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Effect of online case-based learning on nursing students’ self-confidence amid COVID-19 pandemic

  • Totok Harjanto ,
  • Made Satya Nugraha Gautama ,
  • Dimas Sumunar ,


Introduction: Amid the COVID-19 pandemic, nursing educational programs have shifted from physical to online learning, both academic and clinical learning. Case-based learning is one of the clinical learning methods which is adapted to current circumstances. The learning method connects theoretical knowledge and practical experiences on nursing students’ clinical environment. This study aimed to evaluate the effect of online case-based learning on the clinical nursing students' self-confidence.

Methods: Forty-five clinical nursing students participated in this quasi-experimental study with one group pre-post-test design. The students’ self-confidence was evaluated using an instrument consisting of 15 Likert-scale items with cognitive, affective, and psychomotor subscales. The students’ self-confidence was measured before and after the online case-based learning (O-CBL) activities. The activities included case presentation, individual case analysis, small group discussion, and problem-solving practice for students.

Results: This study successfully organized the O-CBL method to enhance the students’ self-confidence. The average self-confidence level of the students increased from 57.84 to 60.62. Paired t-test analysis yielded p=0.006 (p <0.05), which indicated a significant effect of O-CBL on the students’ self-confidence. Significant findings were also discovered from the cognitive (p=0.01) and psychomotor (p=0.004) domains. The students’ affective domain did not significantly improve (p=0.089, p>0.05).

Conclusion: O-CBL increases nursing students' self-confidence specifically in cognitive and psychomotor aspects.


  1. Van den Broucke S. Why health promotion matters to the COVID-19 pandemic, and vice versa. Vol. 35, Health promotion international. 2020. p. 181–6.
  2. Indonesia DI. COVID-19. 2020.
  3. Schneider SL, Council ML. Distance learning in the era of COVID-19. Arch Dermatol Res. 2021;313(5):389–90.
  4. Gaur U, Anwarul M, Majumder A, Sa B, Sarkar S, Williams A, et al. Challenges and Opportunities of Preclinical Medical Education: COVID-19 Crisis and Beyond. SN Compr Clin Med. 2020;2:1992–7. Available from:
  5. Powezka K, Khan T, Narlawar R, Antoniou GA. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- company ’ s public news and information website . Elsevier hereby grants permission to make all its COVID-19-r. 2020;(January):19–21.
  6. Jayasekara R, Smith C, Hall C, Rankin E, Smith M, Visvanathan V, et al. The effectiveness of clinical education models for undergraduate nursing programs: A systematic review. Nurse Educ Pract. 2018;29:116–26.
  7. Pront L, McNeill L. Nursing students’ perceptions of a clinical learning assessment activity: “Linking the puzzle pieces of theory to practice”. Nurse Educ Pract. 2019;36:85–90.
  8. van der Riet P, Levett-Jones T, Courtney-Pratt H. Nursing students’ perceptions of a collaborative clinical placement model: A qualitative descriptive study. Nurse Educ Pract. 2018;30:42–7.
  9. Porter J, Morphet J, Missen K, Raymond A. Preparation for high-acuity clinical placement: confidence levels of final-year nursing students. Adv Med Educ Pract. 2013;4:83–9.
  10. Panduragan S, Abdullah N, Hassan H, Mat S. Level of Confidence among Nursing Students in the Clinical Setting. Procedia - Soc Behav Sci. 2011;18:404–7.
  11. Taylor D, Grant J, Hamdy H, Grant L, Marei H, Venkatramana M. Transformation to learning from a distance. MedEdPublish. 2020;9:76.
  12. Brown A, Lawrence J, Basson M, Redmond P. A conceptual framework to enhance student online learning and engagement in higher education. High Educ Res Dev. 2022;41(2):284–99. Available from:
  13. Durkin M, Gurbutt R, Carson J. Stakeholder perspectives of compassion in nursing: The development of the compassion strengths model. J Adv Nurs. 2019;75(11):2910–22.
  14. Li S, Ye X, Chen W. Practice and effectiveness of “nursing case-based learning” course on nursing student’s critical thinking ability: A comparative study. Nurse Educ Pract. 2019;36(759):91–6. Available from:
  15. Postma TC, White JG. Developing integrated clinical reasoning competencies in dental students using scaffolded case-based learning - empirical evidence. Eur J Dent Educ Off J Assoc Dent Educ Eur. 2016;20(3):180–8.
  16. Yoo M-S, Park J-H. Effect of case-based learning on the development of graduate nurses’ problem-solving ability. Nurse Educ Today. 2014;34(1):47–51.
  17. Hashim R, Azam N, Shafi M, Majeed S, Ali S. Perceptions of undergraduate medical students regarding case based learning and tutorial format. J Pak Med Assoc. 2015;65(10):1050–5.
  18. Thistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, et al. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Med Teach. 2012;34(6):e421-44.
  19. Gautama MSN, Sugiarsih S, Harjanto T. Clinical Nursing Students’ Self Confidence During E-Learning Implementation. J Pendidik Kedokt Indones Indones J Med Educ. 2020;9(2):147.
  20. Unver V, Basak T, Watts P, Gaioso V, Moss J, Tastan S, et al. The reliability and validity of three questionnaires: The Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and Educational Practices Questionnaire. Contemp Nurse. 2017;53(1):60–74.
  21. Maher JM, Markey JC, Ebert-May D. The other half of the story: effect size analysis in quantitative research. CBE Life Sci Educ. 2013;12(3):345–51.
  22. Blanco QA, Carlota ML, Nasibog AJ, Rodriguez B, Saldaña XV, Vasquez EC, et al. Probing on the Relationship between Students’ Self-Confidence and Self-Efficacy while engaging in Online Learning amidst COVID-19. J La Edusci. 2020;1(4):16–25.
  23. Cussó-Calabuig R, Farran X, Bosch-Capblanch X. Effects of intensive use of computers in secondary school on gender differences in attitudes towards ICT: A systematic review. Educ Inf Technol. 2018;23(5):2111–39.
  24. Hong S, Yu P. Comparison of the effectiveness of two styles of case-based learning implemented in lectures for developing nursing students’ critical thinking ability: A randomized controlled trial. Int J Nurs Stud. 2017;68:16–24.
  25. Gholami M, Saki M, Toulabi T, Kordestani Moghadam P, Hossein Pour AH, Dostizadeh R. Iranian Nursing Students’ Experiences of Case-Based Learning: A Qualitative Study. J Prof Nurs Off J Am Assoc Coll Nurs. 2017;33(3):241–9.
  26. Kundu A. Toward a framework for strengthening participants’ self-efficacy in online education. Asian Assoc Open Univ J. 2020;15(3):351–70.
  27. Abu Farha RJ, Zein MH, Al Kawas S. Introducing integrated case-based learning to clinical nutrition training and evaluating students’ learning performance. J Taibah Univ Med Sci. 2021;16(4):558–64.
  28. Raza SA, Qazi W, Umer B. Examining the impact of case-based learning on student engagement learning motivation and learning performance among university students. J of AR in HE 2020 J 13;12(3):517–33. Examining the impact of case-based learning on student engagement, learning motivation and learning performance among university students [Internet]. Vol. 12, Journal of Applied Research in Higher Education. p. 517–33. Available from:
  29. Malureanu A, Panisoara G, Lazar I. The relationship between self-confidence, self-efficacy, grit, usefulness, and ease of use of elearning platforms in corporate training during the covid-19 pandemic. Sustain. 2021;13(12).
  30. Bijani M. A comparative study of the effectiveness of case-based learning and lecturing in enhancing nursing students’ skills in diagnosing cardiac dysrhythmias. Rev Latinoam Hipertens. 2019;14:651–5.
  31. Abdelkader AM, El-aty NSA, Abdelrahman SM. The Relationship between Self-Confidence in Learning and Clinical Educators’ Characteristics by Nursing Students. Int J Nurs Educ. 2021;13(2):1–10.
  32. Abu Sharour L, Bani Salameh A, Suleiman K, Subih M, El-Hneiti M, Al-Husaami M, et al. Nurses’ Self-Efficacy, Confidence and Interaction With Patients With COVID-19: A Cross-Sectional Study. Disaster Med Public Health Prep. 2021;1–5.
  33. Schaber P, Wilcox K, Whiteside A, Marsh L, Brooks D. Designing Learning Environments to Foster Affective Learning: Comparison of Classroom to Blended Learning. Int J Scholarsh Teach Learn. 2010;4(2).
  34. Asoodar M, Vaezi S, Izanloo B. Framework to improve e-learner satisfaction and further strengthen e-learning implementation. Comput Human Behav. 2016;63:704–716.
  35. Kordrostami M, Seitz V. Faculty Online Competence and Student Affective Engagement in Online Learning. Mark Educ Rev. 2022;32(3):240–54. Available from:
  36. Songkram N, Khlaisang J, Puthaseranee B, Likhitdamrongkiat M. E-learning System to Enhance Cognitive Skills for Learners in Higher Education. Procedia - Soc Behav Sci. 2015;174:667–73.
  37. Amouzeshi Z, Zarandi FM. A narrative review of patient education in emergency departments: challenges and solutions. J Surg Trauma. 2022;10(2):48–60.
  38. Kolb A, Kolb D. Experiential Learning Theory as a Guide for Experiential Educators in Highe...: DISCOVER for Books, Articles and Media. A J Engag Educ. 2017;1(1):7–44. Available from:
  39. Cardoso AF, Moreli L, Braga FTMM, Vasques CI, Santos CB, Carvalho EC. Effect of a video on developing skills in undergraduate nursing students for the management of totally implantable central venous access ports. Nurse Educ Today. 2012;32(6):709–13.

How to Cite

Harjanto, T., Gautama, M. S. N. ., & Sumunar, D. . (2023). Effect of online case-based learning on nursing students’ self-confidence amid COVID-19 pandemic. Bali Medical Journal, 12(1), 519–523.




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Totok Harjanto
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Made Satya Nugraha Gautama
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Dimas Sumunar
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