Creating connections: an investigation into the first year experience of undergraduate nursing students.
Taylor, Ruth Fiona
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OVERVIEW OF THE THESIS The aim of the research is to explore the first year experiences of two groups of undergraduate student nurses. The research takes a holistic approach to the investigation of the first year experience. In part, a curriculum change is used as a way to find out about the first year experience, with the research looking at how the introduction of enquirybased learning (EBL) into a curriculum impacted on the first year. The curriculum change is described in detail in chapter 1. The objectives of the thesis were to: 1. Examine the first year experience of nursing students. 2. Describe the curriculum change, the rationale for the change and the context within which this occurred. 3. Compare the demographic profiles of two groups of students one following a ‘traditional’ curriculum and the other using ‘EBL’; to compare students who chose to leave the courses with those who successfully completed first year. 4. Compare experiences with expectations of first year between nursing students undertaking a ‘traditional’ and an ‘EBL’ curriculum. 5. Propose strategies to enhance the student experience and rates of retention in first year undergraduate nursing students. The context for the research is described in chapter 1 – the literature review. This chapter explores the literature on the first year experience from both national and international perspectives. Inevitably, it reviews issues relating to student retention, which is the focus for much of the first year experience literature. The literature review argues that the contemporary context of nursing education requires nurse educators to consider the whole first year student experience when developing curricula that are fit for purpose. While the content of a course is important, the approaches to teaching need to facilitate learning within a diverse student population and need to prepare students to continue to learn in an increasingly dynamic healthcare environment. The chapter goes on to 2 argue that the issues that impact on the students’ first year experiences (e.g. relationships with peers and with academic staff, external domestic and personal circumstances) can be mitigated through curriculum development and other means (such as the availability and effectiveness of student support). The context of the particular nursing course along with the curriculum change and the rationale for the change are described. It can be argued that the retention literature takes a deficit approach to the improvement of the first year experience. Such an approach can be viewed as one that emphasises the factors that cause people to leave (or puts them ‘at risk’), and attempts to address these. On the other hand, a positive approach to the improvement of the first year is one in which measures and interventions aim to enhance the overall experience for all students, not just those who are seen as ‘at risk’. That said, the policy drivers for improving retention cannot be ignored and are discussed within the context of HE and nursing education. Finally, it is contended that the first year experience has not been widely explored within nursing literature and merits attention for a number of reasons, including the policy context and the need to determine whether student nurses have differing needs from students within other specialities. In chapter 2 the research methodology and research methods are described. An overview of case study research is provided and the approach taken within this thesis is described, along with a rationale for its use. The philosophical perspective is discussed with particular emphasis on the relationships between the methodology and the methods used to investigate the first year experience of students. It is argued that case study research is an appropriate methodology to investigate a complex area and provides an opportunity to utilise a number of methods so as to get to a ‘thick’ description of the phenomenon (the first year experience). All students in the two groups under investigation were asked to complete an expectations questionnaire, and an experiences questionnaire. Everyone who chose to leave the courses was asked to undertake an in-depth focused interview, although not all agreed. A sample of students who successfully completed first year was also asked to undertake an in-depth 3 focused interview. Finally, a sample of students was asked to complete a diary for the duration of the first year. The use of multiple methods is fitting, given the case study approach and the aim to create a ‘thick’ description, and an in-depth understanding of the first year experience. The use of the same research methods across the different groups of students allows for some comparisons to be made between the ‘traditional’ and ‘EBL’ curriculum students, and between leavers and stayers. The chapter also describes the approaches to data analysis. Chapter 3 presents the findings from the two questionnaires. Relevant demographic variables are reported, and the quality of the educational experience is measured in relation to the ways in which experiences meet expectations. This chapter shows that the two groups (‘traditional’ and ‘EBL’) are similar in terms of demographic variables. It also shows that the participants appeared to expect a ‘connected’ curriculum experience, but that the experience did not always match expectations. In chapter 4 the findings from the interviews and diaries are presented. Four themes are identified, with a number of categories in each. The themes (and categories) are: relationships with people (broadening horizons, knowing self and others, being supported and valued); the classroom experience (feeling inspired, becoming empowered, engaging with the learning experience); the practice experience (feeling inspired, becoming empowered, engaging with the learning experience); and professional education (motivation, preparedness, making adjustments). The chapter demonstrates the differences and similarities between the groups of students, before introducing the links to the quantitative findings, and to relevant research findings from the literature. Chapter 5 – the Discussion - brings together the findings from the qualitative and quantitative data as the case study. A conceptual framework is presented as a way in which the findings can be framed and through which future research can be organised. The assertion is made that the better the relationships, and the closer that experiences meet 4 expectations, the more likely it is that the student will have a ‘good’ experience and therefore be successful. The first year is seen as the foundation for future experiences on a course. While there are some areas that are particularly relevant to nursing students, it seems that the first year experience of student nurses is similar to that seen in other disciplines. Similar issues are identified within the thesis as within the wider literature, although nursing students’ issues may manifest themselves in slightly different ways (e.g. issues with practice placements/learning). In chapter 6, a number of conclusions are drawn that may enable future curriculum development to take a more holistic view of the student experience. Recommendations for practice are made and a focus for future systematic research is proposed. It is asserted that the conceptual framework that has been developed from the findings has allowed for a contribution to be made to the theoretical debate that relates to enhancing the first year experience and, in particular, to propose policy changes within the HE sector that may improve retention rates. This opening section has provided the reader with the context from which the ideas and focus for the thesis have developed, and has provided an overview of the aim and objectives of the research. It provided signposts for the full thesis and its component parts. Chapter 1 – the literature review – aims to describe the context within which the research is situated.