Assessment of e-learning readiness among different levels of nursing learners in king Saud medical city

Автор: Haimour A., Alkhaibary A., Alabssi H., Tous M., Alqarni A., Saleh M., Alshehri S.

Статья в выпуске: 22, 2022 года.

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Aim: Nurses’ and students’ willingness to increase information and practical skills through electronic platforms may help in setting up hundreds of timesaving and economical e-learning programs. The aim of this study is to evaluate the readiness of e-learning among different levels of nurses and nursing students. Methods: In this quantitative research, 425 participants from King Saud Medical City in Riyadh, Saudi Arabia were included. The study population included nurses and nursing students. Results: With p

E-learning, reediness, nursing learners, king saud medical city, nursing levels

Короткий адрес: https://sciup.org/148324590

IDR: 148324590 | DOI: 10.18137/cardiometry.2022.22.160167

Текст научной статьи Assessment of e-learning readiness among different levels of nursing learners in king Saud medical city

Ahmad Haimour, Ahmad Alkhaibary, Hussein Alabssi, Mohammed Al Tous, Amal Alqarni, Mona Saleh, Sadiah Alshehri. Assessment of E-learning readiness among different levels of Nursing Learners in KING SAUD MEDICAL CITY. Cardiome-try; Issue 22; May 2022; p. 160-167; DOI: 10.18137/cardiome-try.2022.22.160167; Available from: issues/no22-may-2022/assessment-E-learning-readiness

Clinical practice is one of the core elements of the undergraduate nursing curriculum, which emphasizes on the importance of developing clinical training and proficiency. Globally, there are many obstacles that may prevent undergraduate students from attending practical training to learn clinical skills, like limited sources, staff turnover, complex medical cases, and widespread infectious diseases.1 Nurses are required to obtain continuing education throughout the year to increase the quality of patient care. However, the demanding time while working with patients, or engaging in many procedures; may make the attendance of traditional face-to-face classrooms chal-lenging2. Nurses’ and students’ willingness to increase information and practical skills through electronic platforms may help in setting up hundreds of programs at lower cost, very quick, and at any time available to the learner compared with face to face. There are many advantages of shifting from in-classroom to e-learning education: that there will be more flexibility, accessibility, convenient subject matter, and gaining the speed and quality of information exchange.3,4 . Furthermore, introducing students and nurses to e-learning will let them learn according to their time and appropriate location as well as download the important online resources. It will also increase the level of self-management.5 The research concluded that the application of e-learning will be essential to enhance knowledge and practices and with no more obstacles if learners are ready to take on that expe-rience.6 As it is important to improve the quality of patient safety and nursing care in an institution, the level of learners must be taken into consideration7. A study argued over the impact of e-learning on first aid in the form of increasing information for nursing students at selected nursing college in Delhi, e-learning available via the internet and computers on first aids which include a total of nine conditions: general first aid, burn, cardiopulmonary resuscitation, shock, hemorrhage, snake bite, head injury, and dog bite has become an effective educational tool. The authors explain that the participant’s understanding level of the common first aid subject was poor before the study but after the application of an e-learning module on first aid, there was a major enhancement in knowledge related to the first aid8,9

A randomized control trial was conducted to measure the influence of e-learning on knowledge, expertise, and satisfaction related to nurses and nursing students, and results showed that there is no significant difference between the outdated education group and e-learning group regarding nurses or nursing students’ knowledge, abilities and well-being10 Nevertheless, a study, which aimed to investigate the views of registered nurses regarding blood transfusion learning through e-learning practice to match individual learning styles and needs, established that e-learning will be expanded as much as developing the technology and the need will increase to it as well. In this regard, e-learning has benefits in terms of practicing safely and competently as well as meeting the educational standards AUWAN11. Many nursing students come to learn with different educational needs, cultures, and various far places that could obtain the experience of distance education challenges. Despite the good impact of e-learning, technology as a single element is not enough and a mixed and diverse approach to learning must be taken to bridge the theory-practice gap that supports the incorporation of knowledge into clinical practice12. The expectations and opinions of nursing students toward the use of e-learning found that the presence of technology in nursing education has become an urgent necessity to prepare and qualify students to work in a technical work environment. The nursing student at lower academic levels have higher expectations but they will need a lot of effort to develop their skills to make them use technology for academic aims effectively13. Another related study explores the readiness of nursing students for e-learning in Al Dawadmi Applied Medical Science, Shaqra University. The researcher asserted that the willingness of the nursing participants to obtain e-learning courses. Also, establishing e-learning as a tool in undergraduate education is a necessity despite their educational levels or even their age14 Furthermore, there are no associated obstacles with e-learning experiences according to this study. Nurse’s readiness for e-learning must be evaluated before activating e-learning as they must be provided with excellent resources to enable them to use the material effectively15. Consequently, it is important that the organizations encourage their learners by equipping them with the hardware to aid the starting of e-Learning. The aim of this study is to assess and compare the E-Learning readiness among different levels of nursing learners to consequently help in preparing nurses for the E-Learning experi-ence16.

Methodology

Design

This research project utilizes a descriptive- comparative research design that is further described in the following: The targeted participants are classified into five learner levels; advanced beginner, novice, competent, expert, and proficient) according to Patricia –Benner’s Novice to Expert Theory; which is viewed as the best and most effective framework to mentor, develop, and measure the various levels of nursing starting from the beginner up to the expert17. Upon classifying the learners according to definite criteria that are based on theoretical assumptions; The “E-Learning Readiness” for the five learner groups is assessed using the “E-Learner Readiness Self-Assessment Tool”, then the “E-learning readiness” average score for each group of learners will be compared statistically to assess the difference. The secondary objective of proposing the evidence-based strategies to improve E-learning readiness is described according to study results and literature review.

Setting

This study is conducted at King Saud Medical City (KSMC) in Riyadh, Saudi Arabia utilizing an electronic format that will be sent to participant’s emails.

Sampling

The study population is the undergraduate nursing students from the affiliated nursing colleges as well as all staff nurses working at King Saud Medical City in Riyadh, Saudi Arabia. The total study population is 4100 nurses based on the nursing data census and statistics at KSMC.

Convenience sampling is used with an estimated sample size of 325 subjects under a margin of error of 5%, confidence level of 95%, and 50% response distribution.

Data collection

The groups are classified according to learner’s group characteristics using the Demographical data sheet; the classifying domains are (Academic qualification, years of clinical experience, preferred learning style, role-specific behavior, learners’ behavior, and current professional role).

The “E-Learning Readiness” for the five learners’ groups is assessed using the “E-Learner Readiness Self-Assessment Tool”

Tool description

It is a self-assessment tool originated by18. The tool consists of 27 statements that relate to readiness for e-Learning success and was assembled into 6 subscales: (1) technology access (3 items), (2) online skill and relationships (9 items), (3) motivation (3 items), (4) online audio/video (3 items), (5) internet discussions (4 items), and (6) importance to your success (5 items). Participants were found to complete a 5-point Likert- type scale response for each statement. The scale is ranging from “strongly disagree” which equals 1 up to “strongly agree” which equals 5 with the statement. The five levels of e-Learning readiness are: least when the value ranges from 1.00 to 1.49 is least, less when the average ranges from 1.50 to 2.49, fair when the average is from 2.50 to 3.49, high when the value of average ranges from 3.50 to 4.49, and highest when the value of average from 4.50 to 5. The e-Learning readiness assessment tool has a reliability of 0.8527.

Ethical consideration

The project design is not concerned with collecting patient information that may threaten the patient’s confidentiality rights or it may alter the patient treatment plan of care. The confidentiality and anonymity of the collected data will be secured and accessed by the research team members and it will not be shared publically. All research subjects are treated equally, and each participant is given voluntary control for participation. The research was approved by the Institutional Review Board of King Saud Medical City in Riyadh, Saudi Arabia under IRB registration number: IORG0010374

Statistical consideration

The data obtained were analyzed using Statistical Package for the Social Sciences (SPSS IBM Version 25). The level of significance is set at 0.05. The descriptive statistics that include means and frequencies are used to describe the demographical characteristics of the targeted population while the inferential statistics, one-way ANOVA, and Multiple Linear Regression (MLR) are used to measure the primary and secondary objectives.

Results

Demographical data

A total of 425 respondents participated in this research. The demographic variables collected from respondents were age, gender, marital status, academic qualification, experience, and preferred learning style, the role of specific behavior, learner behavior, and current professional role.

Table 1 shows detailed information about frequencies and the presence of each demographic variable and other information collected from participants and table 2 shows categorization of learners to demographical data.

Table 1

Information about frequencies and presence of each demographic variable

Variables	Categories	Frequency	Percentage
Gender	male	35	8.2
Gender	female	390	91.8
Age	18-24 y	23	5.4
	25-34 y	263	61.9
	35-44 y	90	21.2
	45 y or older	49	11.5
Academic Qualification	Diploma	110	25.9
	Bachelor	295	69.4
	Master	20	4.7
Experience	0 to < 1 y	40	9.4
	1 y to < 3 y	44	10.4
	3y to < 5 y	55	12.9
	5 y and above	286	67.3
Preferred learning Style	Auditory	141	33.2
	Reading	16	3.8
	Visual	195	45.9
	Kinesthetic	73	17.2
Role of Specific Behavior	task - oriented nursing care	119	28.0
Role of Specific Behavior	goal-oriented patient care	306	72.0
Learner Behavior	Instructor – Dependent	146	34.4
	Self-directed	69	16.2
	Participative learner	210	49.4
Current Professional Role	undergraduate nurse	24	5.6
	staff nurse	321	75.5
	nurse leader	18	4.2
	nurse preceptor	24	5.6
	nurse mentor	12	2.8
	nurse educator	26	6.1

Table 2

Categorization of learners’ levels according to demographical data

Group No	Learner’s Category	Frequency	Percentage
Group I	Novice	1407	3.31
Group II	Advanced beginner	1480	3.48
Group III	Competent	1923	4.52
Group IV	Proficient	1560	3.67
Group V	Expert	1407	3.31

Readiness of the nurses toward the e-learning

Table 3

E-learning readiness and its sub-variable mean and standard deviation

Variables	Mean	SD
Total Score of Technology Access	10.7059	3.30745
Total Score of Online Skills And Relationship	31.7647	9.63588
Total Score of Motivation	10.1459	3.26103
Total Score of Online AudioVideo Adds	10.4024	3.25207
Total Score of Internet Discussion	13.9976	4.38076
Total Score of Importance Of Your Success	17.8329	5.47747
Total Score of E-Learning Readiness	94.8494	28.12549

Table 4

One-Sample Test

	Test Value = 3
	t	df	Sig. (2-tailed)	Mean Difference	95% Confidence Interval of the Difference
	t	df	Sig. (2-tailed)	Mean Difference	Lower	Upper
Technology Access [I have access to computer with an internet connection]	11.371	424	.000	.661	.55	.78
Technology Access [I can access new computer( enough ,Speaker ,RAM, CD-ROM)]	9.161	424	.000	.515	.40	.63
Technology Access [I have access computer with adequate software ( Microsoft word ,adobe acrobat ) ]	9.317	424	.000	.529	.42	.64
Online Skill and relationships [I have computer operating skills( saving file and making folders )) ]	10.414	424	.000	.588	.48	.70
Online Skill and relationships [I can find my way around the internet ( e.g. using engines search entering passwords]	10.068	424	.000	.574	.46	.69
Online Skill and relationships [I can manage to send an email along with certain file attachments ]	11.405	424	.000	.642	.53	.75
Online Skill and relationships [I think that I would be comfortable using the computer several times a week to participate in a course ]	9.702	424	.000	.565	.45	.68
Online Skill and relationships [I think that I would be able to use online tool like chat and email to work on assignments with students in varying time zones ]	9.243	424	.000	.534	.42	.65
Online Skill and relationships [I think that I would be able to plan my time to provide timely responses to students, and/or the instructors ]	10.163	424	.000	.576	.46	.69
Online Skill and relationships [I think that I would ask necessary questions and make clear written comments ]	9.945	424	.000	.553	.44	.66
Motivations [I think that I would be able to remain motivated even though the instructor is not online all time.]	7.231	424	.000	.405	.29	.51

	Test Value = 3
	t	df	Sig. (2-tailed)	Mean Difference	95% Confidence Interval of the Difference
	t	df	Sig. (2-tailed)	Mean Difference	Lower	Upper
Motivations [I think that I would complete my work even in the online distractions( friend ,sending email ,website to surf ]	5.578	424	.000	.327	.21	.44
Motivations [I believe that I would complete my task even among the distractions in my home ( television, children and such )]	3.577	424	.000	.214	.10	.33
Online audio-video aids [I think that I would relate the content of the short video clips( 1-3 minutes typically ) to the information I have read online or in a book ]	7.681	424	.000	.428	.32	.54
Online audio-video aids [I think that I would be able to take notes while watching a video on the computer ]	8.935	424	.000	.504	.39	.61
Online audio-video aids [I think that I would comprehend with the course-related information when presented in the video ]	9.730	424	.000	.555	.44	.67
Internet Discussion [I think that I would be able to carry on conversations with others using the internet ( internet chat, instant messenger )]	8.327	424	.000	.468	.36	.58
Internet Discussion [I think that I would be able to comfortable having several discussions taking place in the common online chat although I am not taking part in all of them .]	7.038	424	.000	.379	.27	.48
Internet Discussion [I think that I would be able to follow along with an online conversation ( e.g. internet chatting ,instant messenger) while typing ]	8.572	424	.000	.485	.37	.60
Internet Discussion [I sometimes prefer to have some time to prepare a response to questions.]	7.914	424	.000	.447	.34	.56
Importance to your success [Regular contact with the instructor is important to my success in online courses ]	9.233	424	.000	.525	.41	.64
Importance to your success [Quick Technical and administrative support is important to my success in online course work ]	9.660	424	.000	.541	.43	.65
Importance to your success [Frequent participation throughout the learning process is important to my success in online course work.]	10.173	424	.000	.574	.46	.69
Importance to your success [I feel that prior experience with online technologies( e.g. emails, internet chatting, online reading ) are important to my success with online course )]	9.976	424	.000	.562	.45	.67
Importance to your success [The ability to immediately apply course materials is important to my success with online work courses]	9.362	424	.000	.544	.43	.66
Online Skill and relationships [I think that I would be able to express myself clearly through my writing ( e.g. mode .emotions and humors ]	9.229	424	.000	.520	.41	.63
Online Skill and relationships [I think that I would be to communicate effectively with others using online technology ( e.g. .chat ,emails )]	11.247	424	.000	.633	.52	.74

E-learning readiness among different levels of nursing learners

To ensure if there are any statistical differences between nursing categories groups in terms of E-Learning readiness; one Way ANOVA was used.

Null hypothesis: there are no statistically significant differences between nursing with respect to E-Learning readiness.

Alternative hypothesis: there are statistically significant differences between nursing groups with respect to E-Learning readiness.

The results indicate that we rejected the null hypothesis and accepted the alternative hypotheses F (.1809, 5), p < 0.042, table 5.

Table 5

ANOVA results

Variables	Mean	SD	df	F	^p
undergraduate nurse	76.8750	36.74272	5	1809.144	.042*
staff nurse	95.7290	26.92544
nurse leader	98.3333	28.03359
nurse preceptor	94.7500	29.80990
nurse mentor	91.2500	18.14149
nurse educator	99.9231	32.18313

With regards to post hoc, it is conducted once ANOVA results give significant results to understand the difference between the groups of nursing variables. Table 6 indicates the detailed information about the significance between the subgroups of nursing learners.

Discussion

Technology is advancing continuously and it has revolutionized the way in which education is delivered to the students. The research has undertaken an in-depth analysis while integrating quantitative research design to explore different levels of nursing and their readiness towards the e-learning procedures. Instead of using traditional learning, KSMC is adopting e-learning platforms to deliver nursing education to different nursing levels. The research has identified and compared to what extent e-learning readiness differs among different levels of nursing learners. The levels chosen in this regard were novice, advanced beginners, competent, proficient and expert nursing professionals. Whereas, online skills and relationships, access to technology, motivation, internet discussion, online audio-video ads, and importance of success were taken as sub-categories of e-learning readiness19. In this regard, the analysis of the results in the previous section indicated that no big difference is observed between the population mean of the nurses and the sample mean as the p-value for the one-test sample was found to be 0.000, and the results regard-

Table 6

Post HOC of ANOVA results

(I) Current Professional Role: (Please tick all that apply)	(J) Current Professional Role: (Please tick all that apply)	Mean Difference (I-J)	Std. Error	^p	95% Confidence Interval
(I) Current Professional Role: (Please tick all that apply)	(J) Current Professional Role: (Please tick all that apply)	Mean Difference (I-J)	Std. Error	^p	Lower Bound	Upper Bound
undergraduate nurse	staff nurse	-18.85397*	5.90596	.019*	-35.7625	-1.9454
	nurse leader	-21.45833	8.70206	.137	-46.3720	3.4553
	nurse preceptor	-17.87500	8.05654	.231	-40.9405	5.1905
	nurse mentor	-14.37500	9.86721	.692	-42.6244	13.8744
	nurse educator	-23.04808*	7.90009	.043*	-45.6657	-.4305
staff nurse	nurse leader	-2.60436	6.76006	.999	-21.9581	16.7494
	nurse preceptor	.97897	5.90596	1.000	-15.9296	17.8875
	nurse mentor	4.47897	8.20575	.994	-19.0137	27.9717
	nurse educator	-4.19410	5.69069	.977	-20.4863	12.0981
nurse leader	nurse preceptor	3.58333	8.70206	.998	-21.3303	28.4970
	nurse mentor	7.08333	10.40095	.984	-22.6942	36.8608
	nurse educator	-1.58974	8.55742	1.000	-26.0893	22.9098
nurse preceptor	nurse mentor	3.50000	9.86721	.999	-24.7494	31.7494
nurse preceptor	nurse educator	-5.17308	7.90009	.987	-27.7907	17.4445
nurse mentor	nurse educator	-8.67308	9.73988	.949	-36.5580	19.2118

ing the readiness of e-learning among different levels of nursing are true for the whole population. The readiness of e-learning among nurses associated with the sub-categories was also found to be significant as well. Through the analysis, it has also been revealed the nurses to a greater extent are ready for e-learning. This outcome can also be supported by the literature or the previous research studies which indicated that the nursing participants demonstrated a high willingness to access e-learning courses if adequate resources are provided to them14,20. This further enhances the skills and ability to use the technological tool in education and nursing learning practices. Referring to the hypotheses of the research, which are tested in the previous section, the analysis indicated there are statistically significant differences between nursing groups with respect to e-Learning readiness as the p-value was found to be 0.042. The research also indicated that expert nurses are less likely to face difficulty in gaining nursing education through e-learning platforms. This can further be supported by the information provided in the literature which highlights that as compared to beginner expert nurses have a better and organized way to gain nursing education through e-learning as they are self-motivated and familiar with the technological tools21. Hence, it can be critically discussed that even if the willingness and readiness of all nursing levels are high towards e-learning, but still their e-learning experience differs by level which ultimately highlights the need for continuous training of the e-learning platforms to the levels of nursing which so that their online skills and motivation can be enhanced which are associated with the readiness towards e-learning. The research outcomes are in complete alignment with the research objectives which makes the research more reliable22

Conclusion

There are many levels in nursing for education and practice. The nursing students and experienced professionals have demonstrated willingness and readiness to enhance their practical skills and advanced nursing education with the help of electronic platforms as it is a more convenient and flexible option as compared to traditional learning. The research indicates the scope of e-learning in nursing education and analyzed how different levels of nursing have different experiences and motivations towards e-learning, while the readiness to gain education and nursing skills through elec- 166 | Cardiometry | Issue 22. May 2022

tronic platforms remains constant. While considering the literature and analysis provided in the research, it can be said that the nursing staff and students in King Saud Medical City demonstrated significant readiness levels towards e-learning, while the level of readiness and experience towards e-learning vary for different nursing groups, such as undergraduate nurse and staff nurse, as staff nurses might have more skills in accessing online tools for e-learning as compared to the student in KSMC. However, the training for e-learning is required all along with the quality of the e-learning resources for an excellent learning experience.

Recommendations

The enhancement of the e-learning readiness among different levels of nursing learners in KSMC is important for the positive behavioural change and acceptance of technology for education. For this purpose, certain evidence-based recommendations are made to improve e-learning readiness for all nurses. The recommendations include:

• The management of KSMC is recommended to train the nurses to use collaborative e-learning tools along with the training of the staff, so the e-learning platforms can easily be utilized in critical times such as a pandemic.
• It must be ensured the content provide on e-plat-forms is of high-quality, properly structured and include images and relevant videos for better understanding.
• To assess the performance of all nursing levels or groups for continuous improvement in education and nursing practices.

Acknowledgments

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