Distance Learning–Related Stress Among
Undergraduate Nursing Students During the
COVID-19 Pandemic
Dina Masha’al, PhD, MSN, RN; Mohammad Rababa, PhD, CNS, CPT, RN; and
Ghada Shahrour, PhD, PMHCNS, RN
ABSTRACT
Background: The COVID-19 pandemic has forced univer-
sities all over the world to transition to distance learning. The
aim of this study was to examine the stress levels, stressors,
and associated sociodemographic variables among under-
graduate nursing students as a result of the transition to
distance learning amid COVID-19. Method: This study used
a mixed-methods embedded design. A total of 355 nursing
students were recruited. The Higher Education Stress Inven-
tory was used to assess stress levels, and an open-ended
question was used to examine the sources of stress. Descrip-
tive statistics and one-way ANOVA tests were used for data
analysis. Results: Statistically significant differences in stress
levels were found based on some of the sociodemographic
characteristics of the students. Four themes representing
the stressors related to distance learning emerged from
the qualitative data. Conclusion: Distance learning-related
stress and stressors among nursing students were found to
vary based on students’ sociodemographic characteristics. [J
Nurs Educ. 2020;59(12):666-674.]
Dr. Masha’al is Assistant Professor, Adult Health Nursing Department,
Dr. Rababa is Assistant Professor, Adult Health Nursing Department, and
Dr. Shahrour is Assistant Professor, Community and Mental Health Nurs-
ing Department, Faculty of Nursing/WHO Collaborating Center, Jordan
University of Science and Technology, Irbid, Jordan.
This work was supported by Jordan University of Science and Tech-
nology (grant number 20200316). The authors thank Jordan University
of Science and Technology for the financial support and for facilitating
the study.
The authors have disclosed no potential conflicts of interest, financial
or otherwise.
Address correspondence to Dina Masha’al, PhD, MSN, RN, Assistant
Professor, Adult Health Nursing Department, Faculty of Nursing/WHO Col-
laborating Center, Jordan University of Science and Technology, P.O. Box
3030, Irbid 22110, Jordan; email: damashaal@just.edu.jo.
Received: June 22, 2020; Accepted: August 12, 2020
doi:10.3928/01484834-20201118-03
666
T
he 2019 coronavirus disease (COVID-19) is considered
an emergent public health issue worldwide. The rapid
spread of COVID-19 and the serious negative health out-
comes of contracting the virus have imposed several challenges
and reforms on several national sectors in aim of containing the
disease. Social distancing has been implemented as an essential
strategy for preventing the spread of the virus (European Center
for Disease Prevention and Control, 2020), leading educational
institutions to transition to distance learning. Therefore, one
significant challenge, imposed on education sectors worldwide,
has been to continue to meet the educational requirements of
higher education students while maintaining distance learning
and social distancing rules.
Distance learning relies on the use of electronic technologies
and media sources to conduct learning outside of the traditional
classroom. In distance learning, several web-based applications
are used to deliver video conferences, discussion forums, and
audio/video taped lectures (Sowan & Jenkins, 2013). This form
of learning has shifted the role of students from passive learners
to active participants in the learning process (Posey & Pintz,
2017; Sharples et al., 2016). Not only does such a shift pro-
mote the development of students’ critical thinking skills (Shar-
ples et al., 2016), but it also eliminates travel time and allows
students to retrieve course content at their own convenience,
therefore providing students with the flexibility for self-paced
learning (Ali et al., 2016; Bahrambeygi et al., 2018). However,
several disadvantages of distance learning have been reported.
Feelings of isolation and loss of personal contact with instruc-
tors and peers are major concerns for students (Bahrambeygi
et al., 2018; Kattoua et al., 2016; Moore 2014), in addition to
the absence of visual cues and the inability to experience the
nonverbal aspects of communication (Arbour et al., 2015). For
distance learning to be effective, certain requirements related
to course accessibility and navigation skills need to be met.
These requirements include the availability of sufficient infra-
structures, such as computers and internet access, orientation
to a learning management system (LMS), and basic computer
literacy (Sowan & Jenkins, 2013).
The implementation of distance learning due to the
COVID-19 pandemic has imposed many challenges on nursing
Copyright © SLACK Incorporated
students in Jordan, especially considering the fact that distance
learning is a first-time experience for most of these students.
The infrastructure of technology in terms of access to and use
of the internet and computers is not well-developed in Jordan.
The latest available data on internet usage in Jordan indicates
that only 35% of Jordanians have an internet subscription. Fur-
thermore, 50% of Jordanian families do not own a computer
at home, and 13% have reported a lack of knowledge regard-
ing how to use one (The Jordan Times, 2018). About 67% of
internet use among the 18 to 29 age group occurs via smart-
phones (Ghazal, 2014). Connecting with friends and family
through social media platforms has been reported as being the
main reason for internet usage among this age group (Ali et al.,
2016; Ghazal, 2014). As a result, it is assumed that the sub-
stantial number of Jordanian students without access to the in-
ternet or a computer do not meet the requirements of distance
learning. Further, these students may not be well-equipped with
the knowledge or skills necessary to navigate distance learn-
ing technologies (Akhu-Zaheya et al., 2013; Tubaishat, 2014).
Studies have shown that the lack of access to a computer or the
internet at home, especially in the case of medical or nursing
students, increases students’ stress and has a negative impact on
their participation in online learning activities (Ali et al., 2016;
Farrell et al., 2007). Moreover, the lack of skills in using an
LMS was found to decrease students’ satisfaction with distance
learning and hence negatively affect their achievement and re-
tention (Ali et al., 2016; Farrell et al., 2007). These difficulties
are compounded with the inadequate internet coverage in some
areas and the inability of some Jordanian students, particularly
rural residents, to afford internet service plans.
Lazarus and Folkman (1984) stated that stress is experienced
when a person perceives that the demands exceed the personal
and social resources a person can mobilize. Therefore, it is the
individual’s perception of the event that determines whether the
situation is threatening or not. Jordanian culture places strong
emphasis on education and academic success. Heavy workload
and assignments are the primary sources of stress among nurs-
ing students in Jordan (Hamaideh et al., 2017). Other sources
of stress are related to the clinical environment, nursing staff
and teachers, the provision of care to patients, and high paren-
tal expectations (Akhu-Zaheya et al., 2015; Hamaideh et al.,
2017; Khater et al., 2014; Shaban et al., 2012). Further, certain
sociodemographic characteristics can also influence stress lev-
els. The majority of studies in the literature have shown that
female students and/or students with low family income have
higher stress levels compared with other students (Amanya et
al., 2017; Preto et al., 2018; Ribeiro et al., 2020). Meanwhile,
controversial results have been reported regarding whether ju-
nior students or senior students experience the highest stress
levels (Admi et al., 2018; Aslan & Akturk, 2018; Ribeiro et al.,
2020). As for the current study, the main aim was to investigate
students’ perceptions toward the transition to distance learning
during the COVID-19 pandemic. More specifically, this study
aimed to (a) examine the effect of students’ sociodemographic
characteristics on the stress levels and stressors experienced by
nursing students as a result of transitioning to distance learning
during the COVID-19 pandemic, and (b) identify the sources of
stress related to this transition.
Journal of Nursing Education • Vol. 59, No. 12, 2020
METHOD
Design, Sample, and Setting
A mixed-methods, embedded design was used in this study,
whereby qualitative data was used to support the quantitative
findings. This design was chosen to gain an in-depth under-
standing of the stress levels and stressors experienced by nurs-
ing students as a result of transitioning to distance learning and
to validate the results of the quantitative findings. All nursing
students enrolled in nursing programs across five different pub-
lic universities in Jordan at the time of data collection were
recruited conveniently. Students who were taking the semester
off or who were not enrolled in nursing courses were excluded
from the study. The corresponding universities were chosen
based on their accessibility to the researchers.
To determine the sample size, a power analysis was conduct-
ed using the G*Power program. Using ANOVA (fixed effects,
special, main effects and interactions, with a power of .90, a
medium effect size of f = .25 and an alpha of .05), it was deter-
mined that a total of 339 participants would be required (Faul et
al., 2007). In the current study, a total of 355 students completed
the study survey.
Procedure
An online survey using Google™ Forms was used for data
collection. Because all university campuses in Jordan were
closed due to the COVID-19 pandemic, the researchers found
using an online survey to be most appropriate. Online surveys
are time efficient and can be delivered to a large number of par-
ticipants from different universities in different provinces, at no
cost and at no risk to students’ health and safety.
The Institutional Review Board approval was obtained from
Jordan University of Science and Technology, after which a fa-
cilitating request to distribute the online survey to other univer-
sity websites was granted. The study purpose, procedures, and
outcomes were explained on the front page of the survey, along
with the confirmation that the participants’ identities would be
kept anonymous, that participation was voluntary, and that the
participants could quit the survey at any time with no conse-
quences. Prior to the commencement of the survey, the potential
participants were asked to click on either one of the agreement
or refusal buttons to indicate their approval or refusal to partici-
pate. The researchers’ contact information was provided, and
the participants were asked to return the survey by clicking the
“submit” button at the end of the survey.
INSTRUMENTS
Quantitative
The quantitative data were divided into two parts: the stu-
dents’ sociodemographic characteristics and the Higher Ed-
ucation Stress Inventory (Dahlin et al., 2005). The sociode-
mographic characteristics were gender, age, academic year,
number of courses enrolled in, enrollment in any clinical
courses or laboratories, internet service type, family monthly
income (classified according to the National Council for Fam-
ily Affairs [NCFA] (2017) report), type of electronic device
used for distance learning, the extent to which payment for in-
667
ternet services formed a financial burden, and the availability
of a private area to study.
The Higher Education Stress Inventory, developed by a
group of academic researchers who are experts in the area of
stress (Dahlin et al., 2005), was selected because it captures
many stressful aspects in higher education settings and is appli-
cable to a variety of higher education programs. The instrument
includes 33 items describing several stressful aspects of higher
education. A factor analysis conducted by the original author
illustrated that the instrument consisted of seven factors: wor-
ries about future endurance/competence, faculty shortcomings,
nonsupportive climate, workload, insufficient feedback, lack of
commitment, and financial concerns. Responses were scored on
a 4-point Likert scale ranging from 1 = totally disagree to 4 =
totally agree. The order was reversed for the following items, as
they describe the absence of stress: 2, 6, 8, 10, 13, 17, 19, 26,
27, and 33. The Higher Education Stress Inventory was built
based on some of the items of the Perceived Medical School
Stress scale (Vitaliano et al., 1984). Dahlin et al. (2005) found
the Higher Education Stress Inventory to have good internal
consistency reliability and the factors to correspond well with
those identified by the Perceived Medical School Stress scale.
The Cronbach’s alpha for the instrument was .85, and the alpha
values for the seven previously mentioned factors were .78, .69,
.71, .65, .65, .62, and .59, respectively. The seven factors of the
inventory explained 48.7% of the total variance, with 24 items
loading above .3 (Dahlin et al. 2005). The Cronbach’s alpha for
the inventory in our study was .77. The English version of the
inventory was used because English is the official language of
instruction in all nursing schools in Jordan. The online survey
was piloted on 15 students from the six universities. The items
of the inventory were clearly understood by the students, and no
technical problems were reported.
Qualitative
To collect more in-depth information on the sources of
stress, the survey included the following open-ended question:
“What are the sources of stress you are experiencing related to
distance learning in the context of the COVID-19 pandemic?”
Data Analysis
Data analysis was conducted using SPSS® version 26. De-
scriptive statistics, which included frequency, mean, and stan-
dard deviation, were used to describe the sociodemographic
details of the participants. A series of one-way ANOVAs were
run to examine any between-group differences in stress levels
across the sociodemographic variables. The assumptions of the
one-way ANOVA tests were checked before running the tests.
An alpha level of .05 was used to determine the statistical sig-
nificance of all inferential tests used. To demonstrate the effect
size, partial eta-squared values were reported, where .01 = small
effect size, .06 = medium effect size, and .14 = large effect size
(Cohen, 1988). One-way ANOVA tests were also conducted
for the Higher Education Stress Inventory total scale and sub-
scales. Descriptive statistics (means and standard deviation)
were used to describe the overall stress levels and stress levels
in the Higher Education Stress Inventory factors. Finally, the
students’ responses to the open-ended question were analyzed
668
using conventional content analysis (Hsieh & Shannon, 2005).
The three researchers of this study, all of whom have previous
experience in qualitative data analysis, initially reviewed the
students’ responses independently and then worked together to
code the responses and categorize them into themes. Some of
the responses were coded to more than one theme, and the fre-
quency of the themes was reported.
RESULTS
Quantitative Findings
Sociodemographic Characteristics. Over a period of 1 week,
a total of 500 nursing students accessed the survey link and 355
students completed the survey, leading to a response rate of
71%. The mean age of the participants was 20.02 (SD = 1.12),
and the majority of the participants were female (72.7%). The
students’ sociodemographic variables are illustrated in Table 1.
Nursing Students’ Overall Stress Levels. The ANOVA tests
showed family monthly income to have a significant effect on
nursing students’ stress levels [F(2, 352) = 6.85, p =.001], h2 =
.04, whereby the Tukey HSD test revealed a difference between
the stress levels of students from very low-income families
and the stress levels of students from medium- to high-income
families (p = .001). Also, significant differences in stress levels
were found based on the type of electronic device used for dis-
tance learning [F(1,353) = 8.80, p = .003], h2 = .02, the extent to
which payment for internet services formed a financial burden
[F(1,353) = 30.00, p < .00], h2 = .08, and the availability of a
private place to study [F(1,353)=56.87, p < .000], h2 = .140.
Table 1 presents the mean scores of the stress levels between
the comparison groups.
The top 10 scored items of the Higher Education Stress In-
ventory for students who came from very low-income families,
students who used smartphones for distance learning, students
who found payment for internet services to be a financial bur-
den, and students who did not have a private place to study were:
• “1. Studies control my life, and I have little time for other
activities.”
• “3. I am worried that I will not acquire all the knowledge
needed for my future profession.”
• “4. The studies have created anonymity and isolation among
students.”
• “5. The teachers often fail to clarify the aims of the studies.”
• “12. As a student, my financial situation is a worry.”
• “14. I worry about long working hours and responsibilities in
my future career.”
• “15. The training is characterized by an atmosphere where
weakness and personal shortcomings are not accepted”
• “21. There is too much focus on passive learning of facts
and too little on active seeking of knowledge and time for
reflection.”
• “30. The literature is too difficult and extensive.”
• “31. The pace of studies is too high.”
The descending order of these items for the groups of signifi-
cant ANOVAs is illustrated in Table 2.
Nursing Students’ Stress Levels in the Higher Education
Stress Inventory Factors. The factors’ scores were computed as
means of the scores of the items pertaining to each factor. The
Copyright © SLACK Incorporated
highest mean stress levels in
the Higher Education Stress TABLE 1
Inventory factors was in the Nursing Students’ Sociodemographic Characteristics (N = 355)
workload factor (M = 3.19,
Stress Level,
SD = 0.54), and the lowest Students’ Characteristics n % M (SD)
was in the low commitment
factor (M = 1.52, SD = 0.77). Age (M = 20.02, SD = 1.12)
Figure 1 presents the mean Gender
scores of the stress levels in Male 97 27.32 2.58 (0.31)
the seven factors. The results
Female 258 72.68 2.56 (0.31)
of the ANOVA tests indi-
cated significant differences Monthly income
in stress levels in most of Very low income 222 62.54 2.61 (0.30)
the Higher Education Stress Low income 115 32.39 2.50 (0.25)
Inventory factors based on
Medium to high income 18 5.07 2.49 (0.32)
gender, academic year, inter-
net type, type of electronic Academic year
device used for distance First year 60 16.90 2.55 (0.29)
learning, family income, Second year 222 62.54 2.56 (0.31)
the extent to which payment
for internet services caused Third year 41 11.55 2.65 (0.34)
a financial burden, and the Fourth year 32 9.01 2.54 (0.29)
availability of a private place Number of courses enrolled in
to study. Table A (available
Four 55 15.49 2.50 (0.31)
in the online version of this
article) presents the results Five 169 47.61 2.58 (0.32)
of the ANOVAs at the level Six 90 25.35 2.54 (0.30)
of Higher Education Stress Seven 41 11.55 2.66 (0.30)
Inventory factors.
Clinical courses/laboratory
Qualitative Findings Yes 338 95.21 2.56 (0.31)
The students’ responses to No 17 4.89 2.63 (0.32)
the open-ended question were Type of electronic device
analyzed using conventional
content analysis, where cod- Smartphone 300 84.51 2.59 (0.30)
ing categories were extracted Other (desktop computer, laptop, tablet) 55 15.49 2.45 (0.33)
directly from the text data Internet service type
(Hsieh & Shannon, 2005).
Prepaid package 215 60.56 2.57 (0.30)
Two hundred and thirty-six
students responded to the Other (home internet with limited download, 140 39.44 2.56 (0.33)
question, and the themes that unlimited download, fiber)
emerged were huge and unor- Is purchasing internet services a financial
ganized workloads, the lack burden?
of a standardized distance Yes 299 84.23 2.61 (0.29)
learning strategy, limited re- No 56 15.77 2.37 (0.35)
sources, and distracting study
environment. The students’ Do you have your own space to study at home?
responses and frequencies are Yes 142 40 2.43 (0.28)
illustrated in Table B (avail- No 213 60 2.66 (0.29)
able in the online version of
this article).

DISCUSSION tance learning-related stress and stressors among nursing stu-

Although the moderate to high stress levels among nurs-
ing students are well documented in the literature (Alzayyat &
Al-Gamal, 2014; Labrague et al., 2017; Ribeiro et al., 2020),
to our knowledge, the current study is the first to discuss dis-
dents. This study also aimed to explore the effect of nursing
students’ sociodemographic characteristics on their stress levels
in the context of the transition to distance learning during the
COVID-19 pandemic and to investigate the sources of distance
learning-related stress among this cohort.

Journal of Nursing Education • Vol. 59, No. 12, 2020 669

 TABLE 2
Descending Order of the Top 10 Stress-Generating Items Among Groups With Significant ANOVAS
Paying for Internet Services
Very Low Income Smartphones Is a Burden No Private Place to Study
Rank Item No. M (SD) Item No. M (SD) Item No. M (SD) Item No. M (SD)
1 3 3.60 (0.66) 15 3.27 (0.80) 3 3.63 (0.62) 3 3.72 (0.57)
2 30 3.49 (0.69) 12 3.22 (0.85) 30 3.46 (0.70) 30 3.52 (0.65)
3 12 3.36 (0.78) 30 3.16 (0.99) 12 3.26 (0.81) 12 3.38 (0.80)
4 15 3.27 (0.82) 31 3.16 (0.99) 4 3.21 (0.88) 4 3.27 (0.86)
5 4 3.18 (0.90) 4 3.14 (0.92) 15 3.21 (0.84) 15 3.20 (0.86)
6 31 3.14 (1.00) 21 3.14 (0.80) 31 3.17 (0.97) 31 3.20 (0.99)
7 21 3.10 (0.80) 5 3.09 (0.79) 21 3.13 (0.80) 5 3.19 (0.79)
8 5 3.09 (0.77) 14 3.07 (0.89) 5 3.12 (0.76) 21 3.15 (0.81)
9 14 3.09 (0.87) 1 2.98 (0.94) 14 3.08 (0.88) 1 3.08 (0.96)
10 1 3.00 (0.96) 3 2.98 (0.94) 1&29 3.02 (0.93) 14 3.07 (0.91)

Effects of Sociodemographic
Characteristics on Stress Levels
In line with the study by Ribeiro et al. (2020), our study
found overall stress levels to be higher among students with
low family income compared with students with a medium to
high family income. Similarly, Madian et al. (2019) found fam-
ily income to be the most significant indicator of stress among
students, whereby stress levels decreased by 26 times as family
income increased. Further, in a study by Amanya et al. (2017),
24.4% of 258 undergraduate health professional students re-
ported financial problems as being the primary source of stress.
Our results may be explained by the fact that the majority of
families in developing countries are under the poverty line and
live in environments with limited resources (Ali et al., 2016;
Amanya et al., 2017). In Jordan, 84.9% of the population are
under the poverty line (NCFA, 2017).
Although distance learning is known as being cost effective
(Barteit et al., 2020; Kattoua et al., 2016; Bahrambeygi et al.,
2018), the COVID-19 pandemic has imposed many challenges
that have hindered the success of distance learning. Many peo-
ple have lost their jobs, whereas new financial commitments
have emerged for others. Many families cannot provide their
children with the basic requirements of distance learning, such
as internet access and appropriate electronic devices (Sowan &
Jenkins, 2013). This explains the high stress levels among stu-
dents from very low-income families under the financial con-
cern factor, compared with other comparison groups. Further-
more, students from very low-income families were also found
to have higher stress levels under the insufficient feedback fac-
tor. The high cost of internet services constitutes an obstacle for
these students (Jowsey et al., 2020; Moore, 2014) and hinders
them from being able to ask questions and receive feedback
from their instructors online.
Approximately 84.5% of the participating students reported
using their smartphones for distance learning and were found
to have higher stress levels compared with students who used
other devices (i.e., desktops, tablets, laptops). Smartphones are
personal devices that can be easily used to access, manipulate,
and store information, yet many disadvantages of using smart-
phones for distance learning have been documented (Lall et al.,
2019; Zayim & Ozel, 2015). These disadvantages include the
small screen size, limited storage space, and frequent loss of
information due to system crashes (Lall et al., 2019; Raman,
2015).
Furthermore, information applications related to nursing
courses are not available on smartphones offline and therefore
need to be accessed online via university websites. The lack of
offline educational materials on smartphones and the need to
continuously purchase prepaid internet packages constituted a
financial burden for most of the students (60.6%). Also, exces-
sive phone use, the declination of battery life, and the lack of
information technology (IT) support or maintenance all reduce
the shelf life of smartphones (Raman, 2015; Zayim & Ozel,
2015), therefore increasing smartphone users’ stress levels un-
der the financial concerns factor.
The high stress levels under the faculty shortcomings fac-
tor may be a result of teachers’ inability to prepare and create
assignments and activities involving the use of smartphones.
Although students may think that teachers are simply not do-
ing their jobs (Posey & Pintz, 2017), this unpreparedness can
be attributed to the sudden transition to distance learning and
the lack of technological experience among nursing faculties
(Raman, 2015).
In the current study, a significant difference in overall stress
levels based on the financial burden of paying for internet ser-
vices was noted among students, whereby paying for internet
services constituted an additional financial burden for 84.2% of
the students. With 94.9% of the students coming from very low-
to low-income families, this finding was not surprising. Prior to
the transition to distance learning, the students had been satis-
fied with using their prepaid internet packages to check their
email and access social media platforms and using university

670 Copyright © SLACK Incorporated

libraries and computer laboratories to study (Ali et al., 2016).
However, with the transition to distance learning, students’ pre-
paid internet packages became insufficient to support the high
study workloads, which explains the high stress levels under the
financial concern and workload factors. The high study work-
loads of nursing students were found to cause the highest stress
levels in comparison with other factors, which is compatible
with many other studies (Alghamdi et al., 2019; Khater, et al.,
2014; Labrague et al., 2017). Distance learning comes with in-
creased responsibilities for students, hence making it an active,
learner-centered approach to learning (Posey & Pintz, 2017).
However, it also requires a constant and stable internet connec-
tion, which can form a financial burden for many students.
Furthermore, the burden of purchasing internet services was
found to influence the insufficient feedback, faculty shortcom-
ings, and nonsupportive climate factors, as the high stress levels
under these factors can be linked to the financial concern fac-
tor. Students without access to the internet may end up losing
communication with their teachers and classmates, which cre-
ates feelings of isolation, lack of support, frustration, and dis-
satisfaction with the distance learning experience (Jowsey et al.,
2020; Moore, 2014).
Students without a private area to study reported the highest
stress levels among all other groups and in all of the Higher Ed-
ucation Stress Inventory factors. Although the average family
size in Jordan is decreasing, families with up to 11 household
members still exist. With the average home size being 130.24
m2 and the average number of rooms being 3.4, homes in Jordan
are considered crowded and noisy (NCFA, 2017). According to
Sharma and Kaur (2011), the absence of a calm and quiet envi-
ronment increases stress levels. Noisy environments may hinder
students from completing academic work and joining live meet-
ings, leading to a lack of connection with teachers. This may
increase students’ worries regarding their preparedness for join-
ing the workforce, therefore augmenting their concerns about
not being able to pay off their study loans.
Female participants reported higher stress levels compared
with male participants under the worries about future endur-
ance⁄ competence factor. Similarly, female students in the stud-
ies by Madian et al. (2019), Aslan and Akturk (2018), Ribeiro
et al. (2020), and Preto et al. (2018) were found to experience
higher education-related stress levels compared with male
students. This may be because female nursing students often
have other responsibilities besides education, such as house-
hold chores and family care (Ribeiro et al., 2020). These high
levels of stress force females to worry about the stress of their
future professions and the long working hours. Alternatively,
these results can be explained by the fact that, in comparison
to females, males generally face greater difficulty in openly ex-
pressing their feelings and worries (Sentürk & Dogan, 2018).
Nevertheless, this finding should be interpreted with caution,
as female participants comprised 72.7% of this study’s sample.
Third-year students scored higher stress levels under the fac-
ulty shortcomings factor, compared with second-year students.
Senior nursing students have been found to have higher stress
levels compared with junior students in many studies (Aslan &
Akturk, 2018; Ribeiro et al., 2020), which may be attributed
to the increase in the academic workload of students as they
Journal of Nursing Education • Vol. 59, No. 12, 2020
Figure 1. The mean scores of stress levels in Higher Education
Stress Inventory factors.
progress in their studies (Dagistani et al., 2016). Third-year stu-
dents are usually enrolled in more specialized courses, such as
maternal and pediatric health; therefore, they may have higher
expectations and may be dissatisfied with the distance learning
guidance provided by their teachers. Students’ satisfaction has
been found to decline with the increase in difficulties and the
lack of mentorship (Aslan & Akturk, 2018).
Specialized theoretical courses in nursing programs are usu-
ally accompanied by clinical courses that require special cog-
nitive, affective, and psychomotor skills. Thus, not being able
to be present in clinical settings makes students feel that they
are missing out on a golden opportunity to acquire these skills.
This increases students’ doubts and uncertainty regarding their
preparedness for their future profession and the licensing ex-
amination at the end of their studies (Aslan & Akturk, 2018;
Ribeiro et al., 2020). Further, senior students are more aware
than other students of the complex nature of their profession;
the great responsibility of providing health care; and the ex-
posure to pain, suffering, and death that comes with nursing
(Ribeiro et al., 2020).
On the other hand, the low commitment factor was not af-
fected by most of the sociodemographic characteristics and
scored the lowest stress levels compared to other Higher Edu-
cation Stress Inventory factors. This can be explained by the
fact that the students were generally satisfied with their career
choice and felt proud of their future profession. Aslan & Akturk
(2018) and Hamaideh et al. (2017) found lower stress levels
among nursing students who had chosen to study nursing will-
ingly and who were satisfied with their profession.
Sources of Stress Related to Distance
Learning During the COVID-19 Pandemic
The themes that emerged confirmed the results of the quan-
titative findings, which indicated that the huge and unorga-
nized workloads constituted the greatest source of stress for
the students. This was in line with the majority of studies in
the literature (Amanya et al., 2017; Hamaideh et al., 2017;
Ribeiro et al., 2020). Studies have found that high academic
demands negatively influence students’ social lives, as they re-
671
duce family time and the time for rest and recreation (Amanya
et al., 2017; Madian et al., 2019; Ribeiro et al., 2020; Parveen
& Inayat, 2017).
The lack of a standardized distance learning strategy was
the second most prominent theme emerging from the qualitative
findings. According to Ali et al. (2016), transitioning to a new
learning method without preparation may lead students to feel
dissatisfied with the learning experience. Prior to transitioning
to distance learning, universities need to have a clear defini-
tion of distance learning and must create a standardized web-
site template, and faculty members must prepare themselves
through workshops that qualify them to redesign and evaluate
their courses. Further, students’ readiness for distance learning,
including their computer literacy levels and financial condi-
tions, needs to be assessed. Finally, the perceptions of students
and faculty members need to be fully captured during the imple-
mentation of distance learning (Griffiths, 2016; Posey & Pintz,
2017). In our situation, most of the previously recommended
actions could not be achieved. Despite the previous use of an
LMS by universities in Jordan, these systems were not sturdy
enough in design to support the sudden substantial use. There-
fore, many teachers began to search for other applications and
methods for teaching and communicating with students, which
was stressful for both teachers and students. This experienced
stress could be attributed to the lack of experience in technology
and to the documented poor computer skills among both nurs-
ing teachers and students in Jordan (Akhu-Zaheya et al., 2013;
Tubaishat, 2014).
As for the evaluation strategy, students generally find ex-
aminations and evaluations to be stressful (Aslan & Akturk,
2018; Labrague et al., 2017), and the lack of a clear evaluation
strategy increases students’ worries about their grades. Further,
receiving lower grades than expected increases students’ stress
levels (Al-Gamal et al., 2018; Parveen & Inayat, 2017; Sharma,
& Kaur, 2011).
The participating students considered the transition to the
limited delivery of clinical courses online through videos, as-
signments, and quizzes to be a source of stress. This is be-
cause, as supported by the findings of Madian et al. (2019), the
students were forced to practice their knowledge and skills in
a new and unfamiliar learning environment. Alzayyat and Al-
Gamal (2014) and Khater et al. (2014) found that providing
care to patients is a recurrent clinical-related source of stress.
Further, Liu et al. (2015) and Parveen and Inayat (2017) re-
ported the fear of making mistakes in the clinical placement to
be one of the highest scored stressors among nursing students.
In our opinion, these fears have been doubled with the sudden
transition to distance learning and the hindrance to clinical
training. Students may have developed fears of graduating as
incompetent nurses who are prone to making mistakes in the
workplace due to the poor quality of the clinical practice they
received online.
Furthermore, the participating students frequently com-
plained about the poor infrastructure of distance learning; this
includes slow internet connection and recurrent problems in
the LMS (Jowsey et al., 2020). In a study conducted in Oman,
55.6% of 120 nursing students reported slow internet as being
a source of stress, which can be attributed to the poor quality of
672
internet services in developing countries compared with devel-
oped countries (Ali et al., 2016).
In the current study, students complained about the recurrent
problems with the LMS, mainly due to the high pressure from
users. In the study by Ali et al. (2016), the lack of adequate tech-
nical support caused stress for 48% of the students. Students ex-
pect their teachers to be able to use technology effectively and
solve any technical problem (Jowsey et al., 2020). However, in
the current study, students did not receive sufficient technical
support from their universities’ IT departments or from their
teachers.
The students also reported the COVID-19 pandemic itself as
being a source of distraction and stress, affecting their psycho-
logical well-being. Savitsky et al. (2020) found that 60.9% (n =
244) of nursing students suffer from moderate to severe levels
of anxiety. In the current context, fears of having a relative diag-
nosed with COVID-19 may have augmented students’ anxiety
levels (Cao et al., 2020).
LIMITATIONS
Although this study is considered the first to investigate, in
the context of COVID-19, the stress levels and stressors related
to distance learning among nursing students in Jordan and the
impact of students’ sociodemographic characteristics, it is not
without limitations. Due to its novelty, research studies on the
research topic are lacking. Also, this study is cross-sectional
in nature and relied on measuring stress and stressors using
an online, self-administered questionnaire, which may have
increased the possibility of recall bias among the participants.
Further, the use of the convenience sampling method may have
caused selection bias, affecting the internal validity of the study.
Also, the fact that this study was conducted in a single country
(Jordan) may have caused the findings to be culturally biased,
therefore limiting their generalizability. Another limitation is
the use of only one open-ended question to investigate nursing
students’ experience of distance-learning stressors. Therefore,
future cross-cultural empirical studies are needed to validate the
findings of the current study. Longitudinal research is needed to
explore the magnitude of the phenomenon over time. Further-
more, qualitative research is needed to fully comprehend un-
dergraduate nursing students’ experience of distance learning.
CONCLUSION
After being forced by the COVID-19 pandemic to close,
the only option available to universities in Jordan was to re-
sume education via distance learning. However, distance
learning has brought about many challenges that have affected
the psychological well-being of nursing students. This study
found overall stress levels to be higher among students from
very low-income families, students who used smartphones for
distance learning, students who found payment for internet
services to be a financial burden, and students who had no pri-
vate place to study. Further, the stress levels under the Higher
Education Stress Inventory factors varied based on some so-
ciodemographic characteristics of the students. Finally, the
qualitative findings revealed four themes, namely unorganized
Copyright © SLACK Incorporated

workloads, the lack of a standardized distance learning strat-
egy, limited resources, and distracting environment, as being
the main sources of stress.
IMPLICATIONS
The results of this study shed light on the high stress levels
and the stressors experienced by nursing students in Jordan as a
result of the transition to distance learning amid the COVID-19
pandemic. Identifying the variations in stress and stressors will
encourage nursing students to work on these stressors and cope
with them effectively; draw the attention of universities to the
gaps in distance learning and enable them to reevaluate their
readiness to apply such a learning approach; and allow univer-
sities and faculties to provide the appropriate support for their
students and work on designing appropriate stress reduction
strategies that focus on the main sources of stress among stu-
dents.
REFERENCES
Admi, H., Moshe-Eilon, Y., Sharon, D., & Mann, M. (2018). Nursing stu-
dents’ stress and satisfaction in clinical practice along different stages:
A cross-sectional study. Nurse Education Today, 68, 86–92. https://doi.
org/10.1016/j.nedt.2018.05.027 PMID:29894915
Akhu-Zaheya, L., Shaban, I., & Khater, W. (2015). Nursing students’ per-
ceived stress and influences in clinical performance. International Jour-
nal of Advanced Nursing Studies, 4(2), 44–48. https://doi.org/10.14419/
ijans.v4i2.4311
Akhu-Zaheya, L. M., Khater, W., Nasar, M., & Khraisat, O. (2013). Bac-
calaureate nursing students’ anxiety related computer literacy: A sample
from Jordan. Journal of Research in Nursing, 18(1), 36–48. https://doi.
org/10.1177/1744987111399522
Al-Gamal, E., Alhosain, A., & Alsunaye, K. (2018). Stress and coping
strategies among Saudi nursing students during clinical education. Per-
spectives in Psychiatric Care, 54(2), 198–205. https://doi.org/10.1111/
ppc.12223 PMID:28523717
Alghamdi, S., Aljabri, S., Jafari, G., Alzebali, R., Alkunaidiri, N., & Ka-
lantan, N. (2019). Sources of stress among undergraduate nursing stu-
dents. Global Journal of Health Science, 11(9), 116–122. https://doi.
org/10.5539/gjhs.v11n9p116
Ali, N., Jamil, B., Sethi, A., & Ali, S. (2016). Attitude of nursing students
towards e-learning. Advances in Health Professions Education, 2(1),
24–29.
Alzayyat, A., & Al-Gamal, E. (2014). A review of the literature regard-
ing stress among nursing students during their clinical education. In-
ternational Nursing Review, 61(3), 406–415. https://doi.org/10.1111/
inr.12114 PMID:24902996
Amanya, S. B., Nakitende, J., & Ngabirano, T. D. (2017). A cross-sectional
study of stress and its sources among health professional students at
Makerere University, Uganda. Nursing Open, 5(1), 70–76. https://doi.
org/10.1002/nop2.113 PMID:29344397
Arbour, M., Kaspar, R. W., & Teall, A. M. (2015). Strategies to promote
cultural competence in distance education. Journal of Transcultural
Nursing, 26(4), 436–440. https://doi.org/10.1177/1043659614547201
PMID:25122626
Aslan, H., & Akturk, U. (2018). Nursing education stress levels of nursing
students and the associated factors. Annals of Medical Research, 25(4),
660–666. https://doi.org/10.5455/annalsmedres.2018.06.108
Bahrambeygi, F., Shojaeizadeh, D., Sadeghi, R., Nasiri, S., & Ghazanchaei,
E. (2018). The effectiveness of an e-learning program on nurse’s knowl-
edge and behavior for caring of patients with thromboembolism: A
comparative study. Journal of Nursing and Healthcare Management,
1(1), 1–7. https://doi.org/10.18875/2639-7293.1.105
Barteit, S., Guzek, D., Jahn, A., Bärnighausen, T., Jorge, M. M., & Neu-
hann, F. (2020). Evaluation of e-learning for medical education in
low- and middle-income countries: A systematic review. Comput-
Journal of Nursing Education • Vol. 59, No. 12, 2020
ers and Education, 145(September 2018). https://doi.org/10.1016/j.
compedu.2019.103726
Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., & Zheng, J.
(2020). The psychological impact of the COVID-19 epidemic on col-
lege students in China. Psychiatry Research, 287, 112934. https://doi.
org/10.1016/j.psychres.2020.112934 PMID:32229390
Cohen, J. (1988). Statistical power analysis for the behavioural sciences.
(2nd ed.). Erlbaum.
Dagistani, A., Al Hejaili, F., Binsalih, S., Al Jahdali, H., & Al Sayyari, A.
(2016). Stress in medical students in a problem-based learning curricu-
lum. International Journal of Higher Education, 5(3). Advance online
publication. https://doi.org/10.5430/ijhe.v5n3p12
Dahlin, M., Joneborg, N., & Runeson, B. (2005). Stress and depression
among medical students: A cross-sectional study. Medical Education,
39(6), 594–604. https://doi.org/10.1111/j.1365-2929.2005.02176.x
PMID:15910436
European Center for Disease Prevention and Control. (2020). Con-
siderations relating to social distancing measures in response
to COVID-19—Second update. https://www.ecdc.europa.eu/en/
publications-data/considerations-relating-social-distancing-measures-
response-covid-19-second
Farrell, G. A., Cubit, K. A., Bobrowski, C. L., & Salmon, P. (2007). Us-
ing the WWW to teach undergraduate nurses clinical communication.
Nurse Education Today, 27(5), 427–435. https://doi.org/10.1016/j.
nedt.2006.07.005 PMID:16935394
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3:
A flexible statistical power analysis program for the social, behavioral,
and biomedical sciences. Behavior Research Methods, 39(2), 175–191.
https://doi.org/10.3758/BF03193146 PMID:17695343
Ghazal, M. (2014). 95% of Jordanian own mobiles, 47% use the internet.
http://www.Jordantimes.com/news/local/95-Jordanians-own-mobiles-
47-use-internet
Griffiths, B. (2016). A faculty’s approach to distance learning standardiza-
tion. Teaching and Learning in Nursing, 11(4), 157–162. https://doi.
org/10.1016/j.teln.2016.04.004
Hamaideh, S. H., Al-Omari, H., & Al-Modallal, H. (2017). Nursing stu-
dents’ perceived stress and coping behaviors in clinical training in Saudi
Arabia. Journal of Mental Health (Abingdon, England), 26(3), 197–
203. https://doi.org/10.3109/09638237.2016.1139067 PMID:26850046
Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative con-
tent analysis. Qualitative Health Research, 15(9), 1277–1288. https://
doi.org/10.1177/1049732305276687 PMID:16204405
The Jordan Times. (2018). ICT, internet usage among Jordanian house-
holds increases. Retrieved from https://Jordantimes.com/news/local/ict-
internet-usage-among-Jordanian-households-increases-%E2%80%94-
ministry.
Jowsey, T., Foster, G., Cooper-Ioelu, P., & Jacobs, S. (2020). Blended
learning via distance in pre-registration nursing education: A scoping
review. Nurse Education in Practice, 44(January), 102775. https://doi.
org/10.1016/j.nepr.2020.102775 PMID:32247200
Kattoua, T., Al-Lozi, M., & Alrowwad, A. (2016). A review of literature on
e-learning systems in higher education. International Journal of Busi-
ness Management and Economic Research, 7(5), 754–762.
Khater, W., Akhu-zaheya, L. M., & Shaban, I. (2014). Sources of stress
and coping behaviours in clinical practice among baccalaureate nursing
students. International Journal of Humanities and Social Science, 4(6),
194–202.
Labrague, L. J., McEnroe-Petitte, D. M., Gloe, D., Thomas, L., Papathana-
siou, I. V., & Tsaras, K. (2017). A literature review on stress and cop-
ing strategies in nursing students. Journal of Mental Health (Abingdon,
England), 26(5), 471–480. https://doi.org/10.1080/09638237.2016.124
4721 PMID:27960598
Lall, P., Rees, R., Law, G. C. Y., Dunleavy, G., Cotič, Ž., & Car, J. (2019).
Influences on the implementation of mobile learning for medical and
nursing education: Qualitative systematic review by the digital health
education collaboration. Journal of Medical Internet Research, 21(2),
e12895. Advance online publication. https://doi.org/10.2196/12895
PMID:30816847
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping.
Springer.
Liu, M., Gu, K., Wong, T. K. S., Luo, M. Z., & Chan, M. Y. (2015). Per-
673
 ceived stress among Macao nursing students in the clinical learning en-
vironment. International Journal of Nursing Sciences, 2(2), 128–133.
https://doi.org/10.1016/j.ijnss.2015.04.013
Madian, A. M., Abdelaziz, M. M., & Ahmed, H. A. (2019). Level of stress
and coping strategies among nursing students at Damanhour University,
Egypt. American Journal of Nursing Research, 7(5), 684–696. https://
doi.org/10.12691/ajnr-7-5-3
Moore, R. L. (2014). Importance of developing community in distance
education courses. TechTrends, 58(2), 20–24. https://doi.org/10.1007/
s11528-014-0733-x
National Council of Family Affairs. (2017). Jordanian family report. http://
ncfa.org.jo:85/NCFA/sites/default/files/Publications/family-report.pdf
Parveen, A., & Inayat, S. (2017). Evaluation of factors of stress among
nursing students. Advanced Practice Nurse, 2(2), 136. https://doi.
org/10.4172/2573-0347.1000136
Posey, L., & Pintz, C. (2017). Transitioning a bachelor of science in nurs-
ing program to blended learning: Successes, challenges & outcomes.
Nurse Education in Practice, 26, 126–133. https://doi.org/10.1016/j.
nepr.2016.10.006 PMID:28277260
Preto, V. A., Palomo, V. P., Araujo, L. G., Flauzino, M. M., Teixeira, C. C.,
Parmegiane, R. D. S., & Cardoso, L. (2018). Perception of stress in
nursing academics. Journal of Nursing UFPE On Line, 12(3), 708–715.
https://doi.org/10.5205/1981-8963-v12i3a231389p708-715-2018
Raman, J. (2015). Mobile technology in nursing education: Where do we
go from here? A review of the literature. Nurse Education Today, 35(5),
663–672. https://doi.org/10.1016/j.nedt.2015.01.018 PMID:25665926
Ribeiro, F. M. S. E. S., Mussi, F. C., Pires, C. G. da S., da Silva, R. M., de
Macedo, T. T. S., & Santos, C. A. de S. T. (2020). Stress level among
undergraduate nursing students related to the training phase and so-
ciodemographic factors. Revista Latino-Americana de Enfermagem, 28,
e3209. https://doi.org/10.1590/1518-8345.3036.3209
Savitsky, B., Findling, Y., Ereli, A., & Hendel, T. (2020). Anxiety and cop-
ing strategies among nursing students during the covid-19 pandemic.
674
Nurse Education in Practice, 46, 102809. Advance online publication.
https://doi.org/10.1016/j.nepr.2020.102809 PMID:32679465
Sentürk, S., & Dogan, N. (2018). Determination of the stress experienced
by nursing students’ during nursing education. International Journal of
Caring Sciences, 11(2), 896–904.
Shaban, I. A., Khater, W. A., & Akhu-Zaheya, L. M. (2012). Undergraduate
nursing students’ stress sources and coping behaviours during their ini-
tial period of clinical training: A Jordanian perspective. Nurse Education
in Practice, 12(4), 204–209. https://doi.org/10.1016/j.nepr.2012.01.005
PMID:22281123
Sharma, N., & Kaur, A. (2011). Factors associated with stress among nurs-
ing students. Nursing and Midwifery Research Journal, (1), 12–21.
https://doi.org/10.33698/NRF0119
Sharples, M., de Roock, R., Ferguson, R., Gaved, M., Herodotou, C., Koh,
E., Kukulska-Hulme, A., Looi, C. K., McAndrew, P., Rienties, B.,
Weller, M., & Wong, L. H. (2016). Innovating pedagogy 2016: Open
university innovation report 5. Institute of Educational Technology, The
Open University.
Sowan, A. K., & Jenkins, L. S. (2013). Designing, delivering and evaluat-
ing a distance learning nursing course responsive to students’ needs.
International Journal of Medical Informatics, 82, 553–564. https://doi.
org/10.1016/j.ijmedinf.2013.02.004 PMID:23478139
Tubaishat, A. (2014). An investigation into the attitudes of nursing students
toward technology. The Journal of Nursing Research, 22(2), 119–125.
https://doi.org/10.1097/jnr.0000000000000029 PMID:24821419
Vitaliano, P. P., Russo, J., Carr, J. E., & Heerwagen, J. H. (1984). Medi-
cal school pressures and their relationship to anxiety. The Jour-
nal of Nervous and Mental Disease, 172(12), 730–736. https://doi.
org/10.1097/00005053-198412000-00006 PMID:6502152
Zayim, N., & Ozel, D. (2015). Factors affecting nursing students’ readi-
ness and perceptions toward the use of mobile technologies for learn-
ing. Computers, Informatics, Nursing, 33(10), 456–464. https://doi.
org/10.1097/CIN.0000000000000172 PMID:26200902
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Table A
Results of ANOVAs at the Level of the Higher Education Stress Inventory Factors
Sociodemographic Worries About Future Nonsupportive Climate Faculty Shortcomings Workload Insufficient Feedback Low Commitment Financial Concerns
Variables Endurance⁄Competence
M (SD) F η2
M (SD) F η 2
M (SD) F η 2
M (SD) F η2
M (SD) F η2 M (SD) F η2
M (SD) F η2
Gender 4.41* .012 .05 .000 .80 .002 1.03 .003 .00 .000 3.08 .009 2.86 .008
Male 3.04 2.69 2.42(0.46) 3.14(0.53) 2.50(0.78) 1.64(0.80) 2.94(0.83)
(0.59) (0.40)
Female 3.20 2.68 2.37 3.21 2.51 1.48 (0.75) 2.77
(0.62) (0.45) (0.42) (0.54) (0.70) (0.85)
Academic year 2.21 .019 1.20 .010 3.12* .026 .13 .001 .79 .007 2.50 .021 1.17 .010
Second year 3.23 2.71 2.36 3.20 2.48 1.55 (0.77) 2.77
(0.61) (0.45) (0.41) (0.55) (0.68) (0.86)
Third year 3.35 2.67 2.58 3.19 2.57 1.71 (0.69) 2.88
(0.57) (0.37) (0.50) (0.56) (0.81) (0.94)
Numbers of courses en- 3.09* .026 1.17 .010 1.87 .016 .28 .002 1.08 .009 .83 .007 1.30 .011
rolled in
4 courses 3.00 2.63 2.26 3.22 2.60 1.44 (0.69) 2.74
(0.59) (0.49) (0.40) (0.54) (0.77) (0.89)
7 courses 3.34 2.72 2.44 3.24 2.65 1.68 (0.89) 3.04
(0.53) (0.42) (0.45) (0.55) (0.65) (0.75)
Internet type .73 .002 .08 .000 .27 .001 .19 .001 1.00 .003 .01 .000 5.96** .017
Prepaid package 3.13 2.69 2.38 3.20 2.54 1.52 (0.79) 2.90
(0.60) (0.43) (0.42) (0.56) (0.72) (0.81)
Other 3.19 2.68 2.40 3.18 2.46 1.53 (0.75) 2.68
(0.64) (0.46) (0.45) (0.60) (0.72) (0.90)
Electronic device type 1.77 .005 .86 .002 13.61*** .037 .06 .000 4.99* .014 .02 .000 16.86*** .046
Smartphones 3.17 2.70 2.42 3.19 2.55 1.52 (0.77) 2.89
(0.60) (0.45) (0.43) (0.53) (0.73) (0.82)
Other 3.05 2.64 2.19 3.18 2.31 1.54 (0.80) 2.39
(0.67) (0.37) (0.41) (0.60) (0.69) (0.93)
Family income .854 .005 3.01 .017 1.64 .009 1.13 .006 7.14** .039 .39 .002
Very low 3.19 2.73 2.42 3.21 2.61 1.52 (0.78) 3.04 24.88*** .124
(0.61) (0.43) (0.44) (0.52) (0.71) (0.76)
Low 3.06 2.61 2.32 3.31 2.11 1.67 (1.01) 2.14
(0.56) (0.39) (0.51) (0.45) (0.68) (0.82)
Medium to high 3.11 2.61 2.34 3.14 2.38 1.50 (0.71) 2.97
(0.62) (0.46) (0.40) (0.58) (0.73) (0.87)
** * *** **
Availability of a private 8.25 .023 7.71 .021 26.59 .07 11.43 .031 20.13*** .054 8.67** .024 42.92*** .108
*
area to study
Yes 3.04 2.61 2.25 3.08 2.31 1.38 (0.62) 2.47
(0.62) (0.45) (0.39) (0.56) (0.68) (0.89)
No 3.23 2.74 2.48 3.27 2.65 1.62 (0.85) 3.04
(0.60) (0.42) (0.43) (0.51) (0.72) (0.75)
** *** *
Is purchasing internet 6.15 .017 12.49 .034 14.04 .038 5.23 .015 10.61** .029 .02 .000 49.72*** .123
***
services a financial bur-
den?
Yes 3.19 2.72 2.42 3.22 2.56 1.54 (0.77) 2.95
(0.59) (0.43) (0.42) (0.53) (0.70) (0.78)
No 2.97 2.50 2.19 3.04 2.23 1.54 (0.82) 2.13
(0.69) (0.46) (0.46) (0.54) (0.78) (0.88)
a
The post hoc test showed a significant difference between very low-income students with low income and medium to high income students in the both significant results.
* p < .05, ** p < .01, *** p < .000.
Table B
Students’ Response to the Open-Ended Question
Theme Coding
Huge unorganized
workload
Huge daily workload
Compressing the curriculum
in a shorter time
The overlap in online
meetings, and other academic
work.
Lack of
standardized
distance learning
strategy
The use of many applications
and learning methods that are
new to the students and
teachers
Unclear evaluation methods
Dissatisfaction with the way
clinical courses are delivered.
Limited resources
Financial resources
N % Responses
213 90.25
“I am exhausted with the huge number of online classes,
assignments, quizzes every day.”
“I spend the whole day joining online meetings, listening to audios
and PowerPoint slides with voiceover, reading, and doing
assignments and quizzes.”
“My days are full of work and my evenings are full of working on
the assignments and quizzes due next day.”
“New assignments and quizzes that are not part of the syllabus have
emerged. I thought the syllabus was a contract between students and
teachers. Who is violating the terms of this contract now?!”
"Some important subjects were taught in an online meeting or two
when they should have been assigned three or four classes according
to the syllabus.”
“Teachers were extending the time of the online meetings or giving
more online classes than what was scheduled on the pretext that we
do nothing at home.”
“There is no coordination between online classes – class timings may
overlap.”
“Teachers give online classes at any time during the day – after
school hours or at night.”
“Some teachers insist on students joining the live meetings, not
taking into account the overlap with other online classes or even
quizzes.”
164 69.49
“teachers are using different methods and applications for distance
learning, including YouTube, Facebook, Zoom, Microsoft Teams, E-
learning, and Webnar. This has confused me. Am I supposed to be
familiar with all of these applications?”
“This is the first time I use some of the numerous applications that
teachers are using for distance learning. It has taken me a while to
understand the features of each application.”
“Some teachers are not familiar with distance learning; they fail to
use many applications and learning methods. Sometimes we find
problems in the uploaded files, such as the absence of sound in the
PPT slides with voice over.”
“Once, me and my colleagues could not start a quiz on time because
of problems in the settings of that quiz.”
“Some teachers cannot solve simple technical problems during live
meetings, which wastes time. I wonder if this is the best way of
learning during the outbreak?”
“I have noticed that teachers have no clue about correcting
assignments using technology. They only assign grades, without
feedback.”
“The evaluation process is quite vague for students as well as
teachers. Because of the quarantine, instructions for evaluation
methods and strategies should be given by the Ministry of Higher
Education (MoHE). However, they have been working on these
instructions for weeks!”
“Teachers keep giving us unevaluated quizzes, and I am worried that
they will end up counting them. There is no clear method of
evaluation.”
“One of our biggest concerns is the discontinuation of practical
courses. Nursing relies greatly on dealing with real patients, taking
history, building rapport, and providing care.”
“The simulation applications and the videos that have been used to
teach us clinical skills are not sufficient, in my opinion.”
“Our clinical teachers are not satisfied with this way of teaching, and
they are still waiting for MoHE’ instructions.”
178 75.42
“I can’t afford buying internet packages, simply because neither I nor
my parents are currently working with the quarantine.”
 “How can I ask for money to pay for internet over food with our
limited sources?”
Physical resources “I follow up with my studies using an old and broken phone. It is
completely inappropriate for distance learning.”
“I have to share the only computer we have at home with my other
siblings—how can three people share one computer with these huge
amounts of work?”
“I can’t study using a phone with a small screen. I can’t download
large files on my phone, so I have to refer to files available online.
However, this requires internet access, which is another problem”.
Infrastructure “Neither we as students nor universities were prepared for distance
learning. Most students depend on prepaid internet packages, which
provide a slow and weak internet connection. These packages cannot
support the numerous live meetings, downloads, and online quizzes.”
“The university’s e-learning website is not good enough to support
this huge workload. There are always problems, especially during
quizzes, and this affects our performance. How very disappointing!”
Distracting 37 15.68
environment
COVID-19 “I cannot focus on my studies. I follow closely the news of the
outbreak all around the world. It is very scary….”
“I feel threatened by the Coronavirus at any time due to its quick
transmission, even with a quarantine. How can I focus on my
studies? It is very distracting!”
Home environment “We have a small home and seven family members, most of whom
are kids. I do not have a quiet place at home to study and join online
meetings.”
“Being the eldest girl at home means I have to help with the
housework and with my younger siblings alongside my schoolwork.”
a
Total number of responses were 236. Students reported multiple sources of stress.