*4.1. Opportunities*

Virtual teaching and learning and assessment platforms in HSE, including nursing education, provide innovations and growth opportunities for both students and facilitators. Online practical assessments are innovative in a new reality for most student nurses

and teachers and may empower students' nurses by helping them to remove perceived barriers in face-to-face assessments [58]. Technology assessments such as videos and webbased simulation for advance practice programs in the nursing education institutions were considered due to limited access to healthcare facilities during a period of social distancing [62]. Online practical examination such as telecommunication technology simulation can be an effective strategy to assess clinical skills competencies and provides personalised effective and immediate feedback to students [47,54]. Furthermore, it is suggested that online evaluation had benefits and expected impacts on student and teacher happiness and performance during the COVID-19 pandemic [63], and also improved the teaching and learning process both in managing distance education, increasing class size and staff workload [48,50]. Despite the concerns that included unfamiliarity and limited virtual assessment experience and the insufficient number of information technology technicians that interferes with proper digitalisation [48], the convenience of virtual clinical assessment including the removal of travelling to examination centres provides opportunity to partake at the comfort of both students and the examiners' homes [59]. As learning to teach and facilitate knowledge acquisition requires preparation and additional formal education to ensure competency in teaching [26], collaboration to ensure effective online assessment practical examination is critical [52,55,64].

#### *4.2. Challenges*

Virtual practical examination requires sufficient and effective logistics preparation including students' and facilitators' training on how to run and partake in the assessment, internet access and proper connections, availability of ICT structural support, as well as infrastructures. Moreover, conducting practical examinations is a challenging aspect during the COVID-19 pandemic; however, virtual-based practical assessment sessions can help teachers to conduct practical examinations effectively [65]. Practical examinations have a role in protecting patients [66] and it is important to continue their delivery via innovative methods of measuring the same knowledge, understanding, and capabilities with amended assessments such using video conferencing platforms to conduct vivas [66].Additionally, problems with internet connection and other technical aspects, the attitudes of teachers, limited interpersonal relations, limited learning of practical skills, health concerns, students' engagement and distractions during assessment [49,56,67,68] were reported to be worrying factors. The use of virtual practical examination requires abundant preparation on the part of both student nurse educators and the facilitators. Therefore, these issues are undeniably contributory factors to high stress levels experienced by both students as well as the facilitators in HSE during online assessment [12,51]. Furthermore, financial costs and time consumption as the preparation requires more time than the traditional assessment method [69,70] remain part of the challenges. Teachers would require the acquisition of new skills to use digital tools and designing of significant evaluation activities to be used, whereas students are forced to acquire digitals skills that will enable them to use new forms of education [71]. To overcome challenges presented by virtual practical examination during the COVID-19 pandemic is to acknowledge and find ways to deal with those challenges which include collaboration among relevant stakeholders [60,72].

Another challenge presented by virtual practical examination was the question as to whether this method was relevant for some content in HSE. Instances where students could not feel the structure using their hands during virtual practical examination made it difficult for them to identify the structure, its relations and its vascular supply [57,60,73]. It can be argued that despite the positive perceptions, online examinations are not suitable for assessing the physical examination skills [46]. To overcome this challenge, academics in HSE have the responsibility to design and implement strategies that will ensure that the objectives of online practical examination are met which will lead to competent practitioners after completion.

## *4.3. Limitations*

There may be some possible limitations in this study. Therefore, the author acknowledges several limitations related to the methods. Narrative reviews are known to be biased in nature [41]. Firstly, although the narrative reviews does not necessarily follow a systematic approach like other reviews [74], the author took steps to attempt to prevent bias by describing the methods followed during including literature search and selection, and discussion of results. However, despite the fact that there is no strict rule on the number of authors required to conduct a narrative review [74] being a single author, she may have been biased during the review process. Secondly, the review only included studies published between 2020 and 2022, which led to limited number of studies that met the set criteria, whereas there were other Pandemics prior to COVID-19. Finally, the majority of the studies used in this review focused on the perceptions and experiences of students and academics regarding virtual practical examination in other health sciences disciplines. This is an indication of a gap in the virtual assessment of practical examinations for student nurse educators. Therefore, the results cannot be generalised, but might provide a framework for future research.
