Abstract
BACKGROUND:
Conventional face-to-face teaching is considered as a customary model of learning in nursing since a long time. However, the integration of online learning platforms in nursing education has increased in the last few years. It is crucial to know the students’ readiness and willingness to learn in this novel milieu in order to facilitate an effectual and significant learning atmosphere.
MATERIALS AND METHODS:
A descriptive cross-sectional design was employed to assess the satisfaction levels of nursing students regarding online curriculum delivery. Convenience sampling technique was used to recruit the nursing students from nursing colleges in North India. Data were collected from 103 nursing students through student satisfaction scale. Descriptive statistics and Chi-square tests were used for data analysis.
RESULTS:
The majority of students reported moderate satisfaction (76.7%) with online learning. Areas of satisfaction included flexibility in achieving course outcomes (53.40%), location flexibility (59.2%), time-saving (59.2%), instructor effectiveness in terms of explaining concepts (54.3%), friendliness with technology (64.08%), regularity in lectures (70.87%). However, challenges were also identified. These included a lack of student interaction (62.1%), student isolation (61.1%), technical difficulties (74.7%), cost of devices (65.05%) and internet cost (61.1%), and limitations in delivering practical skills (64.08%).
CONCLUSION:
While students appreciate flexibility and convenience, challenges exist. Educators should consider these findings to create more engaging and effective online learning environments that address the unique needs of nursing students.
Keywords: Nursing students, online classes, satisfaction
Introduction
The COVID-19 pandemic transformed the worldwide education system by replacing traditional and face-to-face mode of education with virtual education.[1] Online learning offers a plethora of advantages. The integration of digital technologies facilitates the establishment of diverse and engaging learning environments that cater to the individual needs of students.[2] This flexibility empowers students to learn at their own pace and from any location, fostering a sense of autonomy and control over their educational journey.[3] Furthermore, studies have demonstrated that learning via online medium can be an effectual tool for knowledge acquisition, skill development, and fostering positive learning attitudes.[4] This is particularly relevant in the context of clinical training, where online platforms can bridge geographical limitations and provide ongoing training opportunities even when face-to-face interactions are restricted.[5]
However, the transition to online learning is not without its challenges. Nursing students may perceive a lack of interaction and collaboration compared to traditional classroom settings.[6] The absence of positive peer pressure and the diminished opportunities for peer-to-peer learning can negatively influence student motivation and engagement.[7] Additionally, some students have concerns regarding the quality of online interactions and the effectiveness of teaching practices in the virtual environment.[8] Furthermore, technical difficulties and the financial burden associated with acquiring necessary devices and internet access can pose significant barriers for some students.
There has been a shift in the use of online platforms as an additional tool to assist continuous education or as a means of learning with the introduction of novel technologies that facilitate web-based learning. It has become a widely acknowledged and valued learning medium for both educational institutions and students worldwide as it is easy to use, flexible learning, and controlled settings are the reasons for this appeal.[9]
Moreover, online learning has established a connect between availability of technology and student engagement with improved students’ participation in courses that offer instructional delivery anytime and anywhere with means of web-based courses.[10]
In previous studies, students described an online curriculum approach comparable to conventional or classroom learning in terms of student’s engagement and motivation and also reported students’ satisfaction and increased confidence in learned skills.[11] A study conducted by Schuler et al.[4] found that using the online educational programme (OEPs), the majority of students reported encountering technical difficulties. Concerning to the connectivity, such as the fact that some programs could only be used through online, or concerning in preparation of the assignment, were some of the technological challenges. Despite the mentioned difficulties, some students thought using the OEPs was beneficial. In particular, students valued being able to use a range of instructional strategies and study at their own pace.[12] Comparably, one of the studies carried out by Chan et al.[12] reported that all of the students preferred learning online over face-to-face learning and facilitated them to repeat the pre-recorded lectures to increase their comprehension of the instructional content and it is more flexible, decreased their transport time.[13] On the other hand, students also shared that conventional or face-to-face laboratory classes are required to acquire and practise hands-on nursing psychomotor skills and that an online question-and-answer platform should be usually uphold.[2]
Conventional face-to-face teaching is considered as a customary model of routine learning predominantly in nursing. It not only draws the attention of the students but also secures the focus/concentration through interactions and brainstorming activities. A study conducted by Dutta et al.[5] revealed that virtual online teaching is an essential alternative complementary role in the training of medical and nursing students. Innovation and change in the curriculum, such as the creation of additional online resources for recent medical and nursing graduates, will allow concentrating more on clinical or practical classes. This will also increase the efficiency of the online courses and raise student satisfaction levels.
The landscape of nursing education is undergoing a significant transformation, fuelled by advancements in digital technologies. While traditional classroom-based instruction has long been the cornerstone of nursing education, online learning platforms are emerging as a powerful and complementary approach. Hence, it is crucial for the instructors to find out students’ readiness/willingness to learn in this novel milieu. It also enhances students’ attendance, contentment, and motivation/impetus, thus producing an effectual and significant learning atmosphere.[14]
This research article explores the satisfaction of nursing students regarding online curriculum delivery, delving into the perceived benefits and challenges associated with this novel pedagogy.
Materials and Methods
Study design and Setting
This study employed a descriptive design to investigate the perceptions of nursing students regarding online curriculum delivery in a Bachelor of Science in Nursing (BSN) program. The students pursuing Diploma/degree programs in nursing from Indian nursing Council affiliated nursing colleges in North India were the study participants. The study was done in the year 2021.
Study participants and sampling
Data were collected from a sample of 103 nursing students enrolled in the BSN program across all years. A convenience sampling technique was utilized due to its practicality and feasibility within the research context.
Data collection tools and technique
The researcher used self-developed student satisfaction scale to assess student satisfaction with online teaching, learning activities, and evaluation methods. Students responded to a series of statements using a five-point Likert scale ranging from “Strongly Disagree” (SD) to “Strongly Agree” (SA). Negative items were reverse-scored to ensure consistency in interpretation. The total possible score ranged from 30 to 150, with higher scores representing greater level satisfaction. To ensure content validity, the scale was appraised by the nursing experts. The content validity index (CVI) was calculated to be 0.85, exceeding the recommended threshold for good content validity. Individual item content validity ranged from 0.62 to 1.00. The internal consistency of the questionnaire was evaluated using Cronbach’s alpha, which yielded a score of 0.87, indicating good internal reliability.
Ethical considerations
To ensure informed participation, online consent was obtained from all participating students before commencing with the data collection process. The consent to participate in the study was taken through Google form. The aim of the study was mentioned on the first page of the Google form and the students had to specify their comprehension/understanding and consent by marking/ticking on ‘I agree’ box before proceeding.
Statistical analysis method
SPSS version 20 software was employed for data analysis. Descriptive statistics (frequency, percentage, mean, standard deviation) were used to characterize the sample and summarize student responses. Inferential statistics, specifically Chi-square tests, were utilized to identify potential associations between student satisfaction and demographic variables.
A significance level (alpha) of 0.05 was adopted, implying that findings with a P < 0.05 were deemed statistically significant.
Results
The results revealed that majority of nursing students (49.51%) were in the age group of 21-24 years and 86.40% were male. Most of the nursing students (50.5%) were residing in urban area and 35.9% had monthly income <20,000 Rs/month. Majority of nursing students (75.7%) had no experience of online learning before March 2020. Around 88.3% were using the tab for online classes and 64.70% had access to good internet speed. More than half of the nursing students (56.3%) were spending the Rs 500-1000 on internet connection for online classes [Table 1].
Table 1.
Profile of nursing students n=103
| Selected variable | Categories | f | % | |||
|---|---|---|---|---|---|---|
| Age (years) (n=103) | 17−20 | 38 | 36.89 | |||
| 21−24 | 51 | 49.51 | ||||
| 25−28 | 12 | 11.65 | ||||
| 29−31 | 02 | 1.94 | ||||
| Gender (n=103) | Male | 89 | 86.4 | |||
| Female | 14 | 13.6 | ||||
| Prog under study (n=103) | Diploma | 67 | 65.0 | |||
| Undergraduate | 36 | 35.0 | ||||
| Year under study (n=103) | First | 33 | 32.0 | |||
| Second | 45 | 43.7 | ||||
| Third | 19 | 18.4 | ||||
| Fourth | 6 | 5.8 | ||||
| Residence (n=101) | Urban | 52 | 50.5 | |||
| Rural | 49 | 47.6 | ||||
| Monthly income (per month) | <20,000 Rs | 37 | 35.9 | |||
| Rs 20−39,999 | 30 | 29.1 | ||||
| Rs 40−59,999 | 15 | 14.6 | ||||
| ≥60,000 Rs | 16 | 15.5 | ||||
| Experience of online learning before March 2020 (n=103) | Yes | 25 | 24.3 | |||
| No | 78 | 75.7 | ||||
| Most frequently used online platform (n=103) | WhatsApp/Telegram | 52 | 50.5 | |||
| Google Classroom | 26 | 25.2 | ||||
| ZOOM | 15 | 14.6 | ||||
| Cisco Webex | 9 | 8.7 | ||||
| Google Meet | 1 | 1 | ||||
| Internet speed (n=102) | Excellent | 30 | 29.41 | |||
| Good | 66 | 64.70 | ||||
| Poor | 6 | 5.88 | ||||
| Device used for online classes (n=103) | Tab | 91 | 88.3 | |||
| Mobile phone | 12 | 11.7 | ||||
| Monthly expenditure on internet connection for online classes (n=103) | Less than Rs 500 | 33 | 32.0 | |||
| Rs 500−1000 | 58 | 56.3 | ||||
| Rs 1000−1500 | 9 | 8.7 | ||||
| More than Rs 1500 | 3 | 2.9 |
The mean satisfaction score of nursing students regarding online curriculum delivery was 89.05 ± 15.27 with obtained range of 51-140. It indicates that nursing students were moderately satisfied with the online curriculum delivery [Table 2].
Table 2.
Mean satisfaction score on online curricular delivery n=103
| Range | Mean±SD |
|---|---|
| 51−140 | 89.05±15.27 |
| Minimum score: 30, Maximum score: 150 |
Majority of the nursing students (76.7%) had moderate level of satisfaction, 16.5% had low level of satisfaction, and 6.8% had high level of satisfaction [Table 3].
Table 3.
Level of satisfaction among nursing students n=103
| Level of satisfaction | Range of scores | Frequency | Percentage | |||
|---|---|---|---|---|---|---|
| Low (≤50%) | 30-75 | 17 | 16.5 | |||
| Moderate (51-75%) | 76-112 | 79 | 76.7 | |||
| High (>75%) | 113-150 | 7 | 6.8 |
Students generally appreciated the flexibility offered by online classes, with a majority agreeing that online classes facilitated achieving course outcomes (53.40%), provided location flexibility (59.2%), and were timesaving (59.2%). Distraction-free learning environments (49.5%) were another advantage. Instructors were perceived as effective in explaining concepts (54.3%), comfortable using technology (64.08%), and delivering lectures consistently (70.8%) [Table 4].
Table 4.
Item wise analysis of nursing students on Satisfaction with online classes n=103
| Item | SA (strongly agree) | A (agree) | N (Neutra) | D (disagree) | SD (strongly disagree) | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| I am satisfied with the online classes in terms of | ||||||||||
| Achievement of my course outcomes | 7 | 48 | 35 | 10 | 3 | |||||
| Flexibility of space | 9 | 52 | 33 | 8 | 1 | |||||
| Flexibility of time | 10 | 50 | 36 | 6 | 1 | |||||
| Saving of time | 17 | 44 | 28 | 12 | 2 | |||||
| Effective utilization of time | 8 | 50 | 34 | 8 | 3 | |||||
| Lack of in person classroom disturbances | 11 | 40 | 31 | 16 | 5 | |||||
| Substitution to offline classroom teachings | 10 | 36 | 36 | 14 | 7 | |||||
| Clarity in explanation of concepts by teachers | 10 | 46 | 39 | 5 | 3 | |||||
| Voice audibility of the teachers | 3 | 47 | 36 | 13 | 4 | |||||
| Voice pace of the teachers | 3 | 54 | 35 | 8 | 3 | |||||
| Teacher student interaction during class | 11 | 44 | 33 | 13 | 2 | |||||
| Teachers’ friendliness with the technology | 8 | 58 | 31 | 5 | 1 | |||||
| Teachers’ skills in making the class interesting | 11 | 55 | 28 | 8 | 1 | |||||
| Teachers’ regularity and punctuality in lecture delivery | 13 | 60 | 25 | 3 | 2 | |||||
| Increased opportunity to access and use information like recorded video lectures | 14 | 61 | 20 | 7 | 1 | |||||
| Response time from teachers for online doubt clarification | 9 | 62 | 25 | 4 | 3 |
However, challenges were also identified. A significant portion of students expressed dissatisfaction with the level of student interaction (62.1%). Eye strain and fatigue were prevalent concerns (75.7%), and some students felt isolated due to the inability to see classmates (61.7%). Technical difficulties (74.7%) and the cost of devices (65.05%) and internet cost (61.1%) were additional hurdles. While online exam monitoring elicited mixed reviews (50.4%), many students felt online classes lacked sufficient engagement tools (52.4%) and focus on co-curricular activities (61.17%). The absence of physical activity opportunities (69.9%), proper student mentoring (56.3%), skill-based teaching delivery (64.08%), and opportunities to learn practical skills (57.2%) were significant drawbacks [Table 5].
Table 5.
Item-wise description of student dissatisfaction with online classes n=103
| Item | SA (strongly agree) | A (agree) | N (Neutra) | D (disagree) | SD (strongly disagree) | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| I am dissatisfied with the online classes in terms of | ||||||||||
| Student-to-student interaction | 19 | 45 | 29 | 8 | 2 | |||||
| Emerging eye health problems (eye strains, dry eyes, eye fatigue etc.) | 43 | 35 | 21 | 1 | 3 | |||||
| Feeling of studying in vacuum due to inability to see students | 20 | 43 | 29 | 7 | 4 | |||||
| Nuisances like online fiddling made by students | 18 | 49 | 25 | 7 | 4 | |||||
| Technological issues like voice lag, visual clarity, low audio | 26 | 51 | 19 | 5 | 2 | |||||
| Cost of required devices | 20 | 47 | 24 | 8 | 4 | |||||
| Internet cost | 19 | 44 | 25 | 10 | 5 | |||||
| Vigilance during online exams | 8 | 44 | 37 | 9 | 5 | |||||
| Use of student engagement and classroom interactive tools | 9 | 45 | 36 | 10 | 3 | |||||
| Focus on co-curricular aspects (cultural activities) | 13 | 50 | 31 | 8 | 1 | |||||
| Lack of physical activities/sports activities | 27 | 45 | 21 | 7 | 3 | |||||
| Lack of student mentoring activities | 13 | 45 | 30 | 10 | 5 | |||||
| Delivery of skill-based teachings | 23 | 43 | 29 | 7 | 1 | |||||
| Learning of skill-based curriculum | 18 | 41 | 35 | 8 | 1 |
In essence, while online learning offers flexibility and eliminates distractions, it presents challenges related to interaction, student isolation, technical issues, cost, and limitations in delivering practical skills and fostering a well-rounded educational experience.
Discussion
This study’s demographic data on student age, gender, year of study, and online learning experience partially align with previous research by Dhawan et al.[8] and Kumar et al.[9] However, income distribution and device usage differed from a study done by Mukhopadhyay et al.[11]
The mean satisfaction score (89.05 ± 15.27) aligns with Dhawan et al.[8] regarding perceived benefits of e-learning. Most students reported moderate satisfaction, similar to Kanagaraj et al.[14] Yazdannik et al.[15] in his study reported that the satisfaction scores were significantly different between emergency nurses in e-learning and traditional groups after 2 weeks of the intervention on Emergency Severity Index Triage. The satisfaction scores were significantly higher in e-learning group as compared to traditional group at post-test.
In the present study, nearly 60% of the students were satisfied with the online curriculum delivery in terms of flexibility of time and space which is similar to the findings of study conducted by Khan et al.[16] in which it was found that 58.7% of the participants reported that studying via e-learning/online mode offers the flexibility to learn at the time convenient/suitable to the learner and 73.4% of the participants said that e-learning/online permits students to pursue their studies irrespective of geological differences and helps in the conduction of examinations and submission of assignments/projects online. These findings are consistent with the study conducted by Kumar et al.[9] in which majority (67.57%) of the students were extremely satisfied with the online learning.
In the present study, the majority of the students were dissatisfied with online classes in terms of emerging eye health problems (75.7%); Technological issues like voice lag, visual clarity, low audio (74.76%), and lack of physical activities/sports activities (69.9%). The findings of the study by Kumar et al.[9] reported that the highest barriers that hamper to online learning among nursing students were “low voice and language clarity” (2.16 ± 0.593), “physical health barriers such as eye strain” (2.43 ± 0.613), “reliability, and connectivity problem” (2.26 ± 0.534).
In the study, 72.8% respondents agreed that online classes increase the opportunity to access and use information like recorded video lectures whereas in another study, 68% of the students reported that through e-learning system, they can effortlessly access the required information.
Our findings echo previous research by Dhawan et al.[8] and Nwamu et al.[10] on the advantages of online learning, including flexibility, time-saving benefits, and instructor effectiveness. Technical aspects received mixed reviews, with some students comfortable and others remaining neutral, which partially aligns with Khan et al.[16]
A significant concern was the lack of interaction and missed learning opportunities, mirroring findings by Siah et al.[2] and Mukhopadhyay et al.[11] Students also missed physical activity and proper mentoring, similar to Mukhopadhyay et al.[11] Challenges in online clinical learning, particularly limited opportunities to practice psychomotor skills, were identified, aligning with Mukhopadhyay et al.[11] and Mukasa et al.[17] Cost of devices and internet access emerged as a concern, consistent with multiple studies.
In conclusion, this study adds to the existing body of research by exploring the perceptions of nursing students regarding online curriculum delivery. While students appreciate the flexibility and time-saving benefits, challenges related to interaction, skill development, and cost require further attention for successful implementation of online learning programs in nursing education.
Limitations and recommendations
This study has limitations. The sample was drawn from a single nursing program, potentially limiting generalizability. Additionally, the study relied on self-reported data, which may be susceptible to bias. Future research could explore effective strategies to promote student interaction and collaboration in online nursing education. Additionally, research is needed to develop innovative methods for teaching and assessing practical skills in online environments. Finally, studies investigating the long-term impact of online learning on the competency of nurses are warranted.
Conclusion
This study provides valuable insights into the perceptions and satisfaction levels of nursing students regarding online learning. While students appreciate the flexibility and convenience of online classes, challenges exist, particularly related to student interaction, skill development, and cost. Educators developing online nursing programs should consider these findings to create more engaging and effective learning environments that address the unique needs of nursing students. Regulatory bodies should establish guidelines and monitor standards for inclusion of online curriculum delivery in teaching and evaluation processes.
Conflicts of interest
No known conflicts of interest associated with this study.
Acknowledgement
We would like to acknowledge the study participants for giving their valuable time and support for the conduct of this study.
Funding Statement
The study was a self-financed study. We did not receive any financial grants from any agency.
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