Objective: To compare the effects of synchronous and asynchronous training on the academic achievements and e-learning attitudes of nursing student trained in colostomy and ileostomy care.
Method: The quasi-experimental, descriptive study was conducted at the Nursing Department of a health facility after approval from the Tekirdag Namik Kemal University, Tekirdag, Turkey, from May to June 2020, and comprised nursing students who were divided in intervention group A and control group B. Those in group A were given synchronous training on colostomy and ileostomy care using active learning techniques on an online platform, while those group B received their training only asynchronously. Data was collected using Colostomy and Ileostomy Knowledge Test, and the e-Learning Attitude Scale at baseline and post-intervention. Data was analysed using SPSS 17.
Results: Of the 154 students, there were 77(50%) in each of the two groups. Overall, 53(34.4%) students were in 2nd grade, 60(39%) in 3rd, and 41(26.6%) in 4th grade of their training. The mean age of the sample was 21.50±1.10 years. Post-intervention mean scores for knowledge and e-learning tendency were significantly higher in both the groups compared to the baseline (p<0.01). Mean score for e-learning avoidance was significantly lower and mean knowledge score was significantly higher in group A than group B (p<0.05).
Conclusion: The application of active learning activities among students was found to have a positive effect on nursing education compared to asynchronous teaching.
Keywords: Nursing student, Distance learning, Academic success, E-learning. (JPMA 72: 1553; 2022)
The coronavirus disease-2019 (COVID-19) pandemic, which affected the world, has caused many changes in education. Nursing education has been rapidly changing to become more digital and accessible to meet the demands and educational needs of the students. The changing nature of communication and interaction has affected all other aspects of teaching,1,2 especially e-learning through information technology (IT) has been used frequently in distance learning. Students have started to receive their education synchronously or asynchronously, which has increased the need for more interactive learning systems.1 While in synchronous training, two-way communication and mutual interaction happen simultaneously, in asynchronous training, the course content is prepared in advance and delivered to learners via the internet.3 In nursing education during the pandemic, cognitive, psychomotor, and affective domains are provided to the learner through synchronous or asynchronous training to make the nursing students' learning meaningful by promoting critical thinking and interpretation skills.4 While students try to gain more from online learning, educators likewise evaluate how they can teach more efficiently.5,6 Especially in the context of COVID-19, educators' adaptation to changing technology, learning theories and changing educational needs may have an impact on students' academic achievement and e-learning attitudes in distance learning.4 Distance education practices in Turkey, especially in nursing, have a short history and limited experience.7 The current study was planned to compare the academic achievements and e-learning attitudes of nursing students who received synchronous or asynchronous training in colostomy and ileostomy care.
Subjects and Methods
The quasi-experimental, descriptive study was conducted from May to June 2020 at the Nursing Department of a health facility after approval from the ethics review committee of Tekirdag Namik Kemal University, Tekirdag, Turkey. The sample size was calculated using G-Power8 for Windows v3.1.9, with interactions between the repeated-measures factors and between-group factors set according to a previous study9 with power 0.8, a 0.05 and effect size 0.46. Considering a loss rate of 10%, the sample size was inflated by that much. A pilot study was conducted with 15 students to check the comprehensibility of the questionnaires and scales. These students were not included in the main study.
After written permission from school the students were enrolled after taking informed consent from each of them. All students were clearly informed that their refusal to participate will not affect them in any way. Based on their weighted grade point average (GPA), students who took the surgical nursing course and volunteered to participate in the study were included divided into non-random intervention group A and control group B (Figure-1). The participants were restrained from discussing the content of teaching material during the research progress to avoid any inaccuracies in the results. Basic data was collected using a Student Data Form that had eight questions about the socio-demographic characteristics, including, age, grade, and internet access information. The Colostomy and Ileostomy Care Knowledge Test10 and e-Learning Attitude Scale11 were used to measure the study outcome.
Colostomy and Ileostomy Care Knowledge Test consisted of 30 questions about stoma care. The questions were reviewed by experts on this topic and validity and reliability were assessed. For each item, response options were "True", "False" or "No idea". E-learning Attitude Scale's Turkish version11 consists of 20 items that are scored on a 5-point Likert scale, ranging from "Strongly Disagree" to "Strongly Agree"5. The Cronbach a coefficient of the scale was calculated as 0.93 for 10 positive items and 0.84 for 10 negative items. The alpha value for the 20 items of the scale was 0.93. The Kaiser-Meyer-Olkin (KMO) value was 0.95 and the Bartlett test was significant (p=0.00).
A study12 determined the preferences of students with various learning styles regarding online learning subjects and found that students mostly preferred video lectures. As such, a 90-minute video, including theoretical presentation and nursing skills presentation about colostomy and ileostomy care, was prepared by the trainer. Educational objectives related to the subject were defined and the content was designed in the light of national and international literature.13,14 Video images were used as materials to provide information.15 The video was shot in a lab environment. The video flow plan included the introduction of the materials to be used in the relevant skill and the implementation of all steps by the instructor in line with the skill checklist.15 In the videos, the trainer showed all the implementation steps and explained them aloud.
The Colostomy and Ileostomy Care Knowledge Test and the E-Learning Attitude Scale were applied to each of the two group before the training. Those in group A were given synchronous training on colostomy and ileostomy care using active learning techniques, while those in group B received their training only asynchronously and only videos were shared with group B students. The presentation was presented online by the same educator through an online programme. Nursing skills were both explained verbally and shown in the video. With the participation of students on the online platform in group A, active learning activities, such as question-answer and discussion, were applied, and the training ended.
After the training, the Colostomy and Ileostomy Care Knowledge Test and the E-Learning Attitude Scale were applied again.
Data was analysed using SPSS 17. Kolmogorov-Smirnov and the Shapiro-Wilk tests were used to test the normal distribution of data. Nonparametric Mann-Whitney U test was used when the variables were not normally distributed. Nonparametric Wilcoxon Test was used when examining the difference between paired data that was not normally distributed. P<0.05 was considered statistically significant.
Of the 154 students, there were 77(50%) in each of the two groups. Overall, 53(34.4%) students were in 2nd grade, 60(39%) in 3rd, and 41(26.6%) in 4th grade of their training. The mean age of the sample was 21.50±1.10 years.
Post-intervention mean scores for knowledge and e-learning tendency were significantly higher in both the groups compared to the baseline (p<0.01) (Table-1).
Mean score for e-learning avoidance was significantly lower in group A compared to group B (Table-2).
The mean knowledge score was significantly higher in group A than group B (Table-3).
Clinical practices are considered an important component of education, as they provide students with the opportunity to develop and refine clinical knowledge and skills they have learned in the classroom. Clinical trainings started to be given through distance education during the pandemic period. Although the pandemic is accelerating this process, the adoption of online learning has been inevitable. The benefits of online learning provide opportunities to educate a growing number of nursing students across both temporal and geographic boundaries.16 The current results demonstrated that both synchronous and asynchronous colostomy and ileostomy care training increased academic success and e-learning tendency of both the intervention and control groups. However, synchronous training was more effective. Ogbonna et al.17 compared asynchronous and synchronous training and found that both types of training significantly increased students' success and skill acquisition. Students who received asynchronous training reported higher cognitive achievement, while students who received synchronous training showed improved skill acquisition.17
After the training, the mean scores for e-learning tendency increased in both the groups in the current study. A potential strategy to keep education uninterrupted during COVID-19 is to bring together technologies that facilitate simultaneous distance learning. Combining web-based modules, simulation environments and discussion boards can be used to improve the work and communication skills of the students.18 Largely, webinars offer digital learning environments that students can access from anywhere with their computer devices. A study observed that the integration of synchronous webinars into the distance education curriculum and blended learning programme was effective.19 Technology skills of students who receive education as synchronous or asynchronous also improve,20 which is consistent with the current findings. Also, e-learning avoidance score of the students in the experiment group decreased after the training. This finding suggests that the students in the experiment group were more eager towards e-learning after the training and their avoidance of e-learning decreased.
The post-training knowledge level of the experiment group was higher than that of the control group. In online education, while stakeholders reviewed how to best use online learning, educators also had the opportunity to consider how it could be taught better. The fast-paced field in which it is evolving, especially in the context of COVID-19, requires educators to keep up with changing technology, learning theories, and the changing educational needs of students.19 Some educators prefer synchronous training also because it gives learners the opportunity to engage in dialogue, discuss the topic together, and let the learner think critically.21
Martin et al.22 emphasised that instant feedback and learner-learner, learner-educator interactions are important for success in online learning. They also reported that the use of interesting content and visuals were effective in attracting learners' attention.22 Karal et al.23 investigated the perceptions of students taking synchronous courses with distance education. Some students stated that they were better motivated to the lectures with distance education. They watched the lectures without stress and stated that the lectures could be given easily with discussion and question-answer.23 Malik et al.24 compared asynchronous and synchronous education and concluded that students were more interested in synchronous education. The reason why the knowledge level of students receiving synchronous education is higher than those who receive asynchronous education may be the effectiveness of active learning methods, such as learner-educator interaction, question-answer, and discussion during education.
In terms of limitations, the current study was done at a single centre and comprised only nursing students. As such, the findings are not generalisable.
After colostomy and ileostomy care training, the level of knowledge and tendency towards e-learning of the students in the intervention and control groups increased. Also, academic success was higher in the intervention group receiving synchronous education, and e-learning avoidance was low.
Conflict of Interest: None.
Source of Funding: None.
1. Abuatiq A. E-Learning in Nursing: Tool Development for Evaluating Virtual Patient Learning Systems. Teach Learn Nurs. 2019; 14:291-97.
2. Koch LF. The nursing educator's role in e-learning: A literature review. Nurs Educ Today. 2014; 34:1382-7.
3. Elcicek M. Design and Evaluation of a Video Supported Online Learning Environment for Programming Instruction. [Online] 2019 [Cited 2021 January 25]. Available from: URL: http://acikerisim.trabzon.edu.tr/xmlui/handle/20.500.12598/333.
4. Shala DR, Jones A, Alexander N, Young S, Fairbrother G. Responding to the Challenge of a Pandemic The Rapid Conversion of Electronic Medical Record Training for Nurses From Classroom-Based Instructional Learning to a Blended Learning Approach in a Large Multisite Organization. Comput Inform Nurs. 2021; 39:171-5.
5. Korhan E, Tokem Y, Yılmaz D, Dilemek H. Video-Based Teaching and OSCE Implementation in Nursing Psychomotor Skills Education: Sharing of an Experience. İzmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2016; 1:35-7.
6. Poon J. Blended learning: an institutional approach for enhancing students' learning experiences. J Online Learn Teach. 2013; 9: 271-89.
7. Koçoğlu E, Kalın O, Tekdal D, Yigen V. Covid-19 Pandemic Process, Education at a Glance in Turkey. Int Soc Sci Stud J. 2020; 6: 2956-66.
8. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39:175-91.
9. Leszczyński P, GotlibJ, Kopański Z, Wejnarski A, Świeżewski S, Gałązkowski R. Analysis of Web-based learning methods in emergency medicine: randomized controlled trial. Arch Med Sci. 2018; 14:687-94.
10. Uslu Y, Yavuz, M. The Effect of Three Different Methods in Stoma Care Education on the Knowledge and Skill Levels of Nursing Students. Izmır: Ege University; 2017.
11. Haznedar O, Baran B. Development of a general attitude scale towards e-learning for faculty of education students. Educ Technol Theory Pract. 2012; 2:42-59.
12. Ozdemir M, Rauf Y. Preferences Towards Online Learning Object of Students with Different Learning Styles. Educ Technol Theory Pract. 2016; 6:19-45.
13. Kaplan S, Tüzer S. Effect of web-assisted learning and peer learning on the stoma care-related knowledge and skills of nursing students. Cukurova Med J. 2020; 45:604-12.
14. Zhang L, Zheng W, Cui J, Wu YL, Xu TL, Zhang HZ. Risk factors for non closure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery. Chronic Dis Transl Med. 2020; 6:188-97.
15. SoydasYeşilyurt D, Yıldız Fındık U. Effect of Preoperative Video Information on Anxiety and Satisfaction in Patients Undergoing Abdominal Surgery. Comput Inform Nurs. 2019; 37:430-6.
16. Haslam MB. What might COVID-19 have taught us about the delivery of Nurse Education, in a post-COVID-19 world? Nurs Educ Today. 2021; 97:1-10.
17. Ogbonna CG, Ibezim NE, Obi C. Synchronous Versus Asynchronous E-Learning İn Teaching Word Processing. An Experimental Approach. South Afr J Educ. 2019; 39:1-15.
18. Mootea R, Claiborneb M, Galloway A. Interprofessional education telephone simulation for campus-based pharmacy students and distance-learning family nurse practitioner students. Curr Pharm Teach Learn. 2019; 11:264-9.
19. Gegenfurtner A, Christian Ebner C. Webinars in higher education and Professional training: A meta-analysis and systematic review of randomized controlled trials. Educ Res Rev. 2019; 28:1-19.
20. Jones K, Hein LC, James L. Nursing Leadership Practicum in the Time of COVID19: A Southeastern University Experience. Nurse Lead. 2021; 19:145-9.
21. Jowsey T, Foster G, Cooper-Ioelu P, Jacobs S. Blended learning via distance in pre-registration nursing education: A scoping review. Nurs Educ Pract. 2020; 44:1-10.
22. Martin F, Parker M, Deale D. Examining Interactivity in Synchronous Virtual Classrooms. Int Rev Res Open Dist Learn. 2012; 13:228-60.
23. Karal H, Çebi A, Turgut Y. Perceptions Of Students Who Take Synchronous Courses Through VıdeoConferencıng About Distance Education. Turk Online J Educ Techno. 2011; 10:276-93.
24. Malik M, Fatima G, Hussain A, Sarwar A. E-Learning: Students' Perspectives About Asynchronous and Synchronous Resources at Higher Education Level. Bull Educ Res. 2017; 39:183–95.