In the emerging and ever-changing COVID-19 context, universities should implement a number of measures to slow the virus spread. The safety and health of students and the faculty members should be the top priority. Postponing or cancelling classroom-based class and academic activities are an essential means to protect the health of students and the faculty members. Following the government’s requirement of “nonstop teaching and learning”, almost all existing course were moved to online in a matter of days. This is an unprepared challenge for millions of faculty members and administrators and tens of million students in colleges and universities that everyone must face. In this study, although 38.8% students held positive attitudes towards online teaching, only 8.6% students admitted the effect of online teaching on Surgical Nursing was better than traditional teaching. Evidence has suggested that online learning in undergraduate nursing education is no less effective than traditional means [15, 16]. Although the advantages of online teaching including enhancing engagement, learning easier in groups, flexibility in time allocated to complete tasks have been reported, it is challenge for impaired communication due to poor network access [17]. 70.0% students experienced network interruption and excess phone data traffic resulting in poor teaching effect. During the COVID-19 pandemic, the majority of faulty members and students had encountered technical difficulties such as poor internet connection and the lack of computer. Therefore, ensure the smooth implementation of teaching activities through combined usage of multiple platforms to avoid problems such as stuck and interruption of teaching activities due to network and large visitor volume. In the online course of Surgical Nursing, lectures used various platforms including QQ group, WeChat, Tencent Classroom, Tencent Meeting, Rain Classroom and other apps for online teaching.
In order to ensure the effectiveness of online teaching, well-considered and durable teaching plans as well as emergency prepared plans for unexpected problems were prepared. Therefore, there were various types and quantities of online teaching methods such as live broadcast and online interaction, live broadcast, recording and online interaction, self-directed learning, MOOCs, Small Private Online Courses (SPOC), PPT and online interaction and answering questions online. In this study, 64.8% students admitted that they were more likely to prefer recording videos of each chapter and answering questions online. Each lesson should be limited within 40 min. Meanwhile, if you normally teach a 3-hour class, summarize its essence in a video no longer than 30 minutes [18]. Experts have suggested that lectures should not convert their entire lecture contents to videos because students are not willing to watch slides without a teacher’ face or voice [18]. Compared with traditional in-class lectures, faculty have less control online teaching, and students are more likely to “skip the class” [3]. In order to strengthen learning effectiveness and students’ high-level active learning outside of class, faculty members could release homework and reading requirements. In the course of Surgical Nursing, unit quizzes for each chapter via Rain Classroom, mind map for important knowledge points, keep class notes, reading literatures and taking videos were the common manners of homework. The most popular ways of homework were mind map (35.2%), unit quizzes (29.6%) and self-directed learning (29.6%) in this study. However, most students complained about heavy workload leading to poor effectiveness of completion of homework at initial stage of online teaching. 89.3% students admitted that they felt tired of eyes facing screen for a long time. Hence, each task was best completed within 30 min.
Practical teaching for surgical nursing skills training, as an important part of Surgical Nursing, is difficult to be implemented online. Drainage bag replacement, fracture plaster fixation and closed thoracic drainage were the main practical teaching content in the semester 2. Combined with the current actual situation, teaching plan had been appropriately revised, and training of surgical nursing skills was moved to offline after resuming classes. CBL, TBL and task-driven teaching were applicated in practical lessons online. The most effective ways implemented in practical teaching were watching videos of nursing skills (71.0%), CBL (67.3%) and describing and decomposing surgical nursing skills steps by themselves (56.8%). Evidence has shown that CBL is an effective educational method for developing critical thinking, reinforcing peers' potentials and improving diagnostic abilities [19]. Furthermore, the web-based CBL is not inferior to the traditional classroom CBL method [20]. It was worth to be noted that students were disgusted with taking videos as assignments. In order to diversity case tasks, the lecture asked students to show simple nursing skill such as shoulder joint movement, or health education by taking videos. However, only 16.0% students chose to take video clips in this study. Due to the influence of objective factors such as the network coverage of students’ area, and different family economy, students in remote villages or poor families cannot got equal education. In addition to great difference in students’ personal conditions, heavy workload was also an important factor influencing students’ willing to take video clips. In general, poor learning effectiveness and poor learning atmosphere were the disadvantages of online courses.
Insufficient pre-class preparation, limited participation in class discussion, and inadequate discussion are common phenomena in online teaching [3]. In order to solve such problems in online teaching, expert recommends that faculty should consider two phases of teaching, the offline self-learning phase and the online teaching phase [3]. In the present study, the scores of self-directed and self-efficacy were not significantly different. This outcome could possibly be attributed to the fact that students studied at home, which made students more difficult to manage themselves. Especially, the scores of awareness in self-directed learning were decreased. Students were accustomed to lecture in-class and depend on faculty direction leading to low-level active in learning online. Interestingly, the scores of learning strategies and interpersonal skills in self-directed learning were increased compared with baseline. Maybe it is because that students were required to read the course-specific literature and watch various videos in the offline self-learning phase. Meanwhile, during the COVID-19 pandemic, learning resources were more abundant and open than before, and there were more opportunities for group learning.
Critical thinking is an important skill for all nurses, as the ability to critically assess and interpret situations and to use the knowledge correctly will enable them to provide optimal comprehensive care and other services [21]. In this study, significant differences in the measure of critical thinking between online course and face-to-face class were observed due to various influencing factors, including learning surroundings, the instructors’ approaches to teach, students’ intrinsic motivation and learning strategies. However, it was reported that critical thinking is enhanced via online learning [22, 23]. This inconsistent result may be due to the fact that online teaching as part of blended teaching is well-prepared and technology-support. Among the seven subscales, the scores of truth seeking, maturity, systematicity and inquisitiveness were found to be lower than traditional teaching, suggesting that the students were week in intellectual curiosity and desire for learning, courageous about asking questions, decision-making and using organized and focused methods of reasoning. Nevertheless, the accuracy rate and the proportion of completing all unit quizzes were higher than traditional teaching. Although students actively participated in discussion online and unit quizzes, high-frequency interaction did not achieve the desired outcome and curiosity and desire for learning were still low. The best online instructors set up their courses so that students can pursue self-paced enquiry under their own initiative [18]. The progress of online teaching largely depends on students’ high-level active learning, which adheres to the educational concept of “Student-centered”. Strengthen the learning requirements, enhance the enthusiasm and initiative of self-directed learning are key factors in online teaching. Studying at home was challenge for students’ self-management due to lack of learning atmosphere. It was worth to be noted that the mean score of analyticity was higher than traditional learning, indicating that students prized the application of reasoning and the use of evidence to resolve problem.