Introduction
Since the advent of the COVID-19 pandemic, educational institutions worldwide have increasingly adopted distance learning (DL) as a viable means to sustain educational provisions for students [1]. Embracing DL presents prospects for advancement and innovative educational paradigms. In the contemporary landscape, DL has gained prominence, significantly influenced by the emergence of diverse education platforms, altering individuals’ perceptions and engagement with this mode of education [2]. The inherent flexibility of DL enables students to effectively balance academic pursuits with professional commitments [3‐5], fostering an environment where interaction with platforms and technologies augments their virtual tool skills, providing invaluable experiences applicable to future careers [6].
Graduating nursing students manifest a distinct level of intellect and comprehension, impacting their attitudes and perceived significance of DL in education [7]. Often propelled by aspirations for career progression or personal development, these graduates possess a profound- understanding of their field, having refined critical thinking and analytical prowess throughout their education. Consequently, their perspectives on DL are shaped by their confidence in the robustness and quality of online programs [8]. Graduates in nursing are inclined to view DL as a valuable adjunct to their existing knowledge and experiences, enabling them to deepen their expertise and broaden their professional networks [9]. However, despite its advantages, DL presents notable drawbacks, such as the absence of physical presence, leading to potential communication hindrances and feelings of detachment from the learning community [10]. Furthermore, the absence of a structured physical learning environment necessitates higher self-discipline and motivation to maintain academic progress [11]. Although developing digital skills through online platforms offers benefits in a virtual world, addressing these challenges requires educational institutions’ concerted efforts to support and foster a sense of community among students.
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The perceived value of DL among nursing students is intricately linked to their attitudes and academic motivations [12]. These students evaluate online courses and programs with elevated standards, seeking maintenance of rigor and academic excellence akin to traditional in-person programs [11]. Additionally, nursing students appreciate the flexibility and convenience DL affords, allowing them to harmonize studies with professional obligations.
Engaging in DL demands high self-motivation, discipline, and responsibility from nursing students [13]. Those with positive attitudes towards distance learning often display these characteristics, recognizing its potential for self-directed learning and personal development [10]. Conversely, those harboring negative attitudes might struggle with the independent nature of online education, facing challenges related to accountability and time management [14]. Research indicates that motivated learners are prone to engaging in challenging activities, participating actively, adopting a deep approach to learning, and demonstrating enhanced performance, persistence, and creativity [9]. Contemporary perspectives emphasize the intertwining of academic motivation with individuals’ cognitive and affective processes, highlighting the interactive relationship between learners and the learning environment [15]. Nevertheless, comprehensive studies focusing on attitudes, perceived value, and academic motivation toward distance learning in nursing contexts remain relatively limited in quantity and scope [7, 16]. Hence, understanding and addressing these diverse attitudes and factors among nursing students are pivotal in optimizing their learning experiences.
In contrast to developed nations where distance learning in nursing schools is well-established, Jordan recently introduced DL in nursing education [17]. This issue became more significant in rural cities with the increase in people in these cities. Defining rural areas in Jordan involves considering various socio-economic, geographic, and infrastructural criteria. In the Jordanian context, rural areas are exemplified by regions like the southern governorates of Karak, Tafila, and Ma’an. These areas are characterized by lower population densities, agricultural economies, and less developed infrastructure compared to the bustling, urbanized areas of Amman, Irbid, or Zarqa. According to the World Bank’s development indicators, the rural population in Jordan accounted for 8.173% of the total population in 2022 and 9.3% in 2023 [18]. Thus, studying DL as perceived by students is needed. A recent study among undergraduate medical students in Jordan revealed moderate attitudes and preparedness for DL alongside significant perceived barriers [10]. Nursing students in rural areas face substantial impediments to their education, including limited access to educational institutions, a shortage of qualified instructors, and inadequate learning resources. Geographical isolation often deprives these students of diverse clinical exposures essential for nursing education. While DL proved valuable in Jordan, particularly post-COVID-19, there remains room for enhancing the educational experience, especially in rural areas. Scrutinizing students’ perspectives on technological infrastructure strength and internet reliability in these regions is warranted. Notably, there is a lack of studies in Jordan examining nursing students’ attitudes, perceived value, and challenges toward DL, emphasizing the need for this investigation. This study examined the attitudes, perceived value, and academic motivation surrounding DL among Jordanian nursing students, offering insights crucial to optimizing their educational journey.
Methods
Design
A descriptive cross-sectional design was used. Data were collected via self-reported instruments after the COVID-19 pandemic in Jordan. The study followed the EQUATOR research reporting checklist and the STROBE checklist for cross-sectional research.
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Settings and sample
This study was conducted at two of the largest public universities in the south region of Jordan (Ma’an and Karak). Both universities are accredited for up to 10.000 students, with all university programs accredited by the Jordanian Higher Education Accreditation Commission. The students at these universities faced a complex issue due to various factors, such as limited resources (including faculty expertise, clinical facilities, and educational materials), which hindered the delivery of high-quality education. Both universities were also geographically isolated, resulting in reduced access to diverse clinical experiences and specialized training opportunities for students, limiting their exposure to real-world scenarios. The nursing education offered at rural universities in Jordan required concerted efforts to overcome resource constraints, enhance clinical training opportunities, and adapt curricular content to reflect the realities of rural healthcare delivery.
The study population consisted of undergraduate nursing students from two universities in rural cities (Maan and Karak). A convenience sampling technique was used to enroll students who lived in these cities and were studying nursing. The inclusion criteria were any students studying for a bachelor’s degree in nursing and spending at least one academic semester in the nursing faculty at one of the two universities. Any student from different academic years (ranging from first year to fourth year) who was admitted via regular or bridging admission options, willing to participate, and had a good understanding of English were also included. Students not enrolled in any course that did not consider DL as a teaching method were excluded. The minimal sample size was estimated to be 290 participants based on G* Power software calculation for the t-test (power of 0.95, α level of 0.05, medium effect size 0.3). Five hundred questionnaires were distributed, and 352 were returned (response rate = 70.4%). Fifty-four returned questionnaires were excluded from the analysis because they were incomplete. Finally, a convenience sample of 298 undergraduate nursing students was recruited.
Data collection procedure
The data was collected from 298 undergraduate nursing students from two public universities in rural cities in Jordan between June 2022 and August 2022. The researcher met with the nursing school dean to explain the study’s purpose and the procedure for collecting data. The researcher selected core courses (such as physical assessment, community nursing, and administrative and leadership) that utilized distance learning strategies. These courses were taught through a specific digital learning platform called Moodle, which both universities approved as the official platform for providing students lectures, assignments, and quizzes. Firstly, the researcher met the potential nursing school participants while in the class (at the last 10 min of each lecture). The primary investigator invited them to participate after explaining the study’s aim and methodology, as well as all ethical considerations related to the participation. Interested participants were asked to sign the consent form and complete three questionnaires. The maximum time needed to complete both questionnaires was 10 min. However, due to the consequence of the lectures and the limited time between each lecture, each potential participant was given one hour to return the completed questionnaires in left. The first researcher returned to collect the completed questionnaires at the end of the lectures.
Outcome measures
A self-administered questionnaire was used for this study. The survey consists of four sections: (1) Students’ attitudes about distance learning, (2) Perceived value of distance learning for the students’ learning, (3) Students’ academic motivation in distance learning, and (4) socio-demographic data.
All these questionnaires were originally written in English and then translated into Arabic using the World Health Organization (WHO) translation process using forward and backward transition processes [19]. The questionnaires were evaluated and modified after conducting a pilot study with 25 respondents who were excluded from the final analysis. The face and content validity were assessed by a panel of educators with experience in the field of education and taught DL courses (3 assistant professors, one associate professor, and two lecturers). The panel rated the translated questionnaire based on relevance, clarity, simplicity, and ambiguity. The content validity index was 0.82, 0.77, and 0.74 for tools used to measure the attitudes, perception, and academic motivation, respectively, indicating valid content. Additionally, the reliability was assessed for attitudes, perception, and academic motivation tools using the test-retest method, which revealed adequate internal consistency between items with Cronbach’s α = 0.76, 0.82, and 0.79, respectively.
The attitude scale toward DL was adopted from Stanković and colleagues [20] and modified by authors to measure nursing students’ attitudes about DL. The questionnaire consisted of 8 items. The respondents indicated their attitudes about DL using a 5-Likert scale, whereas “1” indicated ‘strongly disagree’ and “5” reflected ‘strongly agree’. The number and frequencies of each item were measured. The total score was computed by summing up the overall individual scores. The total score for this scale ranged from 8 to 40. Higher scores indicated better attitudes. For this questionnaire, the authors used the principle of interquartile equation in which we depend on percentiles where the 50th percentile (the median) represents the direction that indicates higher or lower attitudes; therefore, those who scored higher than the median tend to be positive and those whose scores lower than the median tend to be negative. Accordingly, all scores higher than 24 probably had positive attitudes, and those lower than 24 probably had negative attitudes.
The second survey examined nursing students’ perceived value toward DL. It was developed and validated by Bediang et al. [21] for faculty members. The original tool includes 10 items, but after translation, one item was removed, “improves methods of personal working,” because the panel decided that this item is related to faculty rather than students. Respondents indicated their perceived value of DL for nursing students with 9 items using a 5-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. The total score was computed by summing up the overall individual scores. The total score for this scale ranged from 9 to 45. The authors also in this questionnaire used the principle of interquartile equation in which the 50th percentile (the median) represents the directions that indicate a higher or lower perceived value of DL; therefore, those who scored higher than the median (P50% = 24) tend to be higher perception and those whose scores lower than the median tend to be lower perception of the DL value.
The third survey was valid and reliable and utilized to examine students’ academic motivation [22]. It comprises 16 items, each scored with 7-Likert points where score 1 reflected “strongly disagree” and score 7 reflected “strongly agree”. The scale was divided into four subscales: intrinsic motivation, identified regulation, external regulation, and amotivation; each subscale had four questions. The highest score indicated the highest motivation/interest among students. To figure out how much a student is self-motivated, the subscale scores calculated a single score called the self-determination index (SDI) based on the following formula: SDI= [(2×intrinsic motivation) + identified regulation – external regulation – (2×amotivation)]. The possible SDI scores ranged from − 72 to + 72, while the student who achieved an SDI score of (≥ 0) was considered a self-motivated student. All academic motivation subscales have adequate internal consistency with Cronbach’s α = 0.71, 0.81, 0.78, and 0.84 for intrinsic motivation, identified regulation, external regulation, and amotivation subscales, respectively. Finally, the last section of the questionnaire includes questions about students’ demographic data, such as age, gender, academic year, and academic achievement, and questions about factors influencing the DL adoption, such as the use of technology, computer skills, availability of internet connection, ownership of a computer, the preferred learning method, receiving training/guidance about online platforms and the flexibility of using DL platforms.
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Analysis
SPSS version 28 was used to analyze the data (IBM, 2021). Descriptive statistics were used to analyze study variables. For categorical variables, the number and percent distribution by category were calculated. Means and standard deviations were calculated for continuous variables. Independent t-test was used to examine the relationship between study variables and dichotomous variables (e.g., gender). ANOVA test was used to examine the relationship between study variables and categorical variables in more than two categories (e.g., internet connection status). Also, the Pearson correlation test was used to assess the relationship between continuous variables.
Result
Normal distribution of the data
The Shapiro-Wilk test (p < 0.05) (Shapiro & Wilk, 1965) and a visual inspection of their histograms, normal Q-Q plots, and box plots showed that the perceived value, attitudes, and academic motivation variables were approximately normally distributed. The skewness and kurtosis values were also within an acceptable range; specifically, the attitudes scale had a skewness of -0.170 (SE = 0.205) and kurtosis of -0.255 (SE = 0.407), for perceived value scale the skewness was of -0.141 (SE = 0.281) and kurtosis of -0.255 (SE = 0.407), and the academic motivation scale had a skewness of 0.032 (SE = 0.205) and kurtosis of 0.129 (SE = 0.407).
Socio-demographic profile
The mean age of students was 20.9 years (SD ± 2.8), and most of them were female (75.5%). Most of the students used technology routinely (92.3%). About 64.4% of students have good–excellent averages in their academic achievement. Most participants had intermediate computer competency (74.8%), somewhat stable internet connection (66.8%), and preferred a blended method of learning (74.8%). On the other hand, most of the participants had not received adequate guidance/training before using the DL platforms (85.6%) and found that using these platforms was difficult (90.3%) (Table 1).
Table 1
Socio-demographic profile of the participants (N = 298)
Characteristic | No. (%) |
|---|---|
Age | |
Mean ± SD | 20.9 (2.8) |
Min-Max | 19–28 |
Gender | |
Male | 73 (24.5%) |
Female | 225 (75.5%) |
Academic Year | |
1st & 2nd year | 116 (38.9%) |
3th – 4th year | 182 (61.1%) |
Academic achievement | |
Excellent – Good | 192 (64.4%) |
Accepted – Poor | 106 (35.6) |
Ownership of a computer | |
Yes | 221 (74.2%) |
No | 77 (25.8) |
Computer competency skills | |
High | 75 (25.2%) |
Intermediate | 223 (74.8) |
Status of internet connection | |
Almost stable overall the time Somewhat stable overall the time | 36 (12.1%) 199 (66.8%) |
Unstable overall the time | 63 (21.1) |
Preferred learning method | |
Traditional (classroom) | 75 (25.2) |
Blended (tradition & DL) | 223 (74.8%) |
Using Technology Routinely | |
Yes | 275 (92.3%) |
No | 23 (7.7%) |
Receiving training/guidance about online platforms | |
Yes | 34 (14.4%) |
No | 255 (85.6%) |
Flexibility of using DL platforms | |
Flexible/ easy | 29 (9.7%) |
Difficult/ not easy | 269 (90.3%) |
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Attitudes toward DL
The mean of students’ attitude toward DL was 17.3 (SD = 4.04). Based on the P50%, most students (n = 179, 60.1%) have negative attitudes toward DL, and only 39.9% reflected positive attitudes. Most participants reported that DL required special computer skills (n = 230, 77.2%). Most participants agree that face-to-face contact is necessary for acquiring and mastering the material compared with DL (n = 204, 68.5%). However, 90.3% of students feel that DL restricts their independence of time and place (n = 269), and DL does not differ in the quality of acquiring knowledge compared with traditional lectures. (n = 262, 87.9%). At the same time, 72.1% (n = 215) of respondents decline that DL motivates them to acquire more knowledge. (Table 2).
Table 2
Students’ attitudes toward DL (N = 298)
Item | Strongly disagree N (%) | Disagree N (%) | Neutral N (%) | Agree N (%) | Strongly Agree N (%) |
|---|---|---|---|---|---|
1. Distance learning provides more motivation for the acquisition of knowledge | 146 (49) | 69 (23.2) | 19 (6.4) | 50 (16.8) | 14 (4.7) |
2. There is no difference in the quality of acquiring knowledge by distance learning and traditional lectures | 135 (45.3) | 127 (42.6) | 16 (5.4) | 9 (3) | 11 (3.7) |
3. Distance learning provides the possibility of independent evaluation | 166 (55.7) | 31 (10.4) | 35 (11.7) | 47 (15.8) | 19 (6.4) |
4. Distance learning provides independence of time and place for instruction | 157 (52.7) | 112 (37.6) | 20 (6.7) | 7 (2.3) | 2 (0.7) |
5. Distance learning requires possessing special skills to work on the computer | 42 (14.1) | 16 (5.4) | 10 (3.3) | 134 (45) | 96 (32.2) |
6. Face-to-face contact is necessary for acquiring and mastering the material | 59 (19.8) | 17 (5.7) | 18 (6) | 135 (45.3) | 69 (23.2) |
7. Distance learning provides faster and easier memorizing the material | 119 (39.9) | 127 (42.6) | 23 (7.7) | 18 (6) | 11 (3.7) |
8. Distance learning provides a faster exchange of information with colleagues | 178 (59.7) | 39 (13.1) | 27 (9.1) | 41 (13.8) | 13 (4.4) |
Perceived value of DL for learning
The mean of students’ perceived value of DL was 20.1 (SD = 3.99). Most students (n = 181, 60.7%) have a low perceived value of DL, and the remaining (117, 39.3%) reflect high value. The majority of students disagree that the DL improved the quality of feedback (n = 269, 90.3%) and improved interactions (n = 261, 87.6%) and collaboration (n = 237, 79.5%) between teacher and learner, see Table 3. On the other hand, most students acknowledged that DL improved their creativity (n = 231, 77.5%) and that it was a more appropriate way of learning (n = 174, 58.4%). Besides, it builds up their critical thinking (n = 168, 56.4%). However, three quadrants of students proved that DL did not improve their learning skills, nor did it improve their feeling of autonomy in learning.
Table 3
Perceived value of DL for the students’ learning (N = 298)
Item | Strongly disagree N (%) | Disagree N (%) | Neutral N (%) | Agree N (%) | Strongly Agree N (%) |
|---|---|---|---|---|---|
1. Improves access to educational resources | 124 (41.6) | 62 (20.8) | 30 (10.1) | 58 (19.4) | 24 (8.1) |
2. Improves teacher/learner interactions | 134 (45) | 127(42.6) | 14 (4.7) | 15 (5) | 8 (2.7) |
3. Improves collaboration with teacher/learner | 166 (55.7) | 71 (23.8) | 35 (11.7) | 10 (10.1) | 16 (10.4) |
4. Improves quality of feedback | 157 (52.7) | 112 (37.6) | 16 (5.4) | 11 (3.7) | 2 (0.7) |
5. Develops a learning more suited to our setting | 12 (9.4) | 5 (2) | 17 (5.7) | 163 (54.7) | 101 (33.9) |
6. Develops critical thinking | 17 (5.7) | 3 (1) | 10 (3.4) | 120 (40.3) | 148 (49.7) |
7. Improves creativity | 23 (16.1) | 21 (6.4) | 23 (7.7) | 142 (47.7) | 89 (29.9) |
8. Develops autonomy in learning | 131 (44) | 90 (30.2) | 36 (12.1) | 36 (22.1) | 5 (3.7) |
9. Develops transversal skills (autonomy, self-assessment, etc.) | 115 (38.6) | 66 (22.1) | 24 (8) | 68 (30.9) | 25 (8.4) |
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Academic motivation toward DL
The mean of self-motivation toward DL was 32.2 (SD = 7.24). Over half of the participants (n = 166, 55.7%) reflected less self-motivation toward DL. Also, the means for academic motivation toward DL subscales were as follow; 8.06 (SD = 2.60), 8.09 (SD = 2.73), 8.32 (SD = 2.88), and 7.69 (SD = 2.26) for intrinsic motivation, identified regulation, external regulation, and amotivation subscales, respectively. Most of the participants were not sure if DL is worth it to them (n = 251, 84.2%), good for them (n = 242, 81.2%) or need to be pursued (n = 242, 81.2%). Nevertheless, 82.9% of respondents reported using DL because they have to do it (n = 247). Some students perceived good reasons to use DL but did not see any (n = 193, 64.8%). Only 37.2% of students (n = 111) approved using DL to improve their own. (Table 4).
Table 4
Students’ academic motivation toward DL (N = 298)
Item | Strongly Disagree N (%) | Disagree N (%) | Neutral | Agree N (%) | Strongly Agree N (%) |
|---|---|---|---|---|---|
1. I think that distance learning is interesting | 116(38.9) | 93 (31.2) | 35(11.7) | 20 (6.7) | 34 (11.4) |
2. I think that distance learning is a pleasure | 110 (36) | 57 (19.1) | 50(16.8) | 44(14.8) | 106(35.6) |
3. I think that distance learning is funny | 90 (30.2) | 77 (25.8) | 67(22.5) | 37(12.4) | 27(9.1) |
4. I feel good when doing this activity (distance learning) | 132(44.3) | 69 (23.2) | 46(15.4) | 10 (3.4) | 41 (13.8) |
5. I used distance learning because I am supposed to do it | 116(38.9) | 76 (25.5) | 30(10.1) | 31(10.4) | 45 (15.1) |
6. I used distance learning because it is something that I have to do | 124(41.6) | 86 (28.9) | 45(15.1) | 13(4.4) | 30(10.1) |
7. I used distance learning because I don’t have any choice | 154(51.7) | 72 (24.2) | 20(6.7) | 19 (6.4) | 33 (11.1) |
8. I used distance learning because I feel that I have to do it | 12(4) | 23 (7.7) | 16(5.4) | 72(24.2) | 175(58.7) |
9. I used distance learning because I am doing it for my own good | 126(42.3) | 31(10.4) | 30(10.1) | 44(14.8) | 67 (22.5) |
10. I used distance learning because I think that it is good for me | 142(47.7) | 100(33.6) | 23(7.7) | 6 (2) | 27 (9.1) |
11. I used distance learning by personal decision | 128 (43) | 95 (31.9) | 20(6.7) | 50(16.8) | 5 (1.7) |
12. I believe that distance learning is important for me | 90 (30.2) | 88(29.5) | 76(25.5) | 15 (5) | 29 (9.7) |
13. There may be good reasons to use distance learning, but personally, I don’t see any | 69 (23.2) | 14 (4.7) | 22(7.3) | 47(15.8) | 146 (49) |
14. I use distance learning, but I am not sure if it is worth it | 134 (45) | 117(39.3) | 15(5) | 15 (5) | 17 (5.7) |
15. I don’t see what distance learning brings me | 126(42.3) | 31(10.4) | 40(13.4) | 30(10.1) | 71 (23.8) |
16. I do distance learning, but I am not sure it is a good thing to pursue it | 140(47) | 102(34.2) | 27(9.1) | 9 (3) | 20 (6.7) |
Relationship between variables
A significant positive relationships were found between students’ perceived value of DL and their attitudes and academic motivation toward DL; low perceived value of DL was significantly related to low attitudes toward DL (X2 = 85.9, p < 0.01) and less academic motivation toward DL (X2 = 74.6, p < 0.01). Also, students’ attitudes were associated with their academic motivation, as negative attitudes were related to less academic motivation (X2 = 39.2, p < 0.01). However, computer ownership, level of computer competency, stable connection, and internet usage were not significantly associated with students’ attitudes toward DL.
Further, a higher perceived value of DL was related to gender and academic performance, whereas the female students (X2 = 49.3, p < 0.01) and higher academic performance (X2 = 52.5, p < 0.05) revealed a higher value of DL. For academic motivation, it was related to gender and academic years, whereas the female students (X2 = 45.7, p < 0.05) and those in the first and second academic years were more motivated than others (X2 = − 43.2, p < 0.05). Students who own a computer are significantly more likely to perceive value (X2 = 24.3, p < 0.05) and self-motivation (X2 = 43.2, p < 0.05) towards DL. (Table 5).
Table 5
Correlation between measures and demographic variables
Measure | Perceived value (High vs. Low) | Attitude (Positive vs. Negative) | Academic Motivation (Self-motivated vs. Not) |
|---|---|---|---|
Perceived value | - | 85.9 $ ** | 74.6 $ ** |
Attitude | 85.9 $ ** | - | 39.2 $ ** |
Age | 32.1 $ | 48.8 $ | 31.3 $ |
Gender | 49.3 $ ** | 0.95 $ * | 45.7 $ * |
Academic Year | 24.3 $ | 27.12 $ | 43.2 $ * |
Academic achievement | 52.5 $ * | 58.1 $ ** | 41.9 $ |
Computer competency | 24.3 $ | 27.12 $ | 43.2 $ * |
Internet connection | 52.5 $ | 58.1 $ | 41.9 $ * |
Ownership a computer | 24.3 $ * | 27.12 $ | 43.2 $ * |
Discussion
This study aimed to assess perceived value, attitudes, and academic motivation in DL among nursing students in rural areas and their associations in Jordan. The current study highlighted that most nursing students in rural areas had negative attitudes, less academic motivation, and low perceived value of DL. A similar finding was found in another study [24], revealing that only 43.4% of participants considered DL useful for health education. This is parallel to our findings, where we found that only 39.9% reflected positive attitudes towards DL. These findings contradicted the previous study [25], which showed positive attitudes towards DL. This study revealed significant barriers among those students toward DL even though this teaching approach was implemented since the COVID-19 pandemic started. Since most of the students had negative attitudes towards DL, this could be considered as a form of resistance and barriers either for those students who have changed the learning method from face-to-face learning to DL or those students who were not ready for the practice of DL which as it forms a new experience for them [26].
Undoubtedly, utilizing and implementing the DL approach in nursing education has introduced a new change in teaching and learning practice [25, 26]. The success or failure of DL across an organization depends on several factors. To adopt the DL approach, nursing as a field of science requires redesigning the current scientific environments and designing new ones from scratch. Therefore, evaluating DL systems is vital to ensure successful implementation, effective use, and positive impacts on learners [27]. From the researchers’ point of view, the overall attitudes of the third-year students towards DL were positive because the faculty members in the department of maternal and newborn health nursing have been using DL in teaching their students for the last few years and they used to conduct their courses electronically in their department.
Even though the results indicated that most nursing students had intermediate computer competency (74.8%) and somewhat stable internet connection (66.8%), they had negative attitudes (60.1%) towards DL. The nursing students considered DL impersonal and lacking in expressing feelings (80.18%), resulting in less student-teacher interaction (75.66%). Findings from other studies have also pointed out that DL provides less social interaction among university students [25, 28]. There were no significant differences in students’ attitudes towards DL regarding the type of school, gender, computer ownership, level of computer competency, stable connection, and internet usage. The findings are similar to the studies conducted in Nepal, the Philippines, and West Bengal, in which there was no significant association of overall attitudes regarding DL with selected socio-demographic variables [25, 26, 29]. However, this study revealed that about half of the nursing students felt that DL was inefficient and reduced their knowledge quality. On the other hand, up to 75% preferred blended learning (incorporating both traditional classroom and DL); this finding was supported by many studies that found a positive effect of a blended learning approach among medical and nursing students [23, 30]. This type of pedagogic design was found to be a promising model in clinical health training and has extensive applicability to move health education for better client-student interaction [31].
Utilizing DL model ensures that students engage with the faculty in practical and bedside sessions. In addition, DL should be incorporated for theoretical sessions that do not require much physical interaction. The DL approach ensures flexibility and reduces crowdedness in lecture rooms, which has already been considered an issue to accommodate at the College of Health Sciences in recent years due to the increased number of students admitted to this institution [32]. Meanwhile, health education has faced some challenges during COVID-19 [35]. Medical education, for instance, has been greatly impacted globally by the pandemic [14, 33].
Moreover, senior medical students in different countries were affected negatively by the COVID-19 pandemic, as there was a huge need to provide additional workforce at the healthcare facilities [34]. Most nursing students in this study stated that the design of the DL system was difficult to use and not flexible. They also reported that the nursing faculty did not have proper infrastructure, including bandwidth connections, and thus, there were frequent system breakdowns. Students also conveyed insufficient guidance, counselling, and training before using the DL platform. From the researchers’ point of view, all these are significant obstacles hindering the effective application and acceptance of DL and, thus, its effectiveness as a learning system. These findings were mentioned in a national study (35, 36), which revealed that the major barriers Jordanian students encounter in DL are poor internet connection, information technology, software, and lack of training courses. The same findings were found among nursing students in Nepal [25].
Limitations
One of the current study’s limitations related to the study’s nature as the results cannot be generalized. Specifically, the study was conducted at two public Jordanian universities in rural cities. These universities are currently grappling with a multifaceted problem impeding the delivery of top-notch education. The issue stems from limited resources, including a shortage of faculty expertise, insufficient clinical facilities, and a lack of educational materials. These impediments prevent students from receiving a high-quality education that prepares them for the real world.
Moreover, the universities’ geographic isolation exacerbates the problem by restricting student access to diverse clinical experiences and specialized training opportunities. This limitation deprives students of gaining hands-on experience and exposure to real-world scenarios, which are critical components of their education. Another limitation is using the convenience sampling method. Even thought of these limitations, this study also has strengths point, as the present study has a high response rate (71%), in addition, to adopt well known questionnaires.
Conclusion
In this study, it is necessary to recognize the unique challenges and opportunities that nursing students may face when utilizing DL in rural areas in Jordan. By scrutinizing the associations between perceived value, attitudes, and academic motivation, we can provide valuable visions that can expand the quality of health education, which will result in the best quality of health care. In the end, DL showed a promising effect on health education, which needs more attention from educators, as we cannot separate health education from using technology.
Acknowledgements
The authors extend their appreciation to Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2024R444), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Declarations
Ethics approval and consent to participate
The Institutional Review Board at the Al-Zaytoonah University of Jordan has approved this study (2023 − 2022/474/12). The study followed the provisions of the Declaration of Helsinki, and all participants provided informed consent. All participants were informed that their involvement was voluntary and that all data was confidential. Permission to use the study’s scales was obtained from the original authors.
Consent for publication
Not applicable.
Conflict of interest
No conflict of interest has been declared by the author(s).
Competing interests
The authors declare no competing interests.
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