American Journal of Nursing Science

2020; 9(4): 295-309

http://www.sciencepublishinggroup.com/j/ajns
doi: 10.11648/j.ajns.20200904.33
ISSN: 2328-5745 (Print); ISSN: 2328-5753 (Online)

E-learning During COVID-19 Pandemic: Obstacles Faced

Nursing Students and Its Effect on Their Attitudes While
Applying It
Gehan Mohamed Abd El-Hamed Diab1, *, Nahid Fouad Elgahsh2
1
Department of Nursing Administration, Faculty of Nursing, Menoufia University, Shebin El-Kom, Egypt
2
Department of Medical Surgical Nursing, Faculty of Nursing, Menoufia University, Shebin El-Kom, Egypt

Email address:
*
Corresponding author

To cite this article:

Gehan Mohamed Abd El-Hamed Diab, Nahid Fouad Elgahsh. E-learning During COVID-19 Pandemic: Obstacles Faced Nursing Students
and Its Effect on Their Attitudes While Applying It. American Journal of Nursing Science. Vol. 9, No. 4, 2020, pp. 295-309.
doi: 10.11648/j.ajns.20200904.33

Received: July 25, 2020; Accepted: August 7, 2020; Published: August 17, 2020

Abstract: Background: E-learning is the use of the internet and its related devices for educational purposes without
geographical restrictions, especially after the outbreak of the coronavirus pandemic, which led to a disruption of education in
the classrooms in Egypt and around the world. Teaching and learning via the internet is a novel experience for most teachers
and students. Aim: to investigate the effect of obstacles faced nursing students on their attitudes towards e-learning while
applying it during COVID-19 pandemic. Design: A descriptive correlational research design. Setting: The study was
conducted at Faculty of Nursing, Menoufia University, Egypt. Subjects: A stratified random sample technique was employed
for the selection of 30% from the students in each of the four academic years enrolled in Faculty of Nursing, Menoufia
University during the academic year 2019/2020. Tools: Interviewing questionnaire, attitude towards e-learning scale, and
obstacles of e-learning questionnaires. Results: The results revealed that overall, 61.6% of students had negative attitudes
towards e-learning. There was the highest level of total obstacles present among academic students in the first year were
(67.6%) and the lowest level of total obstacles present among academic students in the fourth year was (55.7%) that faced
nursing students during using e-learning. the most common dimensions of obstacles to e-learning were infrastructure and
technology, technical and management support, and instructors' characteristics (87.1%, 85.2%, and 82.9%, respectively).
Conclusions: There was a high statistically significant negative correlation between obstacles facing nursing students, and their
attitudes toward e-learning. Recommendations: The Board Directors of the Faculty of Nursing must take the necessary
measures to improve electronic learning and teaching during the closure. Also, a systematic strategy should be followed to
implement e-learning since it is a new experience for Menoufia University.

Keywords: Attitude, COVID-19, E-Learning, Nursing Students, Obstacles

administrations [1, 2].

1. Introduction After the World Health Organization declared a state of a
Nowadays, with the rapid growth of knowledge, a new global emergency due to the outbreak of the COVID-19
approach has been developed to provide educational content pandemic and the Egyptian government has restricted
and facilitate interaction between the learner and the teacher community mobilization to prevent the spread of the disease
around the world using the computer network known as e- [3]. Teachers in different countries began to use e-learning in
learning, and thus universities around the world attempt to education and teaching for students during this period.
take the maximum benefit out from the technological Universities around the world are trying to make the most of
revolutions and provide a better teaching-learning the technological revolution and provide a better educational
environment for various Students, teachers, and learning environment for different stakeholders [4].
 American Journal of Nursing Science 2020; 9(4): 295-309 296

E-learning is defined as "Learning facilitated and learning features and the third group include a set of
supported through the use of information and "contextual inhibitors” related to external variables that
communications technology". It can cover a spectrum of include a lack of ICT skills and organizational support in the
activities from the use of technology to support learning as use of learning techniques [18].
part of a ‘blended’ approach (a combination of traditional Higher education institutions all over the world face a
and e-learning approaches), to learning that is delivered variety of challenges related to the successful
entirely online. Whatever the technology, however, learning implementation, maintenance and development of online
is the vital element [5]. programs. Challenges affecting online learning in the Middle
Electronic learning is a powerful tool that transforms the East include low internet penetration, low public appreciation
traditional method of learning because it strengthens the for online learning, and a lack of online educational
capacity of teaching and learning [6]. It also provides repositories [13]. Furthermore, challenges lead to failure of
interactivity and active learning, which promotes online education are institutional factors such as lack of
collaboration and idea-sharing among students and understanding of online education, patterns of online
instructors [7]. E-learning can be more flexible and offers a learning, lack of management support for online education,
substitution learning of the traditional classroom model and it number of students enrolled, and faculty qualifications [19].
is a process to enhance study by gaining or supporting the In a previous study for Salloum et al. [20], it investigated
distribution of knowledge, through several technological the factors that influenced university students' acceptance of
methods such as audio chatting, video conferencing, and e-learning systems, and the study proposed a new model that
online discussion [8]. examined the impact of innovation, quality, trust, and
E-learning has an important method in education for its knowledge as key factors that enhance the acceptance of e-
efficiency in providing education with a cost-effective learning. In another previous study was discussing the
solution for ease of accessibility at anytime and anywhere for barriers that affect the implementation of e-learning and these
universities and lecturers, and students [9, 10, 11]. Positive barriers were classified into four critical dimensions: learners
developments in internet and telecommunications and teachers, infrastructure, technology, and institutional
technologies have removed time, distance and space barriers management. [21].
and have created a lot of free time in learning and teaching The COVID-19 pandemic had affected faculties, students,
activities and these are fundamental changes in the learning and teachers and the Ministry of Higher Education in Egypt
environment [12]. has recognized the needs of implementation E-Learning in
The proliferation of online learning programs is changing public universities to maintain the teaching and learning
the way teachers view and engage with learning worldwide process. The Universities have implemented e-learning
because of increased online education opportunities [13]. although the universities had little or no experience in e-
Consequently, e-learning is an opportunity to learn without learning and not prepared for e-resources for the teaching and
restrictions due to geographical or temporal constraints. So, learning process faced difficulties and obstacles especially
e-learning is a good option for lifelong learning through when teachers and students do not understand how to use
enhanced access to education [14]. Technology creates online applications [22].
sustainable opportunities for the academic and professional
growth of people and their role as participants and 1.1. Significant of the Study
beneficiaries of institutional and social activities [15]. In light of the conditions that pass through Egypt and with
E-learning provides the technical and logistical benefits to the World Health Organization declaring the COVID-19
learners in terms of flexibility, comfort and ease of virtual pandemic [3] and the lifting of preventive measures in many
learning, and students may not necessarily need to attend a Arab countries, which included the closure of schools and
pre-scheduled classroom lecture, which allows them the universities entirely in some countries, and called on the
freedom and choice and save their time and money to travel Ministry of Higher Education in Egypt to using e-learning as
to the campus [16]. a means to ensure the continuity of the educational process
Although the e-learning providing for the higher education and not to lose an academic year for students. Educational
institutions many educational benefits. Conversely, there institutions are presented with surmounting challenges in its
remain many challenges and obstacles which obstruct using education system and this pandemic will have an impact on
it's effectively. The process of integrating e-learning into the educational and there will be a drop especially in national
teaching and learning can be a complex procedure that may examinations [23]. Therefore, the Faculty of Nursing,
face several difficulties that are sometimes called barriers or Menoufia University, sought to introduce and apply an e-
obstacles to integrating e-learning [17]. learning system to complete the teaching of courses for all
The obstacles to using e-learning are classified into three students of the Faculty of Nursing. From the researcher's
groups. The first is called "personal challenges." This group review of the literature, no studies were investigating the
includes factors associated with internal personality traits, actual obstacles facing students while using the e-learning
behavior characteristics and habits. The second group is system So, the present study aimed to investigate the effect
"attitudinal inhibitors". The internal variables that are most of obstacles faced nursing students on their attitudes towards
relevant to users ’attitudes and perspectives regarding e- e-learning while applying it during the COVID-19 pandemic
297 Gehan Mohamed Abd El-Hamed Diab and Nahid Fouad Elgahsh. E-learning During COVID-19 Pandemic:
Obstacles Faced Nursing Students and Its Effect on Their Attitudes While Applying It

to address and overcome these obstacles and to enhance the 2.4.1. Inclusion Criteria
use of e-learning later as an essential rather than an Students were willing to participate in the study and used
emergency educational tool. Also, the results of this research electronic learning and enrolled in the academic year 2019-
might be leading to provide clear insights that could be 2020.
contributing to the effective implementation of E-learning in
the Egypt Higher Education System. 2.4.2. Exclusion Criteria
Students were not accepting to participate in the study.
1.2. Aim of the Study
2.5. Tools for Data Collection
The aim of this study was to investigate the effect of
obstacles faced nursing students on their attitudes towards e- To fulfill the aim of the study, three tools were used for
learning while applying it during COVID-19 pandemic. data collection.

1.3. Research Question 2.5.1. First Tool: Assessment Sheet

This sheet was designed by the researchers based on
1. What are the nursing students' attitudes towards e- relevant literature [24, 25]. It included personal
learning? characteristics related to the subjects as age, gender,
2. What are the common obstacles faced by nursing residence, marital status, academic years, devices for e-
students during applying e-learning? learning activities, internet facility at home, and years of
3. What is the correlation between obstacles faced by experience in using a computer.
nursing students and their attitudes towards e-learning?
4. Is there a relation between the students’ demographics 2.5.2. Second Tool: Attitude Towards E-learning Scale
characters, obstacles faced, and their attitude towards e- It was developed by the researchers based on relevant
learning? literature [26, 27]. It consisted of 18 questions to assess the
attitudes of nursing students toward e-learning. It contained
three domains: E-learning usefulness 6 items, E-learning ease
2. Subject and Method of use 6 items, and behavioral intension 6 items.
2.1. Research Design Scoring system:
The subjects' response was rated on a five-point Likert
A descriptive correlational research design was utilized. Scale from “1” (strongly disagree) to “5” (strongly agree).
The score of the items was summed-up and the total divided
2.2. Variables of the Study by the number of the items, giving a mean score for each
2.2.1. Independent Variable domain of the e-learning were calculated, and mean overall
E-learning obstacles dimensions which included: Learners’ scores were calculated as well, summing all three domains
characteristics, Technical and Management support, gives an overall score for student attitudes toward e-learning.
Infrastructure and technology, Curriculum content, and These scores were converted into a percent score. The scores
Instructors’ characteristics. of less than 60% were considered negative attitudes, while
the scores of 60% and more were considered positive
2.2.2. Dependent Variable attitudes toward e-learning.
Attitude towards e-learning.
2.5.3. Third Tool: Obstacles of E-learning Questionnaire
2.3. Setting It was developed by the researchers based on relevant
literature [28, 29, and 30]. It consisted of 35 questions to
The study was conducted at Faculty of Nursing, Menoufia identify obstacles facing nursing students during applying the
University, Egypt. e-learning system in the COVID-19 pandemic. It contains
2.4. Subjects five dimensions: Learners’ characteristics 5 items, Technical
and Management support 5 items, Infrastructure and
A stratified random sample technique was employed for technology 5 items, Curriculum content 5 items and
the selection of 30% from the students in each of the four Instructors’ characteristics dimension 5 items.
academic years enrolled in the Faculty of Nursing, Menoufia Scoring system:
University during the academic year 2019/2020. The sample The subjects' response was rated on a five-point Likert Scale
size was 627 student (192 were in the first year, 160 were in from “1” (strongly disagree) to “5” (strongly agree). The score
the second year, 144 were in the third year and 131 were in of the items was summed-up and the total divided by the
the fourth year) out of 2089 students enrolled in the first to number of the items, giving a mean score for each dimension
fourth years (636, 535, 481, 437 respectively) enrolled in of the obstacles of e-learning was calculated. These scores
Baccalaureate nursing program, faculty of nursing, Menoufia were converted into a percent score. The scores of 60% and
University. All undergraduate nursing students accept more it means that obstacles occurrence were present and
participation enrolled in the first to fourth years in the above while the scores of less than 60% it means that obstacles
mentioned setting. occurrence were absent during applying e-learning system.
 American Journal of Nursing Science 2020; 9(4): 295-309 298

2.6. Validity and Reliability of the Instrumentation 2.10. Statistical Analysis

2.6.1. Validity The data were collected and tabulated into the personal
Tools of data collection were translated into Arabic and computer. Statistical analysis was done using Statistical
reviewed for their content validity by five experts who were Package for Social Science (SPSS/version 23). Quantitative
selected to test the content and face validity of the data were expressed as mean and standard deviation (X±SD).
instruments. The panel included two experts from Nursing Qualitative data were expressed as number and percentage. A
Administration department, one expert from Community comparison was performed using chi-square test and
Health Nursing department (Menoufia University), and one ANOVA test. Correlation between variables was evaluated
expert from Faculty of Education (Menoufia University), and using Pearson’s correlation coefficient (r). P-value at 0.05
one expert from Nursing Education department (Cairo was used to determine the level of significance.
University). Necessary modifications and deleting of some
questions were done to reach the final valid version of the 3. Results
tools.
Table 1: Shows the demographic characteristics of the
2.6.2. Reliability study subjects. As shown in the table, the nearly equal
The tools were tested for reliability by measuring their percentage of nursing students was from each academic year.
internal consistency using Cronbach's alpha coefficient Regarding age, more than half of the students were equal 20
method. This turned to be (α = 0.90) for e-learning attitude years or less and the mean age was 19.34 ± 1.46. Moreover,
tool; (α = 0. 85) for e-learning obstacles tool. Thus indicates this table revealed that the highest percentage of nursing
a high degree of reliability for the study tools. students (58.9%) were female and (68.7%) from a rural area
2.7. Pilot Study and the majority was unmarried. Concerning devices for e-
learning activities, the majority of nursing students (90.4%)
A pilot study was conducted after the development of the had devices for e-learning activities and (64.1%) of the
tools and before starting the actual data collection. The pilot students use the mobile device for their e-learning, and
study was done on 10% of the sample who were included in (60.1%) had Internet facility at home. Regarding years of
the main study sample because they did not add any experience in using a computer, more than half of the
modifications to the study tools. students had experienced more than five years using a
computer.
2.8. Fieldwork Table 2: Presents the mean score of attitude towards e-
Data was collected upon two months started from the first learning items among the studied students. As indicated from
of April 2020 until the end of May 2020. The questionnaire the table regarding the e-learning usefulness domain, the
was published through an e-mail containing a Word file sent highest mean score (3.24±0.30&3.12±0.26 respectively)
to all student participants who were chosen according to the among the third and second year were in the item of "e-
availability and the possibility of electronic communication learning contents are informative" and the highest mean
with them. The email to the student recipients helped provide score (3.13±0.38 & 3.02±0.34 respectively) were in the item
familiarization with the goal of the study, which contained an of "e-learning enhances my learning efficiency". Also, the
informed consent statement. The consent statement also highest mean scores (3.01±1.26) among the third year were
informed the recipients about the researchers' name and in the item of "e-learning is a useful learning tool in
contact details either through E-mail, Facebook, or providing distance education". However, regarding the e-
WhatsApp. This information allowed students the learning ease of use domain, the highest mean score
opportunity to contact with the researchers if they had any (3.21±1.02 &3.20±1.00 respectively) among the second and
questions or concerns regarding the study. The statement also fourth years were in the item of "e-learning provides flexible
makes clear that participation in the study is optional. interaction with teachers and friends". As regards the
Recipients who began a survey were informed that they behavioral intension e-learning domain the highest mean
could quit participating at any time with no consequences. score (3.51±0.02, 3.44±0.06 &3.43±0.01 respectively)
among the third, second and fourth year were in the items of
2.9. Administrative and Ethical Consecrations "e-learning is efficient as a teaching method" and the lowest
mean score (1.10±0.52, 1.40±1.04 &1.42±1.00 respectively)
Written approval was obtained from the Dean of the among the first, second and fourth year were in the items of "
Nursing Faculty, Menoufia University to collect data from e-learning is better than face-to-face education in the learning
the students nursing college. The study was conducted with process".
careful attention to ethical standards of research and rights of Table 3: Shows mean scores of e-learning domains and
the participants to accept or refuse to contribute in this study total attitude score toward e-learning as reported by the
and that their information will be treated with confidentiality nursing students. As indicated from the table, the highest
and for the purpose of research. The respondents' anonymity mean score toward total attitude (53.62±11.04) for the third
was maintained as they weren't required to mention their academic year students consider the only positive attitude.
names.
299 Gehan Mohamed Abd El-Hamed Diab and Nahid Fouad Elgahsh. E-learning During COVID-19 Pandemic:
Obstacles Faced Nursing Students and Its Effect on Their Attitudes While Applying It

While the lowest mean score of the studied subjects was the practical nature of some courses are not offered
first academic (34.10±8.02). There was a statistically electronically. However, regarding the items related to the
significant difference between the students' academic years instructors’ characteristics dimension, the highest percentage
and their attitudes toward e-learning. Also, it was observed of nursing students (90.2%, 86.7% & 83.1% respectively)
from the table that all nursing students of all academic years agree/strongly agree that Difficulty contacting with academic
had a low mean score related to the easiness of using the e- staff when at home, teachers prefer conventional ways of
learning domain. Otherwise, the third and second-year teaching and research, and teacher’s delay in submitting
students had the highest mean score (23.74±4.62 & courses online on-time affects their performance.
19.56±4.36 respectively) regarding the e-learning usefulness Figure 3: Illustrates the percentage of obstacles faces
domain and third-year students had the highest mean score nursing students during using e-learning according to
(16.49±3.04) regarding the behavioral intension domain of e- academic years. There was the highest level of total obstacles
learning. present among academic students in the first year were
Figure 1: Illustrates nursing students' attitudes toward e- (67.6%) and the lowest level of total obstacles present among
learning according to their academic years. The highest academic students in the fourth year was (55.7%).
percentage among first and fourth-year students had negative Figure 4: Illustrates ranking nursing students about
attitudes toward e-learning (72.4% & 68% respectively), dimensions of obstacles of e-learning during applying it
while more than half of students in the second year have according to their perception. It showed that infrastructure
negative attitudes (54.4%). The only students in the third and technology, technical and management support, and
year have positive attitudes toward e-learning, but by slightly instructors’ characteristics were the most common
more than half (50.7%). dimensions of obstacles to e-learning (87.1%, 85.2%, &
Figure 2: Illustrates the distribution of nursing students 82.9% respectively) and the least obstacles of e-learning
according to an overall attitude toward e-learning. As dimensions were in the curriculum content dimension and
indicated by the figure, the highest percentage of nursing learners’ characteristics dimension were (69.7& 61.9%
students (61.6%) had a negative attitude towards e-learning. respectively).
While (38.4%) of the nursing students had a positive attitude Table 6: Denoted the relation between the academic years
towards using e-learning of the studied subjects and obstacles of e-learning as reported
Table 4: Presents distribution of e-learning obstacles items by the nursing students. As shown in the table, there were
regarding learners’ characteristics, technical and management statistically significant differences between the academic
support, and technical and management support dimensions years of the studied subjects regarding e learning obstacles.
from the nursing students' perspective. As indicated from the Also, it was observed from the table that all nursing students
table regarding e-learning obstacles items regarding learners’ of all academic years had the highest mean score related to
characteristics, the highest percentage of nursing students infrastructure and technology obstacles and technical and
(69.6% & 68.6% respectively) agree/strongly agree that lack management support obstacles, and curriculum content
time management skills to keep up with the pace of their obstacles. Otherwise, the third and second-year students had
courses and lack of sufficient knowledge and skill in the use the lowest mean score (17.61±3.14 &18.0±3.72 respectively)
of e-learning. However, regarding the items related to the regarding learners’ characteristics obstacles and fourth-year
dimension of technical and management support, the students had the lowest mean score (24.63±2.1) regarding
majority of nursing students (92.6%, 90.2%, &86.2% instructors’ characteristics obstacles.
respectively) agree/strongly agree that system errors and lack Table 7: Indicates the correlation coefficient (r) between e-
of access to the e-learning platform, the college does not learning obstacles dimensions and total scores of attitudes
provide technical support for using e-learning and lack towards e-learning among nursing students. It displayed that
technical assistance to handle technological problems. As there was a statistically significant negative correlation
regards the items related to the dimension of Infrastructure between the total score of attitude toward e- learning and the
and technology, the majority of nursing students (96.6%, scores of five dimensions of the obstacles regarding e-
93.0% & 90.2% respectively) agree/strongly agree that low learning, and there was a significant positive correlation
bandwidth connections with frequent breakdowns and lack of between learners’ characteristics dimension and curriculum
proper training before using e-learning platform and they content and instructors’ characteristics dimension. Also, there
suffered from e-learning system design is not flexible and was a highly significant positive correlation between
difficult to use. technical and management support and infrastructure and
Table 5: Presents distribution of e-learning obstacles items technology dimension regarding e-learning obstacles.
regarding curriculum content and instructors’ characteristics Table 8: Indicates the relation between the nursing students’
dimensions from the nursing students' perspective. As demographics characteristics, obstacles faced them and their
indicated from the table regarding e-learning obstacles items attitudes toward e-learning. The table reflected the highest
regarding curriculum content, the highest percentage of percentages of nursing students had a negative attitude toward
nursing students (84.9%, &83.1% respectively) e-learning regarding age, gender, academic years, marital
agree/strongly agree that difficult to understand the contents status, and residence, devices for e-learning activities, internet
of the subject through e-learning and concerns about the facility at home and experience in using a computer. Also, it
 American Journal of Nursing Science 2020; 9(4): 295-309 300

reflects that a highly statistically significant difference in all activities, internet facility at home and experience in using a
variables except residence and marital status was no computer. Also, no statistically significant difference between
statistically significant difference. Also, the table illustrated the the students' demographic variables and the obstacles they
highest percentages of nursing students had faced e-learning faced them, but statistically significant difference regarding
obstacles during applying it regarding age, gender, academic age, gender variables and devices to be used in conducting e-
years, marital status, residence, devices for e-learning learning activities.
Table 1. Demographic characteristics of the study subjects (n= 627).

Nursing Students (n= 627)

Demographic characteristics
NO. %
Age (years):
≤ 20 321 51.2
21:22 204 23.5
≥ 23 102 16.3
Mean±SD 19.34 ± 1.46
Range 19.0 – 23.0
Gender:
Male 258 41.1
Female 369 58.9
Residence:
Rural 431 68.7
Urban 196 31.3
Marital status:
Married 29 4.6
Not married 598 95.4
Academic years:
First year 192 30.6
Second year 160 25.5
Third year 144 23
Fourth year 131 20.9
Devices for e-learning activities:
Computer 81 13
Laptop 58 9.2
Mobile 402 64.1
Tablet 26 4.1
No Device 60 9.6
Internet facility at home:
Yes 377 60.1
No 250 39.9
Computer Use (years):
5< 298 47.5
≥5 329 52.5

Table 2. Mean score of attitude towards e- learning items among the studied students (n=627).

Academic years Mean± SD

Electronic learning items 1st year 2nd year 3rd year 4th year
(n= 192) (n= 160) (n= 144) (n= 131)
E-learning usefulness
1. E-learning contents are informative. 2.62±0.23 3.12±0.26 3.24±0.30 2.86±0.22
2. E-Learning enhances my learning efficiency. 2.52±0.33 3.02±0.34 3.13±0.38 2.76±0.31
3. E-Learning encourages me to search for additional information on the topic of learning. 1.30±0.33 1.81±0.61 2.03±0.65 1.55±0.35
4. E-learning is a useful learning tool in providing distance education. 2.23±1.15 2.73±1.22 3.01±1.26 2.47±1.17
5. E learning improves my success in my study. 1.47±1.04 1.96±1.22 2.19±1.23 1.71±1.06
6. E-learning enables me to accomplish the learning activities more quickly. 1.18±0.28 1.68±0.77 2.14±0.80 1.42±0.26
E-learning ease of use
7. It is easy for me to handle e-learning content. 1.11±0.90 2.01±0.17 2.11±0.15 2.07±0.08
8. E-learning gives all the materials I need in my studies. 2.40±0.97 2.87±1.00 3.04±0.98 2.94±0.91
9. E-learning gives facilities to manage my time efficiently. 1.09±1.01 2.05±0.15 2.07±0.13 2.01±0.06
10. E-learning makes my learning process easier. 1.26±0.91 1.72±1.05 1.74±1.02 1.74±0.96
11. E-learning reduces students educational cost. 1.38±0.06 1.81±0.44 1.85±0.43 1.78±0.35
12. E-learning provides flexible interaction with teachers and friends 2.11±0.02 3.21±1.02 3.19±0.93 3.20±1.00
Behavioral intension
13. E-learning is efficient as teaching method. 2.41±0.61 3.44±0.06 3.51±0.02 3.43±0.01
14. E learning is better than face-to-face education in learning process. 1.10±0.52 1.40±1.04 1.71±0.98 1.42±1.00
15. I prefer to use e-books for my studies. 1.12±0.72 1.48±0.71 1.62±0.67 1.44±0.65
16. I interested in studying courses that use e-learning. 1.27±0.73 1.59±0.72 2.76±0.62 1.58±0.67
301 Gehan Mohamed Abd El-Hamed Diab and Nahid Fouad Elgahsh. E-learning During COVID-19 Pandemic:
Obstacles Faced Nursing Students and Its Effect on Their Attitudes While Applying It

Academic years Mean± SD

Electronic learning items 1st year 2nd year 3rd year 4th year
(n= 192) (n= 160) (n= 144) (n= 131)
17. I recommend using e learning system for other students. 1.39±0.06 1.73±0.08 1.89±0.09 1.71±0.02
18. I enjoy using e learning system on my course 2.12±0.02 2.01±0.17 2.07±0.13 2.11±0.02

Table 3. Mean score of e-learning domains and total attitude toward e learning as reported by the nursing students (n=627).

1st year (192) 2nd year (160) 3rd year (144) 4th year (131) Total (627) P-
E-learning domains Rank ANOVA
Max Mean± SD Mean± SD Mean± SD Mean± SD Mean± SD value
E-learning usefulness 27 13.91±3.34 19.56±4.36 23.74±4.62 14.93±3.31 18.62±3.81 1
E-learning ease of use 24 9.34±3.71 12.36±3.84 13.47±3.71 14.24±3.29 12.35±3.63 3
16.51 0.000**
Behavioral intension 23 10.85±2.63 13.46±3.27 16.49±3.04 9.43±2.95 12.63±2.87
2
Total Score 74 34.10±8.02 45.39±10.27 53.62±11.04 38.47±7.45 43.23±9.21

(*) statistically significant at p<0.05 (**) highly statistically significant at p≤ 0.001

Table 4. Distribution of e-learning obstacles items regarding learners’ characteristics, technical and management support, and technical and management
support dimensions from the nursing students' perspective (n=627).

++ Disagree /
E-learning obstacles Neutral ++Agree / Agree
Disagree
Learners’ characteristics dimension
1. Lack of sufficient knowledge and skill in the use of e-learning. 14.2% 17.2% 68.6%
2. Lack of devices to use for e-learning. 77.5% 8.9% 13.6%
3. Lack confidence and shyness from learning online. 26.5% 28.1% 45.4%
4. No internet connection. 40.5% 4.5% 55.0%
5. Lack time management skills to keep up with the pace of the course. 11.7% 18.7% 69.6%
6. Lack of interaction with my colleagues through the e-learning platform. 57.2% 8.0% 34.8%
7. Lack language skills and typing skills for online learning 41.3% 8.2% 50.5%
Technical and Management support dimension
8. Faced with system errors and lack of access to the e-learning platform 4.5% 2.9% 92.6%
9. The slowness of network is an obstacle to my learning online 5.3% 11.6% 83.1%
10. Lack of support services such as tutors 42.1% 2.7% 55.2%
11. The e-learning system is unavailable most of the time. 20.4% 9.1% 70.5%
12. The college does not provide technical support for using e-learning 8.1% 1.7% 90.2%
13. University books are not compatible with the use of e-learning. 6.4% 23.1% 70.5%
14. Lack technical assistance to handle technological problems. 12.1% 1.7% 86.2%
Infrastructure and technology dimension
15. Low bandwidth connections with frequent breakdowns 1.3% 2.1% 96.6%
16. Lack of proper training before using e-learning platform. 1.8% 5.2% 93.0%
17. The cost of internet fees/charges from the private cafe' impede e-learning 26.5% 8.1% 65.4%
18. Lack of counselling during taking e-learning courses 10.6% 4.5% 84.9%
19. E-learning system design is not flexible and difficult to use 8.1% 1.7% 90.2%
20. Erratic power supply at home hinders my use of e-learning resources 32.2% 4.5% 63.3%
21. The rules and program directions in using online discussion are difficult to me. 26.5% 8.1% 65.4%

Table 5. Distribution of e-learning obstacles items regarding curriculum content and instructors’ characteristics dimensions from the nursing students'
perspective (n=627).

++ Disagree / ++Agree /
E-learning obstacles Neutral
Disagree Agree
Curriculum content dimension
22. Learning and teaching resources that are available on the e-learning system are not in accordance with the
40.5% 4.5% 55.0%
curriculum.
23. Difficult to access e-resources from the e-platform when at home 34.8% 6.2% 59.0%
24. Difficult to learn the contents of my subject using e-learning 15.6% 7.9% 76.5%
25. Difficult to understand the contents of the subject through e-learning. 10.6% 4.5% 84.9%
26. Disproportion of e-learning with curriculum content 40.5% 4.5% 55.0%
27. Concerns about the practical nature of some courses are not offered electronically 5.3% 11.6% 83.1%
28. Lecture notes are supported by multimedia tools (flash animations, simulations, videos, audios, etc.). 46.0% 16.2% 37.8%
Instructors’ characteristics dimension
29. Instructors do not have sufficient knowledge and skill to use e-learning 10.6% 4.5% 84.9%
30. My teachers not confident in using e-learning 33.3% 14.5% 52.2%
31. Lack of clear instructions from my teacher. 30.7% 1.3% 68.0%
32. Lack of timely feedback from instructor 12.9% 10.7% 76.4%
33. My teachers prefer conventional ways of teaching and research. 8.8% 4.5% 86.7%
34. My teacher’s delay in submitting courses online on time affects my performance 5.3% 11.6% 83.1%
35. Difficulty contacting with academic staff when at home 8.1% 1.7% 90.2%
 American Journal of Nursing Science 2020; 9(4): 295-309 302

Figure 1. Nursing students' attitudes toward e-learning according to their academic years (n=627).

Figure 2. Distribution of nursing students according to overall attitude toward e learning (n=627).

Table 6. Relation between academic years of the studied subject and obstacles of e-learning as reported by the nursing students (n=627).

Academic years
Obstacles Dimensions ANOVA P- value
Max 1st year (n=192) 2nd year (n=160) 3rd year (n=144) 4th year (n=131)
Learners’ characteristics 28 25.87±4.54 18.0±3.72 17.61±3.14 19.62±3.82 17.32 0.001**
Technical and Management support 35 30.21±2.31 30.72±5.45 28.67±3.88 26.64±2.31 16.42 0.001**
Infrastructure and technology 35 31.12±3.52 33.67±4.74 30.63±5.41 29.64±3.52 14.73 0.001**
Curriculum content 30 28.64±2.36 25.70±4.51 25.70±4.51 21.27±4.54 15.29 0.001**
Instructors’ characteristics 35 30.21±4.52 29.84±5.42 29.32±2.1 24.63±2.1 20.95 0.001**

(*) statistically significant at p<0.05 (**) highly statistically significant at p≤ 0.001

Figure 3. Percentage of obstacles faces nursing students during using e- learning according to academic years (n=627).
303 Gehan Mohamed Abd El-Hamed Diab and Nahid Fouad Elgahsh. E-learning During COVID-19 Pandemic:
Obstacles Faced Nursing Students and Its Effect on Their Attitudes While Applying It

Figure 4. Ranking of obstacles of E- Learning during applying it according to nursing students' perception.

Table 7. Correlation coefficient (r) between e-learning obstacles dimensions and attitudes towards e-learning among nursing students (n=627).

Total score of e- Learners’ Technical and Infrastructure Curriculum Instructors’

Variables learning attitude characteristics Management support and technology content characteristics
r P r P r P r P r P r P
Total score of e-learning attitude 1
Learners’ characteristics -0.55 0.000** 1
Technical and Management support -0.37 0.01* 0.54 0.062 1
Infrastructure and technology - 0.62 0.001** 0.59 0.074 0.62 0.001** 1
Curriculum content -0.23 0.005* 0.42 0.01* 0.68 0.001** 0.73 0.11 1
Instructors’ characteristics -0.68 0.000** 0.48 0.001** 0.72 0.06 0.62 0.23 0.98 0.001** 1

(*) statistically significant at p<0.05 (**) highly statistically significant at p≤ 0.001

Table 8. Relation between the nursing students’ demographics characteristics, obstacles faced and their attitudes toward e-learning (n=627).

Overall Attitude toward E learning E learning Obstacles

Positive Negative 2 Present Absent
Demographic characteristics X P value X2 P value
(no =241) (no=386) (no =391) (no =236)
No % No % No % No %
Age (years):
≤ 20 102 31.8 219 68.2 246 76.6 75 23.4
21:22 90 44.1 114 55.9 8.34 0.001** 99 48.5 105 51.5 14.8 0.001**
≥ 23 49 48.0 53 52.0 46 45.0 56 55.0
Gender:
Male 117 45.3 141 54.7 144 55.8 114 44.2
6.09 0.001** 5.82 0.01*
Female 124 33.6 245 66.4 247 66.9 122 33.1
Residence:
Rural 166 38.5 265 61.5 270 62.6 161 37.4
2.1 0.13 1.9 0.17
Urban 75 38.3 121 61.7 121 61.7 75 38.3
Marital status:
Married 10 34.5 19 65.5 20 69.0 9 31.0
2.5 0.11 2.6 0.10
Not married 231 38.6 367 61.4 371 62.0 227 38.0
Academic years:
First year 53 27.6 139 72.4 130 67.7 62 32.3
Second year 73 45.6 87 54.4 101 63.1 59 36.9
14.8 0.001** 4.86 .051
Third year 73 50.7 71 49.3 87 60.4 57 39.6
Fourth year 42 32.0 89 68.0 73 55.7 58 44.3
Devices for e-learning activities:
Computer 31 38.3 50 61.7 55 68.0 26 32.0
Laptop 22 38.0 36 62.0 41 70.7 17 29.3
Mobile 175 43.5 227 56.5 17.1 0.001** 234 58.2 168 41.8 7.1 0.008*
Tablet 12 46.2 14 53.8 15 58.0 11 42.0
No Device 1 1.7 59 98.3 46 76.7 14 23.3
Internet facility at home:
 American Journal of Nursing Science 2020; 9(4): 295-309 304

Overall Attitude toward E learning E learning Obstacles

Positive Negative 2 Present Absent
Demographic characteristics X P value X2 P value
(no =241) (no=386) (no =391) (no =236)
No % No % No % No %
Yes 203 53.8 174 46.2 221 58.6 156 41.4
6.23 0.072 1.8 0.14
No 38 15.2 212 84.2 170 68.0 80 32.0
Computer Use (years):
<5 33 11.0 265 89.0 186 62.4 112 37.6
6.83 0.001** 1.9 0.18
≥5 208 63.2 121 36.8 205 62.3 124 37.7

(*) statistically significant at p<0.05 (**) highly statistically significant at p≤ 0.001

attitude towards e-learning for students was highly negative

4. Discussion considered as a form of resistance and rejection from
Undoubtedly, the implementation of e-learning systems in students for a sudden change from face-to-face learning to
higher education has enabled a fundamental change in electronic learning. Also, the students are not ready for the
teaching and learning practice. The success or failure of e- practice of e-learning which is a new experience for students
learning across an organization depends on several factors. of the Faculty of Nursing at Menoufia University.
This field of science facilitates the provision of the facilities This result is similar to Abbasi et al., [32] who found that
for designing new scientific environments, which was not the overall 77% of students have negative perceptions
possible in the past. Therefore, the evaluation of e-learning towards e-learning. Also, Obaid Ullah et al., [33] reported
systems is vital to ensure successful implementation, that negative approach among students regarding online
effective use, and positive impacts on learners [31]. learning. Besides, recent systematic reviews of Betihavas et
Therefore, the aim of the present study was to investigate al., [34] and Hew and Lo, [35] indicate that e-learning
the effect of obstacles faced nursing students on their attitudes produces neutral or positive academic outcomes in
towards e-learning while applying it during the COVID-19 undergraduate nurses and health professional education.
pandemic. Four questions were answered in the present study. Regarding the overall attitude toward e-learning among
The first question was: what are the nursing students' attitudes nursing students according to their academic years, the
towards e-learning? The second was: what are the common current study showed that the highest percentage among first
obstacles faced by nursing students during applying e-learning? and fourth-year students had negative attitudes toward using
The third question was: what is the correlation between e-learning, while more than half of students in the second
obstacles faced by nursing students and their attitudes towards year have negative attitudes. The only students in the third
e-learning? And the fourth question was: what is the relation year slightly more than half have positive attitudes and the
between the students’ demographics characters, obstacles highest mean score was (53.62±11.04). From the researchers'
faced and their attitude towards e-learning? point of view, the overall attitude of the third year students
Before discussing the results related to answering the study towards e-learning was positive because the faculty members
questions, the light should be directed to socio-demographic in the Department of Maternal and Newborn Health Nursing
characteristics of the study subjects illustrated in table 1. use e-learning in teaching from previous years and they were
Demographic characteristics indicated that the nearly equal the first to do the electronic courses system in their
percentage of nursing students was from each academic year. department. While the highest percentage of first-year
Regarding age, more than half of the students were equal 20 students has negative attitudes toward using e-learning, it
years or less and the mean age was 19.34 ± 1.46. Moreover, may be because they are new to college and have no
this table revealed that the highest percentage of nursing experience using the Internet in their previous school years.
students (58.9%) were female and (68.7%) from a rural area This result agreed with Mahmoud et al., [36] who found
and the majority was unmarried. Concerning devices for e- that second and third years students had positive attitudes
learning activities, the majority of nursing students (90.4%) toward e-learning. In addition, Bhatia, [37] reported that the
had devices for e-learning activities and (64.1%) of the attitude can be negative if the student cannot adapt to the new
students use a mobile device for their e-learning and (60.1%) system because the new form of education not fits the
had Internet facility at home. Regarding years of experience students’ needs and characteristics.
in using computer, more than half of the students had Regarding the total mean scores of the three domains of
experienced more than five years using a computer. students' attitudes toward e-learning, the present study
For answering the first question was: what are the nursing showed that the highest mean scores were the e-learning
students' attitudes towards e-learning? The most important usefulness domain followed by behavioral intension and then
results of the current study were that the highest percentages e-learning ease of use domain respectively as reported by the
of nursing students approximately two-thirds of the study nursing students. Moreover; the present study showed that
sample had negative attitudes and more than one third had third and second-year students respectively had the highest
positive attitudes towards using the e-learning system to mean score related to the e-learning usefulness domain.
complete their studies and curricula during the COVID-19 Otherwise, all nursing students of all academic years had a
pandemic. From the researchers' point of view, the overall low mean score related to the easiness of using the e-learning
305 Gehan Mohamed Abd El-Hamed Diab and Nahid Fouad Elgahsh. E-learning During COVID-19 Pandemic:
Obstacles Faced Nursing Students and Its Effect on Their Attitudes While Applying It

domain. Besides, third-year students had the highest mean infrastructure. Also, Al-Azawei et al., [40] founded that most
score regarding the behavioral intension domain of e- students (62.5%) agreed that low internet bandwidth is one of
learning. All of the e-learning domains among the nursing the issues hindering the successful application of e-learning
students had statistically significant differences. in Iraq. In addition, Vershitskaya et al., [41] found that
From the researchers' point of view, the students’ poverty and lack of ICT infrastructure are the main problems
perceptions that e-learning was useful at enhancing their that have been identified as challenges of e-learning.
academic competence and providing distance education are a As for the second important obstacle identified in the
major factor influencing their overall attitude towards e- present study were obstacles of technical and management
learning. Also, almost all students have a low average score support. The majority of nursing students indicating that
regarding the ease of use of e-learning due to lack of faced with system errors and lack of access to the e-learning
technical assistance for students to handle technological platform and lack of technical assistance to handle
problems and the difficulty of using e-learning because it is a technological problems are significant obstacles in the
new experience for them, especially for first-year students. effective use of e-learning. These findings are in the same
Also, when students feel the e-learning system is easy to use line with Mohammadzadeh et al., [42] who found that
and useful this will enhance their attitude towards e-learning. technical support services will motivate continuity e-
This finding aligns with Al-Samarraie et al., [11] found learning. In addition, Ali et al., [43] reported that one of the
that users' perceptions that e-learning was useful at main barriers to the use of e-learning is technical difficulties
enhancing their performance positively influenced their such as lack of technical support, poor and outdated
attitude towards e-learning. Also, Mislinawati and computer systems and connectivity issues.
Nurmasyitah [38] shows that the students perceived the e- Regarding the third important obstacle in e-learning was
learning web-based module to be useful in improving their the characteristics of instructors' obstacles. The majority of
understanding, independence, self-discipline, motivation to nursing students reported difficulty contacting with academic
learn, and interactions with each other and with the teacher. staff when at home, and teachers do not have sufficient
In addition, Salloum et al., [20] and Aljaraideh and Al knowledge and skill to use e-learning and they delay in
Bataineh [39] reported that easiness and user-friendliness of submitting courses online on time and also, teachers prefer
e-learning systems will have an impact on individuals’ conventional ways of teaching and research. From the
acceptance and intention to use such systems. researchers' point of view, instructors are content experts and
For answering the second question was: what are the facilitators of course delivery and manage students’ learning.
common obstacles faced by nursing students during applying Therefore, the non-use of e-teaching systems by instructors
e-learning? The findings of the present study revealed five will affect learners’ attitudes toward using e-learning and any
dimensions of the obstacles regarding e-learning as obstacle in instructor's characteristics preventing students
contributors to obstructing during applying it. These from applying e-learning effectively.
obstacles have been identified as; learners’ characteristics This result is congruent with Osman et al., [44] mentioned
dimension, technical and management support, infrastructure that instructors play a pivotal role in helping the student to
and technology dimension, curriculum content dimension achieve educational objectives and they are highly active
and instructors’ characteristics dimension. These five using the e-learning system by providing fast response,
obstacles dimensions are similar among nursing students in motivation support, suggestion, and assessment can
different academic years. positively increase student satisfaction. Also, Touray et al.,
The most prevalent obstacle faced by nursing students [45] who stated that if teachers want to succeed in using
were infrastructure and technology, technical and technology in their classes, they should have a positive
management support, and instructors’ characteristics while, attitude towards the new technology implementation.
the least obstacles were the curriculum content and learners’ Otherwise, according to the results, the least obstacles
characteristics dimension as reported by nursing students. regarding e-learning identified in the present study were
According to the results of the current study, the first curriculum content and learners’ characteristics obstacles as
important obstacle was infrastructure and technology. The reported by nursing students. About two-thirds of the study
majority of nursing students reported the lack of infrastructure sample reported the difficulty of their understanding of the
at the nursing faculty to provide guidance, counseling, training contents of the subject through e-learning and the practical
before using an e-learning platform, and low bandwidth application of some courses that are not offered
connections with frequent breakdowns also, the e-learning electronically, and they lack sufficient knowledge and skill in
system design is not flexible and difficult to use. From the using e-learning and also lack the time management skill to
researchers' point of view, all these are significant obstacles keep up with the pace of the course.
hindering the effective application of e-learning and the From the researchers' point of view; students need support
strategic direction is the central feature of the organizational to develop their skills to participate effectively in e-learning
infrastructure that supports students to accept e-learning and opportunities and students' previous experiences may affect
the effectiveness of the learning system. their use of technology in their learning. Tarus et al., [46]
This finding concurs with Aljaraideh and Al Bataineh [39] explained that the successful implementation of e-learning
who found that the major barriers students encounter are poor cannot be achieved without developing individual skills.
 American Journal of Nursing Science 2020; 9(4): 295-309 306

Also, Green and Huntington [47] stated that one of the main Regarding the relation between the students' demographics
benefits of e-learning is its flexibility for learners. and the obstacles, they faced while using e-learning. The
Additionally, Mayerova and Rosicka [48] reported that present study found that there are statistically significant
students with basic computer skills will feel more interested differences in the obstacles of e-learning due to the gender
and motivated to use e-learning, meanwhile, students with no variable in favor of females, and the results indicate that
basic computer skills will feel more difficult to get engaged females faced greater obstacles when using e-learning
because they need to learn how to use the application first. compared to male students. Also, the study found that there
For answering the third question was: what is the are statistically significant differences in the obstacles to e-
correlation between obstacles faced by nursing students and learning due to the lack of devices to be used in conducting
their attitudes towards e-learning? The present study' findings e-learning activities.
revealed that there was a highly significant negative This finding contradicts with Lowes et al., [56] which indicate
correlation between the total score of attitude to e-learning that female are more interested in using e-learning than their
and each of the five dimensions of the obstacles to e-learning peers. Also, the study found that there are statistically significant
(learners’ characteristics, technical and management support, differences in the obstacles to e-learning due to the age variable
infrastructure and technology, curriculum content, and in favor of the youngest age. This study contradicts with Amro
instructors’ characteristics). et al., [57] which indicates age has no impact on academic
The result was supported by Mtebe and Raphael [49] achievement by using online learning.
found that system quality, service quality, and instructor Regarding the relation between the students' demographics
quality had a significant positive effect on learners’ and their attitude towards e-learning, the present study found
satisfaction. Moreover, this result was consistent with that male students have more positive attitudes toward e-
Mahmodi & Moghadam [50] who reported that a positive learning than female students and there are statistically
and significant relationship between student-professor significant differences between gender and their attitudes
interaction with attitude toward online interaction. In towards e-learning. This result was congruent with Rafiq [58]
addition, Kisanga [51] stated that teachers are the key who pointed out that the male students’ attitude is more
stakeholders of education and their perception of adopting e- positive than the female students’ attitude at higher
learning also has a significant impact on students’ attitude educational levels towards e-learning. But this result was
formation towards e-learning. inconsistent with Jan & Mattoo [59] who showed that no
More ever, the present study indicated that the learners’ significant influence of gender, on the attitude towards e
characteristics obstacle had a statistically significant positive learning. Also, the present study found statistically
correlation with dimensions of instructors’ characteristics and significant differences in the attitude towards e-learning due
curriculum content obstacles. The result was supported by to the age variable in favor of the youngest age and the
Mtebe and Raphael [49] who found that instructor quality has results indicate that the younger students have a negative
been found to have a significant positive effect on learners' attitude towards e-learning compared to the older students.
satisfaction with an e-learning system. In the same context, Ramadan et al., [60] found that there was no significant
these results agree with Alone and Mugabirwe [52] who association between the gender and age of participants and
found that a significant, positive correlation between the their attitudes towards using E-learning.
quality of the content in the implemented e-learning and Moreover, the current study revealed that there was a
learners’ attitude. Meanwhile, Harrandi [53] found that statistically significant difference between experiences with
carefully designed course content has a positive effect on using computer and academic years of students with their
student motivation towards e-learning. attitudes towards the use of e-learning. This result consistent
The current study indicated that there was a statistically with Xhaferi et al., [61] who reported there are statistically
significant positive correlation with dimensions of technical significant differences in the levels of attitudes towards e-
and management support obstacles and infrastructure and learning between students of the different year of study
technology obstacles, this results consistent with Naveed et students. Also, Peytcheva-Forsyth et al., [62] who indicated
al., [54] stated that for successful implementation of e- that learner' skills and experience with ICT might
learning, organizations need to ensure appropriate Hard- significantly impact on attitude towards online learning.
wares, Soft-wares, internet connectivity, and technical Finally, address and overcome these obstacles faced by
support system. Also, the current study indicated that there nursing students while applying e-learning platforms and
was a statistically significant positive correlation with improving e-teaching will affect the learners' attitude towards
dimensions of technical and management support obstacles e-learning and will encourage them to use the internet in their
and curriculum content obstacles. This finding is similar to education and communicate with their teachers and colleagues.
Mailizar et al., [55] who found the strongest correlation was
between the school level e-learning barriers and curriculum 5. Conclusion
level e-learning barrier.
For answering the fourth question was: was: what is the In light of the present study findings, it can conclude that the
relation between the students’ demographics characters, overall attitude of nursing students toward e-learning was
obstacles faced and their attitude towards e-learning? negative. The highest percentage among first and fourth-year
307 Gehan Mohamed Abd El-Hamed Diab and Nahid Fouad Elgahsh. E-learning During COVID-19 Pandemic:
Obstacles Faced Nursing Students and Its Effect on Their Attitudes While Applying It

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