Perception towards Online Classes durin g COVID-19 among Nursing Students of a Medical College of Kaski District, Nepal

D,


INTRODUCTION
The Coronavirus Disease 2019 (COVID-19) outbreak which was originated and restricted only in China until February 2020 had suddenly altered into a global pandemic disease from 11th March, 2020 [1,2].This pandemic has aff ected not only on physical health but also the lifestyle, business, stock market and even the education system worldwide as a result of containment measures being taken for its prevention [3,4].A large part of the world experienced a lock down that closed educational institutions aff ecting more than 70% of the world's student population.
Physical classroom teaching was switched into virtual classes quite fast usually few days at university level [5].
Nepal is also not an exception to this disease.A single case was reported to have COVID-19 infection in Nepal till 23, March 2020 and a country-wide lockdown came into eff ect on 24 March which was continued until 21 July 2020 in Nepal [6,7]).As of 30 July 2020, Nepal Ministry of Health and Population had confi rmed a total of 19,547 cases, 14,248 recoveries, and 52 deaths in the country [8].With the beginning of the lockdown to control the COVID-19 outbreak, many educational institutions started switching from traditional classroom teaching to online teaching to cope with the adverse situation in Nepal.Tribhuvan University (TU), the largest and oldest university in Nepal, also offi cially endorsed the virtual class model along with a guideline and circulated a notice among its institutions.Similarly, the Ministry of Education, Science and Technology appealed to stakeholders to start classes through alternative systems.Various news media and relevant stakeholders argued for the need for promoting such classes [9].
Online learning is a virtual learning system which integrates internet connection with teaching and learning process [10].The interaction of teaching and learning activities can be carried out from the distance with the help of internet and online media [11].However, this method can be diffi cult for those teachers who are specialized in conventional teaching and are uncomfortable to use electronic gadgets.Also, students may not feel serious in online teaching as teachers have little control in online teaching [12].Online learning has become a solution for the continuity of teaching and learning process in Nepal during Covid-19 pandemic.Although online learning have various positive impacts, the shift to online education in nursing where student nurses require practical knowledge creates new challenges for nurse educators [13,14].
Various studies have been conducted across diff erent countries to determine medical student's perception on E-learning.A study was done in Pakistani medical and dental students in which students did not prefer e-teaching over face-to-face teaching during the lock down situation.77% students had negative perceptions towards e-learning [15].Further, a study done in Indonesia among medical students found some supportive but also inhibitory factors to distance learning.The most agreed supportive factor was location fl exibility (87.9%) and the most common inhibitory factor was signal dependent (80.2%) [16].A study was conducted to assess the impact of E-learning among nursing students and teachers of Kathmandu during COVID-19 [17].
The study of eff ectiveness of online classes has become essential component in the education system in Nepal.Very little information exists about the experiences of students regarding online classes in Nepal.Therefore, the researcher assessed the perception of nursing students' towards online learning implemented during Covid-19 pandemic in Nepal.This knowledge is necessary to identify student's requirement during online learning to make this learning system benefi cial for the students.

METHODS
A descriptive, cross-sectional research design was used to conduct the study among nursing students studying at Gandaki Medical College (GMC) which is located in Kaski district of Nepal.GMC is one of the constituent colleges of Tribhuvan university, Institute of medicine established in 2010 A.D. It has been providing education facilities to a number of students with diff erent faculties i.e.MBBS, BDS, BNS, Bsc nursing, BPH, B Pharmacy, BMLT, BMIT.An online teaching in nursing program was started in this institute from 11 April 2020 which were conducted every day using ZOOM application.So, this setting was selected purposively for the study purpose.The targeted population for the study were all nursing students of Gandaki medical college whose total number was 135.All nursing students studying at this college were included in the study using census method.
Those students who were sick and unable to respond and were unwilling to participate were excluded from the study.
A self-administered semi-structured questionnaire developed through extensive review of related literature and after consultation with experts was used for data collection.

RESULTS
Out of 135 nursing students, 133 completed the online survey (98.5% response rate).The mean age of the respondents was 22.3 years (SD ± 2.9).Majority of the students (88.7%) were residing in urban area and 87.2% were unmarried.Almost four fi fth (79.7%) had nuclear family.More than half of the students (57.9%) had monthly family income of 36000-111000 (Table 1).

DISCUSSION
The present study assessed the perception of nursing students towards online classes during the period of COVID-19 pandemic.The study found that more than half of the students (54.1%) had negative perception towards online classes.This fi nding is supported by a study conducted among Pakistani medical students which showed 77.4% students had negative perception about e-learning [15].In this study, more than one third of students (48.1%) disagreed that online learning is better than traditional learning.About two third of the students agreed that face to face contact with teacher is necessary to learn (67.6%) and learning environment is better in college than at home (63.9%).These data suggest that nursing students prefer There is lack of interaction during online classes.
Lack of feedback from the instructor.
Single students dominate during online classes.20 Lack of technical know-how (unable to get practical knowledge) traditional in-class methods to online learning.Various studies also support this fi nding.A study conducted among Saudi pharmacy students showed that 72% preferred traditional in-class lectures over the online interactive lectures [18].Similarly, a study also showed that majority (85%) of the student's preferred face to face teaching over e-teaching [15].
This study also reveals that half of the respondents (51.9%) used mobile gadget for their e-learning.Only 24.1% of the respondents used laptop/computer for their online class.A study among Pakistani medical students showed that 76% of them used mobile gadgets for their e-learning [15].Mobile has been a most popular devices among students for e-learning as compared to laptops and tablets  [19].This study highlights that two third of the respondents (66.2%) are using both cellular data and Wifi for attending the class.One third of the students (35.3%) had no access to static internet and 4.5% of them do not have internet at their home.A study done in Nepal showed that 16.7% of students had no internet access at their home for online class [17].
Sound internet connectivity has been one of the most complained aspects and accessing online courses through mobile internet is expensive, which is unaff ordable for many students in Nepal [9].
Approximately, half of the participants agreed that online learning system is easy to use (47.4%) and it is easy to manage study time eff ectively (51.1%).However, 62.6% disagreed to no specifi c preparation is needed to attend online classes.A study conducted among students of Indonesia also showed that 42.4% of students disagreed to no specifi c preparation is needed for long distance learning [16].Online learning is suggested to be convenient and benefi cial for both students and instructors [20].
Only 17.3% of the respondents agreed that there is easy sharing of ideas with colleagues in online learning.
However, 65.4% agreed that they can ask teacher questions and receive a quick response during online studies.A study among nursing students in Nepal also showed that 64.4% of students could clarify their queries through question/ answer session of online class [17].
Although one third of the respondents (34.6%) agreed that it is comfortable communicating electronically during online classes, 62.2% agreed that there is lack of interaction during online classes which is supported by a study of [16].
Collaboration and interaction in online class remain the major barriers [21].
The study also showed a statistically signifi cant association of perception with residence (p = 0.033), type of nursing programme (p = 0.027), family income (p = 0.022), education level of father (p = 0.029) and mother (p = 0.004).
Whereas, there is no statistically signifi cant association between respondent's perception and their age, type of family, type of gadget used and access to static internet.
Our study has limitations.First, it is a cross sectional quantitative study.Second, perception was based on selfreport tool.Third, the study was performed only among nursing students of selected college of Nepal which may

CONCLUSION
Online learning method is a solution taken by higher The questionnaire was organized into 2 parts: Part I: consisted of questions related to sociodemographic and online class related information.Part II: consisted of Likert scale for the measurement of perception.It included twenty four statements using 5 point Likert scale (1= Strongly disagree, 2= Disagree, 3= Neutral, 4= Agree, 5= Strongly agree).The total score range from 24 to 120.The level of perception was computed by using median score and was categorized as: score above the median= Positive perception and score equal to or below the median score= Negative perception.Validity of the instrument was maintained by extensive review of literature and consultation with research experts.Pretesting of the instrument was done among 10% of the sample size and necessary modifi cation was done as required.Reliability in terms of consistency of the tool was tested by calculating Cronbach's alpha value which was 0.785.The study was carried out after obtaining ethical clearance of the research proposal from the Institutional Review Board (IRB) of Gandaki Medical College (Ref no: 94/077/078).Informed verbal and written consent were taken from the respondents after giving information about the nature of the study and use of the data.Researchers collected the data from 15 September to 21 September, 2020 by giving instruction to self-administer the questionnaire sent through email.For those students who had problem communicating online, data was collected using telephone interview.Respondents' dignity was maintained by giving right to reject or discontinue their participation from the study at any time without any penalty.Confi dentiality and anonymity was maintained by not disclosing the name and other information of the respondent except its use in the study.Before receiving the fi lled form from respondent, the fi lled instrument was rechecked for completeness and consistency.After data collection, data were coded and entered in IBM SPSS, version 16.Data were analyzed by employing descriptive statistical method which includes frequency, mean, standard deviation and inferential statistical method such as chi-square test.Statistical signifi cance was considered at p <0.05.
education in Nepal during the Covid-19 outbreak.Based on the survey result, almost half of the respondents had negative perception towards online learning.However, majority felt that online classes should be continued during this pandemic.Therefore, it is recommended to foster face to face interaction between students and teachers and to promote learning environment at home for online learning.

ACKNOWLEDGMENTI
would like to acknowledge Dr. Ishwari Sharma Paudel, Professor and Head, Dept. of Community Medicine Gandaki Medical College and nursing faculties of College of Nursing Sciences Gandaki medical college for validating the survey questionnaire.Our sincere thanks to all the students who participated in this research.

Table 1 :
Demographic and job-related characteristics of respondents (n = 133).Almost half of respondents (51.9%) used mobile for attending online class.Two third of them (66.2%) are using cellular data and Wifi for attending the class.O ne third of the students (35.3%) had no access to static internet and 4.5% of them do not have internet at their home.M ajority of the

Table 4
reveals the statistics of overall scoring of perception towards online classes.It shows that the possible score was 24 to 120 which could be obtained by the respondents.Out of the full score, the mean score obtained by the respondents was 77.33 i.e. 64.4% and standard deviation was 6.1 i.e. 5.08%.The median score was 78 i.e. 65% with minimum perception score of 60 i.e. 50% and maximum score of 94 i.e. 78.3%.

Table 5
reveals the overall level of perception of students towards online classes.M ore than half of the students (54.1%) had negative perception towards online classes.

Table 4 :
Statistics of overall scoring on perception of students regarding online classes (n = 133).

Table 5 :
Overall level of perception of students towards online classes (n = 133).

Table 6 :
Association between Perception and Selected Variables (n = 133).Pearson's Chi square Test; * p value signifi cant at <0.05 level limit the generalizability of the fi ndings.Also, our study could not show gender diff erence in perception as female only pursue nursing career in Nepal.