Creating connections : an investigation into the first year experience of undergraduate nursing students

OVERVIEW OF THE THESIS\nThe aim of the research is to explore the first year experiences of two\ngroups of undergraduate student nurses. The research takes a holistic\napproach to the investigation of the first year experience. In part, a\ncurriculum change is used as a way to find out about the first year\nexperience, with the research looking at how the introduction of enquirybased\nlearning (EBL) into a curriculum impacted on the first year. The\ncurriculum change is described in detail in chapter 1. The objectives of the\nthesis were to:\n1. Examine the first year experience of nursing students.\n2. Describe the curriculum change, the rationale for the change and the\ncontext within which this occurred.\n3. Compare the demographic profiles of two groups of students one\nfollowing a ‘traditional’ curriculum and the other using ‘EBL’; to\ncompare students who chose to leave the courses with those who\nsuccessfully completed first year.\n4. Compare experiences with expectations of first year between nursing\nstudents undertaking a ‘traditional’ and an ‘EBL’ curriculum.\n5. Propose strategies to enhance the student experience and rates of\nretention in first year undergraduate nursing students.\nThe context for the research is described in chapter 1 – the literature\nreview. This chapter explores the literature on the first year experience\nfrom both national and international perspectives. Inevitably, it reviews\nissues relating to student retention, which is the focus for much of the first\nyear experience literature. The literature review argues that the\ncontemporary context of nursing education requires nurse educators to\nconsider the whole first year student experience when developing curricula\nthat are fit for purpose. While the content of a course is important, the\napproaches to teaching need to facilitate learning within a diverse student\npopulation and need to prepare students to continue to learn in an\nincreasingly dynamic healthcare environment. The chapter goes on to\n2\nargue that the issues that impact on the students’ first year experiences\n(e.g. relationships with peers and with academic staff, external domestic\nand personal circumstances) can be mitigated through curriculum\ndevelopment and other means (such as the availability and effectiveness of\nstudent support). The context of the particular nursing course along with\nthe curriculum change and the rationale for the change are described.\nIt can be argued that the retention literature takes a deficit approach to the\nimprovement of the first year experience. Such an approach can be viewed\nas one that emphasises the factors that cause people to leave (or puts\nthem ‘at risk’), and attempts to address these. On the other hand, a\npositive approach to the improvement of the first year is one in which\nmeasures and interventions aim to enhance the overall experience for all\nstudents, not just those who are seen as ‘at risk’. That said, the policy\ndrivers for improving retention cannot be ignored and are discussed within\nthe context of HE and nursing education. Finally, it is contended that the\nfirst year experience has not been widely explored within nursing literature\nand merits attention for a number of reasons, including the policy context\nand the need to determine whether student nurses have differing needs\nfrom students within other specialities.\nIn chapter 2 the research methodology and research methods are\ndescribed. An overview of case study research is provided and the\napproach taken within this thesis is described, along with a rationale for its\nuse. The philosophical perspective is discussed with particular emphasis on\nthe relationships between the methodology and the methods used to\ninvestigate the first year experience of students. It is argued that case\nstudy research is an appropriate methodology to investigate a complex\narea and provides an opportunity to utilise a number of methods so as to\nget to a ‘thick’ description of the phenomenon (the first year experience).\nAll students in the two groups under investigation were asked to complete\nan expectations questionnaire, and an experiences questionnaire. Everyone\nwho chose to leave the courses was asked to undertake an in-depth\nfocused interview, although not all agreed. A sample of students who\nsuccessfully completed first year was also asked to undertake an in-depth\n3\nfocused interview. Finally, a sample of students was asked to complete a\ndiary for the duration of the first year. The use of multiple methods is\nfitting, given the case study approach and the aim to create a ‘thick’\ndescription, and an in-depth understanding of the first year experience. The\nuse of the same research methods across the different groups of students\nallows for some comparisons to be made between the ‘traditional’ and ‘EBL’\ncurriculum students, and between leavers and stayers. The chapter also\ndescribes the approaches to data analysis.\nChapter 3 presents the findings from the two questionnaires. Relevant\ndemographic variables are reported, and the quality of the educational\nexperience is measured in relation to the ways in which experiences meet\nexpectations. This chapter shows that the two groups (‘traditional’ and\n‘EBL’) are similar in terms of demographic variables. It also shows that the\nparticipants appeared to expect a ‘connected’ curriculum experience, but\nthat the experience did not always match expectations.\nIn chapter 4 the findings from the interviews and diaries are presented.\nFour themes are identified, with a number of categories in each. The\nthemes (and categories) are: relationships with people (broadening\nhorizons, knowing self and others, being supported and valued); the\nclassroom experience (feeling inspired, becoming empowered, engaging\nwith the learning experience); the practice experience (feeling inspired,\nbecoming empowered, engaging with the learning experience); and\nprofessional education (motivation, preparedness, making adjustments).\nThe chapter demonstrates the differences and similarities between the\ngroups of students, before introducing the links to the quantitative findings,\nand to relevant research findings from the literature.\nChapter 5 – the Discussion - brings together the findings from the\nqualitative and quantitative data as the case study. A conceptual\nframework is presented as a way in which the findings can be framed and\nthrough which future research can be organised. The assertion is made that\nthe better the relationships, and the closer that experiences meet\n4\nexpectations, the more likely it is that the student will have a ‘good’\nexperience and therefore be successful.\nThe first year is seen as the foundation for future experiences on a course.\nWhile there are some areas that are particularly relevant to nursing\nstudents, it seems that the first year experience of student nurses is similar\nto that seen in other disciplines. Similar issues are identified within the\nthesis as within the wider literature, although nursing students’ issues may\nmanifest themselves in slightly different ways (e.g. issues with practice\nplacements/learning).\nIn chapter 6, a number of conclusions are drawn that may enable future\ncurriculum development to take a more holistic view of the student\nexperience. Recommendations for practice are made and a focus for future\nsystematic research is proposed. It is asserted that the conceptual\nframework that has been developed from the findings has allowed for a\ncontribution to be made to the theoretical debate that relates to enhancing\nthe first year experience and, in particular, to propose policy changes\nwithin the HE sector that may improve retention rates.\nThis opening section has provided the reader with the context from which\nthe ideas and focus for the thesis have developed, and has provided an\noverview of the aim and objectives of the research. It provided signposts\nfor the full thesis and its component parts. Chapter 1 – the literature review\n– aims to describe the context within which the research is situated.