INTRODUCTION:

On March 11, 2020, the World Health Organization (WHO) issued the declaration that the COVID-19 is the cause of a Pandemic. In Japan, the government issued the first nationwide Declaration of Emergency for the period from April 16 to May 25, 2020, and the fourth on January 12, 2021 for Tokyo. Due to the high infectivity of COVID-19, the global pandemic is still ongoing¹.

The state of emergency for Japan differs in its nature from the lockdowns of other countries, and is limited to announcements of requests for people to stay at home with neither compulsory force nor penalties. The number of people infected with COVID-19 is extremely small in Japan compared with other developed countries². The possible factors related to the small number may include the culture unique to Japan, such as taking off shoes at home, and bowing to greet others without physical contact². In addition, as measures to prevent COVID-19 infections, wearing of facial masks and washing hands with disinfectant are recommended³. However, these matters have traditionally been conducted in many households in Japan as well as in medical institutions. It has been reported that the high BCG vaccination rate of Japanese people also may have affected the low COVID-19 infection rate in Japan^4,5,6.

In Japan, during the period of the first state of emergency elementary, junior high and high schools were closed. However, Declarations of Emergency have repeatedly been issued, and from the second state of emergency onward, it was decided to open schools as usual to secure learning opportunities for children. Unlike elementary, junior high, and high school students, university/college students have a wider field of activity and are old enough to refrain from dining and drinking together with others away from their homes. For these reasons, many universities and colleges have provided education by shifting face-to-face classes to on-line classes, reducing the number of students on campus, and integrating face-to-face with on-line classes.

To confront unknown infectious diseases as well as COVID-19, we are required to adopt a new lifestyle making long-term changes as steps to ensure infection prevention. In nursing education, it is necessary to adopt long-term as well as short-term measures, with the continuing digital transformation (DX) in mind. For the future, it will become increasingly important for educational institutions to make changes in the educational provisions including DX for measures to prevent the spread of unknown infectious diseases other than COVID-19. However, as providing on-line lectures has just begun in many countries, there are few studies on on-line lectures published and even fewer studies focusing on on-line nursing education although there are many reports of how to deal with technical issues for this kind of classes.

Nursing science is a discipline where students develop their learning and understanding of a field which has people come in contact also outside the classroom, such as in on-site training. However, with society in the emergency state, many universities had to change their plans for clinical training because hospitals refused to accept trainees for clinical training or requested shortening of training durations⁷, resulting in fewer opportunities for students to learn in actual practical situations. As of May 2020, it was reported that 86.9% of universities in Japan had postponed classes due to the influence of the COVID-19 regulations, and only 10.7% of universities conducted or considered the possibilities of on-line lectures⁷. Under these circumstances, University A took the initiative in on-line lectures from April 6, 2020 using Zoom software in a way that enables interactive communication. The term “on-line lecture” used in this study does not refer to recorded on-demand lectures, but considers an on-line lesson style that enables interactive communication in real time.

Three months have passed since University A started conducting on-line lectures. For this teaching arrangement Sasaki⁸ has stated that the three-month duration is a time unit for a participant to work on one theme, get to understand something related to this, and feel that the knowledge base has changed. The present study investigated how on-line lectures influenced the environment, learning, and physical conditions of nursing students for the three months, and how students evaluated the on-line lectures in a time line. By fully understanding the actual conditions, it may become possible to create more effective learning methods for on-line lectures, contribute to higher-quality learning for students, and develop research on lessons using Information and Communication Technology (ICT) in Japan and in other countries. This study aims to establish and understand the situation of on-line lectures provided by the Faculty of Nursing at University A, including the environment and learning of nursing students for the first three months of on-line study, as well as explore time-line changes in the evaluations of the on-line lectures and physical conditions of the students.

METHODS:

Participants and data collection:

This study analyzed known data to understand the changes in the conditions of the learning environment, learning situation, on-line lecture evaluation, and physical conditions of nursing students, related to on-line lectures at the Faculty of Nursing of University A, which has the largest number of students among Japanese nursing universities. This study used the results from one faculty of this university. From April to July 2020, at the Faculty of Nursing of University A, students were requested to participate in surveys through the student bulletin board available to University A, and conducted questionnaire surveys at four time points using the Google Drive questionnaire form. The participants were all 302 students enrolled in the Faculty (104 students in the first year, 98 in the second year, and 100 in the third year). There are no fourth-year (graduating year) students in this university because it was established only three years ago.

Survey items:

The first to fourth survey items were all examined by the Academic Affairs Committee of the Faculty and the surveys were conducted with the permission of the head of the committee. The dates of and the contents of the survey are as follows.

First survey (April 4 to 5, 2020)

Before starting the on-line lectures, participants were asked whether they wished to have on-line lectures, and if yes, where they would like to do these lectures. The participants were all 198 students in the second and third-year classes. The first-year students were not included because they had just entered the university, had no experience of regular university classes, and it was anticipated that it would be difficult for them to understand the intent of the questions.

Second survey (April 17 to 21, 2020)

Two weeks after the start of the on-line lectures, a survey was conducted about the Internet environment and the situation of the participants and on the learning situation such as preparation and review for the classes. All 302 students in the first, second, and third years participated in this survey.

Third survey (May 8 to 11, 2020)

Four weeks after the start of the on-line lectures, a survey was conducted to learn about the Internet environment, and to ask whether there were problems related to the on-line lectures (including physical conditions, volume of lecture materials), and how the participants evaluated the on-line lectures overall. All 302 students participated in the survey.

Fourth survey (July 8 to 10, 2020)

Twelve weeks after the start of the on-line lectures (three weeks after the request for refraining from leaving the home was lifted), this survey inquired about the learning conditions including the Internet environment and self-study including preparation/reviews, problems related to on-line lectures (including the physical conditions, and volume of lecture materials), and an overall evaluation of how the participants saw the face-to-face and on-line lectures. The second to fourth surveys also had an open-ended question where participants could provide feedback of their thoughts and impressions related to the on-line lectures.

Analysis:

For the statistical analysis we used the SPSS for windows ver. 26, and the significance level < .05 for identifying statistical differences. After a simple tabulation of all survey items, the items that could be evaluated quantitatively were classified into three groups, the first, second, and third-year students, and a one-way analysis of variance was performed. Further, simple regression analysis and t-tests were performed to analyze the relationship between the physical conditions, psychological stress, and other factors.

Ethics considerations:

One of the purposes of this study is to investigate the environment of on-line lectures for undergraduate students of University A. Because the faculty and staff needed to be able to provide immediate support for students who do not have a suitable environment for on-line lectures, and the surveys were administered as non-anonymous questionnaire surveys. The students were requested to cooperate in the survey by explaining the purpose of the study and the ethics considerations in messages via on-campus email and in the questionnaires. The ethics considerations include that the participation or discontinuation is voluntary, that there would be no disadvantages in student life and performance evaluations due to refusal or discontinuation of participation, that the survey results would be presented at academic conferences and submitted as papers, and that identification of specific respondents would not be possible. For the utilization of data from the first to fourth questionnaire surveys, to guarantee the opportunity for students to withdraw their consent, a two-week opt-out period was set with the approval of the ethics review, and the students were asked if they intended to participate in the survey again. This study was approved by the Research Ethics Committee on Humans of Tokyo Healthcare University (approval number 32-16C).

RESULTS:

Of the 302 students, 6 answered that they would not participate in the survey. Excluding 45 students who did not complete any of the second to fourth surveys, we determined that 251 students who participated in all the four surveys (three surveys for the first-year students) as valid (83.1%), and included the responses in the analysis. The participants were 28 males, 223 females, 91 first-year, 78 second-year, and 82 third-year students (Table 1). No students withdrew consent during the opt-out period after having agreed to participate.

Table 1. Demographics n = 251

Sex	Male	28
	Female	223
Year	1st	91
	2nd	78
	3rd	82

Internet environment:

The results of the first survey showed that most students preferred the home as the place to do on-line lectures (n =132, 82.5%), at the university (n = 3, 1.9%), other (n = 2, 1.2%), and no answer (n = 23,14.4%). (A total of 160 second and third-year students were analyzed in the first survey.) The results of the second survey showed that the students used the following devices for the lectures: PC (n = 250, 99.6%) and iPad (n = 1, 0.4%) for the lectures. The classification of the Internet access was: Wi-Fi (n = 249, 99.2%), accessed via a smartphone (tethering) (n = 1, 0.4%), and other (n = 1, 0.4%). For problems in accessing the on-line lectures, 239 students (95.2%) reported no problems, and 12 students (4.8%) had problems. The most common reason as stated in the open-ended question section was problems of network connection. The learning environment responses were: a private room (n = 206, 82.1%), living room (n = 41, 16.3%), and both the private room and the living room (n = 4, 1.6%). Most students used their private room to study. In the third survey, 249 students (99.2%) reported that they were able to view the on-line lectures without access problems or with occasional interruption, and 2 students (0.8%) had problems so they could hardly view the lectures. In the fourth survey, 249 students (99.2%) reported that they were able to view the on-line lectures without access problems or with occasional interruptions, 1 student (0.4%) could hardly view the lectures, and 1 student (0.4%) answered other.

Time spent on self-study:

For the time spent on self-study, the results of the second survey were: 3 hours or more (n = 17, 6.8%), 2 to 3 hours (n = 63, 25.1%), 1 to 2 hours (n = 70, 27.9%), less than 1 hour (n = 58, 23.1%), no study (n = 42, 16.7%), and no answer (n = 1, 0.4%). The results of the fourth survey for self-study were: 3 hours or more (n = 4, 1.6%), 2 to 3 hours (n = 46, 18.3%), 1 to 2 hours (n = 84, 33.5%), less than 1 hour (n = 39, 15.5%), no study (n = 62, 24.7%), and other (n = 16, 6.4%). Comparing the second and fourth surveys, the reported time spent on self-study was significantly longer in the second survey (t = 3.387, p = .001).

Evaluation of on-line lectures:

For the preference of taking on-line lectures, the first survey showed: wishing to take on-line lectures (n = 133, 83.1%), no such wish (n = 4, 2.5%), and no answer (n = 23, 14.4%). For the quality of the on-line lectures, the second survey showed that they were: very good or reasonably good (n = 221, 88.0%), not very good or poor (n = 29, 11.6%), and no answer (n = 1, 0.4%).

For the quality of the on-line lectures that the students evaluated in the third survey, the students reported that these lectures were: very good (n = 26, 10.4%), reasonably good (n = 96, 38.2%), usual (n = 20, 47.8%), not so good (n = 9, 3.6%), and poor (n = 0, 0.0%), and 1 to 5 points were assigned to these answers. The mean point scores of the first, second, and third-year students were: 3.64 (SD = 0.723), 3.56 (SD = 0.783), 3.45 (SD = 0.669). There was no significant difference in the one-way ANOVA for the year groups (p = .241). The most common reason for choosing not so good or poor was anxiety about information technology (IT) skills (n = 4). The results for the volume of lecture materials question were: too large (n =73, 29.1%), just right (n =125, 49.8%), too little (n = 1, 0.4%), and others (n = 52, 20.7%).

The evaluations of the quality of the on-line lectures in the fourth survey were: very good (n = 30, 12.0%), reasonably good (n = 125, 49.8%), usual (n = 82, 32.7%), not so good (n = 12, 4.8%), and poor (n = 1, 0.4%). With 1 to 5 points assigned to these answers as in the third survey, the mean scores of the first, second, and third-year students: 3.81 (SD = 0.773), 3.67 (SD = 0.750), 3.56 (SD = 0.742). There was no significant difference in the one-way ANOVA for the year groups (p = .083). Comparing the evaluations of the quality of the on-line lectures in the third and fourth surveys, the scores in the fourth survey were statistically significantly higher (p = .009). The results for the volume of lecture materials were: too large (n =42, 16.7%), just right (n =164, 65.3%), too little (n = 1, 0.4%), and others (n = 44, 17.5%).

Physical conditions and psychological stress:

In the third survey, the responses for physical conditions and psychological stress were (with marking all that apply): eyestrain (n = 206, 82.1%), headaches (n = 47, 18.7%), shoulder and lower back pain (n = 137, 54.6%), nausea (n = 5, 2.0%), and psychological stress (n = 21, 8.4%). The number of responses with poor physical condition was: none (n = 14, 5.6%), 1 (n = 105, 41.8%), 2 (n = 89, 35.5%), 3 (n = 35, 13.9%), and 4 or more (n = 8, 3.2%). In the fourth survey, the responses about physical conditions and psychological stress were (with marking all that apply): eyestrain (n = 207, 82.5%), headaches (n = 67, 26.7%), shoulders and lower back pain (n = 154, 61.4%), nausea (n = 7, 2.8%), and psychological stress (n = 31, 12.4%). The number of responses with poor physical conditions was: none (n = 2, 0.8%), 1 (n = 79, 31.5%), 2 (n = 89, 35.5%), 3 (n = 36, 14.3%), 4 or more (n = 29, 11.6%), and no answer (n = 16, 6.4%). Comparing the third and fourth surveys, the fourth survey scores had statistically significantly more responses stating poor physical conditions (t = -5.337, p = .00) (Table 4).The comments about physical conditions in the open-ended question section were: “My motivation in the class is declining”, “I dislike large assignments”, “I want to attend a school”, “I want to hear lectures directly from the instructors”, “I want to see friends”, “Lifestyle is disturbed”, and “It is difficult to attend classes”.

The analysis of the responses for physical conditions and the evaluation of on-line lectures in the third and fourth surveys found the following statistically significant differences (Tables 3 and 4): in the third survey, the students with poor physical conditions had a significantly lower rating for the on-line lectures (β = -0.243, p = .00). The students who did not have shoulder or lower back pain in the third survey had significantly lower ratings in the on-line lectures in the third and fourth surveys (t = 2.989, p = .003; t = 2.884, p = .004, respectively). The students with headaches had lower ratings in the on-line lectures in the third survey (t = 2.712, p = .00), and those with mental stress had significantly lower ratings for on-line lectures in the third and fourth surveys (t = 3.404, p = .001; t = 3.163, p = .002, respectively). Those with shoulder and lower back symptoms in the fourth survey had significantly lower ratings for on-line lectures in the fourth survey (t = 2.509, p = .013), and those with mental stress in the fourth survey had significantly lower ratings in the on-line lectures (t = 5.215, p = .000).

Table 2. Frequency distribution of the responses of the question items (excerpt) (n = 251)

		2nd survey		3rd survey			4th survey
		n	%	n	%	Average	n	%	Average
Access problems	No	239	95.2	161	64.1		96	38.2
	Yes	12	4.8
	Occasionally interrupted			88	35.1		153	61
	At times hardly view the lectures			2	0.8		1	0.4
	Other			0	0		1	0.4
Time spent on self-study (hour)	3 <	17	6.8				4	1.6
	2 - 3	63	25.1				46	18.3
	1 - 2	70	27.9				84	33.5
	< 1	58	23.1				39	15.5
	No	42	16.7				62	24.7
	Other	0	0				16	6.4
	No answer	1	0.4				0	0
Evaluation of on-line lectures	Very good	32	12.7	26	10.4	3.56	30	12.0	3.68
	Reasonably good	189	75.3	96	38.2		125	49.8
	Usual			120	47.8		82	32.7
	Not so good	28	11.2	9	3.6		12	4.8
	Poor	1	0.4	0	0		1	0.4
	No answer	1	0.4	0	0		0	0
Volume of lecture materials	Too large			73	29.1		42	16.7
	Just right			125	49.8		164	65.3
	Too little			1	0.4		1	0.4
	Other			52	20.7		44	17.5
Physical conditions / psychological stress (multiple answers)	Eyestrain			206	82.1		207	82.5
	Headache			47	18.7		67	26.7
	Shoulder/lower back pain			137	54.6		154	61.4
	Nausea			5	2.0		7	2.8
	Psychological stress			21	8.4		31	12.4
Number of poor physical conditions	None			14	5.6	1.68	2	0.8	2.09
	1			105	41.8		79	31.5
	2			89	35.5		89	35.5
	3			35	13.9		36	14.3
	4			7	2.8		20	8.0
	5			1	0.4		9	3.6
	No answer			0	0		16	6.4

Since multiple answers are allowed, each item is calculated as a percentage of the total (251 students)

Table 3. Simple regression analysis of the number of poor physical conditions, evaluation of on-line lectures, and the length of self-study

Dependent variable Inde- Pendent variable	Evaluation of on-line lectures (3rd survey)			Evaluation of on-line lectures (4th survey)			Time spent on self-study (4th survey)
	β	t	p	β	t	p	β	t	p
Number of poor physical conditions (3rd survey)	-0.243	-3.951	0.000*	-0.200	-3.223	0.001*	-0.019	-0.297	0.767
Number of poor physical conditions (4th survey)	-0.101	-1.548	0.123	-0.321	-5.172	0.000*	0.034	0.501	0.617

Table 4. T-test for poor physical condition and stress

		Number of poor physical conditions (4^th survey)		Evaluation of on – line lectures (3^rd survey)		Evaluation of on line lectures (4^th survey)		Time spent on self-study (4^th survey)
		t	p	t	p	t	p	t	p
	Number of poor physical conditions	-5.337	0.000*
	Eyestrain			0.924	0.357	1.13	0.259	-0.383	0.702
	Headache			2.712	0.0007*	0.882	0.378	0.679	0.498
3^rd survey	Shoulder/lower back pain			2.989	0.003*	2.884	0.004	-0.738	0.461
	Nausea			-1.389	0.166	-0.938	0.349	1.866	0.063
	Psychological stress			3.404	0.001*	3.163	0.002*	1.448	0.149
	Number of poor physical conditions
	Eyestrain			1.036	0.301	2.191	0.029*	0.111	0.912
	Headache			0.494	0.622	1.273	0.204	-1.043	0.298
4^th survey	Shoulder/lower back pain			1.679	0.094	2.509	0.013*	-0.684	0.495
	Nausea			-2.77	0.006*	-0.66	0.51	-0.003	0.998
	Psychological stress			1.294	0.197	5.215	0.000*	0.532	0.595

DISCUSSION:

Evaluation of on-line lectures:

Hamza et al.⁹ reported that 22.3% of students surveyed there had perceived severe stress as they did not prefer online learning. Mirna et al.¹⁰ investigated students who experienced online learning, and reported that 48.6% of the students felt dissatisfied or very dissatisfied with online learning due to the problems of Internet telecommunication infrastructure. However, in the present study more that 80% of the participants answered that the on-line lectures were “very good”, “reasonably good”, and “usual” in the second, third, and fourth surveys. Further, in the survey at two weeks after starting on-line lectures, only 4.8% of students reported that they had access problems. Many students reported no Internet communication problems. The reason for these would include that the penetration rate of internet access in Japan is 94%, which is in the 11th place in the world rankings¹¹. Another reason includes that for the average fixed internet connection speeds, Japan is the 10th place in the world rankings at 91.9 Mbps, both of these statistics are far higher than the world average, and the communication environment of Japan is much better than that of many other countries. Further, as University A lent computers to all students, there were no students taking on-line lectures with access to only smartphones. University A, where the internet environment is stable, also allowed students with access problems at home to attend school to take classes on campus as long as the students took the necessary measures against infection. These arrangements of the University may have made it possible for the students to take on-line classes through the Internet in stable communication conditions. Compared to other countries, Japanese students may be in a relatively favorable Internet environment for on-line lectures.

The scores of the evaluation of on-line lectures in the fourth survey were statistically significantly higher than in the third survey (p = .009). This may be because the fourth survey was conducted when three months had passed since University A started on-line lectures, and the students had become accustomed to using computers and operating Zoom, and felt it convenient because they were able to take classes at home. When an organization starts something very new, such as on-line lectures, the time unit of three months may be a turning point for evaluation and correction.

Time spent on self-study:

Comparing the second and fourth surveys, the time spent on self-study in the fourth survey was statistically significantly shorter than that in the second survey (p = .001). This may be because in the early days of on-line lectures, both students and faculty had to make efforts to become accustomed to on-line lectures, but by the time of the fourth survey, they became accustomed to on-line lectures and the volume of the assignments gradually increased. Dina et al.¹² reported that “a huge daily workload” and “compressing the curriculum in a shorter time” could be stressors for students in relation to distance learning. In the present study there was a comment in the open-ended question, “having difficulty in on-line lectures due to the increased assignments”. Further, it is considered that the third-year students tend to have more assignments than they have experienced so far because it is the time to learn nursing process. In on-line lectures, instructors tend to give more assignments in on-line classes than face-to-face classes because it is difficult for instructors to understand the proficiency level of students¹³. Instructors need to pay attention not to give students excessive volume of assignments by coordinating with other subjects.

Physical conditions and psychological stress:

In the third and fourth surveys, the most common poor physical condition was “eyestrain” (82.1% in the third survey, 82.5% in the fourth survey). The second most common condition was shoulder and lower back pain, followed by headache and psychological stress. These symptoms are symptoms of health problems caused by using information devices such as computers with Visual Display Terminals (VDT) used for long periods¹⁴. In a survey by the Ministry of Health, Labour and Welfare of Japan (MHLW), it is reported that more than 90% of workers had eye symptoms due to VDT syndromes¹⁵. Because the students reported statistically significantly more responses with poor physical conditions in the fourth survey than in the third (p = .00), the symptoms of VDT syndromes may worsen over time rather than be relieved. When making lesson plans for on-line lectures, instructors need to pay attention to avoid students from developing VDT syndromes as far as it is possible.

For the eyestrain which was the most common VDT syndrome condition and the evaluation of the on-line lectures, there was no significant difference between the third and fourth surveys (p > .05). However, students with shoulder and lower back pain and those with psychological stress had significantly lower ratings for on-line lectures in both the third and fourth surveys (p < .05). Shoulder and lower back pains are central musculoskeletal pain, a characteristic symptom of VDT symptoms, caused by maintaining the same posture for a prolonged period during on-line lectures. In the present study, more than half of the students had shoulder and lower back pain. Kikuchi et al.¹⁶ reported that pain in these body parts causes a wide variety of symptoms such as stress, deteriorated QOL and decreased work performance, but in the present study, it was found that pain affects the evaluation of on-line lectures as well as various physical symptoms.

For psychological stress in relation to on-line classes and Covid-19, there are some previous studies^17,18,19. In the present study, when comparing students with and without psychological stress symptoms, there was a difference of 0.7 or more in the mean point value of the evaluation of on-line lectures. Students with psychological stress in the third survey rated on-line lectures statistically significantly lower in the third and fourth surveys (p < .05). This suggests that students with psychological symptoms have more negative feelings towards on-line lectures than those with physical symptoms, and psychological symptoms may affect the continuous use of on-line lectures in the future. In the third survey 8.4% of students and in the fourth survey 12.4% of students were psychologically stressed. These percentages are small, but it was shown that these numbers should not be disregarded. The fourth survey was conducted in the exam season of the participating university, and this may have increased the anxiety of students as only on-line lectures had been given. It has been reported that nursing students have high stress levels even in normal daily life²⁰, and Hamzah, et al.²¹ have stated that the majority of first-year nursing students feel anxiety about exams. Further, previous studies have reported that being affiliated to a specific religious group, taking part in religious activities, and regularly conducting religious meditation are factors that have a positive effect on mental health^{22, 12}. However, there are few people engaged in regular religious activities for mental well-being in Japan. With lessons mainly provided on-line in Japan, universities may need to provide more following-up for exams than previously.

During the COVID-19 pandemic, opportunities for face-to-face communication and interactions with other people decreased significantly due to the state of emergency in Japan and lockdowns in other countries. Participants in this study expressed their wishes to “attend a school”, “hear lectures directly from the instructors”, and “see friends”. As reported by previous studies, the recommendation to ensure social distancing^23,24 may affect interpersonal relationships and interchanges among individuals²⁵, the first-year students enrolled in 2020 have remained unaware of the joys of university life created by interacting with school friends.

Nursing science is a discipline where students develop their learning through the communication with others, and the spirit of caring for the feelings of others will develop in the communication where students can feel the warmth of other people. Today, when lectures are provided mainly as on-line lectures, nursing education institutions will be required to develop new lifestyles and learning styles by improving communication styles under the COVID-19 pandemic.

LIMITATIONS:

It is difficult to apply the findings of this study for the general population because the present study used the results of a survey conducted at only one university in Japan. Further quantitative research is needed by expanding study populations to many other universities.

CONCLUSIONS:

For the Internet environment, more than 95% of students reported that they had no problem accessing classes in the second and third surveys. For the time spent on self-study, the most common response was1-2 hours in the second and fourth surveys. For the evaluation of on-line lectures, more than 80% of students answered that the on-line lectures were “very good”, “reasonably good”, and “usual” in the second, third, and fourth surveys. Comparing the evaluation of the on-line lectures in the third and fourth surveys, the fourth survey score was statistically significantly higher (p = .009). For the physical condition and psychological stress, the most common condition affected by VDT syndrome symptoms was eyestrain. In the third and fourth surveys, students with shoulder and lower back pain and those with psychological stress had significantly lower ratings for on-line lectures.

As described above, more than 80% of students evaluated the on-line lectures positively. However, students with shoulder and lower back pain and those with psychological stress rated on-line lectures lower than the students without these symptoms. Nursing science needs to elaborate a new learning style that enables students to have continuous interactions with people even under the situation with on-line classes because nursing science is a discipline where students develop their learning through the communication with others.

ACKNOWLEDGEMENTS:

The authors are grateful for the assistance of the people who participated in this study and the staff who were involved.

CONFLICTS OF INTEREST:

There are no conflicts of interest to declare.

SOURCE OF FUNDING:

This study was supported by the research fund allocated to the first author by the institution to which the first author is affiliated.

DATA AVAILABILITY:

The data that support the findings of this study are shown in Tables.

REFERENCES:

1. Rohit, K., Anshul, C., Gaganpreet, D. (2020). A Valuable insight to the novel deadly COVID-19: A Review. Research Journal of Pharmacology and Pharmacodynamics.12(3). DOI: 10.5958/2321-5836.2020.00021.X.

2. Johns Hopkins University Medicine Coronavirus Resource Center. (2021). COVID-19 Data in Motion. https://coronavirus.jhu.edu/. Accessed on February 11, 2021.

3. Rahate, S. K., Bombale, M. R. (2020). Introduction to Covid-19. Research J. Science and Tech.12(4). DOI: 10.5958/2349-2988.2020.00051.0.

4. Ramesh, D. I., Avinash, B. T., Pawan, N. K. (2020). Is Prevaccination the reason for less morbidity and mortality for COVID-19 in India: An Epidemiological study. Research J. Science and Tech. 12(4). DOI: 10.5958/2349-2988.2020.00038.8.

5. Ministry of Health, Labour and Welfare. (2021). Guidelines for the prevention of specific infectious diseases related to tuberculosis-BCG inoculation (measures against pediatric tuberculosis)- (in Japanese). https://www.mhlw.go.jp/file/05-Shingikai-10601000-Daijinkanboukouseikagakuka-Kouseikagakuka/0000110057.pdf. Accessed on August 15, 2021.

6. Ramesh, D. I., Avinash, B. T., Pawan, N. K. (2020). Is Prevaccination the reason for less morbidity and mortality for COVID-19 in India: An Epidemiological study. Research Journal of Science and Technology.12(4). DOI: 10.5958/2349-2988.2020.00038.8.

7. Japan Association of Nursing Programs in Universities. (2020). A survey of the implementation of clinical training courses (required) in the fourth-year students of nursing universities (in Japanese). https://www.janpu.or.jp/wp/wp-content/uploads/2020/09/202009koutoukyouiku-houkokusyo.pdf. Accessed on February, 11, 2021.

8. Sasaki, D. (2018). How to spend three months will change your life (in Japanese). Nippon Jitsugyo Publishing. Tokyo, Japan, p 3.

9. Abdulghani, H. M., Sattar, K., Ahmad, T., and Akram, A. (2020). Association of COVID-19 Pandemic with undergraduate medical students' perceived stress and coping. Psychology research and behavior management. 13, 871-881. https://doi.org/10.2147/PRBM.S276938.

10. Fawaz, M., and Samaha, A. (2020). E-learning: Depression, anxiety, and stress symptomatology among Lebanese university students during COVID-19 quarantine. Nurs Forum, 56 (1), 52-57. https://doi.org/10.1111/nuf.12521.

11. We Are Social Inc. (2019). Internet penetration rates. https://wearesocial.com/global-digital-report-2019. Accessed on February, 6, 2021.

12. Masha'al, D., Rababa, M., and Shahrour, G. (2020). Distance learning-related stress among undergraduate nursing students during the COVID-19 Pandemic. J Nurs Educ, 59(12), 666-674. https://doi.org/10.3928/01484834-20201118-03.

13. Fujimaki, A. (2020). Looking back at education using ICT, 11th Cyber symposium for sharing the efforts related to distance learning at universities since April (held online on June 26) (in Japanese). https://www.nii.ac.jp/event/upload/20200626-4_Fujimaki.pdf. Accessed on February, 6, 2021.

14. Araki, N., and Oda, K. (2020). VDT syndrome, Serviceology web magazine, Society for Serviceology. (June, 10, 2020) (in Japanese). Accessed on February, 10, 2021.

15. Ministry of Health, Labour and Welfare. (2009). 2008 Survey: Table 21. Percentage of workers with physical fatigue and symptoms of VDT work and workers, by symptoms (in Japanese). https://www.mhlw.go.jp/toukei/itiran/roudou/saigai/anzen/08/02.html, Accessed on February 7, 2021.

16. Kikuchi, T., Yamaguchi, S., Igarashi, H., Omata, H., Suzuki, M., Tanaka, K., Isobe, H., and Mimura, T. (2011). Effect of acupuncture on VDT workers (2): Effect on QOL and work performance (in Japanese). Journal of Japan Society of Acupuncture and Moxibustion, 61(1), 51-58.

17. Mheidly, N., Fares, M. Y., and Fares, J. (2020). Coping with stress and burnout associated with telecommunication and online learning. Front Public Health, 8. https://doi.org/10.3389/fpubh.2020.

18. Savarese, G., Curcio, L., D'Elia, D., Fasano, O., and Pecoraro. N. (2020). Online University Counselling Services and Psychological Problems among Italian Students in Lockdown Due to Covid-19. Healthcare (Basel), 8(4), 440. https://doi.org/10.3390/healthcare8040440.

19. AlAteeq, D. A., Aljhani, S., and AlEesa, D. (2020). Perceived stress among students in virtual classrooms during the COVID-19 outbreak in KSA. J Taibah Univ Med Sci, 15(5), 398-403. https://doi.org/10.1016/j.jtumed.2020.07.004.

20. Chanchal, S., Deepshikha, B., Esther, N., Gurgeet, K., Hatneikim, H., Hemprabha, J., Mukesh, C. S., Mohanasundari, S., K. (2020). A Descriptive Study to Assess daily routine activities and level of Stress among students of B.Sc (Hons.). Nursing students at AIIMS.8(1). DOI: 10.5958/2454-2660.2020.00003.4.

21. Farrahdilla, H., Khairi, C., Vidya, B., Safiya, A., Haszalina, H. (2018). Assessing Test Anxiety among the First Year Nursing Students’ of University Sultan Zainal Abidin. Research Journal of Pharmacy and Technology 11(4). DOI: 10.5958/0974-360X.2018.00270.6.

22. Kyung, S. K. (2018). Factors Influencing on the Spiritual well-being among Korean nursing students. Research Journal of Pharmacy and Technology.11(4). DOI: 10.5958/0974-360X.2018.00287.1.

23. Sarfaraz, A., Ambreen, S., Md, S. A., Sarfaraz, A., Nawazish, A., Maksood, A., Ali, M., Ayaz, A., Salahuddin, A., Mohammad, D. A. (2020). Epidemiology, Risk, Myths, Pharmacotherapeutic Management and Socio- economic Burden due to Novel COVID-19. Journal: Research Journal of Pharmacy and Technolog.13(9).

24. Vandna, D., Ram, S., Trilochan, S., Amit, R. (2020). The Exploring of Current Development status and the unusual Symptoms of Coronavirus Pandemic (Covid-19). Research Journal of Pharmacology and Pharmacodynamic.12(4). DOI: 10.5958/2321-5836.2020.00031.2.

25. Sheila, M., FBSCH, V., B. (2021). Review of the impact Covid-19 has on the Psychosocial factors affecting Well-Being. Research Journal of Pharmacy and Technology. 14(6). DOI: 10.52711/0974-360X.2021.00592.

Received on 06.08.2021 Modified on 19.10.2021

Asian J. Nursing Education and Research. 2022; 12(1):13-20.

DOI: 10.52711/2349-2996.2022.00003