DOI: https://doi.org/10.21203/rs.3.rs-1946598/v1
The effects of the use of distance education methods, which entered our lives rapidly with the pandemic, in nursing education should be discussed.
To determine the experiences of nursing students about distance education.
Data were collected using a SWOT analysis interview form developed by the researchers. Study was carried out at a national university in Zonguldak, Turkey between February 2020 and January 2021. The sample of the study comprised 204 students in the nursing department.
Students reported their positive and negative thoughts on issues such as working environment, technological adaptation, economic conditions, lack of clinical education, psychological and health problems.
In terms of nursing education, the distance education system should be researched and developed in depth.
According to the United Nations Development programme, the COVID-19 pandemic is a global crisis that affects every aspect of life, with devastating social, economic and political consequences (United Nations Development programme [UNDP] 2020). Although it is a health crisis, it affects not only health professionals and leaders, but also all systems, including universities and academic institutions. COVID-19 has caused the entire education system to be paused. With the onset of the pandemic, face-to-face classes, clinical practices, and laboratory training have been suspended or restricted globally to protect the health of students and faculty. (British Columbia College of Nursing Professionals 2020; College & Association of Registered Nurses of Alberta 2020; Jackson et al. 2020).
In order to continue teaching and learning during the epidemic, the digital world began to be used by switching to a different dimension from traditional methods. While this world allows the continuation of theoretical education, it has led to the restriction of clinical and laboratory education. Students and teachers put a lot of effort to get used to the new educational environment. Access to educational materials such as technological devices and internet services has caused difficulties for families and governments. In addition to all these, the inability to implement clinical training led to the students' concerns about graduation and not being enough. In addition to its disadvantages, distance education has also brought flexibility to education by providing the repetition feature many times in the comfort of the home environment.
As it is important to understand the experiences and expectations of students regarding the changing education system in this period ( Ramos-Morcillo et al., 2020 ), the researchers decided to investigate the different views of the students. This study aimed to determine the views of nursing students about distance education.
The method used in this study is the SWOT Analysis approach. SWOT analysis is a systematic identification of factors to formulate an organizational strategy. Swot analysis refers to the systematic evaluation of all factors affecting a particular subject. SWOT analysis is used to determine the strengths (S), weaknesses (W), opportunity (O) and threat (T) aspects of the subject, to make a comprehensive analysis of the current situation and to develop plans and strategies for the future in order to improve or strengthen the situation. Considering the internal and external factors in the analysis; While trying to increase strengths and opportunities, measures are taken for threats and weaknesses. (Boydak-Özan vd., 2015; Stoller, 2021 ; Wang & Wang, 2020).
This study used a qualitative design conducted with interviews, to describe the views of nursing students about distance education carried out during the COVID-19 pandemic. X University Human Research Ethics Committee approved the study.
Using purposive sampling, Nursing Management course students who received SWOT analysis training within the scope of the course were included in the sample (n = 204) between between February 2020 and January 2021. In the research, “personal information form” and “semi-structured interview” forms were used as data collection tools to reveal the views of the participants about the distance education system. Personal information form included age, gender, level of income, where you live, how many people you live with during a pandemic, having an appropriate place to listen to lessons, and having equipment needed for distance education. Semi-structured interview form questions included ‘What strengths, weaknesses, opportunities, and threats does the distance education bring?
During the data collection phase, forms were sent to the participants through the web-based application, and audio recordings were requested to answer the questions. On the other hand, the data obtained were coded as student 1, namely “S1, S2, S3,”, considering ethical values; interview structure, date, and duration of the interviews were also recorded. Participants were reassured that their participation was completely voluntary, they were allowed to leave the study at any time, and all audio-recordings would be kept confidential.
Content analysis was performed using the Graneheim and Lundma method. First of all, all the data were written down, the entire content was read and summarized, divided into simple codes, similar codes were gathered under categories, and finally the categories were gathered under themes (Graneheim and Lundman, 2004). The whole process was done by two researchers separately, and then the Lincoln and Guba criteria were used to ensure the validity and reliability of the data, and the themes and categories were clarified by interviewing the research team, paying attention to maximum diversity. Finally, the final version of the categories and themes was prepared by taking the opinions of the participants (Lincoln & Guba, 1985).
Demographic characteristics of the students participating in the study are presented in Table 1. The mean age of the participants in the study was 20.45 ± 1.29 and most of the participants (78.5%) were female. 73.5% of the participants have equal income and expenditure levels and 83.3% of them live in provincial regions. 73.5% of the respondents live with at least 5 people at home. It was determined that 39.2% of them had a special area for studying, while 30.3% of them had the necessary materials for distance education (Table 1).
| Min-Max | Mean ± SD | |
|---|---|---|
| Age | 19–28 | 20.45 ± 1.29 |
| Gender | n | % |
| Female | 160 | 78,5 |
| Male | 44 | 21,5 |
| Have less income than expenses | 38 | 18.7 |
| Have equal income and expenses | 150 | 73,5 |
| Have more income than expenses | 16 | 7,8 |
| Live in provincial centres | 170 | 83,3 |
| Live in towns or villages | 34 | 26,7 |
| Live with 2 people during pandemic | 54 | 26,5 |
| Live with at least 5 people during pandemic | 150 | 73,5 |
| Have an appropriate place to listen to lectures | 80 | 39,2 |
| Have equipment needed for distance education | 62 | 30,3 |
| *SD: Standard Deviation | ||
Based on the responses of nursing students who were interviewed in depth using a semistructured interview form, 4 themes and categories and codes related to these themes were created. The created themes, categories, and codes are shown in Table 2. Some examples of the answers given by the students to the questions asked are presented below (Table 2).
| THEMES | CATEGORIES AND CODES |
|---|---|
| Strengths | • Personal Factors o Digital literacy o Communication o Focus o Time Management o Stress Management o Professional Development • Economy o Materials • Online Education Program o Time Management |
| Weaknesses | • Environment • Health o Sleep disorders o Vision problems o Sedentary life o Emotional state o Nutritional disorders • Economy • Personal Factors o Low motivation o Inefficiency o Lack of Communication o Stres management • Online Education Program o Lack of practice o Inadequate Infrastructure o Group Activity |
| Opportunities | • Environment • Online Education Program o Variety of materials o Infrastructure o Course Continuity o Communication o Time • Economy o Lower Cost o Additional Income |
| Threats | • Environment • Health o Ergonomics o Sedentary life o Technology Addiction o Visual Problems • Online Education Program o Lack of practice o Communication • Personal Factors o Digital literacy o Stress • Economy o Financial Difficulties |
"The computer is like my third hand, so being able to use it well during this period helped me a lot. "(S 35)
"I can communicate more easily with academics because I have overcome my shyness." (S 63)
"I have no problem with concentration." (S 52)
"The time I spend preparing for school or transporting is entirely up to me. "(S 5)
"I take exams in an environment where there is less stress and no distractions." (S 11)
"I can manage the exams with less stress." (S 69)
''I have the opportunity to get to know myself by taking more time for myself and engaging in new hobbies.''(S 47)
''I try to improve myself by attending online nursing trainings and webinars. '' (S 28)
''I have no shortage of Internet access and technical tools. '' (S 12)
''I can attend classes whenever I want.''
"When I'm at home, I don't want to study, and my family also expects me to do housework.
Someone is constantly entering the room, I am distracted. "(S37)
In the health category, 5 codes were created: Sleep disorders, vision disorders, sedentary lifestyle, mood disorders, and nutrition disorders.
"When I look at the computer all the time, I feel sleepy, after a while I get disconnected, I have a hard time concentrating. " (S 40)
"Constant use of digital tools tires my eyes." (S 74)
"I have reduced my movements to a minimal level and I refrain from going for walks, sports, etc. I need to be active in my activities." (S 110)
"Since I am an anxious person, I was very stressed about the problems that distance education might cause." ( S 122)
"I sit in front of the computer all day and eat, I hardly move, I started to have weight problems. " (S 135)
"I do not have a computer at home." (S 78)
"I can not take the practice tests because I do not have an Internet connection or the power goes out during the day." (S 32)
Code 1
Low motivation
"I lost motivation because I was sitting in front of the screen for so long." (S 47)
"There is a feeling of inadequacy in the practice of nursing education. This situation reinforces professional concerns. "(S 82)
"My study has become irregular and I cannot achieve sufficient efficiency." (S 14)
"I was always afraid to ask questions to the teachers because I was ashamed. "(S 20)
"During the exam, I can not focus on the exam as much as I would like to because I am afraid that the system will throw me off track, and I am constantly nervous and excited."
"We lack practical courses, we should focus on theoretical courses in distance education, which we should take as nursing students and which will benefit us a lot in the future when we practice our profession."(S 135)
''Due to the difficulty of teaching practice-oriented courses, I cannot fully understand the topics we cover in the theoretical courses. ''(S 145)
"The system slows down because of the density." ( S 122)
"The system breaks down due to the intensity in the exams. "( S 84)
Participants indicated that they had difficulty in group tasks given in distance education due to inadequate communication and coordination.
''I find it difficult because we can not meet each other during group homework. '' (S 82)
''There are communication breakdowns in the group assignments.'' (S 67)
"We had the opportunity to protect our health by not going into crowded environments during the pandemic." (S 48)
"Distance learning allows me to listen to classes more comfortably in my home environment and in my own order." (S 63)
Category 2: Online Training Program
"As many domestic and foreign universities make their lecture notes publicly available, the variety of resources has increased and access to resources has become easier." (S 52)
"Access to information becomes easier and faster." (S 28)
"After the online lesson is finished, the videos are uploaded to the system and we can watch those videos again and again and rewind if we did not understand something." (S 69)
"There is no problem in terms of absenteeism when I do not attend class due to illness, personal or family reasons." (S 11)
"We can reach the instructors much easier than in formal classes if they want to ask something or if they do not understand a topic and want to reach them later." (S 5)
"Seminars that I can not attend due to time or transportation constraints are held online and I can attend them." (S 91)
"I had the opportunity to spend the time I spent doing other things at school at home with my new hobbies." (S 197)
''Since I have the loan/scholarship money with me, I am comfortable spending it.'' (S 132)
"The financial expenses for face-to-face classes have decreased to a great extent." (S 145)
''Since I have the loan/scholarship money with me, I am comfortable spending it.'' (S 132)
"I do not have expenses such as housing rent, transportation, and food. Instead, I can meet my other needs." (S 38)
"Besides distance learning, I had the opportunity to work in a part-time job and earn money." (S 149)
"There are many distracting noises and events in the home environment." (S 67)
"Because we sit in front of the computer/phone all the time, back and low back pain and eye problems may occur."(S 125)
"My weight has increased because I was always at home and did not exercise." (S 45)
"I have become addicted to technological tools." (S 174)
"My eye degree has increased because I look at the computer and phone a lot." (S 2)
"The fact that I am studying in an applied field and cannot find an opportunity to practice because of distance learning causes me to start my professional life incomplete." (S 123)
"It leads to deficiencies in laboratory and clinical practice, which have an important place in a practice-oriented profession such as nursing." (S 196)
"It is becoming increasingly difficult for me to communicate with my teachers." (S 26)
"I even spent a lot of time learning programs, I don't like using computers. " (S 126)
''Due to my lack of technology and Internet skills, I am not able to participate in class, do homework, write exams, etc. I am behind in the situations.'' (S 136)
''My computer use poses a great threat to my future life because I do not have sufficient skills." (S 49)
" I'm very feared that I will press a worth key on the computer, it causes me to stres. "(S 116)
"Since there is a pool system in the exams, not everyone gets the same question, we learned that we can not go back to a question that we did not answer in that time, such situations stress me out." (S 136)
"If I can manage my stress, it can be an opportunity for me in the future, not a threat." (S 15)
"I don't have internet and computer. I think it's unfair. I'm lagging behind my friends. I don't want to graduate like this. " (S 14)
"It is a financial burden for me because I need a lot of internet." (S 172)
When the answers given by the students were categorized, it was determined that a code in which the codes differed according to the students could be seen in 4 different themes. Digital literacy, which was gathered under the category of personal characteristics, was among the most frequently encountered answers under the themes of strength and threat. Digital literacy (finding, understanding, analyzing, producing and sharing information with digital devices) is a necessary competence for the correct use of technological devices (computer, tablet, smartphone, etc.) and technological software (Office software, Zoom, Microsoft Teams, etc.). While students with weak digital literacy saw this situation as a threat, students who were competent in this subject took a step forward by declaring this situation among their strengths. Students who were inadequate in this regard made an extra effort to learn how to use technology in the learning environment and had difficulties (Ozdamar-Keskin et al., 2015; Griffiths, 2016; Posey & Pintz, 2017; Human Rights Watch, 2020; Jowsey et al., 2020). In order to overcome this situation, many studies have reported that students and instructors should be supported on this issue. It is recommended to organize training programs on the diversification and effective use of teaching materials (Kahyaoğlu Süt and Küçükkaya, 2017; Şanli, 2021; Vatan et al., 2020). (World Health Organization, 2016; Fitzgerald et al., 2020; Berland et al., 2020).
The category of economy is among the most frequently given answers under three different themes. The economic situation has taken its place among the factors affecting distance education with codes such as working environment, technological tools and having internet connection. Students with high economic status did not have difficulties in adapting to distance education. There are studies showing that socioeconomic status positively affects academic achievement. (Ciftci & Caglar, 2014; Liu et al., 2020; Van Hoek et al., 2019). Considering that only 7.8% of the students participating in our study have a high income level, it becomes difficult for other students to support an extra budget for the equipment required for distance education.
Due to the increasing demand during the pandemic period, the price increases in the devices also caused difficulties for students and their families (Nabolsi et al., 2021). Only 30.4% of the students participating in the study reported that they have the necessary devices for distance education. Some of these students, on the other hand, did not have a computer, so they conducted their lessons via mobile phones. 73.5% of the students participating in the study continue their lives with more than 5 people at home. In this case, some students had to share their computers with their siblings, which caused the disruption of their lessons and homework.
Another element that should be in distance education is internet access. Students had some difficulties in accessing the internet according to their regions. Since 26.7% of the students participating in the study live in rural areas, they had difficulty in accessing the courses because their internet access was either limited or not available. This can lead to educational inequality and lifelong problems for students living in these regions (Nature Editorial, 2020). In a study conducted in China, where the Covid-19 pandemic broke out, it is stated that university students experience anxiety due to being in a rural area and uncertainty in family income level in this process (Cao et al., 2020). Students living in rural areas without internet access should be supported by universities so that they can receive education on an equal basis with others (Wang et al., 2020). This issue needs to be put on the agenda and resolved by government policies. It is important that non-governmental organizations raise awareness about these issues and support them in solving the problem (Karaaslan et al., 2022).
Another issue that the students focused on was the inadequate distance education infrastructure conditions of the university. Students emphasized that many students had problems with internet access, they could not follow their lessons and they could not get efficiency from the lessons (Kürtüncü & Kurt, 2020). According to Sahu et al. (2020) also reported in their study that all students accessing the internet at the same time forces the infrastructure conditions and the distance education system has become problematic (Sahu, 2020).
It was determined that only 39.2% of the students participating in the study had a suitable environment for participation in their classes. This situation adversely affects the students' concentration on the lessons. Noise and mobility in the home environment create focus problems for students, which affects their success. ( Erdoğdu & Erdoğdu, 2015 ). Similar to our study, Karaaslan et al. (2022), in their study, it was mentioned that only 25.9% of the students had a room of their own, and this had a negative effect on academic achievement. Libraries, etc., which were closed during the pandemic period, forced students to study at home, in this case it has become important for students to have their own private areas.
Another economic dimension in which students turn the distance education process into an opportunity has emerged as the opportunity to work in other jobs in this process. Thus, the students, who had the chance to earn additional income, supported their families as well as meeting their own budgets. The distance education process also reduces the costs incurred when they study in another city, by providing students with the opportunity to continue their education in their own home environment (Karaaslan et al., 2022).
Students can spare more time for themselves and their families thanks to online asynchronous lessons, they study more efficiently during this time, extra courses, congresses, conferences, etc. stated that they were comfortable participating in the activities. Supporting our study, Gürkan et al. (2020) found that distance education creates opportunities to support learning. The lack of course continuity allowed the students to have the opportunity to develop themselves, and the students reported this among their strengths and opportunities. Ozkose et al. (2013) reported that distance education provides access to students from all walks of life. While some students stated that they could communicate more easily with the instructors in online courses, the majority of students complained that the courses were not effective because they did not have the opportunity to ask questions, discuss, brainstorm and receive feedback in online courses, and they reported that they saw this as a threat. They reported that their communication with the instructor or their communication with their friends was negatively affected by online courses. It has been stated that distance education poses a problem in nursing education, which is frequently used for group assignments. (Mackavey and Cron, 2019).
The uncertainty of the process and self-preservation anxiety make it difficult for students to focus on their lessons and students are psychologically affected negatively (Cao et al., 2020; Lee, 2020; Wang et al., 2020). This is the most important concern brought by the pandemic. Although the focus code was the strength for a group of students, a large number of students reported that they had problems focusing. The students pointed out that the lack of interaction with the instructor, the inconvenience of the home environment, ergonomic problems caused by sitting in front of the computer all the time, and vision and sleep problems caused their inability to focus.
The uncertainty of the process and self-preservation anxiety make it difficult for students to focus on their lessons and students are psychologically affected negatively (Cao et al., 2020; Lee, 2020; Wang et al., 2020). This is the most important concern brought by the pandemic. Although the focus code was the strength for a group of students, a large number of students reported that they had problems focusing. The students pointed out that the lack of interaction with the instructor, the inconvenience of the home environment, ergonomic problems caused by sitting in front of the computer all the time, and vision and sleep problems caused their inability to focus.
One of the most important issues that students see as a threat is that distance education causes sedentary life and nutritional disorders. The students intensely reported that they distanced themselves from their social environments and that they were uncomfortable with this situation. During this period, students stated that the pandemic process had a negative impact on their psychology. Between classes, “I thoght to suspend the studies because I have difficulties in dealing with distance education and the pandemic process.” It was observed that the idea of Similarly, in the study of Cao et al. (2020), it is reported that the reason why students experience stress and postpone their academic studies is the possibility of their relatives being infected and being infected themselves. (Cao et al., 2020; Lee, 2020; Wang et al., 2020).
Nursing education is an active process that combines theory and practice (laboratories, hospital internships, etc.). The most frequently mentioned obstacle of distance education was about how the applied lessons would be. Professional career anxieties, inexperience, insufficient education, shyness and fear of making mistakes appear as the most frequently mentioned problems by students. The students stated that being away from the practice area prevents them from learning in the field, and therefore they think that the distance education system is not the right choice for the nursing department. Especially, 4th grade students (intern students) who take only practical lessons all year stated that they think that it is not enough to give practical lessons remotely (Kürtüncü and Kurt; 2020). It has taken its place in the literature in many studies in which the inability to practice, technological deficiencies and lack of interaction are perceived as weakness and threat. (Barış and Çankaya, 2016; Gürkan, 2020; Özköse et al., 2013)
Since the study was conducted in a single university, it cannot be generalized to the whole country.
The sudden and rapid transition to distance education has also had advantages and disadvantages for students. The most frequently mentioned obstacles to distance education are the lack of practical courses, technological inadequacies, inefficiency, and insufficient interaction. The advantages are that the lessons can be repeated regardless of time/space, learning takes place in the comfort of their own home with the flexibility provided by distance education, and they can do their own research in the areas they want to learn more.
Conflicts Of Interest
The authors declare that there is no conflict of interest.
Funding
No financial and personal relationships with other people or organizations was used in this study.
CRediT authorship contribution statement
All of the authors have contributed to the study on conception and design, drafting the article, revising it critically for important intellectual content, and final approval of the version to be published. All authors are in agreement with the content of the manuscript.
Acknowledgements
The authors would like to thank the contribution of all the students who participated in the
study.