OJN  Vol.10 No.9 , September 2020
Impacts of Online Remote Education on the Learning Process among Nursing Students
Abstract: The period of existence and spread of Corona virus has led to the use of all means of remote education as an urgent necessity for all educational facilities, especially universities. Aim: Therefore, it was necessary to study the impacts of online remote education on the learning process among nursing students through studying of two courses; health information management at 6th semester and gerontology nursing course at 4th semester. Tool of Data Collection: A modified questionnaire comprised of forty statements was used through paper-based survey and online survey. Sample: A total samples (224) of nursing students were participated in the survey who enrolled in 2019 and 2020 spring semesters. Setting: The field of study was the nursing department of Applied Medical Science at Misr University for Science and Technology. Results: Induced positive impacts of online education on the learning process for nursing students experience were proven as more than half of the students (53.9%) had prior experience on online system use, and more than two thirds (62.5%) were competent in mobile/computer applications. Almost, two thirds (59.3%) agreed about online assessment experience, except that the online exam was anxious, and the time was insufficient to answer all questions. Also, more than two thirds (64.7%) agreed about the learning process of the two nursing courses. Conclusion: The study concluded that there were positive impacts of online education system on the learning process for nursing students except that the students were not able to decide that the remote online education system can replace traditional face-to-face learning as the clinical experience was not evaluated through this study. Recommendation: This study is recommended to be repeated on a large scale of participants to assess the possibility of achieving clinical experience through online remote education if Corona virus still coexists.

1. Introduction

Online education management system afford various advantages that encourages students for autonomous learning and promote discovery for particular knowledge provided through presentations, videos, live interactive activities, tests that has automatic correction of questions, re-grading system, immediate scoring, and instant feedback, persistent assignments and assessment, training activities that govern the behaviors of students and teachers. Worldwide, due to the pandemic of COVID-19, all universities were closed to reduce the infection rates, this closure made a sudden unplanned shift to use online education systems. Sounds professional before COVID-19, there were already some embracing of online education as a gate for development and promotion in education technology.

The introduction and implementation of a remote education policy albeit partially within colleges and schools can solve many overcrowding and pollution problems as well as save time and cost, and will prompt students and teachers to discover more information and enhance knowledge with an intellectual analysis that can be reflected in progress in all life science. According to Koch, et al., [1] technology advancement are grown rapidly and assisted nursing educators for delivering learning with several tools to participate students and improve their learning capacity. Recently, Duval, Sharples & Sutherland, [2] emphasized that this advance of ever-changing technology has transformed the education sectors over the world, whereas many countries reshape their educational strategies to encounter the progressing of educational need.

So with or without COVID-19, teachers should not wait for other unknown or unexpected crises, teachers should focus in addition to students’ knowledge, on students motivation through persistent education, summarize points of interest before the semester ends and regularly review materials, provide more encouragement, provide feedback, and provide inspiring and engaging materials using media multiplayer and technology, where teaching students with technology is one way to motivate students through using computers, internet, mobile phone, projector, etc., [3]. Coffman [4] had pointed previously that when technology tools driven by students, it become more complementary because students should discover technology by use of their current knowledge of technology, as they can explore and analyze tests themselves out of teaching and learning hours.

Initiatives that occurred in education had increased the value for the development of enrich computer-based environments of assessment that make students think with rational vision [5]. However, Candrlic, et al., [6] emphasized that online tests can replace old-fashioned paper-based tests for assessing students; however special attention must be awarded to the compound structure of the test. Also, Ghaderi [7] added that computer based tests developed in trendiness and will turn out to be a delivering test in the future. But the resistance of some academic teachers to apply these features of online systems could be a barrier to the inclusive benefits of their privileges [8].

Teachers are responsible for specifying outcomes of nursing education programs that are congruent with the current and future needs of the public. The curriculum reform movement of the 1980s focused on the importance of outcomes rather than process in optimizing the quality of teaching and learning in nursing education. This approach suggests that an orderly curriculum design does not take into account each learner’s individual needs, abilities, and learning styles and that learner can reach the same goal by means of different paths [9].

New learning experiences and concepts learned and acquired are related to the previously known experiences to become a part of new learning experiences and concepts [10]. Online learning has become widely held due to its capabilities for offering better resilience access to contents and instructions at whichever time students want, in their places. So it is pivotal that researchers deliberate, and test the effectiveness of the online learning in educating students [11].

Significance of the Study

It is not necessary to wait for a pandemic of Coronavirus in order to move into the right direction to the use of learning and education via the internet, even if only partially, since most students enrolled in private universities are from far regions and their transfer from their villages or cities to reside around the zone of the university in which they are studying actually adds financial burdens to their families as well as stress and fear that these students could be undisciplined educationally/morally. On the other hand, the future direction of universities focuses on activation of the use of educational technology, researches and increases the effectiveness of the educational process, which in turn contributes to achieving the mission of the university and the college from which the student will graduate.

Egyptian President Abdel Fattah El Sisi has directed the government to develop and expand the system of remote learning as a part of the state’s strategy to deal with the next academic year in schools and universities, amid the coronavirus crisis [12]. In this regard nursing students should broadly work on computer and information literacy to process online learning in an effective manner.

2. Aim of the Study

The study aimed to study the impacts of online remote education on the learning process of nursing students through studying of two courses; health information management systems course and gerontology nursing course.

Research Questions

After passing experience of online education courses among nursing students in two consecutive semesters for four groups of students:

· Did online education achieve a positive impact on the learning process among nursing students?

· Is there an acceptance of online education among nursing students?

3. Subjects and Methods

3.1. Design

A descriptive research design (cross sectional surveys) was used in the study.

3.2. Setting

The research study was performed in the nursing department of the Faculty of Applied Medical Science at Misr University for Science and Technology (MUST). It is a private University and contains 13 Colleges affiliated to the Ministry of Higher Education. The Faculty of Applied Medical Science constituted from four programs: Nursing Major, Respiratory Therapy, Laboratory Technology, and Radiology Technology. The Nursing Major was the first program attained academic accreditation certificate among the other private Universities in June 2016.

3.3. Sample

The sample involved four groups of undergraduate nursing students in health information management course at sixth semester and gerontology nursing course at fourth semester, the two courses are studied during spring semesters 2019 and 2020. The total numbers of students responded to the study and report their feedback were (224) students, forming 45.2% from the total numbers of students enrolled (496) in these nursing courses. The students’ feedback was collected after the final exams were taken for the two studied courses through a paper questionnaire for the groups of students enrolled in the spring semester 2019 and an electronic questionnaire for the groups of students enrolled in the spring semester 2020. The samples were purposive for the aim of the study because these two courses were the first courses used full version of online education in 2019 when the university launched the use of learning management system and on 2020 all departments of the faculty have used the full version of online remote education to manage the urgent situation during the pandemic outbreak of COVID-19. The samples of the students who completed the surveys were distributed as following;

Gerontology nursing course (Spring 2019, paper based-survey included 50 students & Spring 2020, online based-survey included 54 students).

Health Information Management course (Spring 2019, paper based-survey included 58 students & Spring 2020 online based-survey included 62 students).

3.4. Tool of Data Collections

One tool was used in data collection and was modified by the researchers of the current study to correspond with the purpose of the study. The current tool was adopted from the original tool which developed by the department of computer science [16] and was evaluated by distance education expert from the Faculty of Education at kocaeli university, Turkey. Two sections from the original tool related to student agreement on online assessment system “screen and interface design” and student agreement about “system use” were removed because improving the web design is out of the scope of the current research. Another two sections were replaced about “presence of previous experience on online system use” and “evaluation of online learning process” based on the validity of the data collection tool.

The modified tool composed of forty statements distributed to answer four dimensions; First part about students’ prior experience on online system use which contained ten statements in including two open-ended-questions; about grades of ICDL if has passed, and secondly about who assisted the student on use of smart learning website. The scoring system of this part was yes = 2 and no = 1.

Second part contained four statements to evaluate students’ competence of mobile/computer applications. The scoring systems of this part was a 5-points likert scale (1 = poor, 2 = introductory, 3 = none, 4 = good, 5 = advanced).

Third part contained thirteen statements about student evaluation on online course assessment experience.

Fourth part also contained thirteen statements about student evaluation on online learning process.

The scoring systems of the last two parts were 5-points likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree).

The demographic data about student gender, age group, residency destinations were requested to be answered at the top of the questionnaire.

3.5. Validity and Reliability

The modified tool was reviewed and compared versus the original tool with the assistance of the Faculty Dean of Applied Medical Science, who suggested some modification about the prior experience of nursing students on computer and web, so new questions were added with new arrangement of tool questions and sections. The modified tool was revised and checked for contents and face validity for paper and online based surveys. The modified tool was piloted by five students from nursing leadership and management course to assess the reliability and feasibility of the questions.

3.6. Research Procedures

On February 2019, the researchers have received training provided by information technology (IT) department at Misr University for Science and Technology (MUST) on the system use of smart learning “Moodle” “free online platform”. The training was about the web site proper use, login, and formulation of the questions bank, categorizing questions, adding new questions, editing questions, preparing questions formats, opening and closing assessments schedule time, getting the final marks on the assessment, exams, grade book and logout from the website.

The teachers worked hard to be adapted to the online teaching in preparing the weekly power point presentations, videos, assignments, and experimental test before conduction of real online assessments to adapt students on the use of the system. During the conduction of the experimental test and real online assessments, the teachers supported students and opened chat to interact with problems facing them on spot. Traditional education paralleled the online education in this year without audio recording for the contents, as the teachers were explaining the course content in real class room with face-to-face interaction with the students. After the completion of the courses, the first survey was conducted through paper-based survey which distributed to two classes of health information management course at sixth semester and gerontology nursing course at the forth semester.

Spring 2020 was synchronized with the outbreak of Corona virus (COVID-19), during this time there was contingency demand for the use of online remote education because the university education and activities of assembling people were suspended. Therefore, the absence of face-to-face communication has required teachers to promptly plan and prepare for completing courses by online education platforms, and converting lessons from traditional lessons to audio-recording and demonstrating videos to attract the attention of the students, to be able to concentrate mentally and emotionally for the course contents and to shift them from passive learners to active learners through their continuous follow up through chat, participation through interactive questions and answers sessions, tests, presentations and open discussions and taking attendance to enhance commitment. After the course was completed, the second survey carried out through online-based questionnaire for the same two courses, then the responses were collated and percentages.

3.7. Ethical Consideration

At the commencement of embracing the online education system at MUST University, the researcher presented the idea of the current research to the Faculty Dean of Applied Medical Science, as expressed her acceptance and support to the researchers. All the students in the two courses over the two semesters were encouraged to participate in the courses feedback survey. The participated students were informed about the research purpose and they were assured for no blame for any negative responses.

3.8. Statistical Analysis

The qualitative data for the students’ responses in each semester through the first paper-based survey was computed in the form of frequencies and percentages by using excel sheet after coding of each questionnaire sheet. The frequencies and percentages of students’ responses for the online-based survey were computed electronically by the system, and then the sum of total frequencies and percentages was computed for each variable of the total samples for the two surveys.

4. Results

The analysis of data was portrayed over six parts: first one about students' population number and percent as enrolled to the courses, response rate of each sample and the total sample of all participated students, demographic data. Part two revealed the prior experiences of online system use. Part three illustrated students' competence of computer/mobile application. Part four presented student agreement about online assessment and part five demonstrated the students' evaluation of online learning process and Part six revealed the total percentage of main study components.

Table 1 illustrates the response rates of participated students from each group out of the total enrolled students to the nursing courses, which appeared higher responses with the students of 6th semesters, and the total response rate of the total sample was less than half of the enrolled students to the courses (45.2%). Regarding the gender, males’ students were common among the four groups with (60.3%) of total sample. Most of the students (93.7%) have age between 21 - 23 years. In addition, more than two third of total sample were from rural areas (61.6%).

Table 2 showed that the majority of students (82.2%) have no TOEFL experience, while more than half have passed ICDL. Meanwhile, less than three quarters (72.3%) never take previous training on computer skills except ICDL; conversely, all students have smart mobile phones and majority have private email access. More than three quarters (78.2%) of the total sample have done self-training on smart learning and around less quarter relied on informal training from teachers, peer colleague and friends respectively. Only (30.4%) have previous web assessment while majority of student have used web for instructional purposes as per studied courses.

Table 3 presented that the majority of students were competent to use of web browser (76.4%), chat (88.0%), and email (68.3%), however (38.4%) rated themselves as none competent to telnet and (15.6%) was poor competence, (26.8%) have introductory level.

Table 4 displayed that the majority of the students respectively found that the assessment was fair (72.3%), and cheating was difficult (71.9%). Also, system feedback, tracking past exam results, statistical evaluation. Meanwhile, their majority (65.2%) found that a page-by-page question layout makes them feel better in the exam, faster and better than paper-and-pencil form (64.7%), and was consistent with the teaching style (66.5%). Moreover, more than half (52.7%) of

Table 1. Frequency distribution of demographic characteristics and comparison among the four groups of nursing students (n = 224).

Table 2. Students’ prior experiences of online system use (n = 224).

Table 3. Students’ competence with computer/mobile application (n = 224).

Table 4. Students evaluation on online assessment (n = 224).

students reported that exam date was announced in sufficient time and covers all parts that were explained (60.3%), except in more than one quarter (29.9%) of the students found that the online exam time was sufficient to answer all questions and was less anxious (26.3%).

Table 5 deduced that the majority of the students agreed on the quality of audio-recording of power point presentations (93.3%), videos (61.6%), clarity of content objectives (58.5%), use of student self-test (91.1%), online learning interaction make them motivated (53.6%), importance of learning activities (45.9%),

Table 5. Student evaluation for online learning process (n = 224).

also more than two third (70.1%) found that group participations in tasks accomplishment is better than individualized tasks (59.8%). Effectiveness of rapport and respect relationship between teacher and student was reported by more than three quarters of the students (77.6%). While, more than half (59.3%) of the students reported that the system is contemporary but their responses about the online system can replace traditional face to face learning were distributed in approximated percentages on both sides of the scale. Also, less than half of the students agreed on the educational units of the course.

Table 6 clarified that the students’ number and percentages at sixth semesters were higher than the students at fourth semesters in particular during the academic year 2020. Moreover, the table demonstrated the outcome of the study domains as the majority of total samples respectively; (53.9%) have prior experience of online system use, (62.5%) were competent to mobile/computer applications, (59.4%) agreed about online assessment and (64.7%) agreed about the achieved learning process of the nursing courses.

Table 6. Students evaluation of online learning process among the four groups of nursing students (n = 224).

5. Discussion

Although online education puts an extra burden on teachers because it requires more hours to prepare more attractive and interactive content but still has advantage of working without distractions. Also, students have reported regret and dejection of losing face-to-face contact with teachers and colleagues.

Findings of the surveys of the present study revealed that the response rates of the two groups of students at 6th semesters of nursing informatics course were higher than the other two groups of students studying gerontology nursing course, meanwhile the total response rate of the total sample was less than half of the enrolled students in the two courses. Generally, the interpretation of this percentage is due to the fact that students are used to responding to questionnaires related to academic quality of courses in a quick and random manner as a mandatory step before showing the grades of the final exams, which led to a weak of desire to deal with questionnaires as long as they are not forced to. In particular to the higher response rates in the nursing informatics course because students at the end of the course become more competent with computer skills and informatics.

Regarding the gender of the current participated students, males were common among the four groups of the total samples, which notable normal in the private nursing colleges than in governmental nursing colleges. Conversely with Fathalla, Salama, and Elwasefy [13] the authors reported that the female students were majority than male students in their study about the perception towards Moodle use as a pathway for education at Mansoura University.

The present study revealed that most of the participated students have age between 21 - 23 years, and more than two third of total sample were from rural areas. It was notable that some students were inactive to access the remote courses as a result of poor internet connection which were clarified with classmates during running online discussions. This result was confirmed by Liyanagunawardena, et al., [14] that many students complainslowness of internet access through their study of blended learning in distance education. Also, Tien and Fu, [15] reported that lack of digital connectivity has been found in many country regions, with lower income and far areas, especially rural or places of small mass population, which lead to a gap between effective and limited internet access.

Regarding to the participated students’ prior experience to the online system use, the results of the present study indicated that, most of students have no TOEFL experience, and have never taken previous training on computer skills except for those who passed ICDL course where were as majority. The students of the present study at “MUST University” get the advantage of being provided with ICDL course at the first semester as a university requirement to equip them with the skills needed in complex future technology environment but unfortunately some students postpone the course until graduation because they have negative perception from some old students who failed in the course, this fact known from the researcher role as an academic advisor. Also as illustrated in the aforementioned demographic data, the majority of the students come from rural areas where internet access and cyber facilities are not as good or available as in urban areas which in turn lead to ineffective skills of computer, internet and as well online system use.

Also the present study clarified that most of students have smart mobile phones and majority have private email access and have done self-training on smart learning of Moodle system, while little percentage of students relied on informal training from teachers, peer colleague and friends respectively. In consistent with Fathalla, Salama, and Elwasefy [13] most of participated students had computer and mobile and can access internet alongside the day.

As illustrated from the current study, the majorities of the participated students havenot taken any previous web assessment but have used the web for instructional purposes through the current studied courses and for the academic advising. However amongst the four groups of the participated students more than half of themhave prior experience with online system use. Equivalent to the study of Ozden, Erturk, and Sanli [16] most of the students had no prior experience with online assessment and more than one third of students had used the internet for instructional purposes, in addition, none of them had taken an online course before the research when examined the students’ perceptions of online assessment in Turkey.

The current results clarified that, most of participated students evaluated themselves as competent to use the web browser, chatting, and emailing, conversely, in the use of telnet as less than one third were incompetent. However amongst the four groups of the participated students more than half of them were competent to mobile and computer applications which indicate to their goodpotentiality to deal with software and hardware technology. In this regard Bond, [17] had mentioned that nursing students have positive attitudes towards technology, despite poorer internet skills in the formal education in the practice of numerous applications as reported by Maag, [18]. Therefore, students should be assisted to acquire these skills to support their online activities [19]. Also, Hsu et al., [20] asserted that it is beneficial to evaluate these skills regularly. In addition, the results of Forbes and Khoo [21] indicated that the experience enabled the teacher training students to developing their skills and self-confidence to initiate more free inquiry into technology to support the pedagogical objectives through a study aimed to exploring the potential of students' generated podcasts as a method of communicating formative assessment at a distance.

Regarding the participated students' evaluation of the online assessments, the results of current study revealed that most of them found the assessment was fair and that cheating was difficult. However, some students used some tricks to facilitate the cheating, which was reported by some students who scored poorly than their peers in the first tests that the tricking students disseminates the correct answers through “WhatsApp” during making the home tests, moreover, took screenshots during the tests and then published the gathered questions and answers to their closed groups from “WhatsApp” and on printed paper for more of use in other tests. To overcome the fraud tricks, preventive measures were taken for the remaining tests to prevent cheating, included recurrence of tests with maximizing the question bank, the use of multiple versions of the tests, the use of random questions with shuffling of questions and choices, and the use of the computerslaboratory room when conducting the tests, but unfortunately due to COVID-19, the students returned to make exams at home, so limited time restrictions were added, in addition to this, cessation of feedback assistance which provides rationales on correct and wrong answers by the system during the exams has been made and only the overall grades were shown at the end of the exams. These safeguards resulted in a normal statistical distribution of the learning curve among all students on all tests.

This result was consistent with the study of Ozden, Erturk, and Sanli [16] about students’ perceptions of online assessment, as fairness of the assessment process was assessed positively by most of the students, and for preventing online cheating, the authors had mentioned that questions were placed in a random order, and placement of the choices of the questions was also varied from user to user. Moreover, all exams were taken in the labs under observation of proctors. Congruent with other researchers [22] the majority of their students had evaluated the computerized assessment as better as paper-based assessment although experiencing it for the first time. Additionally, Ardid et al., [23] clarified that the use of computer-based assessment was a useful aid for combined assessment, observing a quite perfect balance between online assessment and old-fashioned offprint exams.

The results of the present study illustrated that the majority of students agreed on the benefits of system feedback in tracking past exam results, and the statistical evaluation which indicates their progress and competency. In addition, the majority of them found that the layout of a page-by-page question makes them feel better in reading clearly the exam questions, also, the online exam is faster and better than paper-and-pencil form, and the exams were consistent with the teaching style. Moreover, more than half of the participated students reported that exam dates were announced in sufficient time and the exams covered all parts that were explained. These results was supported by similar published studies, Ozden, Erturk, and Sanli [16] most of their students believed that the system feedback assisted them to reflect their learning level, and their progress was increased by using the online system, alsopage-by-page questions made them feel better in the exam. In agreement with Al-Amri [24] over than half of the students owned a positive attitude to the common features of computer-based test, as it was at ease to navigate through the pages on computer than on paper, and more than one third found it easier to read the items of the test on the computer than on paper.

The current study results revealed that almost two third of the total samplesagreed on the online assessment experience positively amongst the four groups of the participated students except that in the negative side more than half of the students found that the time was insufficient to answer all questions and to make overall revision on the whole exam as they couldn’t return to the previous questions or pages, also the majority of them reported that the online exam was anxious despite that an experimental examhad been establishedprior the formalone to train and familiarize the students on the use and features of online exams. In the same side of the current study results Lee, [25] and Carless, [26] had reported that, students’ satisfaction level is nearly associated with clarity of guidelines, rubrics and helpful feedbackin evaluating effectiveness of online learning.

Students from many countries perceive the bioscience features of their nursing course as difficult and specifically quizzes with feedback assist their learning, also, weekly learning objectives may be useful in increasing their academic performance [1]. In further recent research conducted by Ardid, et al., [27] highlighted on some criticisms in terms of clarity of the questions as teacher was not present in addition to the rigidity of the automatic scoring which may cause poor perception of some students. So it is remarkable to keep on working on the design of questions, considering not only the final result but also the intervening results and procedure through setting strategies that advocate the positive features and to alleviate possible problems of limitations towards its use in a good and more effective merged assessment.

Regarding students evaluation of the components of the online learning process the present study have demonstrated that the majorities of students’ responses were strongly centered on agreement about the quality of audio-recording of power point presentations, videos, clarity of content objectives, and online learning interaction make them motivated to the courses. In this context, Gray and DiLoreto, [28] indicated that achievement of supportive climate of learning and teaching take place when educators professionally supplement audio, video, with synchronized and a synchronized communication, with practical students’ activities and others online means to involve students. Also, Southard, Meddaugh and France-Harris [29] concluded that using of high-impact videos feature increase students’ attention to the content, in return give value to the educator and the course.

Parallel to the current study results, during suspension of COVID-19, a large survey conducted at Southeast University in China, on 39,854 students by Sun, Tang & Zuo, [30] showed that students has requested adding recorded videos and live courses with supplementary interaction to increase students’ participation and almost half of students believed that the intended teaching objectives were fulfilled. Also, Thurmond, [31] had argued that the purpose of students' interaction is to increase understanding of the course contents and attain its defined goals. The current result also consistent with the study of Harandi, [32] regarding students’ motivation as the relation between the electronic learning and motivation of the students was affected significantly in Tehran at Alzahra University.

The present study revealed that, less than half of the students agreed on the educational units of the course, this result explained why the students was requesting from the teachers to lesser the number or the volume of the learning units at the beginning of education suspension as they assumed their inability of full understanding of the educational contents in the absence of face-to-face teaching. In this perspective, Siemens, et al., [33] confirmed that the needs for technological support for students are considered essentials for those who do not have the levels required for computer and information literacy and self-efficacy, and for understanding the underlying causes of student decline.

Regarding the use of student self-test, the present study result reveled that most of the students were satisfied on the placement of frequent self-tests postweekly content which aimed to help students and to avoid uncertainty of content objectives and examine their understanding of difficult questions. Consistent with Roediger & Butler [34] the work of self-tests helps students to stimulate and activate memory, as retrieval of knowledge is one of the most powerful ways of enhancing and making learning more durable although its use still underutilized. In the same line, Bates [35] emphasized that teachers should give students several quizzes in a regular basis for practice to become accustomed with the tests. However, teachers and students recognized the benefits of computerized assessment and communicated the downsides and needs for well application [36].

Concerning importance of learning activities, and students participation in tasks accomplishment, the present study illustrated that less than half of the students agreed on the importance of the learning activities conversely near of two third of the students prefer participations in tasks accomplishment as a group better than individualized tasks. The reason for this result that individualized tasks may pressurize them into self-dependence, full responsibility, and fear of distraction or facing difficulties of dealing with the online system problems such as, lack of connectivity or slow networking as was reported by some students. Likewise with the current research result, Choi, [37] reported that peer-to-peer learning in online learning environments improve satisfaction among students. While on contradictory to this result, Baxter and Haycock, [38] found that some students see that peer-to-peer support has little value.

Moreover the result of current study displayed the effectiveness of rapport and respective relationship between teacher and students as was reported by the majority of the students, as noticed by the teachers that some students were tensioned during conversation with them despite that teachers were answering on all questions submitted from the students through the web in prompt time over seven days of the week which was more than the office hours allocated in meeting the students in the regular time before Corona virus outbreak. This behavior or attitude may be originated as a result of the quarantine of COVID-19 which restricted students’ attendance of their traditional classes without making gradual movement to online learning management that caused them to worry about their educational path. In a shortly time, this tensioned behavior has disappeared due to the persistent efforts of teachers to motivate and reassure students about their worries.

In this respect Sun, Tang & Zuo, [30] argued that most students agreed that teachers induced positive energy during classes to relief students’ tension and anxiety. Other studies, Harandi, [32]; Swanand Shih [39] found that educator with strong presence alongside with the quality of course contents are vital aspects in courses that facilitate online student’s engagement and learning successfully. Gray and DiLoreto, [28] mentioned that instituting educator presence in online courses can be accomplished by certain ways, through regular conversation with students, constant feedback and critical dialogue modeled by the teacher. However, there is a necessity to improve students’ self-discipline and attention amid disruptions alike unstable speed of network, noisy atmosphere and a deficiency of professional equipment [30].

In answering the first research question the majority of the total samples amongst the four participated study groups of students were agreed on the fulfillment of the learning components with positive impacts on the learning process of the two nursing courses under study. This outcome indicates the importance of well-designed supportive learning components when remote education is used especially in nursing profession which values the building of interactive leadership amongst their students. In this concern, Lee, [25]; Gray and Diloreto, [28] argued that course design and various course components stimulates students satisfaction and perceived learning which can contribute to a positive results. In this respect, Fathalla, Salama, and Elwasefy [13] showed that the students’ experience regarding use of Moodle system, was easy and effective as an educational tool, but was unsuitable for conducting activities of the course by slightly more than half of the nursing students. Therefore, the investigation of effectiveness of e-learning is worthwhile for not just the students but also for the trainers as it helps them in refining their methods of teaching. Regular testing of the outcomes of e-learning and efficiency of knowledge transfer guide the teachers to employ techniques that can be more effective in transferring the education [40].

In answering the second research question, the present study also demonstrated that around two thirds of the students reported that the online education system was contemporary, despite that students’ responses about the possibility of the online education system to replace the traditional education were fluctuating on both sides of the scale. This unspecified result indicates many perspectives that need further assessments which may include students inconvenience for the absence of real class room or doubt of secured replacement of the online education system, therefore, various models of online education systems have to be engaged and examined to relief students' worries and anxiety related to their achievement of good academic levels.

A literature review on the factors influencing e-learning and blended learning, Nortvig, Petersen, and Balle, [41] asserted that the design of these courses should strongly link between online and offline activities, between campus-related and practice related activities and between students, teachers and content. In addition, it was reported by Saba, [42] study that the well-designed and effective delivery of online courses can stay endure to connect classroom boundaries together and bond formal learning to a larger area through an energetic online learning community.

Parallel to the current study outcome, the recent published study of online education by Peking University’s in China, when the universities closed the campuses and enforced to launch online teaching due to outbreak of the COVID-19. The study highlighted on 5 principles as highly impacted ideologies of online learning summarized in 1) the relation between online educational designs and students learning are at high importance, 2) provision of effective educational information online, 3) sufficient assistance delivered to students by faculty teachers and instructors, 4) highly qualified participants to increase the depth and wide-ranging of students’ learning, and 5) plan contingently to act with unforeseen events of online education platforms [43].

From an opposite side, Schmid, et al., [44] stated that, the adoption of online learning had revealed various disadvantages of teaching and learning in the online environment such as technology gaps, feelings of isolation, and the cost for the training of educators. Therefore, recognizing a great opportunity and numerous potential threats with the introduction of online learning programs, educators, policymakers, and other relevant stakeholders raised questions about whether instructional technology affects learning and contributes to student achievement.

The need to electronically interchange data and information is an obligation in today’s civilization as the meaningful use of online education gives the advantages of nursing students to possess the computer competencies when become a nurse beginner and later on play the vital role as a nurse informatics in various healthcare settings, as the future of nursing depends on a profession that will continue to innovate using informatics to play an instrumental role in patient safety, change management, and quality improvement as evidenced by quality outcomes, enhanced workflow and user acceptance.

Study Limitations

Assessing the clinical experience and planned clinical activities of the nursing students were not evaluated in this research.


Great thanks and appreciation are forward to the Faculty Dean Professor Dr. Fatma El-Sharkawy for her successful experience on the application of online education initiative courses which provided not only for the current research but also for whole online courses conducted during the academic year 2019/2020. Wherein, the College of Applied Medical Sciences was the first at the university level to implement this system during education suspension caused by COVID-19. Also, we would like to thank the Education Technology Department, Eng. Adel Ali, Eng. Mustafa Mahmoud, Eng. Ayman Hussein respectively who provided us with necessary training on online learning and were available at all times to give support for any technical problem with the system operationability.

Cite this paper: Ali, K. , Khalil, H. and El-Sharkawy, F. (2020) Impacts of Online Remote Education on the Learning Process among Nursing Students. Open Journal of Nursing, 10, 810-830. doi: 10.4236/ojn.2020.109057.

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