INTRODUCTION:

One of the core responsibilities of the nursing profession is to provide high-quality health care and this goal can be achieved basically with high-quality nursing education, which enables the professional nurse to confidently take care of the health and well-being of people¹. And this equilibrium to be maintained, concise follow-up, and evaluation are required for monitoring the online nursing education programs and their ongoing processin Middle Euphrates Region in Iraq.

Different kinds of challenges hinder online education adoption in universities. For example, technological obstacles, lack of up-to-date infrastructure, poor knowledge and experience in computer utilization, internet accessibility barriers, as well as language and culture-specific challenges². The main disadvantage associated with online nursing education is that it is not suitable for clinical education. Besides, in the past few years, the quality of online education was an issue of concern, and studies have shown that it is not systematically evaluated^3,4,5.

Other studies claim that despite the popularity of online education in nursing, further studies are still needed about its impact and effectiveness in nursing curriculums⁶. The majority of nursing colleges were not prepared for online education at the pandemic onset, and this transmission needs well-designed plans and infrastructure, so challenges have been raised⁷. Learners' needs and problems should be kept in mind when switching to online education^6,8,9,10. Researchers mentioned that there are not enough studies that evaluate students' preparedness to engage in online education courses^11,12,13,14.

Based on the early stated evidence, the present study is conducted to deal with the evaluation of the actual challenges that impede the teaching and learning of nursing students at a group of nursing colleges inthe Middle Euphrates Region Iraqi universities, to find out the students' problems and to know the strengths and weaknesses of online nursing education.

METHODOLOGY:

Study design:

This research is the third part of a larger study. A descriptive evaluative approach is conducted to evaluate the current challenges of nursing students regarding online nursing education through web-based courses, programs, online examinations, and quizzes, through the period from September 15, 2020, to April 13, 2021.

Setting and sampling process:

This part of the study is carried out at two Colleges of Nursing in Iraqi Universities, a total sample of (80) undergraduate nursing students is recruited from these colleges using the non-probability sampling approach to gather a convenient sample. The sample is comprised of (40) students from each college of nursing.

Study instrument:

A self-report questionnaire is developed from the literature, for evaluating the current challenges of online nursing education. The instrument consists of two parts, which include students’ demographic data and the current challenges of online nursing education domains, which are: Learning, understanding, and comprehension domain (consist of 13 item); Software and e-learning tools domain (8 items); Instructors skills and experiences from the students perspective domain (17 item); Class discussion and student-teacher communication domain (7 items); Course design and content material domain (9 items); Psycho-social circumstances domain (11 item). A pilot study is conducted for determining the study instrument's internal consistency reliability and content validity.

Pilot Study:

Before the actual data gathering a pilot study is conducted to accomplish the following objectives:

1. To evaluate the evaluation tool content’s clarity, relevancy, and adequacy.

2. To examine the cooperation of the study sample.

3. To estimate the time required for filling each questionnaire form.

4. To identify barriers that may be experienced throughout the study.

5. To determine the reliability and validity of the study instrument.

Validity of the Questionnaire:

Content validity is determined through the use of a panel of (11) experts in online nursing education. These experts are (7) faculty members of the College of Nursing University of Baghdad, (2) faculty member of the College of Nursing University of Babylon, (1) faculty member of the College of Nursing University of Kufa, (1) faculty member of the College of Art University of Al-Sulaymaniyah. All experts are presented with a draft of the questionnaire and they are asked to review and evaluate the questionnaire's clarity, consistency, and adequacy. Their responses indicate that the instrument is qualified to be a clear, consistent, and adequate measure for the phenomena underlying the present study.

Reliability of the Questionnaire:

Internal consistency reliability is determined for the study instrument through the use of the split-half technique and the computation of the Cronbach alpha correlation coefficient. Data are collected from (16) undergraduate nursing students. The sample is excluded from the original study sample. The finding of such technique reveals that the alpha correlation coefficient is (r = 0.86) which is indicating that the questionnaire is an adequately reliable measure.

Data collection and analysis:

Data are collected using the developed self-report questionnaire from undergraduate nursing students out of early stated colleges. Online and paperwork styles are used as means for data collection. The collected data are analyzed through the application of the following approaches: Descriptive statistical data analysis approach and inferential statistical data analysis approach. SPSS (Statistical Package for Social Sciences) Software version 23 and Microsoft Office - Excel 365 were used for the analysis.

Ethical considerations:

Formal ethical approval for the study is obtained from the Scientific Research Ethical Committee in the College of Nursing University of Baghdad. All participants have signed a consent form for their agreement to participate in the study.

RESULTS OF THE STUDY

Table 1: Overall Evaluation of Current Challenges of Online Nursing Education in the Middle Euphrates Region of Iraq

Poor

(74-123.3)

Fair

(123.4-171.6)

Good

(172.7-222)

27(33.75%)

43(53.75%)

10(12.5%)

Table 2: Mean of Scores on Items of Learning, Understanding, andComprehension Domain at Colleges of Nursing in the Middle Euphrates Region of Iraq

List	Learning, Understanding, and Comprehension Domain	Always	Some times	Never	M.S	E.
1	I learn easily with online education.	8	49	23	1.81	Low
2	I got a benefit from what I learned in online education courses.	3	47	30	1.66	Low
3	The assignments are helpful in acquiring a better understanding of course content.	19	36	25	1.93	Low
4	The tests in the online class are directly related to assignments, discussions, and other planned activities.	21	43	16	2.06	High
5	Online education increases the quality of knowledge attained.	11	32	37	1.68	Low
6	Online education will provide me with better learning opportunities than traditional means of learning.	9	33	38	1.64	Low
7	I can manage my study time efficiently to complete assignments on time.	23	43	14	2.11	High
8	Online education provides an opportunity for students to review educational materials at any time without being restricted by the time of the lecture.	32	34	14	2.23	High
9	I learn best when class material is presented in a variety of formats (lectures, videos, podcasts, online discussion/ conferencing).	26	45	9	2.21	High
10	I feel comfortable reading a textbook or articles on a computer screen than a physical textbook or paper.	10	24	46	1.55	Low
11	I have the chance to work with my peers during the online education.	26	39	15	2.14	High
12	Student responsibilities (being prepared, participation, group projects, etc.) are well defined in online education.	27	38	15	2.18	High
13	I believe that using online education technologies will improve my learning performance.	13	32	35	1.73	Low

MS: Mean of Scores, E.: Evaluation, Low: MS ˂ 2, High: MS ˃ 2

Table 3: Mean of Scores on Items of Software and Online education Tools Domain at Colleges of Nursing in Middle Euphrates Region of Iraq

List	Software and Online education Tools Domain	Always	Some times	Never	M.S	E.
1	I am comfortable and proficient at creating, saving, locating, downloading, surfing the Internet, conducting searches, setting bookmarks, and opening different types of files on a computer.	28	39	13	2.19	High
2	I am willing to use e-mail and other online tools to ask my classmates and instructors questions.	41	33	6	2.44	High
3	I can confidently write and format documents using a word processing program.	43	28	9	2.43	High
4	I have access to a webcam and microphone for simple multimedia participation.	15	23	42	1.66	Low
5	It will be easy for me to become skillful in the use of online education tools.	26	45	9	2.21	High
6	I prefer using a computer to prepare my lessons.	17	32	31	1.83	Low
7	Supporting learners in an Online education environment is very easy.	24	41	15	2.11	High
8	It is easy to get help when facing computer problems.	20	42	18	2.03	High

MS: Mean of Scores, E.: Evaluation, Low: MS ˂ 2, High: MS ˃ 2

Table 4: Mean of Scores on Items of Instructors’ Skills andExperiences Domain at Colleges of Nursing in Middle Euphrates Region of Iraq

List	Instructors’ Skills and Experiences Domain	Always	Some times	Never	M.S	E.
1	The instructor expressed ideas clearly.	18	47	15	2.04	High
2	Encouraged students to feel free to ask questions.	34	39	7	2.34	High
3	Carefully answered questions raised by students.	30	46	4	2.33	High
4	Treated students with respect when communicating with various electronic means of communication.	41	34	5	2.45	High
5	Used various teaching methods and techniques that helped me understand the practical applications of the course content.	16	42	22	1.93	Low
6	The instructor is helpful and collaborated with the students.	26	42	12	2.18	High
7	Feedback and evaluation of papers, tests, and other assignments are given promptly.	28	35	17	2.14	High
8	The instructor is well organized and prepared.	22	47	11	2.14	High
9	Competent with computer use during the course.	27	47	6	2.26	High
10	Accessible and available during the online education course.	24	46	10	2.18	High
11	Communicated important due dates/time frames for learning activities.	30	38	12	2.23	High
12	Define and apply clear grading scales.	30	43	7	2.29	High
13	Provide accurate, complete, clear, and accessible content.	21	43	16	2.06	High
14	Offer multiple opportunities for interaction among learners, between learners and the instructor, and between learners and content.	21	48	11	2.13	High
15	Integrate face-to-face interactions and participation in social networks.	24	45	11	2.16	High
16	Provided detailed instructions and guidelines for completing assignments and discussions.	22	47	11	2.14	High
17	Course objectives in online education are provided at the beginning of the course and clearly described.	25	42	13	2.15	High

MS: Mean of Scores, E.: Evaluation, Low: MS ˂ 2, High: MS ˃ 2

Table 5: Mean of Scores on Items of Class Discussion and Student-Faculty Communication Domain at Colleges of Nursing in Middle Euphrates Region of Iraq

List	Class Discussion and Student-Faculty Communication Domain	Always	Some times	Never	M.S	E.
1	The frequency of student and instructor interactions is adequate.	14	53	13	2.01	High
2	I felt comfortable participating in the online course discussions.	24	31	25	1.99	Low
3	The face-to-face method is more learner-centered than the online education method.	49	24	7	2.53	High
4	There is more interaction between all involved parties in online courses compared to a traditional face-to-face class.	15	38	27	1.85	Low
5	Communicating through e-mails is comfortable.	22	32	26	1.95	Low
6	I am comfortable interacting with others in online communication.	27	31	22	2.06	High
7	Online education allows me to communicate with students and instructors at different times.	29	37	14	2.19	High

MS: Mean of Scores, E.: Evaluation, Low: MS ˂ 2, High: MS ˃ 2

Table 6: Mean of scores on Items of Course Design and Content Material Domain at Colleges of Nursing in Middle Euphrates Region of Iraq

List	Course Design and Content Material Domain	Always	Some times	Never	M.S	E.
1	The content is organized and easy to follow.	26	39	15	2.14	High
2	All the images and texts in the online courses are clearly visible.	31	38	11	2.25	High
3	Any sounds in the course are clearly audible.	23	41	16	2.09	High
4	Adequate resources and materials for this online course are easily accessible during the course.	27	43	10	2.21	High
5	All documents (e.g., PDF, doc, and PPT) are accessible via screen readers. (This includes tables and graphs).	44	31	5	2.49	High
6	Educational videos are an essential part of online education.	50	25	5	2.56	High
7	Video/audio files have the possibility to be captioned.	29	46	5	2.3	High
8	The course contained various assessment methods (e.g. discussion, assignments (individual or group), and quizzes).	27	41	12	2.19	High
9	There is a course schedule that shows activities and due dates.	32	38	10	2.28	High

MS: Mean of Scores, E.: Evaluation, High: MS ˃ 2

Table 7: Mean of Scores for Items of Psycho-social Circumstances Domain at Colleges of Nursing in Middle Euphrates Region of Iraq

List	Psycho-social Circumstances Domain	Always	Some times	Never	M.S	E.
1	The test(s) in the online course is accurate and fair.	12	42	26	1.83	Low
2	Online education treats class members equitably and respectfully.	34	31	15	2.24	High
3	Online education decreases learners’ social isolation.	30	25	25	2.06	High
4	Learning through online education is interesting.	27	24	29	1.98	Low
5	I am comfortable with online learning technology.	25	22	33	1.9	Low
6	I am comfortable working and learning independently.	27	32	21	2.08	High
7	I am satisfied with my final grade in the online course.	23	27	30	1.91	Low
8	Conducting the course via the Internet made it easier than other traditional nursing courses I have taken.	23	31	26	1.96	Low
9	I got support and assistance throughout the online education process.	26	36	18	1.99	Low
10	The level of test anxiety in the electronic test is less compared to the traditional test inside university halls.	39	26	15	2.3	High
11	Online education is less expensive for students than in traditional education.	42	21	17	2.31	High

MS: Mean of Scores, E.: Evaluation, Low: MS ˂ 2, High: MS ˃ 2

DISCUSSION:

The Middle Euphrates Region results depicts that more than half of the students have experienced inconsistencies and less than a quarter of them experienced acceptance and positive outlook of online nursing education (Table 1).

More than half of the students stated complications concerning learning, understanding, and comprehension. As the mean of scores is demonstrating, the students reacted to seven questions from this domain as low, which are about the easiness of their learning experience with online education, their benefits from the online course, the feasibility of the assignments in acquiring a better understanding of the content, the quality of knowledge they attained online, their comfortability with reading e-texts, their performance improvement by online learning, and if any learning opportunities offered to them by online education. While they marked (6) questions from (13) as high, these about the assignments relatedness to the curriculum material, completing assignments on time by effective time management, the easiness of reaching the materials any time and anywhere, best learning experience with the different content format, the chance of collaboration between students regarding the online activities, and student’s tasks and responsibilities determination (Table 2).

In light of the aforementioned, a research project by Mehrdad et al³ is being carried out in Iran with the purpose of determining whether or not there is a discernible difference between online education and traditional education in terms of the outcomes of student learning. The undergraduate nursing students who are taking a maternal and child health course are serving as the study's sample. The same course is broken up into two periods: during the first one, students are instructed in the conventional manner, and during the second Both approaches involve measuring the learning results, opinions, and levels of engagement of the students. According to the conclusions drawn from the research, there were not any discernible differences between the two approaches to teaching in terms of the knowledge gained by the students. In addition, the authors of the same study stated that online teaching can be implemented as an educational strategy that is either an alternative to the traditional approach or a complimentary strategy to it.

The overall evaluation of the software and online education tools domain revealed that most of the students experienced a reasonable level of the challenges of current online nursing education. This can be explained by the high mean of scores for the items of comfortable dealing with multiple kinds of files and the proficiency in surfing the internet; the utilization of e-mail in peers contact and student-teacher communication; the confidence in using a word processing program, the expected competence in using online education technologies, learners’ support in the virtual learning environment, and availability of help in case of computer problems. While they marked as low only the access to a webcam and microphone; and preparing homework with electronic devices such as computers (Table 3).

The findings of the current study primarily contradict the findings of Pete and colleagues¹⁵, who stated that students lacked the necessary technological skills and readiness that authorize them to enroll in online courses. The findings of the current study come into contrast with the observations of Pete and colleagues¹⁵. However, Mehrdad et al.³demonstrated that the students are able to use the necessary software that allowed them to complete the online course. Additionally, they said that the website that is utilized for the online course is straightforward and easy to use.

Half of the students experienced a rational challenge concerning the instructors’ skills and experiences domain, whereas one-third experienced a perfect level for the same domain. As they stated as high the following items; instructor’s skills of idea expression, encouraging students to feel free concerning question asking, answering students questions carefully, respectful students’ treatment; cooperation and helpfulness, feedback provision about assignments and exams; arrangements and preparedness; computer usage professionality, accessibility during the online course, due dates and completion standards communication; the application of clear grading strategies, content fabrication skills; interaction and communicational environment creation; social networks utilization for face-to-face educational interaction, providing plain guidance and instructions about assignments and project accomplishments; and the description of course objectives at the course onset. On the other hand, students stated the teachers’ utilization of multiple teaching techniques to help them understand and apply course content, as low (Table 4).

After that, different findings from this domain are confirmed by Ali et al.¹⁶, who stated that teachers announced exam dates and other deadlines with the respect of giving the students sufficient time needed for studying and preparation, as well as the fact that the exam's questions are related to what the teacher has discussed and explained of the content during the online classes. In addition to this, the teachers announced exam dates and other deadlines with the respect of giving the students sufficient time needed for studying and preparation. Systematic feedback is regarded as a stimulating aspect for students, which can drive them to learn better, and it is also the means through which students monitor their performance, which is consistent with the findings of another research that was written about in the aforementioned study. According to this point of view, a number of researchers noted the correlation between the level of satisfaction experienced by students and the presence of course rubrics, syllabi, and timely feedback provided by instructors^17,18,19.

Results revealed that half of the students have experienced complications and struggles relative to class discussion and student-faculty communication as a domain of the current challenges. This result came out due to students’ reaction to more than half of the items as high such as the rate of student-teacher interaction, comparing online method with traditional method regarding the learner-centered feature, whether the online communication considered as a learner-friendly from the students' perspectives; and the online interaction flexibility with respect to time. The remaining items mentioned as low, which are online participation favoring, the level of interaction between the class’s involved parties, and e-mail communication preferring (Table 5).

The findings of Langegard et al.²⁰, who reported that the majority of the participating students experienced positive views of traditional in-campus education, and they showed a high degree of preference about this method, confirm the findings of the current study. In this regard, the result of the current study is supported by the findings of Langegard et al.²⁰. The researcher has drawn attention to the fact that the fundamental cause of this phenomenon is related to social interaction and the nature of online communication in online nursing courses. This is because the students demonstrated a remarkable decline in all aspects of learning after the most recent adoption of online nursing education. While only one-third of the students stated that they are comfortable with online education, the researcher has drawn attention to the fact that the basic cause of this phenomenon is related to the nature of online communication.

Students have experienced an acceptable and high level of challenge about course design and content material domain of online nursing education. Students rated all of the items in this domain as high, including the organization and ease of following the contents, the visibility of images and text materials, high sound files quality, the accessibility of the content and their sufficiency; tables, PDFs, and other kinds of documents are readable with screen readers; the essentiality of video files in online nursing education, students ability to caption whenever they needed that from video or audio files, the utilization of different kinds of techniques in class discussions and students performance assessments; and the adhering to a pre-defined course calendar (Table 6).

Ali et al.¹⁶reported that the students evaluated the course material, which included images, PowerPoint presentations, videos, and audios, etc., as being of high clarity and quality, and that this helped them in creating an environment that was more interactive and learning-assistive. This finding is closely related to the findings of this domain. Further, Southard, Meddaugh, and France-Harris²¹ brought to light the fact that video files are an essential component of online education. Not only do they play a part in drawing the attention of students to the educational materials, but they can also contribute to a heightened awareness of the significance of the class as a whole.

The findings reveal that most of the students have experienced an impartial percentage of challenges about psychosocial circumstances domain of online nursing education. The mean of scores regarding the domain’s items show that students marked multiple items as low including the accuracy and fairness of online examination, interesting online learning, online technology preferring, final grades satisfaction, the easiness of taking online courses, and the support and helping in online education. While, they rated the other items as high, which are the equality between students, minimizing students’ social isolation, working at the students' own pace, test anxiety issues, and online education affordability (Table 7).

In a manner that is congruent with the findings of the present investigation, a number of researchers have emphasized the fact that taking classes online saves money for both the students and the educational institutions that offer them²². In addition, online education is increasingly being acknowledged for its value as a method that encourages students to learn on their own². Students' satisfaction is defined as one of the features of online programs, and this feature is highly correlated with students' technological skills³. In addition, female nursing students experienced higher levels of satisfaction with online nursing education than male nursing students did²².

CONCLUSION:

More than half of the students enrolled in online nursing education courses at colleges of Nursing in the Middle Euphrates Region of Iraq have encountered a fair level of difficulty in these courses. Accordingly, More than half of the students at nursing colleges in the Middle Euphrates Region of Iraq demonstrated a least satisfactory degree of learning, cognition, and comprehension as a domain of the present problems of online nursing education.

RECOMMENDATIONS:

The infrastructure necessary to execute online nursing education should be accessible to both the teaching staff and the students in nursing programs. The implementation of online nursing education should be carefully supervised for the benefit of educational institutions, teaching staff, and the students who attend those institutions.

REFERENCES:

1. Authement RS, Dormire SL. Introduction to the online nursing education best practices guide. SAGE Open Nursing. 2020; 6. https://doi.org/10.1177/2377960820937290

2. Harerimana A, Mtshali NG. Conceptualisation of e-learning in nursing education in the context of Rwanda. Journal of Nursing Education and Practice. 2020; 10(6): 26.

3. Mehrdad N, Zolfaghari M, Bahrani N, Eybpoosh S. Learning outcomes in two different teaching approach in nursing education in Iran: e-learning versus lecture. Acta Medica Iranica. 2011: 296-301.

4. Gupta SK. A study on Problems and Solutions for Distance Learning Education. Asian J Manag. 2015; 6(1):5–11. http://dx.doi.org/10.5958/2321-5763.2015.00002.5

5. Pingle SG, Lahiri MM, Jain NS. Applying ‘Total Quality Management’Concept in Academics in context to higher educational system in rural region Case Study of Shirpur Taluka, Dist. Dhule (MS) India. Asian J Manag. 2012; 3(3):134–8.

6. Lahti M, Hätönen H, Välimäki M. Impact of e-learning on nurses’ and student nurses knowledge, skills, and satisfaction: a systematic review and meta-analysis. International journal of nursing studies. 2014; 51(1): 136-49. https://doi.org/10.1016/j.ijnurstu.2012.12.017

7. Morin, K. H. Nursing education after COVID-19: Same or different? Journal of Clinical Nursing. 2020; 29(17-18): 3117-3119. https://doi.org/10.1111/jocn.15322

8. Vyas HS. Challenges Facing Management Education–An Indian Perspective. Asian J Manag. 2014; 5(2): 235–9.

9. Agrawal V, Kushwaha VS. Creative and Innovative Good Practices in Compulsory Education. Asian J Manag. 2012; 3(2): 114–6.

10. Roy N, Jain Y. Education through ICT Technology: Need of an hour. Asian J Manag. 2014; 5(2): 246–9.

11. Muflih S, Abuhammad S, Karasneh R, Al-Azzam S, Alzoubi KH, Muflih M. Online education for undergraduate health professional education during the COVID-19 pandemic: attitudes, barriers, and ethical issues. Research square. 2020. https://doi.org/10.21203/rs.3.rs-42336/v1

12. Kowar MK. Enhancing Teachers’ Efficiency in Technical Education through MBO. Asian J Manag. 2011;2(2):57–62.

13. Vaidehi R, Girija T. Factors influencing diffusion and continuance of massive open online course (MOOC). Asian J Manag. 2017; 8(3): 731–3.

14. Pandey S, Sharma N, Khare D. Quality Enhancement: A Major Challenge for Management Education with Special Reference to Bilaspur City (CG). Asian J Manag. 2014; 5(2): 232–4.

15. Pete M, Coopasami M, Knight S. e-Learning readiness amongst nursing students at the Durban University of Technology. Health Sa Gesondheid. 2017; 22(1): 300-6. https://doi.org/10.1016/j.hsag.2017.04.003

16. Ali KA, Khalil HE, El-Sharkawy FM. Impact of online remote education on the learning process among nursing students. Open Journal of Nursing. 2020; 10(9): 810-30. https://www.scirp.org/journal/paperinformation.aspx?paperid=102859

17. Carless D. Exploring learning-oriented assessment processes. Higher Education. 2015; 69: 963-76. https://doi.org/10.1007/s10734-014-9816-z

18. Gupta SK. The Role of Distance Education in the Human skill Development of India. Asian J Manag. 2014; 5(3): 306–11.

19. Kumar SS, Bhattacharjee B. Towards student retention: role of educational administrator, Faculty and student. Asian J Manag. 2014; 5(2): 205–7.

20. Langegard U, Kiani K, Nielsen SJ, Svensson PA. Nursing students’ experiences of a pedagogical transition from campus learning to distance learning using digital tools. BMC nursing. 2021; 20(1): 1-0. https://doi.org/10.1186/s12912-021-00542-1

21. Southard S, Meddaugh J, France-Harris A. Can SPOC (self-paced online course) live long and prosper? A comparison study of a new species of online course delivery. Online Journal of Distance Learning Administration. 2015; 18(2): 8. Retrieved from: https://eric.ed.gov/?id=EJ1065388

22. Akimanimpaye F, Fakude LP. Attitudes of undergraduate nursing students towards e-learning at the University of the Western Cape, South Africa: teaching and learning in health care professions. African Journal for Physical Health Education, Recreation and Dance. 2015; 21(Sup-1): 418-33. Retrived from: https://core.ac.uk/download/pdf/62636195.pdf

Received on 11.08.2023 Modified on 18.11.2023

Asian J. Nursing Education and Research. 2024; 14(1):31-37.

DOI: 10.52711/2349-2996.2024.00006