Nursing students’ learning strategies for e-learning during the Covid-19 pandemic: A qualitative study

Nursing students’ learning strategies for e-learning during the Covid-19 pandemic: A qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nursing students’ learning strategies for e-learning during the Covid-19 pandemic: A qualitative study Nesa Cheraghbeigi, Shahram Molavynejad, Dariosh Rokhafroz, Nasrin Elahi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2504543/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 May, 2023 Read the published version in BMC Medical Education → Version 1 posted 13 You are reading this latest preprint version Abstract Background: In response to the emergency brought about by the Covid-19 pandemic, many universities around the world had to change their teaching methods from in-person classes to e-learning. The purpose of this study was to identify the learning strategies of nursing students in e-learning during the pandemic. Methods: This study had a qualitative design and used content analysis approach to collect and analyze the data. Sixteen semi-structured interviews were conducted with 12 Iranian undergraduate nursing students who were selected using purposive sampling method. Results: The results of the study showed that nursing students generally used two different strategies for e-learning, namely self-centered learning strategies and collaborative learning strategies. Some students, on the other hand, adopted a passive approach in their learning. Conclusion: In e-learning during the pandemic, students adopted different learning strategies. Therefore, designing teaching strategies tailored to the students’ strategies can promote their learning and academic achievement. Also, knowledge of these strategies helps policy makers and nursing educators to take necessary measures in order to optimize and facilitate student learning in an e-learning environment. Covid-19 pandemic e-learning learning strategies nursing students Background With the sudden and unprecedented emergence of the Covid-19 pandemic, all sectors of society including education experienced widespread disruptions ( 1 ). In fact, since early 2020, many higher education institutions around the world have quickly shifted from in-person education to online education in order to respond to the restrictions imposed by the pandemic ( 2 ). Nursing education, as a sensitive and key component of higher education was no exception, and with the unexpected emergence of Covid-19, nursing educators were urged to make quick decisions on how the education of nursing students should be continued, and all solutions they came up with were nothing but to quickly replace in-person education with electronic education ( 3 ). Of course, the shift from in-person to e-learning classes was regarded as a provisional solution in response to the crisis caused by the Covid-19, but as the pandemic persisted, fully online or hybrid methods were used for two years ( 2 ). In Iran, before the outbreak of the pandemic, the method of providing medical science education, including nursing education, was through face-to-face education, and electronic education had no specific place in the strategic plans of universities. Nevertheless, in response to the closure of universities and in order to avoid a debilitating pause in the education process of students, the Iranian Ministry of Health, Treatment and Medical Education introduced both a web-based system to offer education in an offline form and a number of computer programs to support online education. By so doing, this ministry called for the rapid presentation of electronic education in universities of medical sciences, including nursing schools, and in this way, electronic education quickly became compulsory in all universities of the country ( 3 ). The sudden and unexpected transition from face-to-face to electronic education undoubtedly made students face various challenges and obstacles, and several studies have identified these challenges. Moradi et al (2022) in their qualitative study, for example, reported the following as the main challenges that nursing students and professors went through in this respect: lack of necessary infrastructure for e-learning, insufficient facilities and equipment, financial problems, professors’ unpreparedness to use e-learning, reluctance of students and professors to use e-learning, and the professors' insufficient adherence to e-learning ( 4 ). In addition, increased workload, anxiety, being away from the clinical environment, insufficient communication and interactions between students and professors, problems related to educational content, superficial learning, and inability to develop critical thinking are other problems of students in e-learning during the pandemic ( 3 , 5 ). In the face of the challenges, the students were urged to adopt strategies to facilitate their learning ( 6 ). Although many studies have been conducted on learning strategies in face-to-face education ( 7 ) and in conventional online education, few have dealt with the extent to which the use of these strategies in mandatory electronic education during the pandemic period is beneficial to students. This is particularly important with respect to nursing students owing to the unique nature of their field of study (involving both theoretical and clinical aspects) ( 6 ). Previous studies that have been conducted in the context of e-learning in nursing during Covid-19 have mainly investigated the challenges ( 4 ), experience ( 3 ), and satisfaction level ( 8 ) of e-learning based on the views of professors and students. In other words, the results of these studies have revealed that students have faced many challenges in e-learning during the pandemic ( 3 , 4 ). However, whether students have been able to avail themselves with learning strategies to cope with these challenges has been a much needed line of inquiry investigated in few, if any, studies ( 6 ). The sudden and unanticipated implementation of e-learning during the Covid-19 pandemic in Iran forced professors and students to be left with no choice but to be engaged in this type of education ( 3 ). This created a unique context that was definitely different from previous studies in terms of scale and participation of participants. In studies conducted before the pandemic, online courses were mainly offered on a voluntary basis or were only mandatory for a certain number of students ( 9 ). Therefore, studies investigating e-learning under the conditions of Covid-19 are significantly worthwhile because students' expectations of e-learning may change due to such differences. On the other hand, most of the studies that have been conducted on learning styles of students in e-learning are quantitative in approach and use self-report questionnaires such as the Kolb Learning Style Inventory, which divides individuals into predetermined categories for data collection ( 10 , 11 ). By contrast, qualitative studies allow researchers to gain a deeper understanding of the phenomenon under investigation, and such studies can provide valuable insights into the special conditions caused by the Covid-19 pandemic. In fact, a study investigating the strategies students have used in their learning under the difficult conditions of the pandemic is worthwhile and of paramount importance since it enables professors to take effective measures to facilitate students' learning in distance education and to help them learn with more independence and motivation. Therefore, the present qualitative study aimed to identify learning strategies used by undergraduate nursing students in online education offered in response to the Covid-19 pandemic in Iran. Methods Aim The present study aimed to identify the learning strategies of nursing students in e-learning during the pandemic. Setting The present study was conducted at Ahvaz University of Medical Sciences in Iran. Although the infrastructure needed to provide electronic education was available since 2015 in this university, until the outbreak of the pandemic, electronic education in Ahvaz University of Medical Sciences was only used in a few cases and voluntarily by interested faculty members. The sudden appearance of covid-19 forced all medical sciences universities of the country, including Ahvaz University of Medical Sciences to quickly shift from face-to-face education to electronic. Therefore, in order to better adapt to electronic education, the university's management of Education Developing Center considered a program that included empowering faculty members to develop educational content for e-learning and empowering students to use e-learning tools. Furthermore, Offline trainings at Ahvaz University of Medical Sciences were provided using the national learning management system "Navid". "Adobe Connect" and "Skyroom" soft wares were also used to support online training. Design In this study, inductive content analysis method was used to identify nursing students' learning strategies for e-learning during the Covid-19 pandemic. Due to its exploratory nature, content analysis approach enables researchers to gain a deeper understanding of the phenomena under study and discover their complexities ( 12 ). Participants The statistical population included undergraduate nursing students of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Twelve undergraduate nursing students were selected using purposive method from among eligible students. The inclusion criteria were: having at least two academic semesters of e-learning experience and willingness to participate in the study. Maximum variation sampling technique was used to capture a diverse range of views and experiences. Therefore, sampling was done from both sexes and from second- to fourth-year students. The research sample included 3 second-year students, 5 third-year students, and 4 fourth-year students. Also, the majority (n = 9) of the students included in the study were female. The age of the participants ranged from 22 to 24 years. Data Collection Semi-structured interviews were used to collect data. Compared to quantitative methods of data collection, interviews provide deeper insights into the phenomenon under study. Interview questions included, but were not limited to, the following: 1- Could you please explain your experience of e-learning? 2- Could you please explain how you attended nursing courses in e-learning? 3- How did you learn in this semester or the previous semesters when your courses were offered electronically? In addition to open questions, probing questions were also used in order to delve into the learning experiences of the participants. Also, at the end of each interview, the participants were given the opportunity to add more points to their statements if they wished. The data collection process continued until data saturation. In cases of any ambiguity, a follow-up interview was also set up. A total of 16 face-to-face interviews were conducted with 12 undergraduate nursing students. Eight students were interviewed once, one student was interviewed three times, and two students were interviewed twice. The interviews were conducted individually in one of the classrooms of the School of Nursing and Midwifery which had a quiet and peaceful atmosphere. The mean length of the conducted interviews was 65 minutes. The interviews were recorded using a digital audio recorder. The content of each interview was transcribed verbatim immediately after the interview. Data analysis The process of data analysis was done simultaneously with data collection. Inductive content analysis as explained by Graneheim and Lundma was used for data analysis which involved the following five stages: 1- Verbatim transcription of each interview immediately after its completion 2- Reading the entire transcribed text in order to get a general understanding of the content of the interview 3- Determination of basic codes and semantic units 4- Classification of primary codes based on their similarities into broader categories 5- Determining the main theme of the categories ( 13 ). In the present study, after the completion of each interview, the entire recorded audio file was listened to carefully by the researcher. After that, the content of the interview was transcribed verbatim in Microsoft Word software. Then, to immerse in the data and to extract the main themes, the interview text was read by the researcher several times. MAXQDA 2020 was used for data management. The lead researcher identified the semantic units by reading the interview text line by line. Semantic units were converted into primary codes. Afterwards, the codes were compared based on similarities and differences and were categorized into themes and sub-themes. Any disagreements regarding codes, themes and sub-themes were resolved by discussion sessions by the research team. Finally, after the themes and sub-themes were refined, they were specified in the text. Rigor The criteria of Guba and Lincoln, namely credibility, confirmability, dependability, and transferability were used to achieve validity and reliability of the data ( 14 ). The lead researcher's long engagement with the data ensured credibility. That is, during the data analysis process, which lasted for six months from May 12, 2022 to November 15, 2022, the researcher repeatedly read the transcript of the interviews. In addition, an expert supervisor supervised the data analysis process and any disagreement was resolved by discussion and agreement. In addition to peer-check, member-check was also used to achieve credibility. To this aim, a summary of the findings was provided to the participants after analyzing each interview and they were asked to check whether the concepts obtained reflected their experiences or ideas. If any additional comments or experiences were added by the participants, they were included in the analysis. Also, maximum variation sampling technique was used by choosing both male and female students studying in different academic years. In order to ensure confirmability and facilitate auditability, a complete description of the research process, including data collection and analysis methods, was presented. Dependability was confirmed by inviting an external audit to check the similarities and differences between the researchers’ and participants’ understanding of the topics. Through complete and accurate description of the participants, the time and place of data collection and the sampling method, the researchers tried to achieve transferability of the data. Results Our data analysis showed that students’ learning strategies for e-learning during the pandemic fall into three main themes of “self-centered learning strategies”, “collaborative learning strategies” and “Remaining passive” (Table 1 ). Using direct quotes from the participants, the themes and their sub-themes are presented below. Table 1 Students' learning strategies in e-learning Code Sub-theme Theme Searching the Internet Exploration Self-centered learning strategies Asking peers Asking teachers Studying reference textbooks Using evidence Studying relevant articles Attending educational webinars Using educational media and tools Using educational systems and software Using educational Telegram channels Watching educational videos Using audio-visual resources Listening to narrated PowerPoint slides Dedicating a quiet and comfortable place for studying Dedicating a place for studying Dedicating a particular place for studying Classification and summarization of content Summarizing and note-taking Note-taking Reflection on the narrated PowerPoint slides Reflection on the materials taught Reflection on educational videos Skimming the content in the first round of studying Skimming Trying to understand the main idea Playing the role of a teacher Individual role playing Teaching to hypothetical students Forming groups for note-taking and pamphlet writing Collaborative note-taking and pamphlet writing Collaborative learning strategies Division of responsibilities in note-taking and pamphlet writing Uploading the group pamphlet Forming a group of peers Peer-to-peer teaching and learning Division of teaching materials between group members Teaching the materials to one another Giving up Giving up and not taking action Remaining passive Not taking action Theme 1: Self-centered Learning Strategies This theme includes the following 9 sub-themes: “Exploration”, “Using evidence”, “Using educational tools and media”, “Using audio-visual resources”, “Dedicating a particular space for studying”, “Summarizing and taking notes”, “Reflection on the content taught”, “Skimming” and “Individual role playing”. Exploration Many students stated that they used this strategy when they were faced with some professors' inadequate teaching and when some topics raised questions or were ambiguous for them. Exploration manifested itself in a variety of behaviors that include “searching the Internet”, “asking the teacher” and “asking peers”. However, the students’ first choice to solve their learning problems was to search the Internet, which was followed by questions from peers and questions from teachers. The following quotes shed more light on how and why these solutions were adopted by the students. “I used to search and download educational videos available on Google. For example, when the teacher taught CPR, I did not learn it very well and didn't know where exactly I should place these leads. That’s why I searched the Internet and found a related video.” (Participant 7, 7th semester female student) “If I happened to have a problem, I would first search the Internet, and if I couldn't find the answer, I would ask one of the classmates who knew the answer.” (Participant 9, 8th semester female student) “Some of the professors were really good. They gave us their numbers and we could ask them in case we had a problem.” (Participant 12, 6th semester male student) Using Evidence Based on the experiences of our participants, using evidence involved reading reference textbooks and reading relevant scientific articles. Students used this strategy when the topics were inadequately presented by the professor or when they did not understand the topics well despite the professor's good teaching. “For example, I had the professor’s pamphlet and the content file, but I felt that the teaching materials were not complete, so I used to supplement those materials from different books to help me learn.” (Participant 8, 6th semester female student) “For some of things that I had problem with such as some points in anatomy, I would look up the answer in books. Or in physiology, for example, I again studied the heart physiology from scratch so that I could understand the different axes. Although the teacher had taught very well, I myself felt that I did not understand, so I read the book again. Or I used the materials and articles that were available on the Internet.” (Participant 3, 4th semester female student) Using Educational Tools And Media According to the experiences of our participants, this strategy included participation in educational webinars, using educational systems and software (Full Code Medical Simulation, Labster, and Faradars), and using Telegram educational channels. Some students stated that in order to better learn the topics in which they felt weak, they participated in educational webinars, which often cost them money: “Yeah, these webinars are very good. I myself attended a webinar on pharmacology. Of course, I paid a fee to participate, and then the topics were taught very nicely; for example, beta blockers or calcium blockers; these were taught in a nice way using diagrams and also audio files explaining the topics very well. I myself participated in these. For example, I was weak in the pharmacology course, so I participated in these and it was very good.” (Participant 1, 4th semester female student) In addition, since practical/clinical topics are not presented to students efficiently in electronic education, some students, especially those who are already familiar with the basics of virtual education, will use the strategy of using simulator software and systems to learn these topics. “Yeah, these apps helped me a lot, because you can go step by step. I had never been to hospital, but when I was working with Full Code, although it was in English, I understood that as a nurse, I am allowed to do some examinations. I mean, I used it to learn physical examination. In addition to Full Code, there is another system called Labster, which is completely designed so that you can wear gloves and a gown, or plug the microscope in, all in that simulation space. So much attention has been paid to the details. This app was one of the things that I used for the laboratory courses.” (Participant 5, 5th semester female student) “I think Faradars system belongs to Tehran University of Medical Sciences, which has some packages that you can buy; for example, you can go and buy content, and some may post free tutorials, and I used to use these tutorials. For example, I used this system to learn NG-Tube placement and also to get familiar with endoscopy and other things.” (Participant 1, 4th semester female student) Using Audio-visual Resources Another strategy adopted by the interviewed students was using audio-visual educational resources. This included watching educational videos and listening to narrated PowerPoint slides. This strategy was mostly used by students who had a visual-auditory learning style. “Because I myself learn better through videos, I prefer watching videos. For example, I found a video clip about CPR. I saw that clip and it was very good.” (Participant 12, 6th semester male student) “I have a habit of having someone explain things to me, and I listen to learn. What I used to do was listen to the teacher's voice. When I was idle, I used to listen to the teacher's voice. In my mind, when I heard the teacher's voice it looked as if the lesson had been repeated for me. Lessons that were repeated were very good.” (Participant 8, 6th semester female student) Summarizing And Taking Notes Another self-centered learning strategy the students participating in the present study used, especially those with a reading/writing learning style, was summarizing and note-taking. Students stated that the flexibility of e-learning facilitated the use of this strategy. Taking notes and summarizing helped these students to review the educational material faster when studying for final exams. “Well, I’m used to writing in order to learn. In e-learning, I had more time to categorize the materials I was supposed to learn. I made a table for myself. The night before the exam, for example, I could easily distinguish between different diseases or the symptoms of different diseases by reading them on a table. It took me much less time.” (Participant 4, 6th semester female student) Dedicating A Particular Place For Studying Some students stated that they dedicated a particular place for studying to facilitate their learning. Such a place, according to the participants, had to be quiet and comfortable. “I used to choose a place to study that was comfortable and without noise. Besides, it had to be a particular place so that my brain would know that it was time to study. Well, this made me learn better and learn faster.” (Participant 2, 4th semester female student) Reflection Reflection on the educational materials was another self-centered learning strategy adopted by some students to learn the topics more deeply. “After I listened to the professor's narrated PowerPoint [slide] or watched an educational video, I would think about those contents and make an analysis for myself of that PowerPoint [slide] or video” (Participant 6, 5th semester female student) Skimming Some students believed that using the skimming strategy led to better learning of the topics. This strategy helped them understand the main idea of the educational material and learn the topics more quickly the next time they study the same content. “Another thing I do is, for example, to read the entire article quickly and then come back to the beginning. Now that I have read it once, I have a general idea about it, and then I read it again in more detail. This makes me learn better.” (Participant 8, 6th semester female student) Individual Role Playing Playing the role of a teacher was another self-centered learning strategy used by some students. These students stated that for a better and deeper understanding of the course material, they imagined themselves to be one of the professors and then taught the topics to hypothetical students. “One of the methods I used, in addition to summarizing the teacher’s voice, was to play the role of the teacher for myself by giving a lecture. I mean, I imagined myself as a teacher and put myself in shoes of Professor X or Y, and I would explain what he or she said to myself, as if I had students and I was the professor and I was teaching the lesson to my students. This way, my efficiency would be much higher.” (Participant 7, 7th semester female student) Theme 2: Collaborative Learning Strategies This theme has two sub-themes, namely “peer-to-peer teaching and learning” and “collaborative note-taking and pamphlet writing”. Peer-to-peer Teaching And Learning The results of our study showed that some students, especially those who had the desire to learn socially, formed groups of friends to facilitate their learning, and after dividing the topics among each team member and achieving mastery over the specified topics, they would teach each other. The use of this strategy led to reduced student workload and better learning owing to the division of responsibilities and the comprehensibility of peer explanations. “Sometimes it was even like each of us would, for example, teach one chapter to the others. For example, if we had five chapters and there were five of us in a group, then each one of us would take one chapter. Well, this way, the work was divided among everyone. On the other hand, because each of the chapters we were responsible for was read very well, when we taught it, it was comprehensible to others.” (Participant 6, 7th semester female student) Collaborative Note-taking And Pamphlet Writing Collaborative note-taking and pamphlet writing was another collaborative strategy employed by the students. The final product of this strategy was a complete and concise educational pamphlet, which significantly reduced the students’ workload and made it easier for them to study for the final exams. “We had a note-taking and pamphlet writing group, and we had a class representative for note-taking and pamphlet writing. This representative would divide the class into smaller groups, and each group was responsible for a certain topic, which had to be written down based on that teacher’s voice and PowerPoint [slides], and then finally the representative would combine all these pamphlets and put them in the pamphlet group. This note-taking and pamphlet writing was very good because the contents were complete, and it was much easier to read at the night before the exam.” (Participant 9, 8th semester female student) Theme 3: Remaining Passive This theme involves two sub-themes, namely “Giving up” and “Not taking action”. The results of our study showed that some students felt lost in the face of the challenges of e-learning and did not take effective action to help their learning. “I didn't do anything special. The amount of material was so large that one would get confused. I would just read some topics the night before the exam only to pass the exam. It was really bad. I would keep praying that the in-person education would resume as soon as possible.” (Participant 11, 6th semester male student) Discussion The aim of the current study was to identify the learning strategies employed by undergraduate nursing students in online education provided in response to the Covid-19 pandemic in Iran. The results of our study showed that these students used self-centered and collaborative strategies to facilitate their e-learning during the pandemic. Some students, on the other hand, chose to remain passive. In the following, these findings are discussed in more details and in separate sections. Self-directed Learning Strategies The results of our study showed that students used various self-centered strategies to facilitate their e-learning. In fact, due to the teacher’s physical absence in e-learning environment, students have more independence in the learning process, and in order to be able to learn and succeed in this type of education, it is necessary to have self-regulation learning skills ( 15 ). One of the self-centered strategies used by some students was exploration. According to our results, students used this strategy when faced with inadequate teaching of some professors and when they came across topics that raised questions for them. Exploration manifested itself in a variety of behaviors including searching the Internet, asking the professor, and asking peers. However, the students’ first resolution for their learning problems was to search the Internet. Questions from peers and questions from teachers were the next strategies that they used, which is consistent with the results of Kee et al (2020) ( 16 ). Another study also showed that students are more willing to ask their peers, and a smaller percentage of students talk to professors ( 17 ). One of the reasons why more students prefer the strategies of searching the Internet and asking peers over the strategy of asking the professor can be related to the shorter time of receiving answers by the first two strategies. The World Wide Web provides students with a valuable opportunity to quickly find the information they need by searching the Internet ( 18 ). On the other hand, students' access to professors during e-learning was limited and they had to wait for a relatively long time to receive answers from them. Therefore, it was easier for students to solve their problems by searching the Internet and asking their peers than to ask their professors. Using evidence was another strategy used by students, which included reading reference textbooks and relevant articles. Some students stated that they used this strategy to supplement the educational materials provided by the professor and to facilitate learning when it was difficult to understand certain topics. Salmani et al. (2022) found that in e-learning classes, after the nursing students take notes from the teaching materials provided by the professor, they use reference textbooks to compare and supplement their notes with ( 3 ). Reference textbooks are considered rich educational resources through which students can obtain reliable knowledge and information ( 18 ). However, in electronic education, due to their more responsibility and independence in learning, students should not only rely on reference textbooks and educational materials provided by the professor, but also research the Internet to find authentic educational articles and expand their knowledge ( 19 ). Therefore, a critical responsibility of professors in this regard is to adequately guide students in choosing the right authentic educational resources and how to use them so that they can extract the right information that meets their educational needs. Another strategy used by some of the students interviewed in this study was using educational tools and media. This included participation in webinars, using educational systems/software such as medical simulation systems, and using Telegram educational channels. This strategy was used mostly in situations where the teaching material had a clinical/practical implication, or when effective learning did not take place due to inadequate teaching. Under such circumstances, the use of these strategies was associated with better and deeper learning of students. In line with our study, Luo et al. (2021) found that using webinars in combination with virtual simulators in e-learning during the Covid-19 pandemic increased the involvement of nursing students in the learning process and improved their clinical reasoning ( 20 ). Webinar and virtual simulators, both as two types of distance education techniques, can simulate face-to-face education for students. Webinar allows professors to be in contact with their students simultaneously and directly through audiovisual communication and provide them with immediate feedback ( 21 ). Virtual simulators also simulate the clinical environment for students, allowing them to perform clinical skills independently and reflect on their performance according to the feedback they receive ( 20 ). In addition, the use of educational tools and media in our study involved using Telegram educational channels. In fact, the special affordances of Telegram application, such as the possibility of forming discussion groups and educational channels with a very large number of members, facilitate students’ access to educational resources and thereby helping them learn better ( 22 ). As another self-centered learning strategy, the students participating in this study used audio-visual educational resources, which included watching educational videos and listening to narrated PowerPoint slides. This strategy was mostly used by students who had a visual-auditory learning style. These students preferred to learn by seeing and hearing instead of writing and reading ( 23 ). Hampton et al. (2016) reported that educational videos and PowerPoint slides narrated by nursing students who participated in an e-learning program were the most engaging and effective learning methods ( 24 ). The results of research investigating the contribution of the human senses to learning indicate that approximately 75% of learning occurs through seeing and 13% through hearing ( 25 ). In addition, the use of audio-visual teaching materials can help learners to reduce their learning time and retrieve information more efficiently ( 26 ). Educational videos and narrated PowerPoint slides enable students to learn anywhere and as many times as they wish by providing a learning environment with no time and space limitations and with the possibility to repeat the content. Thanks to these affordances, the use of this type of educational materials, especially educational videos, in nursing education allows students to improve their cognitive, critical thinking, problem solving, and psychomotor skills ( 3 , 27 ). Summarizing and note-taking was another strategy used by the students participating in our study, especially those with a reading/writing learning style. Salmani et al. (2022) argue that the flexibility of online education allows nursing students to use educational materials in different ways based on their learning style, and one of these ways is note-taking ( 3 ). Since the dominant method of content delivery is asynchronous in e-learning, the flexibility of this method can facilitate the learning of students who prefer to learn by writing and taking notes. This is because in asynchronous content delivery, the students can pause the educational file, skip some sections, or repeat the content as many times as they wish ( 28 ). In addition, summarizing helps students to retrieve essential information from among a multitude of educational materials in a relatively short period of time ( 29 ). The results of our study showed that some students dedicated a place for studying in order to facilitate their learning. This strategy was implemented by allocating a quiet and comfortable place for studying and by allocating a specific place for studying. Consistent with our results, Puska et al. (2021) found that students will be satisfied with e-learning platforms used in universities if they use it in an environment that promotes e-learning ( 30 ). Structuring the environment is one of the dimensions of self-regulatory learning that reveals the independence of learners in e-learning. Because in e-learning, students are not studying in a structured and controlled environment, they need to structure their physical learning environment, whether at home or elsewhere, in a way that reduces distractions and increases their focus ( 31 ). Another strategy used by students in our study was reflection the content taught. According to Gaupp et al. (2018), reflection and learning skills are important factors in the students' acceptance of e-learning ( 32 ). Reflection plays a very important role in nursing students’ learning, and turning them into critical and autonomous nurses, and supporting their reflection practice can help them gain a better understanding of clinical and non-clinical skills ( 33 ). Skimming was another strategy used by some of the students, which was associated with facilitation of student learning. In line with our study, the results of Indah et al. (2018) showed that using skimming as a reading technique by nursing students was associated with a better understanding of the material ( 34 ). In fact, skimming helps students to predict the purpose and the main idea of the text they are studying ( 35 ). Some of the students participating in our study stated that one of their strategies for a better and deeper understanding of the course material was playing the role of a professor. This means that they imagined themselves as one of their professors and taught topics to hypothetical students. This was a very unique strategy since we could not find any studies in which students implemented role-playing strategies in exactly the same way as our participants did. However, role-playing is a fun and stimulating strategy for students because it allows them to step outside of their role as students. Finally, this strategy is associated with a better understanding of subjects due to the active role of the student in the learning process ( 36 ). Collaborative Learning Strategies Apart from strategies in which the learner played the central role, the results of our study showed that some students, especially those who had a desire to learn through others, used certain strategies to facilitate their learning which entailed interaction and cooperation with other students. These were classified as collaborative strategies. One of these strategies was teaching to and learning from peers. In agreement with our study, the results of previous studies confirm that peer-to-peer teaching in e-learning improves students’ learning ( 37 , 38 ). In peer-to-peer education, students will be more at ease to ask questions and then get feedback, and since the peer explanations are more comprehensible, it is easier for students to acquire knowledge which is more durable ( 38 ). Collaborative note-taking and pamphlet writing was another collaborative strategy adopted by the students. The use of this strategy led to obtaining a complete but brief educational pamphlet, which would subsequently reduce the students’ workload and make it easier for them to study for the final exams. When students learn in an electronic environment, they may experience a significant learning burden ( 39 ). In face-to-face education, the range of materials presented to students is usually restricted due to the professor's emphasis on certain important point. However, due to the absence of the professor in e-learning, the amount of information received by students may increase to a large amount .( 40 ) Therefore, the students’ use of collaborative methods allows them to share their ideas with each other and devise plans, and in this way, they manage the workload more effectively ( 41 ). Remaining Passive One of the noteworthy results of our study was that some students assumed a passive role in facing the challenges that e-learning had created for them during the pandemic, and they did not take any special action to promote their learning. The results of a study by Yeung et al. (2022) in Hong Kong indicated that some students felt lost in online education during the pandemic and surrendered to its challenges ( 6 ). Therefore, it is very imperative that professors and policy makers take appropriate measures to support this group of students who do not have the necessary skills to manage their learning in online education. Limitations In this study, we identified the learning strategies used by a group of Iranian nursing students in e-learning. Therefore, the findings of this study cannot be generalized to other settings and populations. This is because in different settings, students may have different demographic characteristics and online learning experiences. Conclusion The sudden shift in education from face-to-face to electronic in response to the emergency conditions caused by the Covid-19 pandemic issued many challenges to nursing students. However, few studies have addressed the strategies students used to learn in such conditions. Our study contributed to bridging this gap by documenting how students tried to learn despite the challenges they faced, by adopting self-directed and collaborative learning strategies. Therefore, it is very necessary for policy makers and nursing professors to be aware of these strategies so that they can take the necessary measures to optimize and facilitate student learning in an online learning environment. Suggestions For Future Studies More studies are recommended to be conducted in other countries in order to shed more light on the nature of students’ learning strategies for e-learning. Also, results of comparisons between strategies adopted by students from different countries can be used to help the students become independent e-learners. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (IR.AJUMS.REC.1400.273). The objectives of the research were fully and accurately explained to the participants. They were assured that participation in the study was voluntary and that they were free to withdraw from the study at any time. The participants were fully briefed on the importance of audio recording and were assured about the confidentiality of the audio files and their anonymity after completing the data analysis process and publication of information. Finally, written informed consent was obtained from the participants. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Availability of data and materials Access to the data obtained from this research is available upon reasonable request from the corresponding author. Competing interests The authors declare that they have no competing interests. Funding This study was financially supported by Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Authors' contributions NC and SM conceived the idea of the study. NC collected and analyzed the data. DR, NE, ER and SM contributed to data interpretation. NC drafted the initial manuscript. SM and DR were the study supervisors. 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K., “The Use of Telegram in Surgical Education: Exploratory Study,” JMIR Med. Educ. 8, e35983 (2022). doi:10.2196/35983. Neuschlova M, Kompanikova J, editors. Learning styles and their use in medical education in the form of e-learning materials. ICERI2019 Proceedings; 2019: 5487-5496 . doi: 10.21125/iceri.2019.1317. Hampton D, Pearce PF, Moser DK. Preferred methods of learning for nursing students in an on-line degree program. J Prof Nurs. 2017;33(1):27-37 . https://doi.org/10.1016/j.profnurs.2016.08.004. Hurtubise L, Martin B, Gilliland A, Mahan J. To play or not to play: leveraging video in medical education. J. Grad. Med. Educ. 2013;5(1):13-8 . https://doi.org/10.4300/JGME-05-01-32. Rudolph M. Cognitive theory of multimedia learning. Journal of Online Higher Education. 2017;1(2):1-10 . Şenyuva E. Reflections on nursing education of technological developments. Florence Nightingale J Nurs. 2019;27(1):79-90 . DOI: 10.26650/FNJN322556. Baldwin, M. P., Fanguy, M., & Costley, J. H. (2019). The Effects of Collaborative Note-Taking in Flipped Learning Contexts. Journal of Language and Education, 5(4), 25-35. doi: https://doi.org/10.17323/jle.2019.9726. Turky SN, Al-Jumaili ASA, Hasoun RK. Deep Learning Based On Different Methods For Text Summary: A Survey. Journal of Al-Qadisiyah for computer science and mathematics. 2021;13(1): 26–35. DOI: https://doi.org/10.29304/jqcm.2021.13.1.766. Puška A, Puška E, Dragić L, Maksimović A, Osmanović N. Students’ satisfaction with E-learning platforms in Bosnia and Herzegovina. Technol. Knowl. 2021;26(1):173-91 . Ejubovic A, Puska A. Impact of self-regulated learning on academic performance and satisfaction of students in the online environment. Knowledge Management & E-Learning: An International Journal. 2019;11(3):345-63 . doi: https://doi.org/10.1007/s10758-020-09446-6. Gaupp R, Fabry G, Körner M. Self-regulated learning and critical reflection in an e-learning on patient safety for third-year medical students. Int. J. Med. Educ. 2018;9:189 . doi: 10.5116/ijme.5b39.d5a8. Epstein I, Bertram M. Using students’ smartphones to learn a nursing skill: students’ perspectives. J Nurs Educ Pract. 2019;9(5):24-31 . DOI: 10.5430/jnep.v9n5p24. Indah CHR. The Effectiveness of Scanning and Skimming in Improving Reading Comprehention Skill of Maharani Nursing Students. Paradigma: Jurnal Filsafat, Sains, Teknologi, dan Sosial Budaya. 2018;24(1):17-24 . Syahputra A, Hidayat M, Wulandari BA. Teachers’ Strategies in Teaching Reading Comprehension through E-learning Platform during the Pandemic. Edukasi: Jurnal Pendidikan dan Pengajaran. 2022;9(1):51-68 . http://jurnal.radenfatah.ac.id/index.php/edukasi/index Latif R, Mumtaz S, Mumtaz R, Hussain A. A comparison of debate and role play in enhancing critical thinking and communication skills of medical students during problem based learning. Biochem Mol Biol Educ. 2018;46(4):336-42 . https://doi.org/10.1002/bmb.21124. Saunders P, Chester A, Xenos S. University student peer tutoring: A pilot program to improve learning for both tutors and tutees. Championing cutting-edge 21st century mentoring and learning models and approaches: Brill; 2020. p. 27-44 . DOI: https://doi.org/10.1163/9789004440371_003. Im Kang K, Lee N, Joung J. Nursing students' experience of online peer tutoring based on the grow model: A qualitative study. Nurse Educ. Today. 2021;107:105131 . https://doi.org/10.1016/j.nedt.2021.105131. Bobbink P, Teixeira CM, Charbonneau L, Chabal L, Guex C, Probst S. E-Learning and Blended-Learning Program in Wound Care for Undergraduate Nursing Students. J. Nurs. Educ. 2022;61(1):53-7 . https://doi.org/10.3928/01484834-20211203-03. Widyanti A, Hasudungan S, Park J. e-Learning readiness and perceived learning workload among students in an Indonesian university. Knowledge Management & E-Learning: Knowledge Management and E-Learning: An International Journal. https://doi.org/10.34105/j.kmel.2020.12.002. Ionescu CA, Paschia L, Gudanescu Nicolau NL, Stanescu SG, Neacsu Stancescu VM, Coman MD, et al. Sustainability analysis of the e-learning education system during pandemic period—covid-19 in Romania. Sustainability. 2020; 12(21):9030 . https://doi.org/10.3390/su12219030. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 08 May, 2023 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Major revision 09 Mar, 2023 Reviews received at journal 08 Mar, 2023 Reviewers agreed at journal 06 Mar, 2023 Reviews received at journal 15 Feb, 2023 Reviews received at journal 29 Jan, 2023 Reviewers agreed at journal 26 Jan, 2023 Reviewers agreed at journal 26 Jan, 2023 Reviewers agreed at journal 26 Jan, 2023 Reviewers invited by journal 26 Jan, 2023 Editor assigned by journal 26 Jan, 2023 Editor invited by journal 24 Jan, 2023 Submission checks completed at journal 24 Jan, 2023 First submitted to journal 22 Jan, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2504543","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":170333262,"identity":"4071d716-f6dd-450f-aa90-0750857c0608","order_by":0,"name":"Nesa Cheraghbeigi","email":"","orcid":"","institution":"Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nesa","middleName":"","lastName":"Cheraghbeigi","suffix":""},{"id":170333263,"identity":"d5c7c272-7afd-4ce0-acb6-8b577c86ecbd","order_by":1,"name":"Shahram Molavynejad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYDACCQY2EJUA5nyAMYjWwjiDZC3MPMRokZ/d/OxxRc22PP7Zhx9/tm2zy+Nnb2D88DEHtxaDO8fMDc8cu10scS7NwDi3LblYsucAs+TMbXi0SCSYSTaw3U5sOMNgkJzbxpy44UYCGzMvHi3yM9K/STb8u504/wz7h8OWbfWEtTDcyDGTbGy7nbjhDI9hM2PbYcJaDG7klEk29t0uNjzDU8zYc+544syeg814/QJ02DbJhm+38+TOsG/+8KOsOrGfvfngh4/4HIYCGMFxxNhArHoQ+EOK4lEwCkbBKBgpAAC3kVdrWAy3FgAAAABJRU5ErkJggg==","orcid":"","institution":"Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Shahram","middleName":"","lastName":"Molavynejad","suffix":""},{"id":170333264,"identity":"ed1e1e9c-bb9b-4f73-83cd-bd41cf772ce1","order_by":2,"name":"Dariosh Rokhafroz","email":"","orcid":"","institution":"Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dariosh","middleName":"","lastName":"Rokhafroz","suffix":""},{"id":170333265,"identity":"631a372a-e5a2-49c1-9e04-67f0b7539529","order_by":3,"name":"Nasrin Elahi","email":"","orcid":"","institution":"Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nasrin","middleName":"","lastName":"Elahi","suffix":""},{"id":170333266,"identity":"645555ae-756a-46e8-8a59-9997fb9e47be","order_by":4,"name":"Eisa Rezaei","email":"","orcid":"","institution":"Smart University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Eisa","middleName":"","lastName":"Rezaei","suffix":""}],"badges":[],"createdAt":"2023-01-22 16:14:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2504543/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2504543/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-023-04270-9","type":"published","date":"2023-05-08T20:46:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":44728975,"identity":"1f2e9f00-16f2-4ecb-9768-eeccf52d5a85","added_by":"auto","created_at":"2023-10-16 21:09:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":447945,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2504543/v1/3164913d-d400-4196-a8ef-15545052ff0d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nursing students’ learning strategies for e-learning during the Covid-19 pandemic: A qualitative study","fulltext":[{"header":"Background","content":"\u003cp\u003eWith the sudden and unprecedented emergence of the Covid-19 pandemic, all sectors of society including education experienced widespread disruptions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In fact, since early 2020, many higher education institutions around the world have quickly shifted from in-person education to online education in order to respond to the restrictions imposed by the pandemic (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Nursing education, as a sensitive and key component of higher education was no exception, and with the unexpected emergence of Covid-19, nursing educators were urged to make quick decisions on how the education of nursing students should be continued, and all solutions they came up with were nothing but to quickly replace in-person education with electronic education (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Of course, the shift from in-person to e-learning classes was regarded as a provisional solution in response to the crisis caused by the Covid-19, but as the pandemic persisted, fully online or hybrid methods were used for two years (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Iran, before the outbreak of the pandemic, the method of providing medical science education, including nursing education, was through face-to-face education, and electronic education had no specific place in the strategic plans of universities. Nevertheless, in response to the closure of universities and in order to avoid a debilitating pause in the education process of students, the Iranian Ministry of Health, Treatment and Medical Education introduced both a web-based system to offer education in an offline form and a number of computer programs to support online education. By so doing, this ministry called for the rapid presentation of electronic education in universities of medical sciences, including nursing schools, and in this way, electronic education quickly became compulsory in all universities of the country (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe sudden and unexpected transition from face-to-face to electronic education undoubtedly made students face various challenges and obstacles, and several studies have identified these challenges. Moradi et al (2022) in their qualitative study, for example, reported the following as the main challenges that nursing students and professors went through in this respect: lack of necessary infrastructure for e-learning, insufficient facilities and equipment, financial problems, professors\u0026rsquo; unpreparedness to use e-learning, reluctance of students and professors to use e-learning, and the professors' insufficient adherence to e-learning (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In addition, increased workload, anxiety, being away from the clinical environment, insufficient communication and interactions between students and professors, problems related to educational content, superficial learning, and inability to develop critical thinking are other problems of students in e-learning during the pandemic (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In the face of the challenges, the students were urged to adopt strategies to facilitate their learning (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although many studies have been conducted on learning strategies in face-to-face education (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and in conventional online education, few have dealt with the extent to which the use of these strategies in mandatory electronic education during the pandemic period is beneficial to students. This is particularly important with respect to nursing students owing to the unique nature of their field of study (involving both theoretical and clinical aspects) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Previous studies that have been conducted in the context of e-learning in nursing during Covid-19 have mainly investigated the challenges (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), experience (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), and satisfaction level (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) of e-learning based on the views of professors and students. In other words, the results of these studies have revealed that students have faced many challenges in e-learning during the pandemic (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). However, whether students have been able to avail themselves with learning strategies to cope with these challenges has been a much needed line of inquiry investigated in few, if any, studies (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe sudden and unanticipated implementation of e-learning during the Covid-19 pandemic in Iran forced professors and students to be left with no choice but to be engaged in this type of education (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This created a unique context that was definitely different from previous studies in terms of scale and participation of participants. In studies conducted before the pandemic, online courses were mainly offered on a voluntary basis or were only mandatory for a certain number of students (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Therefore, studies investigating e-learning under the conditions of Covid-19 are significantly worthwhile because students' expectations of e-learning may change due to such differences. On the other hand, most of the studies that have been conducted on learning styles of students in e-learning are quantitative in approach and use self-report questionnaires such as the Kolb Learning Style Inventory, which divides individuals into predetermined categories for data collection (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). By contrast, qualitative studies allow researchers to gain a deeper understanding of the phenomenon under investigation, and such studies can provide valuable insights into the special conditions caused by the Covid-19 pandemic. In fact, a study investigating the strategies students have used in their learning under the difficult conditions of the pandemic is worthwhile and of paramount importance since it enables professors to take effective measures to facilitate students' learning in distance education and to help them learn with more independence and motivation. Therefore, the present qualitative study aimed to identify learning strategies used by undergraduate nursing students in online education offered in response to the Covid-19 pandemic in Iran.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe present study aimed to identify the learning strategies of nursing students in e-learning during the pandemic.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting\u003c/h3\u003e\n\u003cp\u003eThe present study was conducted at Ahvaz University of Medical Sciences in Iran. Although the infrastructure needed to provide electronic education was available since 2015 in this university, until the outbreak of the pandemic, electronic education in Ahvaz University of Medical Sciences was only used in a few cases and voluntarily by interested faculty members. The sudden appearance of covid-19 forced all medical sciences universities of the country, including Ahvaz University of Medical Sciences to quickly shift from face-to-face education to electronic. Therefore, in order to better adapt to electronic education, the university's management of Education Developing Center considered a program that included empowering faculty members to develop educational content for e-learning and empowering students to use e-learning tools. Furthermore, Offline trainings at Ahvaz University of Medical Sciences were provided using the national learning management system \"Navid\". \"Adobe Connect\" and \"Skyroom\" soft wares were also used to support online training.\u003c/p\u003e\n\u003ch3\u003eDesign\u003c/h3\u003e\n\u003cp\u003eIn this study, inductive content analysis method was used to identify nursing students' learning strategies for e-learning during the Covid-19 pandemic. Due to its exploratory nature, content analysis approach enables researchers to gain a deeper understanding of the phenomena under study and discover their complexities (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe statistical population included undergraduate nursing students of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Twelve undergraduate nursing students were selected using purposive method from among eligible students. The inclusion criteria were: having at least two academic semesters of e-learning experience and willingness to participate in the study. Maximum variation sampling technique was used to capture a diverse range of views and experiences. Therefore, sampling was done from both sexes and from second- to fourth-year students. The research sample included 3 second-year students, 5 third-year students, and 4 fourth-year students. Also, the majority (n\u0026thinsp;=\u0026thinsp;9) of the students included in the study were female. The age of the participants ranged from 22 to 24 years.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eSemi-structured interviews were used to collect data. Compared to quantitative methods of data collection, interviews provide deeper insights into the phenomenon under study. Interview questions included, but were not limited to, the following:\u003c/p\u003e \u003cp\u003e1- Could you please explain your experience of e-learning?\u003c/p\u003e \u003cp\u003e2- Could you please explain how you attended nursing courses in e-learning?\u003c/p\u003e \u003cp\u003e3- How did you learn in this semester or the previous semesters when your courses were offered electronically?\u003c/p\u003e \u003cp\u003e In addition to open questions, probing questions were also used in order to delve into the learning experiences of the participants. Also, at the end of each interview, the participants were given the opportunity to add more points to their statements if they wished. The data collection process continued until data saturation. In cases of any ambiguity, a follow-up interview was also set up. A total of 16 face-to-face interviews were conducted with 12 undergraduate nursing students. Eight students were interviewed once, one student was interviewed three times, and two students were interviewed twice. The interviews were conducted individually in one of the classrooms of the School of Nursing and Midwifery which had a quiet and peaceful atmosphere. The mean length of the conducted interviews was 65 minutes. The interviews were recorded using a digital audio recorder. The content of each interview was transcribed verbatim immediately after the interview.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe process of data analysis was done simultaneously with data collection. Inductive content analysis as explained by Graneheim and Lundma was used for data analysis which involved the following five stages:\u003c/p\u003e \u003cp\u003e1- Verbatim transcription of each interview immediately after its completion\u003c/p\u003e \u003cp\u003e2- Reading the entire transcribed text in order to get a general understanding of the content of the interview\u003c/p\u003e \u003cp\u003e3- Determination of basic codes and semantic units\u003c/p\u003e \u003cp\u003e4- Classification of primary codes based on their similarities into broader categories\u003c/p\u003e \u003cp\u003e5- Determining the main theme of the categories (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e In the present study, after the completion of each interview, the entire recorded audio file was listened to carefully by the researcher. After that, the content of the interview was transcribed verbatim in Microsoft Word software. Then, to immerse in the data and to extract the main themes, the interview text was read by the researcher several times. MAXQDA 2020 was used for data management. The lead researcher identified the semantic units by reading the interview text line by line. Semantic units were converted into primary codes. Afterwards, the codes were compared based on similarities and differences and were categorized into themes and sub-themes. Any disagreements regarding codes, themes and sub-themes were resolved by discussion sessions by the research team. Finally, after the themes and sub-themes were refined, they were specified in the text.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRigor\u003c/h3\u003e\n\u003cp\u003eThe criteria of Guba and Lincoln, namely credibility, confirmability, dependability, and transferability were used to achieve validity and reliability of the data (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The lead researcher's long engagement with the data ensured credibility. That is, during the data analysis process, which lasted for six months from May 12, 2022 to November 15, 2022, the researcher repeatedly read the transcript of the interviews. In addition, an expert supervisor supervised the data analysis process and any disagreement was resolved by discussion and agreement. In addition to peer-check, member-check was also used to achieve credibility. To this aim, a summary of the findings was provided to the participants after analyzing each interview and they were asked to check whether the concepts obtained reflected their experiences or ideas. If any additional comments or experiences were added by the participants, they were included in the analysis. Also, maximum variation sampling technique was used by choosing both male and female students studying in different academic years. In order to ensure confirmability and facilitate auditability, a complete description of the research process, including data collection and analysis methods, was presented. Dependability was confirmed by inviting an external audit to check the similarities and differences between the researchers\u0026rsquo; and participants\u0026rsquo; understanding of the topics. Through complete and accurate description of the participants, the time and place of data collection and the sampling method, the researchers tried to achieve transferability of the data.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOur data analysis showed that students\u0026rsquo; learning strategies for e-learning during the pandemic fall into three main themes of \u0026ldquo;self-centered learning strategies\u0026rdquo;, \u0026ldquo;collaborative learning strategies\u0026rdquo; and \u0026ldquo;Remaining passive\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Using direct quotes from the participants, the themes and their sub-themes are presented below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudents' learning strategies in e-learning\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCode\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSearching the Internet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eExploration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"15\" rowspan=\"16\"\u003e \u003cp\u003eSelf-centered learning strategies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsking peers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsking teachers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudying reference textbooks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUsing evidence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudying relevant articles\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttending educational webinars\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eUsing educational media and tools\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsing educational systems and software\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsing educational Telegram channels\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWatching educational videos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUsing audio-visual resources\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eListening to narrated PowerPoint slides\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDedicating a quiet and comfortable place for studying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDedicating a place for studying\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDedicating a particular place for studying\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClassification and summarization of content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSummarizing and note-taking\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNote-taking\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReflection on the narrated PowerPoint slides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReflection on the materials taught\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReflection on educational videos\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkimming the content in the first round of studying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSkimming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrying to understand the main idea\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlaying the role of a teacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIndividual role playing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching to hypothetical students\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForming groups for note-taking and pamphlet writing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCollaborative note-taking and pamphlet writing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eCollaborative learning strategies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivision of responsibilities in note-taking and pamphlet writing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUploading the group pamphlet\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForming a group of peers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePeer-to-peer teaching and learning\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivision of teaching materials between group members\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching the materials to one another\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGiving up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGiving up and not taking action\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRemaining passive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot taking action\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eTheme 1: Self-centered Learning Strategies\u003c/h3\u003e\n\u003cp\u003eThis theme includes the following 9 sub-themes: \u0026ldquo;Exploration\u0026rdquo;, \u0026ldquo;Using evidence\u0026rdquo;, \u0026ldquo;Using educational tools and media\u0026rdquo;, \u0026ldquo;Using audio-visual resources\u0026rdquo;, \u0026ldquo;Dedicating a particular space for studying\u0026rdquo;, \u0026ldquo;Summarizing and taking notes\u0026rdquo;, \u0026ldquo;Reflection on the content taught\u0026rdquo;, \u0026ldquo;Skimming\u0026rdquo; and \u0026ldquo;Individual role playing\u0026rdquo;.\u003c/p\u003e\n\u003ch3\u003eExploration\u003c/h3\u003e\n\u003cp\u003eMany students stated that they used this strategy when they were faced with some professors' inadequate teaching and when some topics raised questions or were ambiguous for them. Exploration manifested itself in a variety of behaviors that include \u0026ldquo;searching the Internet\u0026rdquo;, \u0026ldquo;asking the teacher\u0026rdquo; and \u0026ldquo;asking peers\u0026rdquo;. However, the students\u0026rsquo; first choice to solve their learning problems was to search the Internet, which was followed by questions from peers and questions from teachers. The following quotes shed more light on how and why these solutions were adopted by the students.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I used to search and download educational videos available on Google. For example, when the teacher taught CPR, I did not learn it very well and didn't know where exactly I should place these leads. That\u0026rsquo;s why I searched the Internet and found a related video.\u0026rdquo; (Participant 7, 7th semester female student)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If I happened to have a problem, I would first search the Internet, and if I couldn't find the answer, I would ask one of the classmates who knew the answer.\u0026rdquo; (Participant 9, 8th semester female student)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Some of the professors were really good. They gave us their numbers and we could ask them in case we had a problem.\u0026rdquo; (Participant 12, 6th semester male student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eUsing Evidence\u003c/h3\u003e\n\u003cp\u003eBased on the experiences of our participants, using evidence involved reading reference textbooks and reading relevant scientific articles. Students used this strategy when the topics were inadequately presented by the professor or when they did not understand the topics well despite the professor's good teaching.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For example, I had the professor\u0026rsquo;s pamphlet and the content file, but I felt that the teaching materials were not complete, so I used to supplement those materials from different books to help me learn.\u0026rdquo; (Participant 8, 6th semester female student)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For some of things that I had problem with such as some points in anatomy, I would look up the answer in books. Or in physiology, for example, I again studied the heart physiology from scratch so that I could understand the different axes. Although the teacher had taught very well, I myself felt that I did not understand, so I read the book again. Or I used the materials and articles that were available on the Internet.\u0026rdquo; (Participant 3, 4th semester female student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eUsing Educational Tools And Media\u003c/h3\u003e\n\u003cp\u003eAccording to the experiences of our participants, this strategy included participation in educational webinars, using educational systems and software (Full Code Medical Simulation, Labster, and Faradars), and using Telegram educational channels. Some students stated that in order to better learn the topics in which they felt weak, they participated in educational webinars, which often cost them money:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yeah, these webinars are very good. I myself attended a webinar on pharmacology. Of course, I paid a fee to participate, and then the topics were taught very nicely; for example, beta blockers or calcium blockers; these were taught in a nice way using diagrams and also audio files explaining the topics very well. I myself participated in these. For example, I was weak in the pharmacology course, so I participated in these and it was very good.\u0026rdquo; (Participant 1, 4th semester female student)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn addition, since practical/clinical topics are not presented to students efficiently in electronic education, some students, especially those who are already familiar with the basics of virtual education, will use the strategy of using simulator software and systems to learn these topics.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yeah, these apps helped me a lot, because you can go step by step. I had never been to hospital, but when I was working with Full Code, although it was in English, I understood that as a nurse, I am allowed to do some examinations. I mean, I used it to learn physical examination. In addition to Full Code, there is another system called Labster, which is completely designed so that you can wear gloves and a gown, or plug the microscope in, all in that simulation space. So much attention has been paid to the details. This app was one of the things that I used for the laboratory courses.\u0026rdquo; (Participant 5, 5th semester female student)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think Faradars system belongs to Tehran University of Medical Sciences, which has some packages that you can buy; for example, you can go and buy content, and some may post free tutorials, and I used to use these tutorials. For example, I used this system to learn NG-Tube placement and also to get familiar with endoscopy and other things.\u0026rdquo; (Participant 1, 4th semester female student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eUsing Audio-visual Resources\u003c/h3\u003e\n\u003cp\u003eAnother strategy adopted by the interviewed students was using audio-visual educational resources. This included watching educational videos and listening to narrated PowerPoint slides. This strategy was mostly used by students who had a visual-auditory learning style.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Because I myself learn better through videos, I prefer watching videos. For example, I found a video clip about CPR. I saw that clip and it was very good.\u0026rdquo; (Participant 12, 6th semester male student)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I have a habit of having someone explain things to me, and I listen to learn. What I used to do was listen to the teacher's voice. When I was idle, I used to listen to the teacher's voice. In my mind, when I heard the teacher's voice it looked as if the lesson had been repeated for me. Lessons that were repeated were very good.\u0026rdquo; (Participant 8, 6th semester female student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eSummarizing And Taking Notes\u003c/h3\u003e\n\u003cp\u003eAnother self-centered learning strategy the students participating in the present study used, especially those with a reading/writing learning style, was summarizing and note-taking. Students stated that the flexibility of e-learning facilitated the use of this strategy. Taking notes and summarizing helped these students to review the educational material faster when studying for final exams.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Well, I\u0026rsquo;m used to writing in order to learn. In e-learning, I had more time to categorize the materials I was supposed to learn. I made a table for myself. The night before the exam, for example, I could easily distinguish between different diseases or the symptoms of different diseases by reading them on a table. It took me much less time.\u0026rdquo; (Participant 4, 6th semester female student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eDedicating A Particular Place For Studying\u003c/h3\u003e\n\u003cp\u003eSome students stated that they dedicated a particular place for studying to facilitate their learning. Such a place, according to the participants, had to be quiet and comfortable.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I used to choose a place to study that was comfortable and without noise. Besides, it had to be a particular place so that my brain would know that it was time to study. Well, this made me learn better and learn faster.\u0026rdquo; (Participant 2, 4th semester female student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eReflection\u003c/h3\u003e\n\u003cp\u003eReflection on the educational materials was another self-centered learning strategy adopted by some students to learn the topics more deeply.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;After I listened to the professor's narrated PowerPoint [slide] or watched an educational video, I would think about those contents and make an analysis for myself of that PowerPoint [slide] or video\u0026rdquo; (Participant 6, 5th semester female student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eSkimming\u003c/h3\u003e\n\u003cp\u003eSome students believed that using the skimming strategy led to better learning of the topics. This strategy helped them understand the main idea of the educational material and learn the topics more quickly the next time they study the same content.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Another thing I do is, for example, to read the entire article quickly and then come back to the beginning. Now that I have read it once, I have a general idea about it, and then I read it again in more detail. This makes me learn better.\u0026rdquo; (Participant 8, 6th semester female student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eIndividual Role Playing\u003c/h3\u003e\n\u003cp\u003ePlaying the role of a teacher was another self-centered learning strategy used by some students. These students stated that for a better and deeper understanding of the course material, they imagined themselves to be one of the professors and then taught the topics to hypothetical students.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;One of the methods I used, in addition to summarizing the teacher\u0026rsquo;s voice, was to play the role of the teacher for myself by giving a lecture. I mean, I imagined myself as a teacher and put myself in shoes of Professor X or Y, and I would explain what he or she said to myself, as if I had students and I was the professor and I was teaching the lesson to my students. This way, my efficiency would be much higher.\u0026rdquo; (Participant 7, 7th semester female student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eTheme 2: Collaborative Learning Strategies\u003c/h3\u003e\n\u003cp\u003eThis theme has two sub-themes, namely \u0026ldquo;peer-to-peer teaching and learning\u0026rdquo; and \u0026ldquo;collaborative note-taking and pamphlet writing\u0026rdquo;.\u003c/p\u003e\n\u003ch3\u003ePeer-to-peer Teaching And Learning\u003c/h3\u003e\n\u003cp\u003eThe results of our study showed that some students, especially those who had the desire to learn socially, formed groups of friends to facilitate their learning, and after dividing the topics among each team member and achieving mastery over the specified topics, they would teach each other. The use of this strategy led to reduced student workload and better learning owing to the division of responsibilities and the comprehensibility of peer explanations.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Sometimes it was even like each of us would, for example, teach one chapter to the others. For example, if we had five chapters and there were five of us in a group, then each one of us would take one chapter. Well, this way, the work was divided among everyone. On the other hand, because each of the chapters we were responsible for was read very well, when we taught it, it was comprehensible to others.\u0026rdquo; (Participant 6, 7th semester female student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eCollaborative Note-taking And Pamphlet Writing\u003c/h3\u003e\n\u003cp\u003eCollaborative note-taking and pamphlet writing was another collaborative strategy employed by the students. The final product of this strategy was a complete and concise educational pamphlet, which significantly reduced the students\u0026rsquo; workload and made it easier for them to study for the final exams.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We had a note-taking and pamphlet writing group, and we had a class representative for note-taking and pamphlet writing. This representative would divide the class into smaller groups, and each group was responsible for a certain topic, which had to be written down based on that teacher\u0026rsquo;s voice and PowerPoint [slides], and then finally the representative would combine all these pamphlets and put them in the pamphlet group. This note-taking and pamphlet writing was very good because the contents were complete, and it was much easier to read at the night before the exam.\u0026rdquo; (Participant 9, 8th semester female student)\u003c/em\u003e \u003c/p\u003e\n\u003ch3\u003eTheme 3: Remaining Passive\u003c/h3\u003e\n\u003cp\u003eThis theme involves two sub-themes, namely \u0026ldquo;Giving up\u0026rdquo; and \u0026ldquo;Not taking action\u0026rdquo;. The results of our study showed that some students felt lost in the face of the challenges of e-learning and did not take effective action to help their learning.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I didn't do anything special. The amount of material was so large that one would get confused. I would just read some topics the night before the exam only to pass the exam. It was really bad. I would keep praying that the in-person education would resume as soon as possible.\u0026rdquo; (Participant 11, 6th semester male student)\u003c/em\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of the current study was to identify the learning strategies employed by undergraduate nursing students in online education provided in response to the Covid-19 pandemic in Iran. The results of our study showed that these students used self-centered and collaborative strategies to facilitate their e-learning during the pandemic. Some students, on the other hand, chose to remain passive. In the following, these findings are discussed in more details and in separate sections.\u003c/p\u003e\n\u003ch3\u003eSelf-directed Learning Strategies\u003c/h3\u003e\n\u003cp\u003eThe results of our study showed that students used various self-centered strategies to facilitate their e-learning. In fact, due to the teacher\u0026rsquo;s physical absence in e-learning environment, students have more independence in the learning process, and in order to be able to learn and succeed in this type of education, it is necessary to have self-regulation learning skills (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). One of the self-centered strategies used by some students was exploration. According to our results, students used this strategy when faced with inadequate teaching of some professors and when they came across topics that raised questions for them. Exploration manifested itself in a variety of behaviors including searching the Internet, asking the professor, and asking peers. However, the students\u0026rsquo; first resolution for their learning problems was to search the Internet. Questions from peers and questions from teachers were the next strategies that they used, which is consistent with the results of Kee et al (2020) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Another study also showed that students are more willing to ask their peers, and a smaller percentage of students talk to professors (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). One of the reasons why more students prefer the strategies of searching the Internet and asking peers over the strategy of asking the professor can be related to the shorter time of receiving answers by the first two strategies. The World Wide Web provides students with a valuable opportunity to quickly find the information they need by searching the Internet (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). On the other hand, students' access to professors during e-learning was limited and they had to wait for a relatively long time to receive answers from them. Therefore, it was easier for students to solve their problems by searching the Internet and asking their peers than to ask their professors.\u003c/p\u003e \u003cp\u003eUsing evidence was another strategy used by students, which included reading reference textbooks and relevant articles. Some students stated that they used this strategy to supplement the educational materials provided by the professor and to facilitate learning when it was difficult to understand certain topics. Salmani et al. (2022) found that in e-learning classes, after the nursing students take notes from the teaching materials provided by the professor, they use reference textbooks to compare and supplement their notes with (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Reference textbooks are considered rich educational resources through which students can obtain reliable knowledge and information (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, in electronic education, due to their more responsibility and independence in learning, students should not only rely on reference textbooks and educational materials provided by the professor, but also research the Internet to find authentic educational articles and expand their knowledge (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Therefore, a critical responsibility of professors in this regard is to adequately guide students in choosing the right authentic educational resources and how to use them so that they can extract the right information that meets their educational needs.\u003c/p\u003e \u003cp\u003eAnother strategy used by some of the students interviewed in this study was using educational tools and media. This included participation in webinars, using educational systems/software such as medical simulation systems, and using Telegram educational channels. This strategy was used mostly in situations where the teaching material had a clinical/practical implication, or when effective learning did not take place due to inadequate teaching. Under such circumstances, the use of these strategies was associated with better and deeper learning of students. In line with our study, Luo et al. (2021) found that using webinars in combination with virtual simulators in e-learning during the Covid-19 pandemic increased the involvement of nursing students in the learning process and improved their clinical reasoning (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Webinar and virtual simulators, both as two types of distance education techniques, can simulate face-to-face education for students. Webinar allows professors to be in contact with their students simultaneously and directly through audiovisual communication and provide them with immediate feedback (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Virtual simulators also simulate the clinical environment for students, allowing them to perform clinical skills independently and reflect on their performance according to the feedback they receive (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In addition, the use of educational tools and media in our study involved using Telegram educational channels. In fact, the special affordances of Telegram application, such as the possibility of forming discussion groups and educational channels with a very large number of members, facilitate students\u0026rsquo; access to educational resources and thereby helping them learn better (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs another self-centered learning strategy, the students participating in this study used audio-visual educational resources, which included watching educational videos and listening to narrated PowerPoint slides. This strategy was mostly used by students who had a visual-auditory learning style. These students preferred to learn by seeing and hearing instead of writing and reading (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Hampton et al. (2016) reported that educational videos and PowerPoint slides narrated by nursing students who participated in an e-learning program were the most engaging and effective learning methods (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The results of research investigating the contribution of the human senses to learning indicate that approximately 75% of learning occurs through seeing and 13% through hearing (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In addition, the use of audio-visual teaching materials can help learners to reduce their learning time and retrieve information more efficiently (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Educational videos and narrated PowerPoint slides enable students to learn anywhere and as many times as they wish by providing a learning environment with no time and space limitations and with the possibility to repeat the content. Thanks to these affordances, the use of this type of educational materials, especially educational videos, in nursing education allows students to improve their cognitive, critical thinking, problem solving, and psychomotor skills (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSummarizing and note-taking was another strategy used by the students participating in our study, especially those with a reading/writing learning style. Salmani et al. (2022) argue that the flexibility of online education allows nursing students to use educational materials in different ways based on their learning style, and one of these ways is note-taking (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Since the dominant method of content delivery is asynchronous in e-learning, the flexibility of this method can facilitate the learning of students who prefer to learn by writing and taking notes. This is because in asynchronous content delivery, the students can pause the educational file, skip some sections, or repeat the content as many times as they wish (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In addition, summarizing helps students to retrieve essential information from among a multitude of educational materials in a relatively short period of time (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe results of our study showed that some students dedicated a place for studying in order to facilitate their learning. This strategy was implemented by allocating a quiet and comfortable place for studying and by allocating a specific place for studying. Consistent with our results, Puska et al. (2021) found that students will be satisfied with e-learning platforms used in universities if they use it in an environment that promotes e-learning (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Structuring the environment is one of the dimensions of self-regulatory learning that reveals the independence of learners in e-learning. Because in e-learning, students are not studying in a structured and controlled environment, they need to structure their physical learning environment, whether at home or elsewhere, in a way that reduces distractions and increases their focus (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother strategy used by students in our study was reflection the content taught. According to Gaupp et al. (2018), reflection and learning skills are important factors in the students' acceptance of e-learning (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Reflection plays a very important role in nursing students\u0026rsquo; learning, and turning them into critical and autonomous nurses, and supporting their reflection practice can help them gain a better understanding of clinical and non-clinical skills (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSkimming was another strategy used by some of the students, which was associated with facilitation of student learning. In line with our study, the results of Indah et al. (2018) showed that using skimming as a reading technique by nursing students was associated with a better understanding of the material (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In fact, skimming helps students to predict the purpose and the main idea of the text they are studying (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSome of the students participating in our study stated that one of their strategies for a better and deeper understanding of the course material was playing the role of a professor. This means that they imagined themselves as one of their professors and taught topics to hypothetical students. This was a very unique strategy since we could not find any studies in which students implemented role-playing strategies in exactly the same way as our participants did. However, role-playing is a fun and stimulating strategy for students because it allows them to step outside of their role as students. Finally, this strategy is associated with a better understanding of subjects due to the active role of the student in the learning process (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eCollaborative Learning Strategies\u003c/h3\u003e\n\u003cp\u003eApart from strategies in which the learner played the central role, the results of our study showed that some students, especially those who had a desire to learn through others, used certain strategies to facilitate their learning which entailed interaction and cooperation with other students. These were classified as collaborative strategies. One of these strategies was teaching to and learning from peers. In agreement with our study, the results of previous studies confirm that peer-to-peer teaching in e-learning improves students\u0026rsquo; learning (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In peer-to-peer education, students will be more at ease to ask questions and then get feedback, and since the peer explanations are more comprehensible, it is easier for students to acquire knowledge which is more durable (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCollaborative note-taking and pamphlet writing was another collaborative strategy adopted by the students. The use of this strategy led to obtaining a complete but brief educational pamphlet, which would subsequently reduce the students\u0026rsquo; workload and make it easier for them to study for the final exams. When students learn in an electronic environment, they may experience a significant learning burden (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). In face-to-face education, the range of materials presented to students is usually restricted due to the professor's emphasis on certain important point. However, due to the absence of the professor in e-learning, the amount of information received by students may increase to a large amount .(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) Therefore, the students\u0026rsquo; use of collaborative methods allows them to share their ideas with each other and devise plans, and in this way, they manage the workload more effectively (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eRemaining Passive\u003c/h3\u003e\n\u003cp\u003eOne of the noteworthy results of our study was that some students assumed a passive role in facing the challenges that e-learning had created for them during the pandemic, and they did not take any special action to promote their learning. The results of a study by Yeung et al. (2022) in Hong Kong indicated that some students felt lost in online education during the pandemic and surrendered to its challenges (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Therefore, it is very imperative that professors and policy makers take appropriate measures to support this group of students who do not have the necessary skills to manage their learning in online education.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eIn this study, we identified the learning strategies used by a group of Iranian nursing students in e-learning. Therefore, the findings of this study cannot be generalized to other settings and populations. This is because in different settings, students may have different demographic characteristics and online learning experiences.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe sudden shift in education from face-to-face to electronic in response to the emergency conditions caused by the Covid-19 pandemic issued many challenges to nursing students. However, few studies have addressed the strategies students used to learn in such conditions. Our study contributed to bridging this gap by documenting how students tried to learn despite the challenges they faced, by adopting self-directed and collaborative learning strategies. Therefore, it is very necessary for policy makers and nursing professors to be aware of these strategies so that they can take the necessary measures to optimize and facilitate student learning in an online learning environment.\u003c/p\u003e\n\u003ch3\u003eSuggestions For Future Studies\u003c/h3\u003e\n\u003cp\u003eMore studies are recommended to be conducted in other countries in order to shed more light on the nature of students\u0026rsquo; learning strategies for e-learning. Also, results of comparisons between strategies adopted by students from different countries can be used to help the students become independent e-learners.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (IR.AJUMS.REC.1400.273). The objectives of the research were fully and accurately explained to the participants. They were assured that participation in the study was voluntary and that they were free to withdraw from the study at any time. The participants were fully briefed on the importance of audio recording and were assured about the confidentiality of the audio files and their anonymity after completing the data analysis process and publication of information. Finally, written informed consent was obtained from the participants.\u003cstrong\u003e\u0026nbsp;All methods were carried out in accordance with relevant guidelines and regulations.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccess to the data obtained from this research is available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was financially supported by Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNC and SM conceived the idea of the study. NC collected and analyzed the data. DR, NE, ER and SM contributed to data interpretation. NC drafted the initial manuscript. SM and DR were the study supervisors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor express their special gratitude to all undergraduate nursing students who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eIqbal MZ, Alradhi HI, Alhumaidi AA, Alshaikh KH, AlObaid AM, Alhashim MT, et al. Telegram as a tool to supplement online medical education during COVID-19 crisis. Acta Informatica Medica. 2020;28(2):94\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e doi: 10.5455/aim.2020.28.94-97.\u003c/li\u003e\n\u003cli\u003eKoh JHL, Daniel BK. Shifting online during COVID-19: A systematic review of teaching and learning strategies and their outcomes. 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K., \u0026ldquo;The Use of Telegram in Surgical Education: Exploratory Study,\u0026rdquo; JMIR Med. Educ. 8, e35983 (2022). doi:10.2196/35983.\u003c/li\u003e\n\u003cli\u003eNeuschlova M, Kompanikova J, editors. Learning styles and their use in medical education in the form of e-learning materials. ICERI2019 Proceedings; 2019: 5487-5496\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e doi: 10.21125/iceri.2019.1317.\u003c/li\u003e\n\u003cli\u003eHampton D, Pearce PF, Moser DK. Preferred methods of learning for nursing students in an on-line degree program. J Prof Nurs. 2017;33(1):27-37\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e https://doi.org/10.1016/j.profnurs.2016.08.004.\u003c/li\u003e\n\u003cli\u003eHurtubise L, Martin B, Gilliland A, Mahan J. To play or not to play: leveraging video in medical education. J. Grad. Med. Educ. 2013;5(1):13-8\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e https://doi.org/10.4300/JGME-05-01-32.\u003c/li\u003e\n\u003cli\u003eRudolph M. 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Nursing students\u0026apos; experience of online peer tutoring based on the grow model: A qualitative study. Nurse Educ. Today. 2021;107:105131\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e https://doi.org/10.1016/j.nedt.2021.105131.\u003c/li\u003e\n\u003cli\u003eBobbink P, Teixeira CM, Charbonneau L, Chabal\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eL, Guex C, Probst S. E-Learning and Blended-Learning Program in Wound Care for Undergraduate Nursing Students. J. Nurs. Educ. 2022;61(1):53-7\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e https://doi.org/10.3928/01484834-20211203-03.\u003c/li\u003e\n\u003cli\u003eWidyanti A, Hasudungan S, Park J. e-Learning readiness and perceived learning workload among\u003cspan dir=\"RTL\"\u003e \u003c/span\u003estudents in an Indonesian university. Knowledge Management \u0026amp; E-Learning: Knowledge Management and E-Learning: An International Journal. https://doi.org/10.34105/j.kmel.2020.12.002.\u003c/li\u003e\n\u003cli\u003eIonescu CA, Paschia L, Gudanescu Nicolau NL, Stanescu SG, Neacsu Stancescu VM, Coman MD, et al. Sustainability analysis of the e-learning education system during pandemic period\u0026mdash;covid-19 in Romania. Sustainability. 2020; 12(21):9030\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e https://doi.org/10.3390/su12219030.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Covid-19 pandemic, e-learning, learning strategies, nursing students","lastPublishedDoi":"10.21203/rs.3.rs-2504543/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2504543/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e In response to the emergency brought about by the Covid-19 pandemic, many universities around the world had to change their teaching methods from in-person classes to e-learning. The purpose of this study was to identify the learning strategies of nursing students in e-learning during the pandemic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study had a qualitative design and used content analysis approach to collect and analyze the data. Sixteen semi-structured interviews were conducted with 12 Iranian undergraduate nursing students who were selected using purposive sampling method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The results of the study showed that nursing students generally used two different strategies for e-learning, namely self-centered learning strategies and collaborative learning strategies. Some students, on the other hand, adopted a passive approach in their learning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e In e-learning during the pandemic, students adopted different learning strategies. Therefore, designing teaching strategies tailored to the students’ strategies can promote their learning and academic achievement. Also, knowledge of these strategies helps policy makers and nursing educators to take necessary measures in order to optimize and facilitate student learning in an e-learning environment.\u003c/p\u003e","manuscriptTitle":"Nursing students’ learning strategies for e-learning during the Covid-19 pandemic: A qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-27 22:23:22","doi":"10.21203/rs.3.rs-2504543/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-03-09T09:53:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-03-08T05:45:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5d5fd70f-172b-4106-8f51-07449d9111db","date":"2023-03-06T05:32:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-02-15T15:43:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-01-29T23:38:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4d4f9cd0-6245-4d8b-825f-4e407ce36619","date":"2023-01-26T15:33:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0a974e05-3cbf-4b91-b46d-fa186b5a3d40","date":"2023-01-26T12:05:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"dd074b21-0d08-4f39-959f-c00a19ecac4f","date":"2023-01-26T09:49:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-01-26T08:48:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-01-26T08:37:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-01-24T13:00:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-01-24T12:32:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2023-01-22T16:12:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b93ddab-a336-4438-9f2d-dfd4352ea2c3","owner":[],"postedDate":"January 27th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T20:58:31+00:00","versionOfRecord":{"articleIdentity":"rs-2504543","link":"https://doi.org/10.1186/s12909-023-04270-9","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2023-05-08 20:46:56","publishedOnDateReadable":"May 8th, 2023"},"versionCreatedAt":"2023-01-27 22:23:22","video":"","vorDoi":"10.1186/s12909-023-04270-9","vorDoiUrl":"https://doi.org/10.1186/s12909-023-04270-9","workflowStages":[]},"version":"v1","identity":"rs-2504543","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2504543","identity":"rs-2504543","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}