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Evaluation of Nursing Students' Views on Education and Professional Competencies during the Coronavirus Pandemic Process

Dilek Sarpkaya^* Department of Birth and Women’s Health Nursing, Cyprus
^*Correspondence: Dilek Sarpkaya, Department of Birth and Women’s Health Nursing, Cyprus, Tel: 05338838066, Email:

Received: 01-Aug-2023, Manuscript No. Iphsj-23-13987; Editor assigned: 03-Aug-2023, Pre QC No. Iphsj-23-13987(PQ); Reviewed: 17-Aug-2023, QC No. Iphsj-23-13987; Revised: 24-Aug-2023, Manuscript No. Iphsj-23-13987(R); Published: 31-Aug-2023, DOI: 10.36648/1791- 809X.17.8.1048

Summary of relevance

Problem or issue: The coronavirus pandemic can lead to the inability to acquire the basic skills necessary for professional competence and the inability to train competent nurses.

What is already known: Some studies have explained that the coronavirus pandemic may has adversely affected the nursing education and training process.

What this paper adds: This study is first study investigating the determine of opinions and professional competencies of nursing students regarding their education during the coronavirus (Covid-19) pandemic process in Northern Cyprus. Also, since there are very few studies on this topic in the literature, its contribution is considered to be important.

Introduction

Competence is explained as “the competence to work independently and take responsibility, learning competence, communication and social competence, and field-specific competence” [2] Competence in nursing is defined as the ability of nurses to make professional judgments from the knowledge gained in nursing education and to adopt a holistic approach [1, 2]. There are internationally determined standards and guidelines that nurses must comply with in order to be competent [3, 4]. In these guidelines, it is stated that nurses should have many competent skills such as having a holistic perspective, providing appropriate effective care, clinical decision making, critical thinking, taking responsibility and functional competence [5]. Nursing students need to have sufficient practical skills as well as sufficient theoretical knowledge in order to gain sufficient nursing skills [6-8]. Therefore, the clinical experience of nursing students is very important. Clinical experience is gained when nursing students can use the knowledge and skills they learned in theoretical education in the field of practice. It also helps students gain self-confidence, autonomy and good communication skills with staff and patients in the work environment while performing clinical practice experience, critical thinking, research, and health care tasks [9].

The coronavirus (Covid-19) pandemic has adversely affected the whole world. Especially, the negativities experienced in the field of education have significantly affected the nursing education and training process. The distance measures taken to prevent the spread of the Covid 19 epidemic brought about the cancellation of face-to-face training. With the decision taken by the Council of Higher Education (YÖK) and the Higher Education Planning, Supervision, Accreditation and Coordination Board, it has been decided to continue distance education from 2019-2020. Many universities continued their education with distance education in order to prevent the spread of the epidemic towards the end of 2021. Afterwards, the hybrid model including face-toface and distance education model was applied [10] In addition to the positive aspects of distance education, it has negative aspects for both students and educators [11, 12]. During the Covid-19 pandemic, due to the inability of nursing students to receive the necessary training and lack of clinical practice, it will lead to the inability to acquire the basic skills necessary for professional competence and the inability to train competent nurses [13-17] One way to understand the impact of the pandemic on the nursing education program is for students to assess their own competencies. In this respect, it is important for nursing students to understand that they have sufficient theoretical education and clinical skills during their studies. With this study, it is thought that the awareness of the faculty and students about the deficiencies in the education program and the elimination of these deficiencies will increase by evaluating the opinions and professional competencies of nursing students in the Covid 19 pandemic. In addition, the competency levels and low competency skills determined during the pandemic process may guide the development of the missing skills of these students after graduation with the cooperation of the university and the hospital. No studies on this subject have been found in Northern Cyprus, and it is thought that the study will contribute significantly to the literature in terms of limited research on the competencies of nursing students.

The purpose of this study is to determine the opinions and professional competencies of nursing students regarding their education during the coronavirus (Covid-19) pandemic process in Northern Cyprus.

The questions of study

1. What are the views of nursing students on theoretical and practical training during the Covid-19 pandemic?

2. What is the competency level of nursing students during the Covid-19 pandemic?

3. During the Covid-19 pandemic, is there a difference between the proficiency level of nursing students and the latest school type, grade level, work experience and education, were they positively or negatively affected?

Methods

Participants and sample

This research was designed as a cross-sectional and descriptive study. The participants of the research consisted of third and fourth grade students (N=282) who were studying and clinical practice in a private Faculty of Nursing in Northern Cyprus in the 2021-2022 Spring Semester. It was aimed to reach the entire population and no sampling method was used. The sample of the study consisted of 260 students who agreed to participate in this study. Third-year nursing students included in the study could not do any laboratory work and only had the opportunity to do clinical practice for two semesters, while fourth-year students had the opportunity to do clinical practice for only one semester and three semesters of clinical practice. The reason for choosing this university within the scope of the research is that it is the first institution and the only nursing faculty to provide undergraduate education in nursing in Northern Cyprus. In addition, the fact that the number of nursing students is higher than other universities in the country and that the university has a training and research hospital for its students to do clinical practice has also formed the priority of selection at the research site. Other classes were not included in the sample, as the university's nursing faculty students were allowed to practice in the hospital during the pandemic, and because only the third and fourth grades had clinical practice in a single hospital.

Inclusion criteria of the study

• continuing the clinical practice regularly,

• studying in the Nursing Turkish program,

• it is voluntary to participate in the research.

Criteria for not being included in the sample of the study

• Not continuing clinical practice regularly,

• They are students who cannot fill the online Google survey form due to technical problems.

A total of 22 students were not included in the study because 15 students were not accepted and 7 students did not fill out the questionnaire due to technical problems.

Data tools and procedure

The data were collected through the personal information form for nursing students, the data collection form regarding the nursing education of the students during the Covid-19 pandemic, and the Nursing Students Competency Scale. The data were collected between 18 Marchand25 May 2022 via an online Google form. It takes approximately 10 minutes to fill out all the forms. In the data collection form regarding the personal information of the students; There are a total of 9 questions about age, gender, class, nationality, perception of economic status, last school completed and work experience. In the data collection form, in which students' opinions on nursing theoretical and clinical practice training during the Covid-19 pandemic were asked; there are 6 open and closed ended questions. The competency scale of nursing students includes 7-point Likert-type answer options and each of them consists of 6 closed-ended sections and 43 questions. In the first part, there are 5 questions about clinical biomedical science, in the second part 7 questions about general clinical skills, and in the third part 4 questions about critical thinking and reasoning. In addition, the fourth part consists of 6 questions about care, the fifth part consists of 15 questions about ethics and responsibility, and finally the sixth part consists of 6 questions about lifelong learning [18] The Cronbach Alpha value of this scale was determined to be between 0.91-0.98. The Turkish validity and reliability study of this scale was conducted by Ülker in 2018 [18] the total score obtained from the scale varies between 43-301 points. Scale score evaluation has no limitations, and scaling scores will indicate high or low competency.

Before starting the data collection process of the study, the final list of third and fourth year students, clinical practice rotation schedule and the information of the student representative of the classes were requested from the Dean of the Faculty of Nursing. In line with these lists, a general explanation about the research was given to the students via whatsapp groups and the Google form link was shared. Then, the student representatives were asked to state that the participating students agreed to participate in the research and that they filled out the form. At the end of the data collection process, the students were reminded by sharing the research link every week, depending on whether the number in the student list and the number of students filling out the form were reached or not.

Data analysis

As a result of the research, the analysis of the data obtained from 260 participants was evaluated with appropriate statistical methods in the IBM SPSS Statistics 22 program. In the evaluation of students' introductory information and data on nursing education; Descriptive statistics (mean, standard deviation, and percentage) were used. And, with the scale used in the research, t-test in Independent Groups was used for two-group comparisons in demographic comparisons; One-Way Analysis of Variance and Kruskal-Wallis H-Test analysis were used in comparisons of more than two groups.

Results

The mean age score of the students is 22.67±2.17. It was determined that 57.3% of the students participating in the study were between the ages of 22-23, 43.8% were in the third grade, 56.2% were in the fourth grade, and 57.7% were female students. It is noteworthy that most of the students graduated from high school with 65.0% and associate degree in the field of health with 18.8%. It was determined that 53.8% of the students within the scope of the study were working, and 60.0% of the employees were working in the field of health (Table 1). It was observed that the Covid-19 pandemic affected 21.2% of the students positively, 42.6% negatively affected them, and 36.8% were undecided in the theoretical training of nursing. For the nursing practice training received, it was seen that 20.8% had a positive effect, 51.9% had a negative effect, and 27.3% were undecided. When the views of the students regarding the nursing education proficiency they received during the pandemic were examined, it was determined that the majority of the students (57.7%) did not find the education they received sufficient. It has been observed that 70.9% of the students who were positively affected by the Covid-19 pandemic from the nursing theoretical education received found the theoretical education sufficient, 9.1% had one-to-one training and repetition of the course, and 20.0% stated that they gained awareness of hygiene and protection from diseases. It was stated that 60.9% of the students who found the theoretical education negative, found the theoretical education insufficient and 17.3% could not gain knowledge and experience. Of the students who were positively affected by the clinical practice training, 63.2% found the practice training sufficient, 22.4% stated that they gained experience, 5.5% gained efficiency from the internship, 7.4% gained awareness of hygiene and protection from diseases. stated. Students who were negatively affected by the practical training, 45.1% found the education received insufficient, 11.3% did not gain experience, 21.8% did not have the opportunity to practice, 14.3% had a lack of internship and 7%, 5 of them expressed a negative opinion about the practical training, such as the lack of laboratory training.

Table 1. Socio-demographic characteristics of the participants (N=260).

When Table 2 is examined, it is observed that the total mean score of the competency scale of nursing students is 242.10±46.17, the minimum score taken from the scale is 43, and the maximum score is 301. When the sub-score averages of the scale were examined, the highest average score was obtained from the ethics and responsibility sub-dimension, and the lowest score average was taken from the critical thinking and reasoning subdimension. Considering the total average score obtained from the competency scale in terms of age, high school type, class level, work experience and field of the students; While there was a significant difference between the students' grade level and the total mean score of the competency scale in terms of their grades (X2=9.80, p=0.02), there was no significant difference in terms of age, high school, type of work experience and field (p>0.05). Nursing fourth-year students have higher competency level scale (HÖYÖ) scores than third-year students (p<0.05). Ethics and responsibility sub-dimension total score of fourth-grade students (mean=91.80) is higher than third-year students' ethics and responsibility sub-dimension total score (mean=85.94) was found to be higher. In addition, it was determined that the subdimension scores of the students who graduated from associate degree in the field of health, lifelong learning (X2=10.26, p=0.01) and clinical biomedical science (X2=9.80, p=0.02) compared to vocational, high school and other associate degree graduates. Was found to be higher.

Considering the total score average obtained from the competency scale in terms of the views of the nursing students included in the study on the nursing education they received during Covid 19; It was found that there was no significant difference between the total score average of the nursing student competency scale of the students who evaluated the nursing theoretical education positively (p>0.05). When the total score distribution of the students from the nursing students' competency level scale (HÖYÖ) is examined in terms of their applied education levels, it has been determined that there is a significant difference between the total scores of the students who express positive opinions (253.39 44.72) and students who express negative opinions (244.41 44.22) (p<0.05). In addition, a statistically significant difference was found between the mean scores of the nursing competency sub-dimension scales in terms of nursing students' views on applied education, among all subdimension mean scores except lifelong learning and care subdimension (p<0.05).

Discussion

In this study, which was conducted with 260 nursing students in order to determine the opinions and professional competencies of nursing students regarding their education during Covid-19, the students determined that their competencies were at a good level, but it was noted that their views on nursing theoretical and applied education were mostly negative. The fact that most of the students included in the study worked in the pandemic unit of the university's own research and practice hospital or in various clinics four or five days a week due to the lack of nurses during the pandemic suggests that the students' professional competence scores increased. Celik et al. (2020), in a study involving intern nursing students, it was determined that the students had a high level of competence. In another study in which the validity and reliability study of the nursing students competency scale was conducted, it was found that the competency level of nursing students was at a good level [19] In studies conducted in different countries to examine the competency levels of nursing students, it was determined that the competency levels of the students were good [20-22] The findings obtained in our study are similar to the literature. In the literature, it was determined that competence was evaluated on nurses working in various fields and their competence levels were found to be good [23, 24].

Considering the average scores of nursing students from the subdimensions of the competency scale, it was determined that the highest score was from the ethics and responsibility dimension, and the lowest score was from the dimension of critical thinking and reasoning (Table 2). The high ethical attitudes of the students may have caused them to comply more with the ethical principles of the nursing profession. The fact that education and training techniques used to develop critical thinking and creativity in the lessons are used less is also thought to be the reason for the subdimension with the lowest score. In another study conducted with intern nurses using the same scale, it was determined that intern nurses who were determined to have good competency levels were competent in the lowest clinical biomedical science subdimension and the highest score in the ethics and responsibility sub-dimension [20, 21], it was found that the highest score was the ethics and responsibility sub-dimension, and the lowest score was the clinical biomedical science dimension [18]. In the study conducted by Hsieh and Hsu (2013), the competency level of nursing students is good, ethics and responsibility sub-dimension received the highest score, and critical thinking and reasoning sub-dimension received the lowest score [23].

Table 2. Students' Nursing students' competency scale (CINS) scores (N=26).

As can be seen, in studies conducted to evaluate the competencies of nursing students, the highest average score was obtained from the sub-dimension of ethics and responsibility and showed similarities with our study [22-24] It can be said that the reason for the high score of ethics and responsibility sub-dimension is that the ethical issues in nursing and the ethical issues taught in vocational courses that nursing students take during their nursing education have a positive effect. In studies examining the ethical sensitivity of nursing students and the effect of ethics course on ethical decision making; Nursing students' ethical sensitivities were found to be high, their adoption of ethical values above the average, and it was determined that the ethics course taken in nursing education improved the level of ethical decision-making examined the ethical decision-making levels of nursing students who took and did not take ethics courses, and stated that students who took ethics courses could make decisions about solving problems more easily in situations where ethical problems were experienced [24]. As can be seen from the results of the studies, ethics courses are of great importance for the professional professionalism of nursing students.

When the sub-dimension mean scores of the nursing students were examined in the study, it was determined that the lowest score was obtained from the critical thinking and reasoning (21.15±5.12) dimension (Table 2). In studies examining the critical thinking and problem solving skills of nursing students, it was found that these skills of the students were at low and moderate levels. In order to increase the critical thinking and reasoning levels of nursing students, increasing the courses related to critical thinking in nursing education and using methods and techniques that support critical thinking may have a positive effect on the development of these skills of the students. In addition, the effective use of education and training techniques in the clinical setting is considered important.

When the proficiency scale mean scores of the students within the scope of the study were compared according to their views on the nursing education they received during the pandemic period, the proficiency scale score sub-dimension of the students' proficiency scale score sub-dimension scores was not found statistically significant, while the other sub-dimensions were found to be significant. The skills that students gained in clinical practice increased their satisfaction and professional competence. In addition, online training during the pandemic period may have reinforced the traditional nursing education model in nursing, if the instructors have problems using interactive teaching techniques in the online environment or if the students cannot actively participate in the classes. In this respect, it is thought that the medical model in nursing has come to the fore. The fact that students carry out many practice-based courses with online support and cannot participate in activities that support education on campus did not show an increase in those who reported positive opinions on the lifelong learning sub-dimension score. In addition, due to the inability to stay in the patient rooms for a long time during the pandemic, the students may have done their routine work and stayed in the patient room for a short time, and therefore the ability to develop care proficiency may have been lacking.

Theoretical and applied courses given in the nursing education process have positive effects on students' self-perception and positive attitudes towards their nursing roles. The use of methods and techniques to develop students' competencies during the nursing education given is important in gaining their basic competencies.

Conclusion

It is recommended that all students who continue their education and training during the pandemic should improve their critical thinking and problem-solving skills before graduation, and evaluate their competence levels with the cooperation of the school and hospital after graduation and eliminate the educational deficiencies. In addition, it is recommended to repeat studies on the competence of nursing students in Northern Cyprus.

Limitations of research

The research was limited to the 3rd and 4th year nursing students of a university in Northern Cyprus who filled out the form without having any technical problems in accessing the google form. Therefore, the findings of the study cannot be generalized to other nursing education institutions in the country.

Compliance with ethical standards

The necessary written permission and the approval of the Scientific Research Ethics Committee (Date: 27.01.2022 / Decision no: YDU2022/99-1477) were obtained from the Dean of the Faculty of Nursing for the study. Permission was obtained from Ülker (2018) to use the scale within the scope of the research.

Acknowledgements

I would like to offer our thanks to the students who participated in our study and to my advisor who helped me during the process of my master thesis.

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