mode of access to remote teaching learning, and the device used.

Perception of pandemic pedagogy
Students perception of pandemic pedagogy were assessed using a four-point Likert scale.It consisted of 35 items with four open-ended questions.The questionnaire had three domains, including student-related (19 items), teacher-related (5 items), and physical learning environment-related factors (11 items).The response options for each item were: strongly agree (SA), agree (A), disagree (D), and strongly disagree (SD) with scores of 4, 3, 2, and 1, respectively.The total score ranged from 35 to 140, with a cut-off of > 87 as an indicator of favouring remote learning.Scores less than 86 indicated that the students favoured face-to-face classroom learning during the pandemic.The open-ended questions explored the favouring factors and the challenges students faced during emergency remote teaching.
The investigators developed this survey questionnaire after reviewing the available literature and taking opinions from the students.It was validated by five experts from the fields of nursing (three) and medical education (two).The scale content validity index (S-CVI) was computed based on the experts' agreement, and the questionnaire was valid (S-CVI: 0.82).As per the suggestions from the experts a few modifications were made in the final tool.The reliability was established by administering the scale to 20 post-basic BSc.nursing students, and Cronbach's alpha computed was 0.86.

Statistical analysis
Data cleaning was carried out using Microsoft Excel for irrelevant observations, inaccuracies, and unwanted outliers before analysis in SPSS.There were no missing data as all mandatory items were completed in the Google Form.The data analysis of the study was carried out using SPSS version 16 (SPSS, RRID:SCR_002865).The demographic variables and the perceptions of the students on remote learning were expressed in frequencies and percentages.The mean and the standard deviation of the perception score based on the year of study are described.To find the difference in the perception score between the years of study, ANOVA was used and post hoc comparisons were performed using the Hochberg's GT2 test.Independent sample t-test were performed to find the difference between the areas of residence and the perception score.The factors facilitating pandemic pedagogy and the challenges faced were described in frequency.

Nursing students' perception of pandemic pedagogy
The overall mean score of the perceptions of students on pandemic pedagogy was 89.03AE10.03.The year-wise mean scores are given in Table 3. Sixty-three percent of students had a total perception score above 87, indicating that they preferred remote learning during the pandemic, whereas 45% preferred face-to-face learning in the classroom.The response for the individual items on the perception scale is summarized in Table 2.
A comparison of nursing students' perception of pandemic pedagogy with years of study The three domains included in the perception tool were student-related, teacher-related, and physical learning environment-related factors.This section of the article discusses the comparison of domain wise analysis with the students as per their years of study.The comparison table depicted in Table 3 reveals no changes between the mean values of the domain scores across the different years of study.To compare nursing students' perception of pandemic pedagogy with years of study, ANOVA was computed, and it revealed that there was a significant difference (M=89.03,SD=10.03,F (3, 978)=4.96,p=0.002) in the total perception scores and the years of study.The post hoc comparisons using Hochberg's GT2 test indicated that the mean perception score of the first-year students (M=86.48,SD=10.95) was significantly different than that of the second-year students (M=90.97,SD=9.83).However, the third (M=89.43,SD=9.11) and fourth-year (M=88.65,SD=10.26)students' perception scores did not significantly differ from those of the first and second-year students.
Comparison of nursing students' perception of pandemic pedagogy with the area of residence A comparison of the perceptions of the nursing students on pandemic pedagogy with the area of residence has been described in Table 4.To make the comparison an independent sample 't' test was used.The findings reveal that there is no significant difference in the perception scores of the students residing in rural (M=88.68,SD=9.86) and urban (M=89.43,SD=10.23)areas; t (1.16), p=0.243.

Factors favouring pandemic pedagogy
The participants were asked to express their views on the factors that favoured remote learning during the COVID-19 pandemic.The responses are summarized descriptively, and the major aspects revealed were: 'an opportunity to view the recorded classes even after the live classes' (n=165), 'more time to spend for learning activities' (n=152), 'ample opportunity to clarify doubts like physical classroom' (n=139) and 'able to concentrate well as the teacher is directly interacting' (n=110).Other opinions were as follows; "flexible and convenient class timings motivated self-directed learning, study materials were made available immediately after each lecture helped in completing studies on time, in the current situation of a pandemic being along with parents were relaxing and stress-free and which helped in better learning, training sessions arranged by the college helped a lot in handling the remote teaching-learning platform efficiently."

Challenges faced during pandemic pedagogy
A descriptive summarization of the responses regarding the factors that hindered learning or the challenges faced in remote teaching-learning during the COVID-19 pandemic is discussed in this section.The majority of nursing students responded that internet issues, either due to poor network coverage, bad weather or monsoons, were a major concern as they could not understand the topics discussed (n=451).The participants also quoted a few other challenges: 'could not have group study and discussion which was practiced in the college campus' (n=326), 'Clinical skills cannot be taught well through the remote teaching platforms'(n=315), 'attending the classes through the mobile phone was difficult as often getting tired (headache, eye issues) due to the constant use' (n=262), 'less motivation to learn being away from the college' (n=205), and 'not able to concentrate being at home' (n=135).Some of them also mentioned the unavailability of library facilities and fewer opportunities to maintain interpersonal relationships with teachers and friends as the challenges faced during this pandemic time.
Opinion on future directives for classes during the postpandemic period Participants were asked to express their opinion on having a few hours of remote instruction along with face-to-face classes during the academic year post pandemic.The descriptive summary of the open-ended questions reveals that the future directions on the remote instructions were inconclusive.Most of them preferred to be at safe places during the pandemic and continue with remote learning.Under the favouring factors and the challenges faced during remote instruction, there is a mixture of opinions about the future direction of remote learning.As the curriculum demands handson clinical experience through direct patient care, they opined that it was a major missing.A few of them even suggested that the theory hours in the future could be a mixture of both online and offline classes, whereas a few felt that there were a lot of negative impacts of remote learning since it had pros and cons.To list a few physical ill effects, no opportunity for cocurricular activities, less opportunity to be together and interact with friends and teachers.Most of them expressed that although there were pros and cons for the remote instruction, the greatest challenges were network issues, the impact of weather on electricity, and data connectivity.

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 crosssectional 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 futureready curricula that prepare nurses to navigate complex healthcare scenarios with confidence.

Open Peer Review
Current Peer Review Status:

Carlos Laranjeira
School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal Thank you for attending to the concerns raised by the reviewers across multiple revisions.The quality of the manuscript has been greatly improved as a result of the changes that you have made.
I have some additional comments which focus primarily on improving the clarity of the paper: The paper does not cite an actual and appropriate range of literature sources.Relevant literature should be presented more deeply in order to support the research problem.

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Please provide the specific questions/hypotheses under study, it would be useful for the readers.

Method
In your methods section, say that you used the STROBE cross-sectional reporting guidelines.

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When the data were collected?Data collection period?○ A rationale is needed for the sampling procedure used.
○ Some subjects refused to participate.Response rate?

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The process of analysis should be made as transparent as possible.What strategies were used to avoid duplications or fraud in the online survey?Did you analyze any potential nonresponse bias?And early vs late bias?Did you check if data can suffer from common method bias?
○ Discussion A stronger discussion of implications for future research and potential intervention work is needed.

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Theoretical and methodological limitations should be emphasized more deeply.

Carlos Laranjeira
School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal I appreciate the opportunity to review this manuscript and hope my comments assist in the revision process.The material is interesting and the topic is timely and relevant.The method seems to have been followed faithfully and the authors were well-positioned to conduct the analysis.Despite these positives, in my view, the paper needs more work before it could be published and I have made some specific suggestions below.The paper does not cite an actual and appropriate range of literature sources.Relevant literature should be presented more deeply in order to support the research problem.Further, there is no clear distinction between manuscript sections in terms of the content they report.First, I suggest dividing the section "INTRODUCTION" into three components, respectively introduction (explain the general argument of the paper, without going into specific details) background (situate the study concepts within the context of extant knowledge, discuss the international relevance of the concepts) and purpose, creating greater clarity in the analysis of the reader.What is the study's biggest contribution?The contribution should be clearly stated in the introduction.

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As a reader, I was a bit confused with regard to the purpose addressed in this study.Please provide the specific questions/hypotheses under study, it would be useful for the readers.

Method
In your methods section, say that you used the STROBE cross-sectional reporting guidelines.

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When the data were collected?Data collection period?
○ Provide a clear description of the method used to select the participants for the study (e.g.convenience or consecutive).A rationale is needed for the sampling procedure used.

Results
How authors handled missing data?
○ Discussion Some of the contributions that are highlighted here could be flagged in the introduction for a more consistent narrative throughout the paper.Discussion can be improved if questions/hypotheses will be outlined in the introduction, then answered suitably in this section, and the results interpreted appropriately.I believe there should be better integration of the results with the existing literature.

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A stronger discussion of implications for future research and potential intervention work is needed.

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Theoretical and methodological limitations should be emphasized more deeply.

CHECKLIST FOR STYLE
The manuscript will serve a broad audience of students, researchers, and practitioners, however, the manuscript needs to be carefully and attentively proofread, because some sentences are awkwardly constructed, punctuation is deficient, and therefore reading is occasionally difficult to follow.That leads me to believe that it needs careful editing by a native English speaker.○ Instrument Validation: You mentioned that nursing and medical education experts validated the survey questionnaire.However, further details on this process would be useful.How many experts reviewed the questionnaire?What was their feedback?Was any revision made based on their feedback?
○ Sample Selection Description: Your description of the sample selection process seems a bit unclear.When describing that only three out of 13 institutions accepted to participate, was this due to the institutions not providing permission, or was it due to other reasons?Clarification on this point would help readers understand the context of your study.

Results
The data is well presented and analyzed.
You have included the p-values for the tests you conducted, but there are places where the description of significance is not clear.For instance, for the independent sample 't' test between rural and urban students, you report a p-value of 0.0243.While this is generally considered significant, you reported no significant difference.Please clarify or correct this.

Discussion
Your discussion comprehensively covers the students' experiences and compares them with previous studies, providing depth to the topic.However, every reference used should contribute directly to your findings or show how your work expands upon previous research.Please present your findings in a more simplified manner to aid reader understanding.Avoid repetition of similar points across the paper to prevent redundancy.Finally, ensure that your conclusion explicitly states your main findings and their implications for nursing education in the context of COVID-19.

General flow and clarity of manuscript
There are several areas in your manuscript that could benefit from further refinement to enhance clarity, precision, and readability.Here are my compiled comments: Grammar and Language Usage: The manuscript occasionally exhibits grammatical errors, inappropriate word choices, and awkward sentence constructions.These issues disrupt the smooth reading of the content and may confuse readers.For instance, "The most students" should be corrected to "Most students".I recommend comprehensive proofreading of the manuscript to identify and correct such errors.
○ Clarity: There are instances where the ideas conveyed are unclear or difficult to understand due to complex sentence structures.Simplifying sentences and using active voice more often could help with this.For example, "The perceptions of remote learning conducted among 804 medical students from Poland reported various advantages and disadvantages" might be better expressed as "A study conducted among 804 medical students from Poland reported various advantages and disadvantages of remote learning".

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Be consistent in capitalising the phrase of "Three Deemed to be University nursing institutions of Southern India".There are areas where this is in small case and in other areas, the are upper cases.school students from France concerning online learning."Does not seem to reflect or compare to deemed university nursing students.Suggest a reference to students in another similar university setting as a freshman.
Technology Platform: Regarding the platform used "Initially, teachers themselves explored various platforms and later they were oriented to online teaching platforms by the institutions too."This leaves the question.What was the platform used?
Results/Discussion: The following information needed to be explicated earlier -"The institutions adopted synchronous and asynchronous technology based on convenience and availability.
The synchronous technology included live interactions between teacher and students during online classes, whereas the asynchronous had a time gap between the instructor and its recipient."Again, this needed to be explicated earlier in learner engagement application descriptions to understand the modality.

References
References were applicable and up-to-date to support the background and results.Summary, Overall good article.Interesting and timely.

Is the work clearly and accurately presented and does it cite the current literature? Partly
Is the study design appropriate and is the work technically sound?Yes

Are sufficient details of methods and analysis provided to allow replication by others? Partly
If applicable, is the statistical analysis and its interpretation appropriate?I cannot comment.A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?Yes

Are the conclusions drawn adequately supported by the results? Yes
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Nursing education, vulnerable populations, and health disparities.
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Anil Raj Assariparambil
We appreciate the reviewer's effort in systematically cross-checking the manuscript and for your valuable suggestions.Abstract: Students favored synchronized online learning during the pandemic; however, there were several challenges.(We have modified it as per the reviewer's comment) 1.
Sample: "The sample characteristics would flow better under demographics instead of results." Respected reviewer, we are not very clear about this comment.However, is that before the results section, do we need to add a separate heading as sample demographics?We usually describe the sample demographics under the results section.Hence, we would like to retain the same format in the manuscript.

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Remote versus Online instruction: "Some parts of the article (i.e. the introduction) refer to "online" and other sections speak to "remote" teaching."Thank you for notifying us with the detailed description.It was really an eyeopener!We have changed it to remote instruction instead of online.

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Introduction: Citation and reference were updated as per suggestion 4.
Technology Platform: Modified the sentence mentioning the platforms 5.
Results/Discussion: The following information needed to be explicated earlier -"The institutions adopted synchronous and asynchronous technology based on convenience and availability.We have incorporated this statement into the introduction 6.
Once again thank you so much for you generous inputs to modify the manuscript.

Competing Interests: No competing interests
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Figure 1 .
Figure 1.A schematic flow chart representing sample selection.

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Is the work clearly and accurately presented and does it cite the current literature?PartlyIs the study design appropriate and is the work technically sound?PartlyAre sufficient details of methods and analysis provided to allow replication by others?PartlyIf applicable, is the statistical analysis and its interpretation appropriate?PartlyAre all the source data underlying the results available to ensure full reproducibility?Yes Are the conclusions drawn adequately supported by the results?

Table 1 .
A description of sample characteristics (N=982).The orientation is given by the institution on the use of the remote teaching platform
I was able to concentrate better during the remote classes compared to the face-to-face classes.I was able to communicate with my classmates well during this pandemic time like that in the classroom.

Table 3 .
A comparison of nursing students' perceptions of pandemic pedagogy mean scores by years of study (N=982).
*Significant at the level of p<0.05.

Table 4 .
A comparison of perceptions of nursing students on pandemic pedagogy with the area of residence (N=982).
This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Some subjects refused to participate.Response rate?Were the sample sizes sufficiently powered to detect effects?How did the researchers decide on sample size?Please cite the literature that supported the development of the data collection instrument.The validation of instrument needs more detail.The process of analysis should be made as transparent as possible.What strategies were used to avoid duplications or fraud in the online survey?Did you analyze any potential nonresponse bias?And early vs late bias?Did you check if data can suffer from common method bias?

the work clearly and accurately presented and does it cite the current literature? No Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility?
For instance, when you state, "Before the pandemic, most of the teachinglearning activities occurred either in formal classrooms or laboratories under teacher's constant mentoring, whereas in the mode of emergency remote teaching, the students had to take the responsibility for learning themselves," it would be helpful to cite literature supporting these observations.If these observations are based on anecdotal evidence or specific to the Indian context, please clarify this.The sentence, "COVID-19 pandemic had pushed us towards elearning from traditional classroom learning," may require more context or elaboration.While it's accurate that the pandemic hastened the transition towards e-learning, the trend towards online education had already been gaining momentum before the pandemic, particularly in countries like the United States.It would be beneficial to modify this statement to reflect the broader context.You mention, "The abrupt interruption of the well-planned academic activities in the face-to-face classes and the shift to remote teaching and learning was challenging for both teachers and students due to the technology and its accessibility."This sentence seems to make an assumption about the state of academic activities before the pandemic.Were all academic activities indeed well-planned before COVID-19?It would be beneficial to back this claim with evidence or rephrase it to avoid making potentially unfounded assumptions.For such a large sample with survey delivered online, it would be useful to report the response rate.This is important to assess the representativeness of your sample and understand the generalizability of your findings.Please provide this information.How was data prepared for analysis?Did you clean the data before the analysis?If so, what processes did you follow?Providing this information enhances the transparency of your study and allows for the replication of your study by other researchers.
○ Is ○ Use of Citations: Please provide references to support certain claims made in your ○ introduction.○SubstantiatedClaims:○MethodsMissingData:please indicate if there were any missing data and how such cases were handled in the analysis.It is important to disclose this information as it affects the interpretation of your findings.Please consider providing information on how missing data were managed in the study.○ResponseRate:○Data Preparation: