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

What is already known about the topic?

What this paper adds?

Introduction

The outbreak of Coronavirus Disease 2019 (COVID-19) hampered educational activities worldwide. Educational institutions in most countries had to go remote instructions from face-to-face teaching during lockdown and after. When COVID-19 crisis would end in uncertain and colleges started functioning as before has led to continuing e-learning in many parts of the world indefinitely until the pandemic comes under control.

What we experienced during the 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). COVID-19 pandemic had pushed us towards e-learning from traditional classroom learning (Hodges et al., 2020). 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.

Nursing education focuses on the development of knowledge and clinical competency for providing quality care to the patients. During the course of study, theory and practicum go hand-in-hand for students and thereby bridge the gap between theories and practice. Students acquire their clinical skills by practicing in both laboratory and hospital. Getting adequate clinical experiences would improves the skills in performing nursing procedure, rather than enhancing critical thinking and clinical decision-making abilities. 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 teacher and students during online classes, whereas the asynchronous had a time gap between the instructor and its recipient (Finkelstein, 2006). The implementation of emergency remote teaching helped to 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 the changes in learning environment. Before the pandemic, most of the teaching-learning 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.

A study conducted by Dvořáková et al. (2021) on university students’ perception of remote learning during the first wave of the COVID pandemic. A total of 68 under-graduates and 31 post-graduates were included in the online survey using MS forms. Among 99 participants, the average overall score for satisfaction with 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 regular face-to-face teaching.

The emergency remote teaching or pandemic pedagogy in nursing and other professions has not been much explored. The objective of the study is to assess the perceptions of the undergraduate students of nursing on the 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 of the deemed to be universities of 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 accepted to participate in the study. The online survey questionnaire was sent to all the students of the three colleges and requested them 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 paper intended to study undergraduate nursing student’s perception towards the remote learning adopted during the COVID-19 pandemic. The institutions of nursing education quickly moved on to the mode of remote learning to have uninterrupted learning during the lockdown. This was an unprepared and sudden change in the education for which the students and the teachers were not ready. Due to a lack of preparedness, the teachers and the students faced many challenges, especially during the transition period. 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. The most students (43.3% D, 15.3% SD) disagreed that they could concentrate better during the remote instructions compared to the face-to-face teaching and the remote instructions were more interactive than the classroom learning (47.4% D, 15.2% SD). Though there was an online learner engagement with the remote learning, the majority worried (64.6%) about the depth of knowledge of the course content.

Bali and Liu (2018) explored higher education students’ perception and indicated that social presence, social interaction, and satisfaction were higher in the face-to-face learning than the remote learning. However, a few students preferred the remote learning as the technology led them to be innovative. The student engagement remains a challenge in the remote learning. Engaging the students and enhancing the student-learning may not be as effective in the remote learning as in the classroom learning. The students may not be able to discuss and have their 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). The remote teaching-only classes may affect the student performance, especially for those who are already academically struggling. The face-to-face instructions would enable the academic performance of students than the online courses (Xu & Jaggars, 2014). 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 like that happened in the classroom (43.6% A, 36.9% D). The most of them (57.4 % A, 8.5% SA) agreed that they never got a sense of isolation while attending the remote classes being away from the regular classroom and 63% agreed that the opportunities for extracurricular activities were more in the regular classroom learning. The majority of them (71%) perceived that the teachers kept the learners active throughout the class and 59% agreed that the use of learner engagement applications (Kahoot, Mentimeter, etc.) kept them active during the remote class.

The remote learning would hinder in acquiring clinical skills. A study conducted among the dental students and the staff reported that the closure of teaching clinics would affect the students’ clinical competence (Loch et al., 2020). In the present study, the most students felt that they were not confident to perform 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 develop the clinical decision-making skills (15.2% SA, 68.6% A).

Due to the abrupt shift from the face-to-face to the e-learning education, there were concerns about the availability of technology in terms of the devices used for attending the remote instructions, internet access, and skills in the use of technology. Based on the socioeconomic status, the students used the devices for the remote learning, and hence the quality of the device they used would vary. The researchers have found that when the students expected to use the electronic devices for the remote instructions, 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 the remote learning was user-friendly and 69% of them agreed that the teachers’ technical skills helped them a lot to have uninterrupted classes. However, contradicting that 53% of them perceived that unfamiliarity with the use of technology made the remote learning difficult. Along with the technical issues, there were the major challenges such as network issues (52% A and 34.5% SA), electricity issues and bad weather during the remote learning. One of the significant factors that favoured the remote learning was the availability of teaching-learning material and the recordings of the classes on the same platform (72%).

The perceptions of remote learning conducted among 804 medical students from Poland reported various advantages and disadvantages. The majority (73%) of students enjoyed the remote learning. Learning at the students’ own pace (64%), ability to stay at home (69%), continuous access to online material (69%), and the comfortable environment were reported as the advantages of the remote learning whereas, lack of patient interaction (70%) and technology-related problems (54%) were the disadvantages that the medical students faced. The remote learning was considered less effective in honing the skills and the social competencies (p<0.001) than the face-to-face learning whereas there was no difference in knowledge gain (p=0.46). However, the students were less active during the remote teaching than the traditional classes (Bączek et al., 2020). In the present study, 71.5% of them expressed that the remote instruction timings were convenient than the classroom learning. Mukhtar et al. (n.d.), reported that the remote learning encouraged student-centred 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.

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 the doubts with the teacher and they even agreed (70.7%) that the teachers did motivate them being 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 the classes remotely was a stressful situation for them. They perceive that being away from the regular classes affected the 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 clear as in the physical classroom. The most of the participants (66%) agreed that the remote teaching mode gave an adequate opportunity for the instructor feedback for the students as in the physical classes.

Accessibility is a major concern in the remote teaching learning in most countries. The students from the remote areas faced connectivity problems. The English language education study programme in Indonesia identified that the availability and the sustainability of internet connection, accessibility of teaching media, and compatibility of the device used to access the media were the major obstacles for the remote learning. Hence, to increase the student participation in the remote learning there should be more friendly platforms (Agung & Surtikanti, 2020). A study conducted by Baloran (2020) reported that due to poor internet connectivity the college students refused to have a blended online learning approach during the COVID-19 pandemic. The majority students (61.78%) preferred learning inside the classroom 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% internet problem, only 64.4% of the students had the internet access for their remote classes. Khalil et al. (2020) reported that poor internet connectivity and utility of the online tools were the challenges of the remote learning. In the present study, 86.2% of students reported that the connectivity issue (34.5% SA and 51.7% A) was a major concern during the classes, especially in the rural area.

The COVID-19 pandemic had a psychological and emotional impact and affected the students’ mental health (Lee, 2020). The students of the institutions of higher education, including nursing, experienced moderate to severe stress and anxiety in the 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 being away from the institution for a long time and attending the classes remotely. Providing a high-quality remote teaching learning using a stable educational framework and encouraging the students may help in lowering their anxiety (Savitsky et al., 2020). The perceptions of the students from a university of higher education from India reported that the 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 exceeded for the day (Mishra et al., 2020). In the present study, the majority of students agreed that they were able to accomplish the learning objectives (72.8% A, 8.6% DA).

The students found that if the recorded classes were available during the remote classes, it helped in better understanding the information whereas if the concepts were difficult it was harder to follow (Khalil et al., 2020). Deepika (2020) reported that the quality and the timely interaction between the student and the teacher, availability of technical support, a structured module for the remote classes, and facilities for conducting practical classes were essential for the student and the teacher satisfaction with the remote instructions. Most of the students (66.2%) agreed that they had an opportunity for the instructor feedback during the remote teaching.

The present study findings revealed that among the student nurses who participated, 62% agreed and 29% of them strongly agreed that the remote learning was safer amidst the COVID pandemic and 53% of them agreed that the remote classes were interesting, and they enjoyed learning. The majority of them (65.0%) agreed that the new teaching environment improved self-directed learning skills. They perceived it as they needed to be more accountable (74.2%) and responsible (72.6%) to achieve the learning outcomes during the pandemic pedagogy. The half of the participants (51.0%) perceived no difference between the remote and the face-to-face classroom learning, as both helped them to understand the course concepts in the same manner. Nearly half of them (49%) agreed that a virtual demonstration of nursing procedures helped them to develop clinical skills as in the regular teaching. The students agreed that being away from the clinical setting for a long time affected the clinical skills (59%) and felt they were not confident in performing the procedures that they missed to practice (62.4%).

A study conducted to explore the challenges to remote medical education during the COVID-19 pandemic reported that pandemic related stress, issues related to the online experience, communication, and time management were the challenges faced (Rajab et al., 2020). The challenges faced by the teachers may influence the students’ remote learning. A qualitative study conducted among the 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 as the barriers faced by the teachers during the 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, an opportunity for group study, and lack of opportunity for the clinical practice.

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

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

Conclusions

The COVID-19 pandemic posed significant concerns among the students of higher education institutions. The results from the present study conclude that the students prefer the remote learning as well as face-to-face classes. Though remote learning only could be adopted during the pandemic, to achieve adequate clinical skills the students need to get clinical experience with adequate simulated learning and direct patient care. The nursing institutions must adopt blended learning to achieve competencies needed keeping in mind the control of the spreading COVID-19 infection. In addition, the challenges of the pandemic COVID-19 lead to prospects for the development of nursing education and provide quality education by adopting the technology.

Data availability