Lesson Learned During Covid-19 Pandemic: Impact, Challenges and Opportunities in Nursing Education – A Review
Radha. K1*, N. Vijayanarayanan2, Sri Devi. K3, Sharat. V. Kondaguli1
1Bhopal Nursing College, Under ICMR, MOH and FW, Govt of India. BMHRC, Bhopal, MP State, India.
2Professor, R.D. Memorial College of Nursing, Bhopal, MP State, India.
3Lecturer, Omaskthi college of Nursing, Dharmapauri, Tamil Nadu, India.
*Corresponding Author E-mail: radha.adn@gmail.com
ABSTRACT:
Nursing training is a combination of both theoretical and practical learning experiences that enable nursing students to acquire the cognitive, affective, and psychomotor components for providing nursing care. World Health Day, an annual event organized by WHO, stated that this year is focused on supporting nurses and midwives, many of whom are serving on the frontlines of the COVID-19 response. Globally, COVID-19 has huge impact on academic delivery and adds a further degree of complexity to nursing education due to temporary lock down because most countries have suspended face-to-face teaching/physical class room teaching. Thus, they had to find new alternatives to academic delivery, and virtual classes/on-line mode were the ways forward. In present search, it has attempted to explore the impact of covid-19, challenges and opportunities in nursing education which influences the different aspects of academic activity. It has accelerate the academic delivery by using variety of online platforms and learning management system such as Google class room, Google meet, Google hangout, Zoom meetings, Microsoft team, Cisco webex meeting, go to webinar, you tube streaming, Google duo, college website, social media platforms such as face book groups, whatsApp, telegram etc. Covid-19 has provided a lot challenges and opportunities to learner, educator, university, organization, and evaluation system and research activities. The lesson learned from covid-19 is converting those challenges into opportunities by learning and adopting with advanced technology in teaching-learning; blended learning; team work; promoting for trans/ inter/ multidisciplinary collaborative education; integrating innovative method of teaching, sharing and facilitating right kind of information, are enhancing ways of quality of education during crisis (lock down) situation and further new-normal situation.
KEYWORDS: Impact of nursing education, covid-19, online teaching, learner and teacher, virtual learning, e-learning, challenges, opportunities.
INTRODUCTION:
Nursing training is a combination of both theoretical and practical learning experiences; Learning is an ongoing, complex and never ending process also considered as vital and integral part of nursing education that enable nursing students to acquire the cognitive, affective, and psychomotor components for providing nursing care1 World Health Organization (WHO) estimates that there are 27.9 million nurses around the world and there was a global shortage of 5.9 million nurses in 2018. The World Health Day celebration on 7th April 2020, WHO stated that this year, is focusing on nurses and midwives and many who are serving as frontline warriors of the COVID-19 response2. As we continue in the Year of the Nurse and Midwife, we are being challenged by the pandemic of COVID-19 caused by SARS-CoV-2. We need to be resilient and demonstrate flexibility, adaptability, kindness as we shift the curriculum to virtual environments, defer hands-on clinical training to ensure that front-line staff have the necessary personal protective equipment (PPE) also reinforce principles of social distancing to our families and the general public3. Nurse educators and administrators are concerned with ensuring that students meet educational objectives and requirements while considering the current pressure faced by health services, at the same time the need for nurses to be able to meet the demands on them as nurses, students, parents, siblings, partners and the myriad of other roles that each nurse has to manage in their daily lives4.
Most of the countries have suspended face-to-face teaching and learning activities, physical class room teaching where the chances of transmission of the disease is believed to be high due to direct contact, which forced them to find and practice alternatives for academic delivery like virtual classes, simulation based learning ,on-line mode teaching were the ways forward2. Hence, the objectives of this article focused to find out the impact of the COVID 19 pandemic, challenges and opportunities on the Nursing Education in the context of academic delivery of both theory and practical, role of the teacher/facilitator, educational institutions and governing/regulatory bodies, examination system nursing research activities in midst covid-19 and so on.
Impacts of covid-19 pandemic in the following context of academic delivery are as follows:
1. Impact of Covid-19 in the Teaching-Learning Process of Nursing Education:
In nursing education, nursing students encountered the most immediate impact has the temporary cessation of face to face teaching-learning activity. Now the situation is compelling the nurse educators’ to move the academic delivery from offline to online mode/alternative mode, and it felt that the transfer has not been quite easy.
a. Impact of online/virtual learning environment in the teaching–learning process:
Virtual Academic applications that can be offered through a variety Learning Management System (LMS). Many studies suggests that the concept and application of online/virtual learning environment to enhance the teaching–learning process of nursing education. The online environment plays a pivotal role in accelerating the nature of learning and alternative mode of communicating the academic delivery. The term virtual environment is defined as “a synthetic, real time, unique simulated experiences, world seen from a first- person point of view. The virtual learning environment provides a cost-effective alternative to physical lab, hands-on lab exercise, as well as to run scientific applications for e-learning with high configuration.5,6,7,8
Virtual Learning Environments (VLEs) are web-based system that enable the teacher interact with the students and vice-versa. And also the students were not much attentive to have access to audio/video conferencing facilities, blogs, wikis, or chat either.9 The study on Blended learning (BL) with hypermedia shows that resources and project- based learning increase students´ learning outcomes and interaction.10 Another study suggests that nurse educator is need to update their skill in order to deliver the effective blended learning to achieve learner’s achievement and involve their active participation in the learning process.11 An analytical survey study reports on the user Satisfaction with Online Education Platforms in China during the COVID-19 Pandemic. The study concluded that there were many factors influences regarding online teaching and the satisfaction of the online education platform such as “network congestion”, “live interactive stuck” “unable to log in personal information” and availability study platform.12
b. Context in the delivery of theoretical contents:
No one knows the absolute solution however we need to promote the internal reflection from the nurse educators as well as students for renewal of teaching-learning process and pedagogical renewal that favors both quality and equality. The academic delivery in the aspects of facilitation of theory contents can be done by using variety of online platforms and learning management system such as Google class room, Google meet, Google hangout, Zoom meetings, Microsoft team, Cisco webex meeting, go to webinar, you tube streaming, Google duo, college website, social media platforms such as face book groups, whatsApp etc13. A survey study evaluated the use of Google classroom from students and they favored that the speed of uploading files is perfect for working inside and outside the classroom14.
c. There are so many strategies can be adopted for active participation, accelerate the learning and to fulfill the curriculum objectives in nursing education with the use of advanced ICT (information and communication Tools) as depicted in Table 1:
Table 1.
Strategies / Methods |
ICT (information and communication Tools) |
Pre-class assignments, compare and contrast methods (asynchronous) |
whatsapp, telegram, mail, face book, Blogs, Google classroom and use of organizational LMS system. |
Creative power point presentation |
prezi, google presentation, presentation tools app |
Using Recording video |
YouTube, screencastify, free cam, AZ recorder, presentation tube |
Online virtual - interaction, group project/work, Role play |
zoom, Google meet, cisco webex, gotomeet, live you tube, padlet (virtual Bulletin board), edmoto and other online face to face platforms |
Puzzles and Games |
Kahoot apps, quiz game. |
Concept maps |
mindomo app |
Simulation activities |
V-sim technology, and septris18(free- med.standford.edu) |
Cloud based student response |
socrative |
Graphic design of the content, flyer, invitation, creative content development with audio effects |
canva |
Facilitator wish to teach with board on virtual mode |
white board app, blackboard.com23 |
Case studies |
wolter’s kluwar, elsevior publishing campus, tele-simulation (www.simulationiq.com)19 |
Real time objective answers from the learner and real time monitoring and assessment |
Quizlet, Google forms, Monkey survey, Mentimeter, classcick, Testmoz (auto graded tests and quizzes) |
2. To enhance the clinical competency in nursing during Covid-19:
The clinical competency or clinical skills in nursing are always measurable outcome and integrated part of nursing. It includes cognitive skills, reasoning, technical aspects, and communication ability, decision-making and so on. There are several platforms available such as Elsevier clinical skills, for simulator training – V-sim technology and septris (med. standford.edu15), using tele-simulation (www.simulationiq.com) to enhance the clinical skills of the nursing students during covid-19. Nursing facilitator/teacher could use there are many stimuli methods to enhance the clinical skills of the students such as using vignettes, case studies, virtual simulation, computer based test, Objective Structured Clinical Examination/Objective Structured Practical Examination etc. As per INC guidelines, the institutions will be responsible to maintain attendance, assignments, online assessment, etc. Students must be updated with Covid- 19 information and ensure with the government latest guidelines13. Nursing colleges have to plan and develop high fidelity skill lab settings within the campus. Before students enter the clinical environment, it should be ascertained that they are theoretically and practically prepared in the skill lab17.
3. Impact of covid-19 on Nursing Students/learner:
The impact of covid-19, nursing students they may encounter anxiety and depression about results, examinations, assignments, clinical competencies, scholarship, course completion, job, continuing the situations of isolation, or fail to adjust with Tech communications/online classes, fear of the event of a long duration of the cessation of face-to-face activities since march 2020 (more than 6 months) to till date of 2020, it is most likely that there will be a spike in the next academic year or delay in completing the course, fear about delayed placements, delayed registration18. Its prime responsibility of the nurse educator’s to identify the challenges of the students to improve the training and outcome of quality learning.20
A longitudinal study on sleep pattern changes in nursing students during the COVID-19, conducted with 205 study subjects, measured by using the Pittsburgh sleep quality index contains 19 items. The mean time the students spent in bed was 8.5 h (SD = 1.2 h) during lockdown comparing to before lockdown 7.6 h (SD = 1.1 h). Although students spent more time in bed during lockdown, it was observed a reduction in sleep quality, statistically significantly affected (p ≤ 0.05), and of these, the most changed were sleep latency, sleep duration, and sleep efficiency19. A study on virtual classroom education approach helps to address the learning gap in theoretical strengthening of hand hygiene during clinical nursing training21. There are opportunities and challenges of the learner due to virtual learning as mentioned in the table below (2):
Table 2.
Opportunities of learner on virtual learning |
Challenges of learner on virtual learning |
· new online courses, academic collaboration, blended learning in curriculum development, free to access online resources, · Free to access journal, e-books and other study materials · Repository learning · Globalized learning education · Universal knowledge |
Isolation. Lack of practical session, less student engagement, method of assessment, scheduled university examination, practical examination and viva-voce, technical support, clinical competencies, time constraints, Lack of motivation, mental balance, internet connection, suitable electronic devices, knowledge of pedagogical techniques specific to academic delivery, attendance on synchronous teaching,22,12 learner readiness for virtual environment learning, screen time, Self-discipline and self-direction learning23. |
Table 3.
Opportunities of Instructors/ Facilitators on virtual learning |
Challenges of Instructors/ Facilitators on virtual learning |
· Skill in operating technology science · Application and demand of innovative and creative ideas · Continue the academic presentation in the absence of physical face-to- face interaction to virtual interaction and increases the confident to continue · Adapting innovative method of teaching and learning such as problem based learning, case studies, symposium, critical learning, conceptual map, project method, team based method, competency based education and outcome based education. · Possibilities to engage Online/short term/virtual Faculty development programme · Increase acceptance of distance/online mode |
· Learning style and differences among learners · Technological issues · Time management through online teaching · Integrate pedagogical with technical aspects · Balancing the Mental health of the individual learner through virtual platform · Maintains the Self-discipline of the learner · Role of the teacher - student searching and gaining a lot of information through online. It is may be a challenges to the nurse educator to tackle individual capacity along with technology learning. |
4. Impact of Covid19 on Teacher/ Facilitator/ instructor
“Necessity is the mother of invention”, the world is facing an extraordinary health emergency in which the nurses are, as always, on the front line. Challenges are even greater in this period of pandemic Covid-19. There are many opportunities and challenges perceived by the nurse educator/instructor on exposed to virtual teaching that those are pointed in below table (3):
· Impact of Nursing educational institution and Library:
At the institutional level, attention must inevitably focus first on how to manage the processes, particularly teaching-learning continuity, during and immediately after the crisis. Measures to be taken to screen for any fever, respiratory infections, and other infection prevention control measures and all nursing students would need their temperature taken when they come onto campus, college , hostel , the examination venue or before conducting any practical examination (during or immediate after crisis24). Strictly health is front line attention and also provision has been made for regular (thermal) screening of all staffs and students25.
· Role of Library/ virtual library during covid-19:
As per the James MM, John N (2018) highlighted about the academic libraries as the “heart” of the learning community, it is a learning centre for students and faculty and it has to shift the behavior of learning to find the sources to use e-books, e-journal, e-library, e-learning, online data bases, free contents, research data, share the information of open access options and choices, create open access portal through library website and communicate to the faculty and students.26
5. Impact of Covid-19 and Regulatory bodies/ University/Examinations:
a) Regulatory bodies may undergo many challenges about how to organize and coordinate the nursing educational intuitions are reopened for classroom teaching clinical, and community postings in post Covid-19? Indian Nursing council has already announced its guidelines regarding the conduction of theory examination should only be planned after the lock down opens and it should be conducted systematically maintaining social distancing norms, following staggered time table forms, with less number of students, preferably batch wise, not compromising with quality, reducing duration of examination to two hours, in a best possible way following multiple shifts16. Displayed and adhered the guidance from the state Government guidelines, Ministry of Health and Family Welfare, Government of India, Centers for Disease Control and Prevention (CDC), and WHO and develop the appropriate plans and policies to safeguard the well-being of their students and communities, to ensure the continuity of their education and research works27.
b) Conduction of practical examination is a challenging aspect during covid19 pandemic however Virtual simulation based practical assessment sessions or Objective Structured Clinical Examination (OSCE)/ Objective Structured Practical Examination (OSPE) can help the teachers to conduct practical examinations effectively. As per INC guidelines practical examination will be conducted either after the relaxation in lockdown period in the clinical settings or in the simulation setup skill lab using OSCE approach and without compromising the quality theory examination also conducted in multiple shifts, reduced hours of examinations, with small number of students by maintaining infection prevention and control strategies, social distancing and hygienic norms16. (INC)
6. Nursing Research:
There are remarkable impact in nursing research activities like face-face to meeting with client or patients, nursing care related research activities, clinical related research activities, research team meetings, research committee meetings, student-guide meetings, submission of proposal and revised proposals, interest in newer proposal, may significantly influences on the completion of research studies. Many are revised their proposal to descriptive research studies instead of intervention studies because of unavailability of the sample, time constraints to complete the projects, dead line give by the university. The mode of collection of data is also switching from face-face to interaction to online mode such as Google form, monkey survey etc.28
Lesson learned during covid-19 to overcome the challenges and utilize the opportunities in nursing education:
There are several lessons learned from covid-19, the boom success of the lesson is how we are converting those challenges into opportunities and applying it during and post covid-19 scenario to enhance the quality of nursing education. It may be effective if we adhere some of the below strategies such as:
· Continue and follow Hand hygiene strategy, Social isolation, Respiratory hygiene and importance of Infection prevention and control and its practices in the premises of college, hostel and hospital.
· Uses of Technology in social media, webinar platform, online software, virtual learning environment, and simulation learning.
· Integrating high fidelity/moderate fidelity and low fidelity skill lab compulsory in nursing designated practical hours in addition with existing laboratory designing in nursing.
· Nurse educator has to design the academic strategies with inclusive of innovative method of teaching and learning such as problem based learning, case studies, symposium, critical learning, conceptual map, project method, team based method, competency based education and outcome based education.
· Motivate to OSCE/OSPE method of conducting practical examination in addition with tradition method of practical examination.
· Ensure the Learning management system and technical and technological Infrastructure designing are to be strengthen and monitor at the institutional level such as skill lab, simulator education, provision for blended learning, e- learning, digitalized library etc;Promotes for strong Team building within the organization; Links the Simulation/virtual simulation based lab practices in nursing curriculum; Updates and connect with other professionals and promote for trans/inter/multidisciplinary collaboration; Increases the skill of assertiveness in decision making, and concentrate on public image and Reframe the curriculum with professional and technological integration.
CONCLUSION:
It is a time to agree that the impacts of the pandemic unfold around us daily. “No one make the timeline, the corona virus makes the timeline.” For the moment, only interim delays have been proclaimed, hence we have to be in a waiting and watching mode to resuming an extended suspension (new normal) to the normal mode and focusing efforts on ensuring the formal training in nursing education. We must remember that, as the Chinese proverb says, spring always ends winter. While the plan for the reopening of educational institutions may be uncertain or indefinite, now is the best time to plan our way out of the crisis.12 One positive ripple effect from COVID-19 should be the complete reevaluation of health care delivery. We want to thank nurses everywhere for their tireless efforts in this unparalleled health emergency. All would agree that Technology cannot replace the job of the facilitator/nursing instructor. No matter how much the social media and others calls nurses heroes during or after this, those of us “in the know” will expect much, much more on the other side.
Plan….Prepare……Proceed….Re-plan….until recovery.
CONFLICT OF INTERESTS:
None
REFERENCES:
1. M. Nabolsi, A. Zumot, L. Wardam, and F. Abu-Moghli, “The experience of Jordanian nursing students in their clinical practice,” Procedia-Social and Behavioral Sciences, 2012; 46: 5849–5857,.
2. WHO/ 2020/ On World Health Day, new report says the world needs 6 million more nurses/ Health forum/ 7th April world health day 2020.
3. Commentary E. An Open Letter to Members of the Nursing Education Community. 2020; 59(4).
4. Nurs C. Life in the pandemic: Some reflections on nursing in the context of COVID-19. Jou of clini Nursing. 2020; 1–3.
5. Roddy C, Amiet DL, Chung) . Roddy C, Amiet DL, Chung J, Holt C, Jordan RC, Vaughan JL. Applying Best Practice Online Learning, Teaching, and Support to intensive Online environments: An integrative Review. 2017; 2(November): 1–10.
6. Smith S, Maund K, Hilaire T, Gajendran T, Lyneham J, Geale S. Enhancing discipline specific skills using a virtual environment built with gaming technology. Int J Work Learn. 2020; 21(3): 211–22.
7. Al Shehri, W. (2012). Work integrated learning (WIL) in virtual reality. IJSCI International Journal of Computer Science Issues, 9(5): 332-344. Retrieved from http://arxiv.org/abs/1211.2412
8. Education and Information Technologies; New York
9. Burcin HN, Orhan G, Duman I, Ali K, Mubin K. Evaluating students experiences using a virtual learning environment: satisfaction and preferences. Educational Technology, Research and Development 2020 02; 68(1): 437-462.
10. International Journal of Environmental Research and Public Health; 2020;
11. Jowsey T, Foster G, Cooper-ioelu P, Jacobs S. Nurse Education in Practice Blended learning via distance in pre-registration nursing education: A scoping review. Nurse Educ Pract [Internet]. 2020; 44(October 2018): 102775. Available from: https://doi.org/ 10.1016/j.nepr.2020.102775
12. Chen T, Peng L, Yin X, Rong J, Yang J. Analysis of User Satisfaction with Online Education Platforms in China during the COVID-19 Pandemic. Healthcare (Basel). 2020; Jul 7; 8(3): doi: 10.3390/healthcare8030200
13. Indian Nursing Council. http://www.indiannursingcouncil.org/pdf/ exam_guidelines.pdf. dated 2020
14. Iftakhar, S. Google classroom: What works and how. J. Educ. Soc. Sci. 2016, PP 3, 12–18. 42.
15. V-simaulation (www.laerdal.com) and septris (med.standford.edu)
16. wolter’s kluwar, elsevior publishing campus (https:// www.elsevier.com) and tele-simulation (www.simulationiq.com)
17. Nahid Jamshidi, 1 ZahraMolazem, 1 Farkhondeh Sharif, Camellia Torabizadeh, and Majid Najafi Kalyani. The Challenges of Nursing Students in the Clinical Learning Environment: A Qualitative Study. The Scientific World Journal. Volume 2016, Article ID 1846178, 7 pages.
18. COVID-19 and higher education: Today and tomorrow; impact analysis, policy reponse and recommendations. 9April 2020. UNESCO International Institute for Higher Education in Latin America and the Caribbean (IESALC).
19. Romero-blanco C, Hern A. Sleep Pattern Changes in Nursing Students during the COVID-19 Lockdown. International Journal of Environmental Research and Public Health. 2020; 2-11.
20. R. Borzou, M. Safari, M. Khodavisi, and B. Torkaman, “The viewpoints of nurses towards applicability of nursing curriculum in hospitals affiliated to Hamedan University of Medical Sciences,” Iranian Journal of Medical Education, 2009; 8(2): 205–211.
21. Ng Y, Lai P, Or P. Coronavirus disease (COVID-19) prevention: Virtual classroom education for hand hygiene. Nurse Education in Practice. Nurse Educ Pract [Internet]. 2020; 45: 102782. Available from: https://doi.org/10.1016/j.nepr.2020.102782)
22. Longhurst GJ, Stone DM, Dulohery K, Scully D, Campbell T, Smith CF. Anatomical Education in the United Kingdom and Republic of Ireland in Response to the COVID-19. doi: 10.1002/ ASE.1967.
23. Regmi, K., Jones, L., 2020. A systematic review of the factors – enablers and barriers – affecting e-learning in health sciences education. BMC Med. Educ. 20, 91. https://doi-org/10.1186/ s12909-020-02007-6.
24. Philip Docking Guest Editorial. SARS and the effect on Nurse Education in Singapore. Contemporary Nurse, 2003; 15: 1-2, 5-8, DOI: 10.5172/conu.15.1-2.5
25. Elizabeth Redden. ttps://www.insidehighered.com/news/2020/03/ 05/students-studying-be-health-care-professionals-front-lines-coronavirus-outbreak.Health-Care Students on the Front Lines. March 5, 2020.
26. James MM, John N. Learning Space in a selected College of Nursing in New Delhi. Int. J. Nurs. Midwif. Res. 2018; 5(4)
27. Minstry of health and family welfare. General health services (EMS) division. May 15 2020.
28. Joke Bradt,” Impact of COVID-19 on clinical research” Pages 297-299 | Published online: 04 Jul 2020. (https://doi.org/10.1080/ 08098131.2020.1777785
Received on 22.02.2021 Modified on 27.05.2021
Accepted on 06.07.2021 ©A&V Publications All right reserved
Int. J. of Advances in Nur. Management. 2021; 9(4):417-422.
DOI: 10.52711/2454-2652.2021.00096