|Year : 2020 | Volume
| Issue : 2 | Page : 104-111
Online Classes for Nursing Fraternity: A Systematic Review of the Impact on Attitude, Knowledge, and Skills
Prerna Sharma1, Smriti Arora2
1 Department of Nursing, GTB Hospital, Government of NCT, Delhi, India
2 Amity College of Nursing, Amity University, Haryana, India
|Date of Submission||05-Jul-2020|
|Date of Decision||13-Jul-2020|
|Date of Acceptance||29-Sep-2020|
|Date of Web Publication||08-Feb-2021|
Ms. Prerna Sharma
D-467, Near Mandir Marg Police Station, Gol Market, New Delhi-110 001
Source of Support: None, Conflict of Interest: None
Owing to COVID-19, there has been a lot of emphasis on online classes among educational institutes. Online classes have their own merits and demerits as compared to traditional classes. COVID-19 crisis changed the teaching–learning pedagogy dramatically and pushes the learning platform from conventional methods to more use of online or electronic methods. This objective of the study was to review the effect of online classes on attitude, knowledge, and skill among nursing fraternity (nursing students, staff nurses, and nursing faculty) so that measures can be planned to deliver online education to students in a more efficient and acceptable manner. The studies included were published between January 2010 and March 2020 using the following databases: CINAHL, ERIC, Medline, EMBASE, Dissertation, and Theses. The experimental study (randomized controlled trial) and nonexperimental study designs were included. Thirty-three studies were found eligible for inclusion in the analysis. The review demonstrates that the nursing fraternity has positive attitude toward online classes. There is a significant change in knowledge scores also, but limited data could be found regarding skill improvement after the online classes. Data were extracted using a narrative synthesis. There was significant improvement in nurses' attitude and knowledge between groups who attended online classes and the ones who participated in traditional learning.
Keywords: Attitude, e-learning, knowledge, nurses, online classes, skill
|How to cite this article:|
Sharma P, Arora S. Online Classes for Nursing Fraternity: A Systematic Review of the Impact on Attitude, Knowledge, and Skills. Indian J Psy Nsg 2020;17:104-11
|How to cite this URL:|
Sharma P, Arora S. Online Classes for Nursing Fraternity: A Systematic Review of the Impact on Attitude, Knowledge, and Skills. Indian J Psy Nsg [serial online] 2020 [cited 2022 Jul 3];17:104-11. Available from: https://www.ijpn.in/text.asp?2020/17/2/104/308827
| Introduction|| |
The concept of online education is relatively new. Earlier, there used to be correspondence courses where teachers used to send lessons and receive student's responses or assignments by mail. The online courses of today are modern versions of distance learning. The benefits of online education are decrease mail transit time.
In a present scenario, the use of online learning has grown as technology is used everywhere in education and training. As per the scholar, “e-learning” is defined as the teaching method which is delivered via multimedia platforms.
Whether online classes are fruitful to modify the students' attitude, knowledge, and skills is a concern. Academicians view that though knowledge, critical thinking, and attitude can be altered by virtual classes, developing clinical skills needs real-time interaction with students. For example, the skills such as administering injections and performing oral or endotracheal suctioning need practice in real hospital settings. Typing on keyboards or scrolling with the mouse will not make a pair of skillful hands which can work upon patients.
Some researchers believed that curriculum of any course challenges or motivates students. Their concern in their study was to identify the best tools for successful learning in online courses. Scholars suggested that lack of experience regarding online course among teaching faculty and students is a major drawback for its successful implementation.
Pew Research Centre reported that many colleges and universities preferred courses that are fully online or blended online.
National Centre for Education Statistics reported that the flexible schedules, easy access of college for students, more courses available, and increasing student enrolments factors are the important markers for universities to offer online courses.
In one of the studies, there was improvement in learner–teacher interaction which was important in increasing student satisfaction.
A systematic study was done by the US Department of Education from 1996 to July 2008. They compared an online to traditional class and measured outcomes of students in terms of their learning. They concluded that the results of online classes were not significantly effective in terms of learning.
Need of the review
Online classes have become the new normal in the field of nursing education amid lockdown due to COVID-19. In Indian scenario, conducting and working through online classes are quite challenging owing to limited availability of infrastructure, workforce, skill, and other facilities. There is a constant debate whether skills can be taught online as nurses are dealing with real human beings where “touch” is very important.
In spite of the volume of literature, a quick review revealed that there is a variation in the attitude and perception of nursing students and teachers toward an online method of education. At present, only a limited Indian studies are available related to the use of online classes; this review was done to synthesize the evidence. This systematic review was done and evaluate to examining effect of online classes on attitude, knowledge, and skill among the nursing fraternity.
| Methods|| |
The studies included were published between january 2010 to march 2020 by using the following databases CINAHL, ERIC, Medline, EMBASE, Dissertation and theses. The primary search terms were online classes, attitude, knowledge, skills, nursing students, nurses, and nursing faculty. Reference lists of relevant topics were also searched.
Inclusion and exclusion criteria of the review
- Study design: Experimental studies (randomized controlled trial [RCT]) and non-RCTs [Table 1].
- Participants: we have included nursing students (diploma, undergraduate, and postgraduate), staff nurses involved in healthcare, and nursing faculty who are involved in nursing education. Participants must have exposure of online classes during the study
- Intervention: we defined online classes as any nursing course or programs aimed at its effect on attitude, knowledge, skills, and challenges in online classes and other factors affecting online classes in undertaking the completion of online courses or syllabus. Although online classes include different diploma courses in the nursing curriculum, certificate courses were excluded from the study
- Outcomes: studies included were reported outcomes related to attitude, knowledge, skills, and challenges in online classes and other factors affecting online classes in undertaking the completion of online classes or syllabus.
Researchers read titles and abstract of all the articles. Then, they were assessed that whether they met the inclusion criteria. Apparently potential eligible articles were retrieved full for systematic review. The researcher synthesized the data narratively. Based on the full articles, data were used regarding study design, participants, setting, intervention, control group, and outcome using a self-developed data extraction sheet by the researcher.
Risk bias assessment
Researcher assessed studies for all the biases such as selection, participation, attrition, detection, reporting, and any other bias. The bias and judgment about their presence were based on the Cochrane collaboration risk of bias assessment tool in the Cochrane handbook for systematic reviews of intervention.
Risk of bias
The selection bias was not clear in RCTs as information provided on random sequence was insufficient. The risk of attrition and outcomes were excluded from the study.
For non-RCT studies, all studies were evaluated to assess the risk of performance bias as group allocation was not done.
All the data set of included studies was analyzed. The full texts of 65 articles were assessed for inclusion. The total numbers of studies excluded in the study were 32, most commonly on the basis of intervention and participants, and finally, 33 were included in the review as shown in [Figure 1]. The participants ranged from 1st-year students to staff nurses in healthcare and faculty members. The sample sizes were ranged from 16 to 1041. Most studies evaluated the effects on online classes on attitude, knowledge, and skill, while fewer evaluated the comparison of online classes with traditional educational effect. Outcome measures included changes in attitude (n = 17, 51.5%), changes in knowledge (n = 6, 18.18%), changes in skill (n = 6, 18.18%), factors affecting online class success (n = 2, 6.06%), and challenges faced during online classes (n = 2, 6.06%).
| Results|| |
Attitude of nursing students, staff nurses, and nursing faculty toward online classes
The outcomes of the included studies are shown in [Table 2].,,,,,,,,,,,,,,,, There was evidence that nurses have positive attitude toward online classes. Thirteen of the 17 studies showed that there is favorable attitude of nursing students, staff nurses, and nursing faculty toward online classes,,,,,,,,,,,,, one study has shown that there is unfavorable attitude toward online classes, and remaining three studies,, demonstrated that there is no significant difference in the attitude toward online classes among nursing students, staff nurses, and nursing faculty members.
|Table 2: Effect of online classes on attitude among nursing students, staff nurses, and nursing faculty (n=17)|
Click here to view
Effect of online classes on knowledge of nursing students, staff nurses, and nursing faculty
There is evidence that online classes improve knowledge among nursing students, staff nurses, and faculty. Six studies [Table 3],,,,, were reported for the effect of online classes on knowledge. Three studies,, have shown that online classes have improved knowledge, and the remaining studies have shown,, that there is no improvement in knowledge with the help of online classes and staff nurses have supported offline traditional education method.
|Table 3: Effect of online classes on knowledge of nursing students, staff nurses, and nursing faculty (n=6)|
Click here to view
Effect of online classes on skill of nursing students, staff nurses, and nursing faculty
The evidence, about the effect of online classes on skill development of nursing student, staff, nurses, and faculty was limited. As the total study reported [Table 4] were six,,,,,, of which two studies, have shown improvement in the skill development after the online program while three studies,, have shown no improvement or less improvement in skill after the online program. One study has shown that there is no significant finding in the results after the online classes.
|Table 4: Effect of online classes on skill of nursing students, staff nurses, and nursing faculty (n=6)|
Click here to view
Although the challenges and factors contributing the effect of online classes were not one of the predefined outcome measures, it was noticed when the researcher collected the data. Two studies, reported [Table 5] that communication, administration support, technology issues, time management, and cost of the program were the main challenges faced during the online classes which affect the attitude, perception, and behavior of nursing students, staff nurses, and faculty toward online classes. Two studies, stated that the factors which affect the successful implementation of online classes were motivation, satisfaction, time management skill, self-efficacy, and increased communication.
|Table 5: Studies assessing the effect of online classes on other outcomes (n=4)|
Click here to view
| Discussion|| |
The result of the present study is reported on the effect of online classes on nursing fraternity. The study suggested that an online class does lead to changes in attitude, knowledge, and skill. The findings of the current study findings are similar to previous results of online classes review.
This systematic review included 33 primary studies reporting the effect of online classes among nursing students, staff nurses, and faculty members. Most included studies demonstrated a statistically significant effect on attitude,, and knowledge.,, Only limited number of studies evaluated effect of online classes on nursing skill.,,,,, There were few studies that have shown the challenges and factors which may be associated with the successful implementation of online classes program.,,,
The review has demonstrated that there is a consistent positive attitude of nurses toward online classes.,,,,,,,,,,,, Online classes were also effective in bringing about the change in knowledge,, among nursing students, staff nurses, and nursing faculty, but there were limited data that present significant changes in skill, improvement. As included studies did not measure the complication and contraindication of online classes, the extent to which statistically significant improvement in online class's implementation is unclear.
In review, 39.39% have shown favorable attitude toward online classes, 9.09% of the studies have shown significantly improvement in knowledge, and 6.02% of the studies have shown significantly skill improvement. The result of the study applies to nursing fraternity from different universities and colleges. As per one study, nursing students are ready to adopt online learning and are able to utilize in education, but they consider the difficulties with technical support.
The study has many strengths. The review was based on a thorough search of available literature. The review includes experimental studies (RCT), non-RCTs, controlled before and after the implementation of an intervention, and controlled observational studies. To ensure the quality of data, article was screened properly and data extraction was done independently by both the authors to avoid subjective bias.
Mainly, studies included in our study were published after 2010, earliest included study being published in January 2010. Performance bias is unavoidable as during the data collection the participant or the researcher was not blinded.
| Conclusion|| |
The findings suggest that, in the present review, some evidence supports the provision of online class's implementation, particularly for undergraduate nursing students. The age of the nursing students also varied between the studies; hence, no conclusion can be drawn with the effect of age on online classes. Only two studies were reviewed which have included the challenges during online class's implementation, and the other two studies have included the factors effecting online classes. Thus, further research should be done regarding the factors which effect positively online class's implementation; we should also do further research on the challenges that face during the online class's implementation so that policy development and the successful implementation of online classes program can be done.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hall O, Singh O. Students' perceptions of online learning: A comparative study. J Inf Technol Edu Res 2003;5:201-19.
Dunbar AE. Genesis of an online course. Issues Account Educ 2004;19:321-43.
Grundmann O, Wielbo D, Tebbett I. The implementation and growth of an international online forensic science graduate program at the University of Florida. J Coll Sci Teach 2010;40:34-40.
Parsad B., Lewis L, Tice P. Distance Education at Degree-Granting Postsecondary Institutions. Washington D.C.: National Center for Education Statistics, Institute of Education Sciences; 2008. Available from: https://nces.ed.gov/pubs2009/2009044.pdf
. [Last accessed on 2020 Jun 29].
Kuo YC, Walker AE, Schroder KE, Belland BR. Interaction, internet self-efficacy, and self-regulated learning as predictors of student satisfaction in online classes courses. Internet High Educ 2013;20:35-50.
Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al
. Starting a review. In: Higgins JP, editor. Text Book of Cochrane Handbook for Systematic Reviews of Interventions. 2nd
ed. United Kingdom: Wiley Blackwail; 2019. p. 3-12.
Akimanimpaye F, Fakude LP. Attitudes of undergraduate nursing students towards e-learning at the University of the Western Cape, South Africa. Afr J Phys Health Edu Recreat Dance 2015;1:418-33.
Borhani F, Vatanparast M, Zadeh AA, Ranjbar H, Pour RS. Virtual education effect on cognitive learning and attitude of nursing students towards it. Iran J Nurs Midwifery Res 2011;16:321-4.
Al-Huneit R, Hunaiti Z, Al-Masaeed S, Ebrahim Mansour WB. Nurse's attitude towards e-learning for e-health education. Int J Handheld Comput Res 2016;7:77-84.
Karaman S. Nurses' perceptions of online continuing education. BMC Med Educ 2011;11:86.
Zaid B, Jamaludin R, Abas M. Investigate the self-efficacy and attitudes of teachers towards e-learning in Saudi Arabia. Int J Sci Eng Res 2012;3:391-94.
Mahmoud SR, El Magrabi NM, Mohamed FR. Faculty of nursing teaching staff members and students attitudes toward e-learning. IOSR J Nurs Health Sci 2015;4:36-45.
Sohrabi Z, Koohestani HR, Baghcheghi N, Delavari S, Rezaei Shahsavarloo Z. The effects of group blogging on the attitude towards virtual education in nursing students. Med J Islam Repub Iran 2017;31:132.
Frazer C, Sullivan DH, Weatherspoon D, Hussey L. Faculty perceptions of online teaching effectiveness and indicators of quality. Nurs Res Pract 2017;2017:9374189.
Yangoz S. The use of e-learning program in nursing education. New Trends Issues Proc Humanit Soc Sci 2017;4:230-36.
Ullah O. Students' attitude towards online learning at tertiary level. PUTAJ-Humanit Soc Sci 2017;25:63-82.
Xing W, Ao L, Xiao H, Cheng L, Liang Y, Wang J. Nurses' attitudes toward, and needs for online learning: Differences between rural and urban hospitals in Shanghai, East China. Int J Environ Res Public Health 2018;15.
Ali N, Jamil B, Sethi A, Ali S. Attitude of nursing students towards e-learning. Adv Health Prof Educ 2016;2:24-29.
Fadel EA, Elbilgahy AA, Ibrahim IA, Elmashad HA. Undergraduate nursing students' and lecturers' attitudes towards modular object oriented dynamic learning environment: A quasi experimental study. Am J Nurs Res 2019;7:24-30.
Reis ZA. Investigating the attitude of students towards online learning. Int J E-Adoption 2010;2:35-47.
Pourghaznein T, Sabeghi H, Shariatinejad K. Effects of e-learning, lectures, and role playing on nursing students' knowledge acquisition, retention and satisfaction. Med J Islam Repub Iran 2015;29:162.
Männistö M, Mikkonen K, Vuopala E, Kuivila HM, Virtanen M, Kyngäs H, et al
. Effects of a digital educational intervention on collaborative learning in nursing education: A quasi-experimental study. Nord J Nurs Res 2019;39:191-200.
Rouleau G, Gagnon MP, Côté J, Payne-Gagnon J, Hudson E, Dubois CA, et al
. Effects of e-learning in a continuing education context on nursing care: Systematic review of systematic qualitative, quantitative, and mixed-studies reviews. J Med Internet Res 2019;21:e15118.
Pei L, Wu H. Does online learning work better than offline learning in undergraduate medical education? A systematic review and meta-analysis. Med Educ Online 2019;24:1666538.
Auld DP. The relationship between motivation, learning strategies and choice of environment whether traditional or including an online component. Br J Educ Technol 2010;41:349-64.
Behrambeygi F, Shojaejadeh D, Sadeghi R, Nasiri S, Ghazanchaie E. The effectiveness of an E learning programme on staff nurses's knowledge and behaviour for caring of patient with thromboembolism-A comparative study. J Nurs Health Care Manag 2010;1:1-7.
Opeyemi OZ, Adeyemi AA, Olajuwon TD, Oloruntosin ON, Oladeji BS. Perception of nursing students towards online learning: A case study of Lautech Open and Distance Learning Centre, Ogbomoso, Oyo State, Nigeria. Galore Int J Health Sci Res 2019;4:1-8.
Jeong HS. Effects of nursing students' practices using smartphone videos on fundamental nursing skills, self-efficacy, and learning satisfaction in South Korea, Eurasia. J Math Sci Technol Edu 2017;13:2351-65.
Wilson A. The impact of online video learning activities on staff nurses' and midwives' continuing professional education. JOJ Nurs Health Care 2018;6:1-7.
Moradimokhles H, Hwang GJ. The effect of online vs. blended learning in developing English language skills by nursing student: An experimental study. Interact Learn Environ 2020. Available from: https://doi.org/10.1080/10494820.2020.1739079
. [Last accessed on 2020 Apr 09].
McDonald EW, Boulton JL, Davis JL. E-learning and nursing assessment skills and knowledge-An integrative review. Nurse Educ Today 2018;66:166-74.
McCutcheon K, O'Halloran P, Lohan M. Online learning versus blended learning of clinical supervisee skills with pre-registration nursing students: A randomised controlled trial. Int J Nurs Stud 2018;82:30-9.
Abbaszadeh A, Sabeghi H, Borhani F, Heydari A. A comparative study on effect of e-learning and instructor-led methods on nurses' documentation competency. Iran J Nurs Midwifery Res 2011;16:235-43.
Wingo NP, Peters GB, Ivankova NV, Gurley DK. Benefits and challenges of teaching nursing online: Exploring perspectives of different stakeholders. J Nurs Educ 2016;55:433-40.
Hart C. Factors associated with student persistence in an online program of study: A review of the literature. J Interact Online Learn 2012;11:19-42.
Wei HC, Chou C. Online learning performance and satisfaction: Do perceptions and readiness matter? J Distance Edu 2020;41:48-69.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]