Nursing Students’ Satisfaction with Online Learning

Introduction

Globally, the present COVID-19 epidemic and its devastating consequences have resulted in poor living circumstances, medical issues, and deaths due to the virus’s highly communicable and contagious nature spreading around the world. The COVID-19 epidemic, which continues unabated, also hurts economic, social, and educational activities worldwide (Wang et al., 2020). As a viable alternative to traditional learning and teaching when traditional methods are no longer available, online learning (synchronous or asynchronous) provides the flexibility, accessibility, and convenience necessary to ensure that learners continue their education even amid a pandemic (Adedoyin and Soykan, 2020; Selvanathan et al., 2020).

Most higher education institutions transitioned from face-to-face learning to emergency remote teaching in January 2020 to reduce the spread of the coronavirus and ensure that students and educators could continue their education during the challenging times of lockdown among students and educators (Bayham and Fenichel, 2020; Wang et al., 2020). Regarding nurses’ and students’ prior knowledge and performance, online learning does not provide a comparable experience to traditional in-person studying approaches. However, when online learning methods are combined with traditional methods, the influence on learners’ pleasure, motivation, and self-assessment is far more potent (Linjawi et al., 2018).

As a result of the COVID-19 outbreak, educational scenarios worldwide have been altered, with traditional learning being replaced by alternative remote counterparts or DL to deter infectious disease transmission through social interaction (Li et al., 2020; Wang et al., 2020). This has harmed students’ lives and their grades and learning achievements (Naji et al., 2020). However, online learning modules provide practical and constructive learning settings, the majority of nursing community members who participated in COVID-19 as first-time online learners found online learning difficult (Demuyakor, 2020). Because online study draws students from a wide range of academic disciplines, the individuals who participate in online learning programs have a wide range of perspectives on the programs (Zolotov et al., 2020).

Recent research conducted in India among nursing students revealed that the majority of participants were delighted with online learning and that among the barriers to online learning were poor voice and language clarity, reliability and connectivity issues, as well as eye strain during long periods on the computer (Kumar et al., 2021). It has long been recognized that student interaction in a completely online learning environment is a significant aspect in determining whether or not they are pleased with their online education experience (Cidral et al., 2018). However, relevant research also shows a positive overview of nurses when it comes to remote learning as exemplified in the study conducted by (Xing et al., 2018). Thus, the complexity of the responses highlights different opinions on whether online learning facilitates efficient learning for nurses and nursing students or compromises it.

Poor student engagement and satisfaction are frequently exacerbated by a lack of connection between teachers and students (Martin et al., 2018; Rahmatpour et al., 2021). It may be stated that interaction in online learning frequently results in students’ involvement in their academic activities before having a beneficial impact on students’ happiness with their academic experiences (Kim and Kim, 2021). As a result, the primary goal of this systematic review is to determine how satisfied nurses and nursing students are with their online learning experiences.

Main Purpose

The main objective of this systematic review is to investigate the level and factors associated with satisfaction with online learning among staff nurses and nursing students during the pandemic of COVID-19.

PICOT Question

Are nursing students satisfied with online learning compared to traditional learning during the pandemic COVID-19?

Methods and Search Strategy

This research is a systematic review that establishes the incremental approach developed. In this approach, six steps were applied, including identifying the research question, identifying the relevant studies, the study selection, charting the data, collecting, summarizing, reporting the results, and consulting with the stakeholders. Different databases were used for search strategy and systematic literature search; databases include Ovid MEDLINE, PubMed, Ovid OLDMEDLINE, Embase Classic + EMBASE (Ovid), The Web of Science (Thomson Reuters), The Cochrane Library (Wiley), and CINAHL Plus (EBSCOhost).

The researchers were interested in searching for relevant studies in valid databases that allow access to peer-reviewed scientific journals, and the search was conducted in the English language. Additionally, a search in Google Scholar was done. Also, a hand search was conducted, reference lists of articles that have been included were made, and the relevant names of the authors were also searched to identify more relevant articles. Keywords for the search included: online learning; E-learning; satisfaction; traditional learning; blended learning; COVID-19; nursing students. In this systematic review, the studies included were those that addressed the main aim of the present systematic review, finding evidence of online learning. Quantitative studies were eligible to be included as well. Also, the studies have been eligible for those conducted in clinical practice settings and other community settings.

Inclusion criteria for selected articles

For this paper, the criteria for the selected articles imply they are to be published in peer-reviews journals and linked to the main aim of the study. Thus, the articles that exemplify nurses’ and nursing students’ satisfaction or dissatisfaction with online learning are selected. Moreover, the only papers that are considered are recent ones, thus, published within the last 5 years to ensure the methodologies and findings are still valid and uncontested. The descriptive and cross-sectional studies that are selected provide an overview of online learning for staff nurses and students and allow for an examination of the e-learning phenomenon, as well as the negative and positive contributions. The summary of the systematic review’s findings was collected in one table (Figure 1).

Quality evaluation of the selected articles

Data extraction was done by the researchers independently. Data extracted in combination with the narratives were then tabulated to provide an overview of the obtained results and to explicate the interpretative process.

PRISMA Flow Diagram

Databases: Ovid MEDLINE, PubMed, Ovid OLDMEDLINE, Embase Classic + EMBASE (Ovid), The Web of Science (Thomson Reuters), The Cochrane Library (Wiley), and CINAHL Plus (EBSCOhost).

Figure 1: Flow diagram (PRISMA) of the process of identifying and including references.

Author / year	Country	Design	Quality	Sample	Findings
Alqahtani et al. (2021)	Saudi Arabia	A cross-sectional, correlational descriptive study	The cross-sectional design based on self-reported questioners and the lack of conflict of interest reported by researchers highlight the validity and reliability of the study	139 nursing students	The research defines that students’ overall happiness with e-learning and satisfaction with assessment were impacted by their previous experience with e-learning and preparation for e-learning. Among the variables studied, only preparation for e-learning was shown to be connected with satisfaction with instruction and general skills and learning experiences.
Kumar et al. (2021)	India	Cross-sectional study	The online research facilitates a quantitative analysis, an evidence-based approach highlighting the study’s validity and reliability.	219 nursing students	The study determined that the vast majority of students who took part in the study were pleased with their online learning experience. In all demographic data, the degree of satisfaction with online learning is highly correlated with the learner’s age. According to the research data, the most significant hurdles to online learning among nursing students include poor voice and language clarity, physical health barriers such as eye strain, and dependability and connectivity issues.
Moreno-Sánchez et al. (2022)	Spain	Cross-sectional study	The tool used in the research is the Bob Hayes questioner to measure satisfaction, a valid and reliable method of assessing positive or negative overviews of a phenomenon.	400 nursing students	The authors defined that majority of educators were having difficulty comprehending the implications of the virus and putting in place appropriate safety measures because there was a great deal of conflicting information relating to the effectiveness of personal protective safety equipment and the lifespan of the virus on various media outside of the host, among other factors. So, it should be no surprise that pupils were not given adequate knowledge in this area. As a whole, the study determined that the vast majority of pupils expressed unhappiness with the virtual education they were provided.
Kim et al. (2021)	South Korea	Quasi-experimental	The survey data was examined through the structural equation model, a reliable way of analyzing raw information	164 nursing students	The research marked a statistically significant improvement in knowledge and learning flow in the post-test. The study found that there was a statistically significant rise in self-regulation from the pre- to the post-test, although the increase was not statistically significant. The findings might be used to assist teachers in providing more information to students participating in online learning. The findings emphasize the need to assess learners’ preparation for online learning and prepare the learning environment via systematic educational planning, design, development, and assessment to improve the efficacy of online learning results.
Seada & Mostafa (2017)	Egypt	Descriptive	5 experts in critical care nursing and information technology tested the structured questionnaire for content validity	350 nursing students	The research determined that majority of the students in the study (93.4 percent) expressed high levels of satisfaction with their e-learning experience, and nearly three-quarters of the students in the study had minimal obstacles to participating in the e-learning course. Furthermore, E-learning was favored by 60 percent of the study sample because it saved time and money and boosted self-responsibility and self-confidence in 51.1 percent of the participants.
Ali et al. (2020)	Egypt	A quasi experimental	The tool, a modified questionnaire, was reviewed by a group of experts to ensure validity and reliability.	224 nursing students224 nursing students	In the questionnaire results, almost two-thirds of respondents agreed on their online assessment experience, except that the online exam was stressful and that there was not enough time to answer all questions. Furthermore, more than two-thirds of the participants agreed on the learning process features of the two nursing programs. Lastly, since more than half of the students had prior experience with online systems and more than two-thirds were proficient in mobile/computer apps, remote online education has a favorable influence on the learning process.
Oducado & Estoque (2021)	Philippines	Cross-sectional	The data were collected using a web-based survey questionnaire and then analyzed using descriptive statistics and Spearman’s rho correlation, a valid tool for examination of raw data.	108 nursing students	The author explored how the COVID-19 pandemic harmed the academic performance of undergraduate nursing students, resulting in poor (37 percent) to fair (50 percent) academic performance, as well as being significantly (43.6 percent) and profoundly (30.6 percent) affected by the pandemic. Undergraduate nursing students rated their experience with online learning during the COVID-19 outbreak as stressful (44.4 percent) and highly stressful (24.4 percent) (47.2 percent). The undergraduate nursing students who participated in online learning during the COVID-19 epidemic expressed low satisfaction (37 percent) and moderate satisfaction (46.3 percent) with their experience. Online learning stress was found to have a statistically significant and inverse relationship with online learning satisfaction and academic achievement.
Al-Huneit et al. (2018)	Jordan	Descriptive	The survey was performed to examine the subjective opinion of nurses through the descriptive research, the validity of which is evident through the reviewed questionnaire administered by the researchers.	52 nursing students	In the study, student respondents, in overall, expressed that they were favorable about taking online courses.
Fadel et al. (2019)	Egypt	Quasi-experimental	Two reliable and evidence-based tools were applied: the undergraduate student’ Moodle attitudes structured questionnaire and the nursing lecturers’ Moodle attitudes structured questionnaire	286 nursing students and lecturers	The research indicated that nursing students and teachers indicated positive attitudes during the study.
Xing et al. (2018)	Shanghai	Descriptive	The study is a secondary analysis of a peer-reviewed cross-sectional study, illustrating the validity of the findings.	550 nurses	The research defined that nurses in rural areas had a more optimistic attitude than nurses in metropolitan areas.

Discussion

According to the International Association of Universities (IAU) – COVID-19 Global Impact Survey, approximately 90 percent of institutes experienced significant disruption or were closed entirely during this pandemic, and nearly two-thirds of institutes replaced their traditional classroom teaching activities with virtual teaching via platforms such as e-Classrooms, Google meets, Zoom video communications, and other similar platforms during this pandemic (Marinoni et al., 2020). The abrupt transitions from regular physical teaching, practical classes, and clinical postings to virtual teaching were intended to balance the students’ professional learning and the safe and prudent use of limited preventive resources such as personal protective equipment while adhering to social distancing norms the process. Trelease et al. concluded in their study that the incorporation of virtual teaching is a necessary reform for continuing medical education and that it has the potential to improve it (Trelease et al., 2016) significantly.

Traditional face-to-face education is regarded as a regular pattern of routine learning, particularly in professional courses such as medicine and nursing, and is therefore encouraged. Face-to-face workshops capture the attention of the learners and help to keep the emphasis on the subject by encouraging more interactions and brainstorming sessions. Some students have also expressed concerns about stress and health-related issues due to the unexpected move to virtual instruction. Singh et al. (2020) conducted a study in which they discovered that students considered that physical classrooms were a better platform than virtual classes, even if the virtual sessions were properly adapted (Singh et al., 2020). This study looked at how satisfied students were with their online courses.

Students expressed satisfaction with the source and quality of information, customized learning, control over educational content, sequence of learning, and time management, among other things. The cancellation of clinical rounds, ward postings, and real patient interaction, according to some studies, has resulted in a significant decrease in student satisfaction because it has prevented them from developing and refining the skills that are an essential part of the medical and nursing professional curriculum. Studies have found that contact with virtual teaching during undergraduate medical training improves core competency, medical knowledge, and overall learning due to the interaction (Guze, 2015; Pei & Wu, 2019).

On the other hand, much research has found that undergraduate nursing students incur economic costs from participating in online courses (Deo et al., 2020). A global study of higher education students revealed that they were experiencing difficulties with Internet access (Aristovnik et al., 2020). Despite this, it is possible that the cumulative effect of the variables listed above contributed to the nursing students’ discontent with the program. As a consequence of this comprehensive study, curriculum planners are urged to carefully create and prepare the online curriculum for nursing and other health-related disciplines, including practical courses in the following semesters or even beyond the pandemic. Nursing colleges should also consider aspects identified in the research that influence the quality of online learning (Elumalai et al., 2020).

Conclusion

In addition to negatively impacting academic performance, the COVID-19 epidemic has resulted in unprecedented stress levels for undergraduate nursing students across the country. Students’ contentment with their education and academic achievement is highly influenced by stress. According to the findings of this systematic study, online learning and its effects on student happiness and academic achievement in the context of the COVID-19 epidemic were examined. According to the study’s findings, interventions must be designed to alleviate stress among nursing students and assist them in coping with the academic hurdles and expectations they would experience as a result of the pandemic.

Recommendations

While online learning may be a beneficial tool in mitigating viral transmission during the COVID-19 epidemic, efforts should be made to enhance the methods used in the existing learning environment to satisfy the needs of the students. It is possible that rethinking how nursing education should be offered in the following months of the pandemic may be highly beneficial. Once the safety of pupils has been ensured, a phased return to face-to-face education may be implemented. As an alternative, a hybrid format with just little face–to–face contact may be explored as well.

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