Qom University of Medical Sciences Journal

Introduction
Following the coronavirus disease 2019 (COVID-19) pandemic, face-to-face education was replaced with distance education and students were given distance education without the right to choose. In this fast transition without prior planning, first attention was paid to solving technical issues and gradually to empowering teachers in distance education and improving the quality of education. In distance education, the interaction of the learner with the content, other learners, and the teacher is established through information and communication technologies. A distance learning environment is a social structure that includes elements such as instructor support, student interaction and collaboration, personal relevance, authentic learning, active learning, student autonomy, and student perception.
The development of e-learning is one of key areas of medical education development in the upstream documents whose goal is to examine and meet the needs of learners in distance education. Despite the sudden and forced start of distance education, it can be used in the post-COVID-19 era in combination with other learning methods due to its benefits, flexibility, low costs, and ability to provide education to a larger population with no geographical limitation. Receiving feedback from learners on the quality of distance education is necessary to identify and address shortcomings and improve the experience of e-learning. Therefore, the present study aims to investigate the perceptions of the distance learning environment in nursing students of Islamic Azad University, Karaj Branch during the COVID-19 pandemic in 2021.
Methods
This is a cross-sectional study. in The study population consists of undergraduate nursing & midwifery students of Islamic Azad University, Karaj Branch in 2020-2021. Sampling was done by a convenience sampling method. Inclusion criteria were willingness to participate in the study, having experience of e-learning, and being the 1th to 6th semester student. Students of the 7th and 8th semesters, those whom were clinical units, and those returned questionnaire incomplete were excluded from the study. An informed consent form was signed by them prior to the study.

The data collection tool was a two-part questionnaire. The first part surveys demographic information and the second part was the Distance Education Learning Environment Survey (DELES) designed by Walker in 2005 to assess learners’ attitudes on the quality of distance learning environments in higher education. It has 42 items and seven subscales. The online link of the questionnaire was prepared by using the Google Forms and sent to the students via the social media applications. Data were analyzed in SPSS software, version 22 software using descriptive statistics, t-test, ANOVA, and Pearson correlation test.
Results
Of 194 students, 81.4% were female and 89.2% were single. Their mean age was 21.9±6.2 years, with a mean family income of 96,800,000±83.780.000 Rials per month and the internet cost of 979.3±794.1 thousands Rials per month. Regarding the quality of distance learning environment, 115 students (59.3%) reported it at as good, 50(25.8%) as moderate, and 29(14.9%) as excellent. The mean total score of DELES was 100.1±23.8. The mean scores related to the areas of instructor support, student interaction and collaboration, personal relevance, active learning, and student autonomy were at high level, while the mean score for authentic learning was at moderate level and the mean score for the enjoyment of distance learning was at low level. Based on the results of Pearson correlation test, there was a positive significant correlation between students’ age and total DELES score (r=0.193 P= 0.007), but no significant correlation was observed between their income and the total DELES score (P>0.05).
One-way ANOVA results showed a statistically significant difference in the mean total score of DELES in terms of semester (P=0.043), but no statistically significant difference was found in terms of gender, marital status, place of residence, and having a job (P>0.05).
Discussion
The present study showed that more than half of the nursing students of Islamic Azad University, Karaj Branch perceived their distance learning environment as good. Their perceptions of the areas of instructor support, student interaction and collaboration, personal relevance, active learning, and student autonomy were high, while their perception of authentic learning was at moderate level and their enjoyment of distance education was at low level. To achieve maximum student satisfaction, attention to different areas of distance learning environment survey should be paid by teachers, managers, curriculum and distance education planners, as well as to the empowerment of teachers for distance education in the School of Nursing & Midwifery, Islamic Azad University, Karaj Branch.  Further studies are recommended to improve the quality of the distance learning environments.
Ethical Considerations
Compliance with ethical guidelines
The present study was derived from the research project (Fitrat) of the Young Researchers and Elite Club, Karaj Branch, Islamic Azad University, and the code of ethics IR.IAU.ABHAR.REC.1400.003.
Funding
The financial sponsor of this study was the club of young and elite researchers of Islamic Azad University, Karaj branch.
Authors contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
We hereby thank the nursing and midwifery students who participated in this research project, as well as the Young Researchers and Elite Club of the Islamic Azad University for the approval and financial support of the project.