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Table of Contents
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 138-142

Online learning: Indian nurses' perception and a feasibility study

1 Department of Mental Health Nursing, Ramaiah Institute of Nursing Education and Research, Bengaluru, Karnataka, India
2 Department of Nursing, NIMHANS, Bengaluru, Karnataka, India
3 Department of Mental Health Nursing, ESIC College of Nursing, Bengaluru, Karnataka, India

Date of Submission13-Oct-2021
Date of Decision11-Nov-2021
Date of Acceptance15-Nov-2021
Date of Web Publication21-Dec-2021

Correspondence Address:
G Balamurugan
Department of Mental Health Nursing, Ramaiah Institute of Nursing Education and Research, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/iopn.iopn_86_21

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How to cite this article:
Balamurugan G, Govindan R, Vijayarani M. Online learning: Indian nurses' perception and a feasibility study. Indian J Psy Nsg 2021;18:138-42

How to cite this URL:
Balamurugan G, Govindan R, Vijayarani M. Online learning: Indian nurses' perception and a feasibility study. Indian J Psy Nsg [serial online] 2021 [cited 2022 Aug 15];18:138-42. Available from: https://www.ijpn.in/text.asp?2021/18/2/138/332803

  Introduction Top

The field of healthcare is constantly evolving and improving through advancements in technology and knowledge. Therefore, healthcare professionals need to be up-to-date to deliver quality care to their customers.[1] Continuing education will help healthcare professionals to keep them up-to-date with recent advancements in their respective fields.[2] There are various ways and means of continuing education such as conferences, workshops, journals, research articles, online learning, etc.

Continuing education will provide a mechanism for all professional colleagues to share their knowledge and learn from others' experiences.[3] There are various disciplines involved in healthcare delivery such as physicians, nurses, pharmacists, and physiotherapists. CE serves as a networking platform, which improves interdisciplinary collaboration.

  Need for the Study Top

Being the largest healthcare workforce,[4] nurses are no longer exempted from updating their knowledge and skill. In earlier years, the state nursing councils issues Life Membership to the Nurses in India; hence, the nurses were least bothered about Continuing Nursing Education (CNE). However, in the year 2012–2013, the Central Government of India and Indian Nursing Council has directed the state nursing councils to renew the license of its member every 5 years with stipulated CNE credit points.[5]

Based on the new guidelines, a Registered Nurse (RN) should earn 30 CNE credit points/year for 5 years, totaling 150 credit points to renew his/her license. As per the National Health Profile (2018), there are 1,980,536 RNs registered in various state nursing councils.[4] These 19 lakh nurses are in need to attend conferences, workshops, seminars, etc., to earn their credit points. As per the CNE guidelines of TamilNadu State Nurses and Midwives Council, a 1-day CNE program (approved by the State Nursing Council) carries 4–6 credit points.[6] Therefore, each RN should attend at least 5–8 days of the CNE program per year, to earn 150 credit hours in 5 years.

This is a big challenge for Indian Nursing Professionals, to provide an opportunity for all these 19 and odd RN to obtain CNE credit points through conferences, workshops, etc., At the same time, such license renewal guidelines are successfully followed in developed countries, which may be attributable to the availability of online CNE learning modules.[7] Online CNEs will be one of the measures to meet this challenge.

Hence, as a part of ISPN Indian Society of Psychiatric Nurses, we have developed an online module on Mental Status Examination (MSE) as a pilot project, intending to assess the perception of Indian nursing professionals in taking online modules as CNE credit points and to find the feasibility to start such modules in future.

  Methods Top

The online module on Mental Status Examination

The Moodle cloud platform is used to design this module. This module covers different aspects of MSE such as general appearance and behavior, psychomotor activity, speech, thought, mood and affect, perception, and cognitive functions. All these aspects are covered in 32 videos with a total duration of 67.8 mins, ranges from 0.18 to 7.02 min [Table 1].
Table 1: List of videos

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Selection of sample

An email in this regard was sent to all the members of ISPN India. Similar emails were sent to the delegates, who attended the annual ISPN India national conference during the year 2018, 2019, and 2020. And in a letter to the editor, an online invite was in the Indian Journal of Psychiatric Nursing.

Delivery of the module

The interested learners are asked to create a profile in the ISPN India learning center platform (https://ispnindialc.moodlecloud.com/login/index.php). After verification of the profile, the module is activated for the registered learners. Then, the learner needs to undergo a pretest followed by the MSE modules. The module is designed in such a way that the learner should complete one section before moving to the next. After completing the entire modules, the learners have to complete the post-test, online learner's perception survey, and The Constructivist On-Line Learning Environment Survey (COLLES).


The following online scales are used to collect the data:

Pretest and posttest knowledge questionnaire

This scale consists of 10 Multiple Choice Questions related to the topics covered in the module. Each correct answer carries 1 mark, whereas wrong answers are awarded as '0'. The total score ranges from 0 to 10.

Online learner's perception survey

There are nine items on this scale, of which four items are open-ended. The remaining five items are in the form of a 5-point rating scale such as online is much more effective, online is somewhat more effective, online is equally effective, online is somewhat less effective, and online is much less effective.

The Constructivist On-Line Learning Environment Survey

This scale was developed by Peter Charles Taylor and Dorit Maor Curtin University of Technology. The COLLES comprises 24 statements grouped into six scales: Relevance, reflection, interactivity, tutor support, peer support, and interpretation. The COLLES contains a 5-point Likert-type response scale - Almost Never (1), Seldom (2), Sometimes (3), Often (4), Almost Always (5) - with scores shown in parentheses.

  Results Top

Learner characteristics

From March 2018 to August 2021, around 513 learners underwent this module [Figure 1]. A high number of learners were from Bangalore (126/513) followed by Anand (40/513) and Tezpur (35/513).
Figure 1: Number of learners from March 2018 to August 2021

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Knowledge enhancement

[Table 2] shows that there is a significant improvement in the knowledge of the learners from pretest (7.245 ± 2.642) to posttest (8.181 ± 2.256, t = 6.205, P < 0.001). This shows that this online module is significantly effective in improving the knowledge of the learners.
Table 2: Effectiveness of online module on knowledge regarding mental status examination (n=513)

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Online learner's perception survey

[Table 3] depicts that nearly one-fourth of the learners felt that online learning is equally effective when compared to regular classrooms in terms of convenience, meeting individual needs, communication in class, sense of community, and promotion of student participation. Around one-third of the learners felt that online is somewhat more effective than regular classrooms in terms of convenience and meeting individual needs. As far as communication is concerned, 30.2% of the learners said that online is somewhat less effective than in regular classrooms. Around 31.4% of the learners felt that online is much less effective than regular classrooms in terms of increasing interaction with the instructor and fellow students.
Table 3: Online learner's perception survey (n=513)

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[Figure 2] explains that more than half of the learners preferred a combined class format with online and regular classrooms, whereas 27.5% of them preferred for classroom and 14% preferred an online format.
Figure 2: Preferred class format

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All the learners expressed their interest to obtain CNE credit points and a certificate of completion for this module. Moreover, the learners suggested the following topics for the online modules.

  • Mini-MSE
  • Neurological examination
  • Process recording
  • Schizophrenia
  • Bipolar disorders
  • De-addiction
  • Somatoform disorders
  • Psychosocial therapies
  • Counseling
  • Psychotropic drugs
  • Psychological first aid.

The constructivist online learning environment survey

[Figure 3] depicts that the actual and preferred expectations were almost matched for "relevance and reflective thinking," and in the other four domains, the preferred expectation is slightly higher than the actual.
Figure 3: The overall feedback

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Similarly, the following six figures [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8],[Figure 9] compare the learners' expectations versus the actual in this MSE online module.
Figure 4: Relevance

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Figure 5: Reflective thinking

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Figure 6: Interactivity

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Figure 7: Tutor support

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Figure 8: Peer support

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Figure 9: Interpretation

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  Recommendations Top

  • Thus the current study recommends that online learning is one of the reliable modes of learning to help the learners to learn at their own pace and interest
  • The study suggests that a combination of both online and offline may be very helpful for the learners to clarify the concepts and doubts
  • Furthermore, credit points need to be given for such kind of online module to patch up the difficulty of attending the CNE in offline mode
  • The study also suggests that certain selected areas need to be identified based on the need of the learners and the modules may be prepared and validated
  • Also after getting the apex body approval a valid credit point may be awarded for the learners based on the content coverage and time duration.

  Conclusion Top

Though the online mode of studying has its drawbacks it has its benefits and opportunities. Along with the traditional methods of learning online learning, do pose an opportunity for the learners to update and enhance their knowledge. It would help them to keep themselves updated. Shortly, ISPN India would develop similar online modules based on the needs and interests of the learners.


We profoundly thank all the Executive Committee members of ISPN India for providing an opportunity to develop and test this online module. We sincerely thank all the participants, who underwent this module, spared their time, and shared their valuable feedback.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Quan K. The Importance of Nursing Continuing Education-Nursing CE. Nursingce; 2018. Available from: https://www.nursingce.com/blog/the-importance-of-continuing-education-for-nurses. [Last accessed on 2018 Sep 04].  Back to cited text no. 1
Ryan C, Young L, McAllister M. The impact of an online learning platform about nursing education on enrolled nurse preceptor teaching capabilities: A pre–post-test evaluation. Contemp Nurse 2017;53:335-47.  Back to cited text no. 2
Syed-Mohamad SM, Pardi KW, Zainal NA, Ismail Z. Expanding nursing education through e-learning: A case study in Malaysia. Stud Health Technol Inform 2006;122:186-9.  Back to cited text no. 3
CBHI. National Health Profile. Central Bureau of Health Intelligence. New Delhi; 2018. Available from: http://www.indiaenvironmentportal.org.in/files/file/NHP 2018.pdf. [Last accessed on 2018 Sep 06].  Back to cited text no. 4
TNNMC. Licensure to be Renewed. Tamilnadu Nurses and Midwives Council; 2013. Available from: http://www.tamilnadunursingcouncil.com/qualification_renewal.php. [Last accessed on 2018 Sep 04].  Back to cited text no. 5
TNMC. CONTINUING NURSING EDUCATION (CNE) in MODERN NURSING. Chennai; 2017. Available from: http://www.tamilnadunursingcouncil.com/images/cne/GUIDELINES.pdf. [Last accessed on 2018 Sep 04].  Back to cited text no. 6
Lee MK, Park BK. Effects of flipped learning using online materials in a surgical nursing practicum: A pilot stratified group-randomized trial. Healthc Inform Res 2018;24:69-78.  Back to cited text no. 7


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]

  [Table 1], [Table 2], [Table 3]


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