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. 2023 Apr 17;18:100573. doi: 10.1016/j.ijans.2023.100573

Reflections on a nursing education institution transitioning to online education during the Covid-19 pandemic

MA Jarvis 1,1, OB Baloyi 1,⁎,2
PMCID: PMC10108558  PMID: 37101536

Abstract

In 2022, nursing faculty reflect on the transition without global or national benchmarks or blueprints of a South African Nursing Education Institution to online education during the Covid-19 pandemic. Objective: To provide policy makers a resource in preparation for future crises in education. A theoretical-reflective study supported by a SWOT analysis aimed to understand the transition to online teaching and learning and assessments for the Nursing Discipline (nursing faculty n = 22; undergraduate students n = 291) of a select South African university. It revealed four key lessons learned. Firstly, whether change is planned or unplanned, policy frameworks should guide it. Secondly, resources exist within faculty, and at times, change agents might not be necessary as strengths can be drawn from within. Thirdly, through managing a crisis, faculty-service partnership can be strengthened. Lastly, a need exists for continual surveillance as the inequality gap in Higher Education students has become increasingly visible and amplified further marginalisation. Our reflections have highlighted that opportunities and strengths abound as the pandemic has fast-tracked nursing education institutions to embrace technology for teaching and learning and assessments. Three of the key lessons learned emphasise what is known about the successful outcome of working together.

Keywords: Online education, Nursing education, Pandemic, Reflections, Transitioning, Strengths, Weakness opportunities, Threats analysis

1. Introduction

In 2022 as we reflect on the initial events surrounding the 2020 declaration of a state of disaster, including lockdowns in attempts to flatten the curve of the expected COVID-19 trajectory, we are left in awe of how much was achieved in such a short period. It allows us to rephrase Winston Churchill’s statement to read: ‘Never was so much owed in higher education by so many to so few.’ Higher Education Institutions responded by closing campuses and moving to emergency online teaching and learning (Landa, Zhou & Marongwe 2021). Risk level-5 lockdown curtailed human interaction and limited South African faculty and students' movement, confined to their homes, away from the university. While recess was moved forward and students had time to re-acclimatise to living at home, faculty were given no break and plunged into a world of darkness, expected to craft a new era of online education. Neither global nor national benchmarks nor blueprints existed. Hence it is relevant that we as faculty members reflect on and share our Nursing Education Institution’s (NEI) transitioning to online education during the pandemic. In this reflection, we highlight the threats, challenges, strengths, and opportunities we faced, with the resultant four key lessons learned. Thereby through our sharing, we offer a resource for policymakers as responsive, relevant benchmarks are developed in preparation and readiness for future crises in education. It is to be noted that the reflective nature of this paper does not require ethical clearance (00016637).

Despite the emergency and urgency of the pandemic, couched in stories of moral distress and injury (Hines, Chin, Glick & Wickwire 2021), it would have been morally and ethically incorrect for Higher Education Institutions to return the students to academia or clinical settings without adequate preparation. However, questions lay in what was correct in a pandemic filled with epidemiology questions and its knock-on effects (Bozkurt et al. 2020). A pragmatic approach was relevant in the absence of lead-time; however, it would be birthed in isolation. Each higher education institution became pioneers in rapidly navigating unchartered waters with the evolution of teaching and learning and assessment plans in the transition to online learning and the transition back to the clinical setting.

In the abyss, nursing faculty failed to find the answer in global nursing bodies whose approaches to the return of students varied. Countries such as Spain offered employment to their final-year students (Casafont et al., 2021), while in the United Kingdom, the students were given an option to opt into remunerated extended clinical placement or to optout and defer clinical placements, following a “theory-only” route (Haslam 2020). In comparison, Canada was adamant that Canadians’ health needed safeguarding (Lira, Adamy, Teixeira & Silva 2020). Like the Caribbean (Agu, et al. 2021), South Africa moved to online learning; however, little detail was available for emulation.

The motto “No student or staff shall be left behind” held strong relevance in a country known for an inequality gap (Bozkurt et al. 2020). The motto blazed the path at every turn, determining the pace of addressing all transition activities as the “new normal” for teaching and learning and assessments evolved.

2. Method

In the South African university of this reflection, the preparation of the Nursing faculty (n = 22) and amongst others the undergraduate students (n = 291) of the 4-year Bachelor Nursing degree, was not without threats, challenges, strengths, and opportunities. A theoretical-reflective study supported by the theoretical framework (Backes, Malgarin, Erdmann, & Büscher 2021) of a SWOT [Strengths, Challenges (Weaknesses), Opportunities, Threats] analysis aimed at understanding the transition to online teaching and learning and assessments, for the Nursing Discipline of a select South African university, in order to highlight to nursing education institutions, the key lessons learnt.

3. Threats, challenges, strengths and opportunities

3.1. Threats to the transition

The faculty interfaced with the threats experienced by both themselves and the students. The faculty needed to be cognisant of the threats facing the students that surrounded the three areas of transition: transitioning back to campus, transitioning to online teaching and learning and assessments, and thirdly transitioning to the clinical settings. Firstly, most students live in residences, and threats to their physical health existed in transitioning from rural areas (n = 192), back to the city as a “hot-spot” for SARS-CoV-2 (Jarvis et al. 2021). This physical threat affected students’ mental health in expressions of anxiety, shared with faculty (Jarvis et al. 2021). Secondly, in the students’ transition to online teaching and learning pedagogy, threats existed in the inequality gap for the students, synonymous with constraints in access to digital resources, restricted spaces conducive to learning, limited electricity, and finances (Bozkurt et al. 2020). Thirdly, the clinical settings posed threats to the students’ health and skill base as they were unprepared for nursing at the peak of a pandemic. Faculty were at the coalface of these threats as students off-loaded and shared their difficulties, necessitating faculty to intervene through the development of a psychological first aid package (Jarvis et al., 2021, Jarvis and Baloyi, 2021).

Furthermore, the faculty had their threats to leverage. Many felt threatened as digital migrants with limited capacity in the use of ICT tools for the curation and delivery of online material requiring upskilling in digital skills (University of KwaZulu-Natal 2020a). The lack of a disaster management plan for education threatened a successful outcome to address the educational crisis, further compounded by financial demands on unplanned expenses in the university’s budget, such as faculty members needing data to enable the uploading and downloading of online material (UKZN 2020a). The university’s finances were already threatened in the wake of the 2016 move for financial concession labelled #FeesMustFall (Dlamini, 2019, Hedding et al., 2020).

3.2. Challenges and responses to the transition

The Information and Computer division, and Teaching and Learning Committees, rose to the fore and worked hand-in-hand on the emergency plan without a blueprint with our School. However, despite the university’s efforts to assist the students in transitioning to online learning, there were challenges. With the majority of students coming from rural and hard to reach areas (Landa et al. 2021), it posed similar transition challenges to those experienced by students from other South African Higher Education institutions (Hedding et al., 2020, Landa et al., 2021, Mpungose, 2020) and those further afield (Aristovnik, et al. 2020). The remote nature of the homes to which the students returned presented with poor network strength and internet connectivity issues, reflecting South Africa’s Network Readiness Index ranking of 72 out of 121 countries (Dutta & Lanvin 2020). In addition, despite the students’ age group classifying them as digital natives (Thompson 2013), a digital divide was evident between the first and fourth-year students (Harerimana & Mtshali 2018).

Further, conversations with students revealed evidence of the inequality gap (Bozkurt et al. 2020). Some students had to walk a distance to find a network signal or compete with siblings in a restricted area for quietness. The university negotiated with cellular network providers who provided data (e.g. 10GB day-time, 30GB night-time) and zero-rated university sites (Baloyi, Jarvis & Mtshali 2022), which unfortunately did not include Zoom web conferencing. Students needed to learn to use data economically because if data was depleted, limited family resources challenged the students replenishing the data to continue with their studies. In addition, the students’ time available to study was reduced through family expectations that they contribute to home activities, which included looking after younger siblings, collecting firewood, cooking, or going to the river to do the washing. Faculty could not deny the uniqueness of their students as they planned for the transition.

Challenges were not limited to internet access but extended to the students’ ability to access devices to facilitate the remote nature of teaching and learning and assessments. While the students waited for laptops from National Student Financial Aid Schemes (NSFAS) (Hammond 2020) or through university loan options, they attempted to navigate online learning by using their smartphones. Faculty exercised tolerance in the ensuing challenges experienced by the students. In many situations, faculty and the students used social media applications such as WhatsApp and initially learned through trial and error until support structures were implemented to use synchronous interactive online communication tools (Zoom, Microsoft Teams, Google Meet). The faculty had access to laptops, but the high data costs and data demands that ensued through online teaching necessitated the university providing data. Counter to the acquisition of skills for real-time online meetings, data, and devices, on many occasions, the country’s electricity supplier’s national load shedding schedule interrupted the delivery of lectures, demanding quick thinking alternatives.

Like others (Koffman, Gross, Etkind, & Selman 2020) we reflect on the uncertainty that surrounded the Covid-19 pandemic and how the Regulations of the Disaster Management Act, No. 57 of 2002 (Republic of South Africa RSA, 2002) and legislated concession for nurses to return to campus attempted to create a sense of order. However, we as faculty had to drive the goal to save the 2020 academic year (South African Government 2020). In the novel context of uncertainty, we were expected to use our ingenuity, creativity, and innovation to ensure continuity of teaching and learning. In implementing innovative educational responses, rivalries between universities ‘slipped into thin air’ as we came together for a common cause, formally and informally networking with each other, sharing newly learned e-learning skills, in the transition to an online teaching pedagogy. The university was very diligent in providing numerous online workshops to build our online teaching skills, which showed large variances in capabilities (UKZN, 2020a). In the university’s drive for a seamless transition, it felt as if we were repeatedly modifying module templates until there was certainty they were aligned with the remote online teaching pedagogy (UKZN, 2020a). The format of most assessments changed from traditional examinations to continuous assessments (UKZN, 2020a). A week of dry runs for teaching and for assessments was held in preparation for ‘going live’ (UKZN, 2020a). The adjustment to the adapted pedagogical approach without the aforementioned could have been perceived as a challenge (UKZN, 2020a).

Nevertheless, migration of the modules to online learning, the dry run phase, the time needed to negotiate with cellular providers, capacity building of faculty and students, and the constant echo of the adopted motto all caused a lag time in the formal commencement of online lectures as well as the return to the clinical settings. All faculty were required to produce catch-up plans, which despite personal sacrifices to time involving after-hour and weekend activities, the students met the adjustments positively (Mtshali & Jarvis 2021). The students’ primary goal was to complete their degree requirements, similar to students in other countries (Lovrić, Farčić, Mikšić & Včev 2020). Unity was evident in the crisis as clinical settings and academia joined hands in working towards a common goal while simultaneously abiding with the Covid-19 regulations that limited facilities.

An additional challenge is that Nursing Education Institutions (NEI) are answerable to two regulatory bodies: the university and the South African Nursing Council (SANC). Despite the university providing guidance, direction was required from the regulatory body, SANC. Attempting to navigate the change, NEIs turned to their regulatory body for direction on managing the unplanned change. SANC developed and distributed a circular (South African Nursing Council SANC 2020a). Another circular was published later to cater to the clinical learning challenges confronting nursing education institutions (Mtshali & Jarvis 2021). SANC responded to the NEI request to extend the clinical training time by increasing simulation learning to 20 percent of the clinical hours (SANC 2020b). The openness of SANC to special requests by NEIs, as they were at the coalface of the disaster, was an indication that all stakeholders were working towards a common purpose of ensuring that students complete their academic year.

3.3. Strengths in the transition

Due to the clinical nature of the Bachelor Nursing programme the preparation of the students for the return to the clinical settings during the height of the Covid-19 pandemic was not only dependent on the transition to online teaching and learning and assessments. A strength shown by the university was the concern for the physical well-being of its faculty and students and the protection of the healthcare providers and users with whom they were to engage. Residences were deep cleaned in preparation for the students’ return. Students were placed on quarantine for two weeks in the residences or their homes, offered the influenza vaccine and tested for SARS-CoV-2. Effective use was made of the quarantine period through online teaching of the theory component and skills that could be taught virtually. Students were provided cloth facemasks, hand sanitisers, and surgical personal protective equipment to meet the shortfall experienced by some clinical settings.

As a further safety measure, students were expected to download a five-item Covid-19 self-screening application (UKZN, 2020b), with the back-end of the results managed by the campus clinic. The campus clinic formed significant support to faculty and students alike. They were custodians of the Department of Health processes for Covid-19 infections and suspected infections and active participants in the College’s Task Team assigned to strategic planning of the pandemic within the university community. We value that central to the activities of the Task Team and aligned with the country-wide goal to “flatten the curve” was the preservation of life for staff and students alike, especially higher-risk population groups. Access to campus was controlled through an electronic permit system.

To further decrease faculty/student risk of infection, discussions and more often debates revolved around the transition from direct care to virtual clinical experience and mobile technology involving sharing video or audio-recorded interactions with patients to assess for competency in assigned skills. Clinical supervision migrated online, held after hours to prevent disruption of services and ensure data efficiency. Notwithstanding the importance of physical safety, the mental health safety of the students was included in the preparations for their return through a Psychological First Aid package (psychological safety, epidemiology of Covid-19, and competent use of personal protective equipment, four-week mHealth programme) (Jarvis & Baloyi 2021). In addition, campus Student Support Services remained available throughout online access.

The management of risks was not only located in the risks to the students’ and the faculty’s mental and physical health, but extended to prevent the risk of losing the academic year, that both the final year nursing students, and the Department of Higher Education and Training (DHET) wanted to save. DHET, the university, we as faculty and health facilities responded to this request by the students. In keeping with the university’s principle that students should be central to all decisions (UKZN. 2020a), the voices of the students were amplified and considered for effective management of change. All stakeholders, including students, administrative staff, and faculty, were actively involved in managing the change process inputting into the development of plans to achieve the desired common goal. Students, and faculty alike, we agreed to work longer hours and conduct after hours assessments. The strength lay in the unity in approaching a common goal.

At no time during any of these numerous, sudden and unexpected changes experienced by the stakeholders was a change agent available to facilitate the transitions. Learning was through trial and error with reflections and corrections as we journeyed through the process. The process of continuous quality improvement guided learning.

3.4. Opportunity of online migration

Aside from recognizing the students' mental and physical well-being, a further unintended strength and opportunity of online migration for us as faculty, labelled digital migrants, was the fast-tracking of digital skills’ acquisition. The newness of the skills allowed us to practise and experiment with new online methodologies, protected from the students’ criticism as they joined in the learning. The students needed to adjust to the university’s adoption of the flipped classroom approach in which blended learning was enshrined; however, it stimulated independent study.

4. Recommendations and lessons learnt

Our reflection of the threats, challenges, strengths and opportunities of our NEI’s transition to online teaching and learning has resulted in us identifying recommendations and four key lessons learnt.

Change has become synonymous with the pandemic, and in most instances, it is not planned. Our first lesson highlighted that whether change is planned or unplanned, it should be guided by policy frameworks. Ideally, the policy frameworks should be framed within systems thinking approach, with all parts of the system considered to ensure that they all work towards a common goal as education is a complex system (Education Development Trust 2019). Policymakers have to adopt systems thinking approach when developing policies to ensure that different parts of the system or stakeholders affected by change are considered. Systems thinking fosters transformational change within organisations and allows them to adapt to change.

Managing unplanned change led to our second lesson and realizing the location of resources within the faculty and between NEIs. Resources exist within faculty and at times, change agents might not be necessary as strengths can be drawn from within. In addition, intrinsic motivation can be the best agent in times of unplanned change (Owens & Valensky, 2014). This was observed from almost all of the stakeholders, and that yielded positive results. Further, effective management of change is facilitated by sharing resources and best practices. Sharing between and among NEIs needs to occur within HEI to facilitate quicker or stronger change mindful of the larger education system and its outputs for the country as a whole. A recommendation is that if all stakeholders within the system work towards a common goal, managing change is likely successful. Nursing education is no exception.

Our third lesson learnt is that through managing a crisis faculty-service partnership can be strengthened. In the continual consultation between nurse managers from service and NEI a recommendation is that it is possible to have a successful process of developing and implementing plans for the benefit of the student.

While we are mindful of how in a short period the narrative of the threats and challenges has changed, we reflect on the fourth and last very important lesson we learnt. The lesson stresses that we remain aware of the need for continual surveillance as the inequality gap in Higher Education students has become increasingly visible and at times amplified further marginalisation.

5. Conclusion

The Covid-19 colloquial saying ‘life will never return to how we knew it’, has significance in this pivotal period for long term changes in NEI. Our reflections have highlighted that opportunities and strengths abound as the pandemic has fast tracked NEI to embrace technology for teaching and learning and assessments. Three of the key lessons learnt emphasise what is known about the successful outcome of working together.

Author contributions

Both authors were involved in the conceptualisation and writing of the article.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgement

The authors acknowledge all faculty who tirelessly transitioned at such short notice to online education during the pandemic.

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