Barriers and gateways: a study of nursing students’ utilisation of learning support resources

Barriers and gateways: a study of nursing students’ utilisation of learning support resources

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  © 2001 Harcourt Publishers Ltd Nurse Education Today  (2001) 21, 209–217 209 Introduction Development of literacy and numeracy skillswithin nursing education has been the subject of the literature for more than a decade. During thistime the discipline of nursing has workedtowards establishing its own identity withinAustralian Universities. However, thedevelopment of academic skills in undergraduatenursing students presented nurse academics withan ongoing educational challenge, particularly inrelation to ‘non-traditional’ tertiary students whogain entry into nursing degree courses (Friedrichet al. 1985, Allen et al. 1988, Hughes 1988, Donovan 1989, Chally 1992, Holtz & Wilson 1992, Cust 1995, Silva et al. 1999). Current nursing students are drawn from diverse social andeducational backgrounds and can enter tertiarystudy through routes other than the traditionalmodes. According to Billings and Halstead (1998,p.xi) ‘the non-traditional student is now thenorm’ and they bring with them not only diverse backgrounds but also diverse needs. Murray-Harvey and Keeves (1994) challenge teachers of higher education to offer academic support tostudents particularly in their first year. Theyemphasize that learning support is necessary toprevent students from developing ‘coping ratherthan learning strategies for getting through thecourse’ (Murray-Harvey & Keeves 1994, p.3).Furthermore, they claim that learning processvariables such as traditional entry mode based onhigh school performance, learning style, andapproach to learning together with age, gender Article Barriers and gateways: a studyof nursing students’ utilisationof learning support resources Lyn Stewart, Pam Mort and Carol McVeigh Lyn Stewart RN RM BHSc (Nsg),MEd. (Adult Ed),Associate Lecturer,College of Socialand HealthSciences, School ofNursing, Familyand CommunityHealth, Universityof Western Sydney,Locked Bag 1797,Penrith South DC,NSW 1797, Australia.Tel.: +61 2 97726692; Fax: +61 2 9773 0998 Pam Mort BA(Vis.Art), Grad.Dip(Vis.Art), Grad Dip(Ed), MA(Linguistics),Learning Adviser,The LearningCentre, TheUniversity of NewSouth Wales,Sydney, Australia. Carol McVeigh RN, RM, MNS, PhD,Deputy Head ofSchool &MidwiferyConvenor, GriffithUniversity Schoolof Nursing,Australia.(Requests foroffprints to LS) Manuscript accepted  : 31 October 2000 Many first year nursing students require additional academic support from both their lecturersand learning resources. Anecdotal evidence at an Australian university suggested that ‘at risk’students did not follow up lecturer referral. This study identified what learning resources wereaccessed and what factors influenced students’ decisions to follow up or not to follow uplecturer referral. First-year nursing students ( n =150) were surveyed towards the end of theirsecond semester regarding their use of learning support services. Twelve students wererandomly selected and interviewed regarding their use of learning support and their first yearlearning experience. Demographic data were analyzed using descriptive statistics. Qualitativedata were subjected to content analysis. Results revealed learning support utilisation wasrelated to age and publicity but unrelated to gender or culture. Older students enteringthrough non-traditional entry modes displayed a tendency to self refer to learning support.Younger students (<25 years) often lacked effective learning strategies and were reluctant toaccess on-campus learning support. For all students positive on and off campus support led topositive outcomes. Faculty and learning support lecturers need to foster integration of learningsupport for all students and encourage peer-learning partnerships within the foundationsubjects. © 2001 Harcourt Publishers Ltd doi:10.1054/nedt.2000.0539, available online at on  and cognitive abilities, affect student outcomesespecially within the first year of tertiaryeducation. Literature review A major issue for undergraduate nursingstudents is the development of self-directedlearning capabilities. Brookfield (1990) arguesthat ‘the impostor syndrome’ is a key barrierpreventing students developing self-directedlearning behaviors. Brookfield also explains howstudents may also regress and become ‘child like’and exhibit ‘authority dependence’ when re-entering formal education settings. This creates adichotomy between lecturers and students whichresults in students failing to developcriticalthinking and competent academiccommunication skills. Other commonly raisedissues by adult learning theorists (Knowles 1980,Brookfield 1986, 1990, Mace 1996, Johnson 1996) include: the anxiety associated with academicwriting; fear of changing perceptions and actions;the need for course developers and lecturers toconsider individual needs and interests and torecognize barriers to learning. Nursing students’ failure to develop criticalthinking and deeper learning strategies has also been documented in the USA. Duncan (1996)found that between the first semester and thefourth semesters, undergraduate nursingstudents did not alter their learning style. Thesestudents preferred to process ‘information in astructured, organized, step-by-step, hands onexperience’ rather than develop skills to receiveinformation ‘in an unstructured manner andreflectively assimilate the material’ (Duncan1996). Nursing requires these latter skills in orderto provide competent patient care. Stiernborgetal. (1997) study of nursing students at anAustralian university also revealed that there wasno change in study orientation from first to thirdyear, and that the undergraduate nursingstudents were predominately surface learners.Stiernborg et al. predict that deep learningapproaches will help nursing students becomeself-directed learners. Nurse educators are beingencouraged to introduce further strategies thatencourage a deeper learning approach in theirnursing students (Biggs & Moore 1993, Stiernborg et al. 1997, Chenoweth, 1998,   Jeffreys 1998). Burris (1990), maintains that student support by both faculty and peer support services are keyfactors in determining a successful academicoutcome. This support includes earlyidentification of ‘at-risk’ students followed bypositively marketed strategies. Burris (1990)documents the results of a successful ‘academicenrichment program’ that improved students’academic skills. The 3-year funded projectconsisted of three main components: studentsupport, faculty development and peer tutoring.The program was integrated into the baccalaureate nursing course by skilling faculty staff and students in both reading and study skills. Burris reported a higher pass and decreased attrition rate over a 5-yearperiod. Students considered at risk of failure are oftenreferred to specialist learning support resources.At the institution where the study wasconducted, anecdotal evidence from nursing andlearning support lecturers suggested that manynursing students referred to academic supportservices for assistance did not follow up referral.The research objectives were to: •Ascertain whether or not students followed uplecturers’ referrals to the LearningDevelopment Centre (LDC) •Categorize which students followed up asopposed to those who did not •Investigate why students chose not to take upreferrals to learning support •Investigate students’ perceptions and use of learning support resources •Investigate differences in age and entry modewith referral follow up. Methods This collaborative study used a triangulatedapproach, which included a survey and semi-structured interview, to explore the relationship between student utilisation of the LDC and manypersonal, demographic, social and environmentalfactors. Stage 1 A preliminary survey tool had been designed,approved and piloted with a sample group of 30 210 Nurse Education Today  (2001) 21, 209–217© 2001 Harcourt Publishers Ltd Barriers and gateways  Barriers and gateways Bachelor of Nursing (BN) second year students.Following the pilot study the surveyquestionnaire was revised and expanded. The study was conducted on two campuses32km apart, where the BN course was offered.Nursing lecturers on both campuses werepersonally briefed on the research project andinstructed by memo in the method of datacollection. A convenience sample of all first yearBN students in the second half of Spring Semesterwere asked to complete the survey. One-hundredand fifty-one surveys were administered duringtimetabled tutorials. Students were briefed aboutthe project and were invited to complete an ethicsapproved questionnaire. The signed consentforms were separated from the questionnaires bythe lecturer to maintain confidentiality. Surveys were coded for campus location andnumbered according to entry into SPSS 7.5 so thatall entries could be checked. Frequencies,descriptives and Chi-square analysis were carriedout to determine significant differences based onreferral, follow-up and demographic andenvironmental information. Stage 2 From the students agreeing to be interviewed ( n = 60), a random sample of 20 students (10 fromeach campus) were invited to participate in anindividual semi-structured interview followingthe exam period. Interviews were conducted oncampus by the primary researchers. Six primary questions and optional probequestions were developed which explored thestudents’ positive and negative learningexperiences, support networks and theirperceptions of the learning support provided bythe university. The authors’ aim was to gatherdescriptions and perform content analysis (Burns1997, p. 338) of personal and social factors thathad impacted on each interviewees’ learningexperience during their first year of tertiarystudy. Interviews were audio recorded andtranscribed. The qualitative data were analysedaccording to common themes and issuessurrounding first year tertiary education. Thedata were compared to known demographic dataof the interviewees. © 2001 Harcourt Publishers Ltd Nurse Education Today  (2001) 21, 209–217 211Table 1 Sample characteristics Characteristic: ( n = 150)No.% Age<25 years10268 ≥ 25 years4832 GenderMale2114 Female12785 Marital statusNever married10671 Married2315 Other2114 *Parenting responsibilitiesYes3221 No11879 Dominant languageEnglish9865 Non-English5235 Birth placeAustralia10067 Overseas5033 Arrival in Australia<18 years3674 ≥ 18 years1326 Mode of studyFull-time14798 Part-time32 Prior education<Year 12128 Completed Year 129563 Higher Education4329 *Students who were coming for dependent children.  Phase 1: Quantitative results Sample One-hundred and fifty surveys were returned,only one student chose not to participate. Table 1 shows the diverse nature of thestudent cohort which is representative of othernursing years (University of Western Sydney,Macarthur 1998). Further demographic resultsrevealed that from the 35% of students from aNon English Speaking Background (NESB), 15%of these students migrated to Australia post-secondary education. Of the 29% of students whoentered university with post-secondaryeducation, 20% of this group heldTAFE/Technical qualifications with only 7% of this group identifying EN articulation. Only 5%of students had entered the BN via tertiarypreparation courses. While the majority of students were aged under twenty-five, 32% wereaged between twenty-five and forty-five (Fig. 1).  Knowledge of Learning Support Services Almost 97% of students reported being aware of the LDC and 60% remembered receiving a brochure about the unit. The development of writing skills was most consistently associatedwith LDC (Table 2). Some students associated theunit with counseling, possibly reflecting thestressors associated with tertiary study (Johnson1996). Numeracy was least associated with LDCservices. At the time of the research numeracysupport was not widely available. Resultsindicated that students from a NESB weresignificantly less likely to be aware of the servicesavailable through the LDC (X 2 = 4.752, df 1, P = 0.029). No other significant results were noted. Use of learning resources Students indicated which LDC resources theyhad accessed. Some students had used more thanone resource. Table 3 summarizes awareness andutilisation of LDC resources. No significantdifferences in service utilisation were found based on a variety of demographic and personalcharacteristics. Referral to learning support services Sixty-five percent ( n =98) indicated they had beenreferred to LDC. These students were referred bythe lecturer in person (39%), by writtencomments on their assignments (35%), by formalcorrespondence (3%) and through other modes(4%) such as peer recommendations. Resultssuggest that significantly more older students (> 25 years) self- referred to the unit (X 2 = 6.704, 212 Nurse Education Today  (2001) 21, 209–217© 2001 Harcourt Publishers Ltd Barriers and gateways >4535-4425-3419-24<181141742260 10 20 30 40 50 Fig. 1 Percentage of students according to agecategory. Table 2 Student perception of services associatedwith LDC and percentage of responses ServicePercentage Writing68 Counseling18.7 Advice9.3 Study Skills8.0 Referencing8.0 Grammar7.3 Learning6.7 Verbal communication5.3 Information Tech.3.3 Time Management2.7 Maths2 Table 3 Use of LDC resources 61% had used LDC handouts on aspects of academiccommunication.60% received a LDC publicity brochure. 42% had had an individual appointment with a LDCadvisor. 32% had attended a LDC workshop.10% had used LDC web-pages.3% had attended a LDC university preparationprogram.  Barriers and gateways df1, P = 0.01) and significantly more studentswho had entered via non-traditional mode alsoself-referred to the unit (X 2 = 6.110, df 1, P =0.013). No other significant differences in mode of referral were found. Follow up In total 69% of students who were referred to theLDC reported contacting or visited the centre foradvice. Reasons for not following up on a referralincluded no reason (32%), no time (29%),timetable clash (16%), work and timetable clash(9%), family commitments (3%), and otherreasons (9%). Significantly more older students (> 25 years) followed up on referrals to the LDC(X 2 = 5.462, df 1, P = 0.019). Most students whochose not to follow up referral accessed the centre by other modes, using handouts and learningsupport web pages. These students were leastlikely to have a consultation with a learningadviser or attend an LDC workshop, preferringanonymous support interventions. No othersignificant differences in follow-up were noted. Students who did follow up lecturer referralshowed a wide range of approaches to using LDCresources. Faculty specific writing workshops areoffered inter-semester for students who have been referred. Self-referring students could alsoattend. Many chose not to access these week longcommunication competency workshops, ratherthey utilised individual consultations, shorterworkshops and online resources. Table 4summarizes attendance patterns. Non-utilisation of learning support Fifty four (36%) of all respondents gave reasonsfor not using LDC services (Table 5). It wouldappear that for these students extrinsic factors dodeter them from accessing support. Phase 2: Qualitative results The interviews were conducted on bothcampuses at completion of the Spring semester.Of the twenty students contacted, twelveparticipated in a 40 minute individual interviewreflecting on their experience and perception of learning during their first year of tertiary study.Eight students were willing to be interviewed butunable to attend due to full-time work and familycommitments. The sample consisted of fiveschool leavers (1 NESB and all female), and 7mature age students (1 NESB, 3 male, 4 female).The interviews identified the students’ positiveand negative learning experiences, their supportsystems and learning strategies, their perceivedlearning needs as well as their perceptions of LDC services. Motivation and Confidence When answering the first question, ‘what wereyour best experiences this year’ many studentscommented that receiving feedback from theirfirst assignment was a major indicator of theircapabilities. Some mentioned they had ‘learnt somuch’. Most valued their clinical experience. Afew mentioned they enjoyed being part of adiverse student body. All students commentedthat they ‘did better than they thought theywould’. When answering the second question: ‘what helped you most to complete the year’off-campus support was seen as a valuable © 2001 Harcourt Publishers Ltd Nurse Education Today  (2001) 21, 209–217 213Table 4 Attendance pattern LDC services used after referral% Communication competency workshop21 Individual consultations18 Other Workshops5 Online2 Missing1 Total47 Table 5 Reasons for not using LDC services Reason% Work commitment10.0 No need8.7 Family commitment4.7 Work timetable3.3 Timetable clash3.3 Other2.7 Family + work2.0 Family + timetable1.3 Total36.0
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