Original Article


Academic Experiences and Challenges Faced by Students at Bachelors’ of Sciences in Nursing Universities of Sindh in Pakistan

Authors: Farzana Soomro , Farzana Memon , Mushtaque Talpur , Muhammad Bux Lolai , Pir Bux Jokhio , Fateh Muhammad Brohi
DOI: https://doi.org/10.37184/lnjpc.2707-3521.4.8
Year: 2022
Volume: 4
Received: Dec 24, 2021
Revised: Feb 07, 2022
Accepted: Mar 01, 2022
Corresponding Auhtor: Pir Bux Jokhio (pjokhyo@pumhs.edu.pk)
All articles are published under the Creative Commons Attribution License



Abstract

Background: Academic environment plays an essential role in students’ professional development. An effective and protected academic experience always promotes students’ critical thinking and enhances reflective practices that help them to become trained in the field of nursing.

Objective: The study aimed to identify students’ academic experiences and professional challenges.

Methodology: A descriptive, cross-sectional study was conducted from the students of Bachelors’ of Sciences in Nursing (Generic) and (Post-Registered) degree programs of Begum Bilqees Sultana, Institute of Nursing at Nawabshah. The study covers the duration from November to December 2021. The study sample size consisted of 151 students. Data were collected through a 10-items self- structured questionnaire to capture students’ academic experiences and professional challenges.

Results: The response rate of the survey questionnaire was 93%. One hundred twenty-four (87.9%), and 112 (79.4%) respondents contradicted the available teaching aids and teachers’ efforts to complete lengthy course contents. The teachers’ use of traditional teaching methods and the existence of the theory-practice gap are endorsed by n=108 (76.6%), and n=103 (73%), respectively. Eighty-six respondents (60.9%) disputed the statement that teachers give feedback on time. Unexpectedly, 74 (52%) and 59 (41.8%) remained neutral on institutional favors to the particular students in graded/final examinations marks, and teachers use problem- solving skills to bring the students into the right path for learning outcomes respectively.

Conclusion: Institutions need to manage teaching resources for better academic learning experiences. Teachers’ Professional development and in-service training are given top priority. Contemporary teaching and learning approaches enhance the experiences of the learners. It also develops students’ critical thinking and reflective practice capabilities.

Keywords: Nursing students, academic experiences and challenges, theory-practice gap, appropriate feedback, contemporary teaching trends.

INTRODUCTION

Nursing education is a way of formal learning and training in the science of nursing. Effective practice and sound knowledge prepare them for their duties as nursing care professionals. It aims to facilitate students for enhancing their expertise at wide-ranging to help and care for the needy. In order to be more expert in this field, students need proper atmosphere, latest knowledge and timely guidance to support them to sharpen their capabilities and be active and result-oriented in their particular field. Unfortunately, the conditions are not satisfactory, resultantly, students encounter innumerable challenges during their academic years [1]. The teacher’s outdated teaching strategies can produce passive learners. They merely focus on passing their examinations rather than developing their knowledge and skills. Students require proper motivation and inspiration to revisit their

roles and responsibilities to be proactive learners. This change only can be possible when teachers adopt student-centered approaches to maximize students’ subject-based knowledge and learning experiences [2]. Effective communication between teachers and students can create a supportive and healthy environment. It will provide them self-respect, autonomy, and empowerment to overcome their learning issues [3]. The vast reading material (theory-practice fissure) for students is (poorly managed) out of its insufficient use in practice only. Students complained of their weak practical skills during the application of the nursing process. They termed clinical teaching as ineffective [4].

The supportive and positive learning environment is a good initiator to mobilizing nurse students for the future effective workforce to face challenges of known to unknown nature (such as the COVID-19 pandemic).

*Corresponding author: Pir Bux Jokhio, Begum Bilqees Sultana, Institute of Nursing, Peoples University of Medical & Health Sciences for Women, Nawabshah Shaheed Benazirabad, Pakistan; Email: pjokhyo@pumhs.edu.pk Received: December 24, 2021; Revised: February 07, 2022; Accepted: March 01, 2022 DOI: https://doi.org/10.37184/lnjpc.2707-3521.4.8

This is fundamental and necessary for present students to manage their physical and emotional burdens related to the health care system. Good learning environments always encourage students to face challenges and solve problems ethically according to the situations. Moral and ethical support promotes confidence and develops learning capabilities to make sound clinical judgments and understand their future roles and responsibilities positively. They will be able to confidently survive during their academic phases without any fear, panic, and discrimination. A supportive and competitive educational environment can ensure learning capabilities. The innumerable nurses face a lot of challenges. They must be morally and ethically strong to ensure patient’s safety and care to accomplish their job satisfaction. It is also necessary to overcome the shortage issue of nursing staff and reduce erosion rates [5].

The evidence supports while focusing on both cognitive and non-cognitive challenges to promote students’ confidence, resilience, and developing skills. The theory- practice gap is a failure to integrate the theoretical concepts into practice. Students are expected to translate the learned concepts into their practice. Their failure produces low confidence [1]. The students as reflective learners must be able to observe situations, get experience, and analyze the different situations before taking any pragmatic actions. They need to develop their listening skills because rote learning fails to cover reflect practice part of the learners [6]. Therefore, the importance of cognitive and non-cognitive domains cannot be ignored in this regard [1].

The literature review was conducted with keywords Nurses students, academic experiences and challenges, theory-practice gap, proper or inappropriate feedback, and contemporary teaching approaches/strategies through Google, Google scholar, and Elsevier. The articles published from 2010 to 2021 were included. All the articles included are in the English language. Twenty articles were selected for relevance to the objective of the study. The above-mentioned brief literature review highlights the importance of identifying educational challenges faced by nursing students. Therefore, the present study tries to identify the challenges faced by nursing students during their academic sessions. The study result will be useful for both faculties and institutions. This study will provide proper guidance and appropriate strategies for present needs and future plantings. It is a prime need of the time focus should be given on student- centered teaching and learning approaches rather than traditional methods of teaching and learning. Moreover, the study tries to find out the gap and address the issue in light of the literature review. In this regard, the due roles of faculties and institutions have been encouraged. They should understand their role and responsibility to provide a supportive and conducive learning environment from where students’ can get good learning experiences that will help them to be professionally sound and expert. In this regard, evidence-based sufficient information can be included to support student’s professional development and maintain their worth.

METHODS

To complete this study, a descriptive, cross-sectional, quantitative design was used. The study center was Begum Bilqees Sultana, Institute of nursing (BBS- ION), People University of Medical & Health Sciences for women, Shaheed Benazirabad (PUMHSW-SBA, Pakistan. The ethical approval was received by the ethical review committee of PUMHSW, SBA.

The study duration was November- December 2021. The confidentiality of the data was ensured through strict precautionary measures. The names of the participants were replaced by code numbers. All the data remained in lock and key. The data was entered into a password- protected computer. The study population for this research study was 04-years, Generic Bachelors’ of Science in Nursing (BSNG) and 02-years Bachelors’ of Science (Post –Registered Nurses) (BSN-PRN) degree programs. This university enrolls only female students. There were 243 students enrolled in both programs, 221 (Two hundred & twenty-one) BSNG and 22 (twenty-two) BSN-PRN. Inclusion criteria for the study were students enrolled in BSNG and BSN-PRN degree programs and willingness to participate in the study voluntarily. Students remaining absent for one month (November 2021) were excluded from the study. The sample size was calculated by the formula. n= N/1+ N (e)2. (n)= sample size, N= Total population, (e) = margin of the error [4]. Taking N=243 and e=5% yielding a sample size of 151participants.

A proportional allocation method (Table 1) was used to calculate the sample size for each year. It helps to ensure the representative drawn sample from the whole population. In the end, students’ class attendance sheets were used to select the sample. The selected participants were seated according to the year of study in different rooms and explained the aim of the study. The written informed consent forms were signed by the participants after they agreed to voluntarily participate. The participants returned the filled questionnaire after one hour.

Table 1: The description of students’ number of enrollment in each year with percentage and required number for sample selection.

Program by year

Enrolled Students

Percentage

Required Number

BSNG

1st year

80

32%

49

BSN

2nd year

61

25%

37

BSNG

3rd year

49

21%

31

BSN

4th year

31

13%

20

BSN (PRN)

1st year

10

04%

06

BSN (PRN)

2nd year

12

05%

08

Generic Bachelors’ of Science in Nursing (BSNG), Post Registered, Bachelors’ of Science in Nursing (BSN- PRN)

A self-structured 10-item closed-ended questionnaire (with slight modifications) was used for data collection. This questionnaire is developed and used by Fatima et al. (2019) [4]. Originally, the instrument used in the study [4] contains statements related to educational and clinical experiences. In line with the study purpose, 10-statements related to educational experiences and challenges were used. The first part of the questionnaire documented the demographic variables of age, gender, program (BSNG or BSN-PRN), and year of the study. The second part of the questionnaire contained 10-items related to the education environment. The two items (# 3 & 4) ask teacher-related questions such as feedback by the teacher and teaching strategy used by the teacher). Item (# 1) addresses the issue of resources available in the institute. Items (# 2, 5, 9 & 10) focus on curriculum strengths and weaknesses. The items (# 6, 7 & 8) focus on students learning outcomes-related points. All the scale statements are worded assertively.

The educational environment-related items were measured on a 5-point Likert scale, showing 1= strongly agree, 2= agree, 3= neutral, 4= disagree and 5= strongly disagree. In the final, agree and strongly agree were merged as agreed, and disagree and strongly disagree as disagree. The neutral score remained unchanged in the analysis. The data were managed in SPSS version 20 for statistical analysis. The frequencies and percentages were computed for demographic as well as educational environment challenges.

RESULTS

The researcher shared a questionnaire with 151 participants to fill out for this survey study. The participants’ response rate to the filled questionnaire was 141 (93%). Their age ranged between 18-36 years. The majority were between the age range of 18-33 years (n=119, 84.5%). The number of participants in age groups 26-32 and 33-36 was 18 (12.7%) and 4 (2.8%), respectively. The average age was 22.6±3.3 years. There were 129 (91.5%) and 12 (8.5%) participants in BSNG and BSN-PRN programs, respectively. The number and percentages of 1st, 2nd, 3rd, & 4th year were 45 (31.9%), 35 (24.7%), 27 (19.1%), & 23 (16.2%) in BSNG program and 8 (5.5%), & 4 (2.6%) in BSN-PRN, 1st and 2nd year, respectively.

Table 2: The challenges of the educational environment related to teaching.

Statement

Strongly Agree n(%)

Agree n(%)

Neutral n(%)

Disagree n(%)

Strongly Disagree n(%)

Teachers are willing to give feedback on time

6

(4.3%)

16

(11.3%)

33

(23.4%)

16

(11.3%)

70

(49.6%)

Teachers following traditional ways of teaching during regular classes

77

(54.6)

31

(22)

16

(11.3)

1

(7)

16

(11.3)

Table 2 indicates that 86 (60.9%) were dissatisfied with the statement ‘teachers give feedback on time willingly’ as against 22 (15.6%), who disagreed. For the statement, ‘teachers follow traditional ways of teaching during regular classes’, 108 (76.6%) agreed, while 17 (12%), disagreed.

Table 3 displays that 124 (87.9%) respondents disputed the available teaching aids (resources) in the institute, whereas, only, 6 (4.2%), agreed.

Table 3: The challenges of the educational environment related to resources availability.

Statement

Strongly Agree n(%)

Agree n(%)

Neutral n(%)

Disagree n(%)

Strongly Disagree n(%)

Teaching aids (resources) are present in the institute

4

(2.8)

2

(1.4)

11

(7.8)

36

(25.5)

88

(62.4)

Table 4 shows that the majority of the respondent (n=112, 79.4%), disagreed with the statement that teachers focus on completing comprehensive content. Only 14 (9.9%) agreed with the statement. For the statement, there is a ‘theory-practice gap’, 103 (73%), consented while 30 (21.3%) differed. For the statement, the amount of time devoted to teaching nursing-specific knowledge (courses), 38 (27%), agreed while 39 (27.7%) didn’t agree. For the statement, ‘the relevance of theoretical course contents for clinical needs’, the response was even. 50 (35.4%), approved, however, 46 (32.6%) objected.

Table 4: The challenges of the educational environment related to curriculum strengths & weaknesses.

Statement

Strongly Agree n(%)

Agree n(%)

Neutral n(%)

Disagree n(%)

Strongly Disagree n(%)

Teachers mostly focus on completing

lengthy contents

5

(3.5)

9

(6.4)

15

(10.6)

34

(24.1)

78

(55.3)

There is a gap between education and practice

59

(41.8)

44

(31.2)

8

(5.7)

9

(6.4)

21

(14.9)

The amount of time is enough to devote

to teaching special nursing knowledge

10

(7.1)

28

(19.9)

64

(45.4)

28

(19.9)

11

(7.8)

Relevance of theoretical

course’s content and clinical needs.

23

(16.3)

27

(19.1)

45

(31.9)

27

(19.1)

19

(13.5)

Table 5 reveals the students’ learning outcomes.

47 (33.4%), respondents agreed that teachers use problem-solving methods to sort out students’ learning, 59 (41.8%), respondents disagreed with the response. Nearly half of the respondents 74 (52%) remained neutral for the statement; the institution favors particular students in grades in the final examinations. The number of students who agreed with the statement was 41 (29.1%), respondents whereas, 26 (18.5%) respondents disagreed. The last and 10th statement is based on teachers’ subject-based knowledge of nursing. 59 (41.8%), respondents disagreed with the statement whereas 47 (33.4%), respondents agreed with the statement.

Table 5: Displays the challenges of the educational environment related to educational outcomes.

Statement

Strongly Agree n(%)

Agree n(%)

Neutral n(%)

Disagree n(%)

Strongly Disagree n(%)

Teachers use problem-solving methods to track students' learning

18

(12.8)

29

(20.6)

35

(24.8)

34

(34.1)

25

(17.7)

Institution favors particular students in graded and final exams

17

(12.1)

24

(17)

74

(52)

20

(14.2)

6

(4.3)

Teaching the theoretical subjects based on specific knowledge of nursing

18

(12.8)

29

(20.6)

35

(24.8)

34

(24.1)

25

(17.7)

DISCUSSION

Nursing education is in the transformation as a humanistic and scientific model. It facilitates students’ assimilation towards active learners and patients’ advocates [6]. An effective communication-based educational environment is useful in this regard. It hones students’ coping and resilience competencies during the academic period [7]. The current study results are a hopeful step to identify and remedy the upfront challenges.

In the light of results, participants identified ‘teaching resources unavailability’ as a 1st major problem. The results are in line with a sequential exploratory mixed- method study which was conducted to discover nurse educators’ viewpoints associated with their clinical and academic teaching [8]. The study found inadequate resources such as improper skill and simulation lab, underdeveloped curriculum, and high teacher-student ratio as hurdles of effective classroom teaching [8]. The results are further supported by a cross-session study, conducted at Shifa College of Nursing, Islamabad, Pakistan [9]. The participants perceived the educational environment as positive (with a mean score of 119 of 200). The mean score of 13 out of 28 on the social self-perception sub-scale suggested ‘educational environment’ as being ‘not a nice place’. A stressed educational atmosphere may cause students’ poor performance [9].

The results presented teachers’ failure ‘to complete lengthy content’ as 2nd important problem. The teachers’ heavy workload, high student-teacher ratio, and unavailability of teaching resources aggravate the issue. The teaching resource availability is an extrinsic motivation factor for students’ learning and achievement. A good learning environment has a significant and different impact [10]. On the other hand, resource limitations frustrate teachers and they leave the class without completing sessions [4].

The teachers’ failure ‘to adopt contemporary teaching methods’ during regular classes was the 3rd problem. This is in congruence with the results of a qualitative study that utilized the content analyses method to capture students’ experiences and encounters. The students were worried and detested for teachers’ one- way content description [11]. It was also further explored and examined in the descriptive correlation design with triangulation method study which articulated teachers’ style of teaching (student-centered versus teacher- centered) [12]. The findings revealed teacher-centered learning strategies as more appallingly. Teachers valued student-centered teaching strategies and espouse them through teaching philosophies but failed to adopt them because of time limitations and workload. The teachers were aware of students’ uniqueness but they failed to deliberate accordingly [12]. The large attendance in a class was one reason recognized in this respect [13].

The 4th major problem accredited in our study was the ‘theory-practice gap’ as 103 (73%) participants indicated the issue. The results closely match with the results of a study [4] as 98.1% of participants agreed that there was a theory-practice gap. In another descriptive design (conducted in Lahore, Pakistan), to assess the gap between theory and training in the nursing education system, the 126 (84%) respondents disagreed that there was a relationship between theoretical classes and clinical procedures in the ward [14]. Theory- practice crack is a disadvantage. It pushes students backward as they abandon to grow critical and reflective professionals [4]. The findings also disclosed a students’ need for timely feedback. The learning is competency progression with thinking critically and reflectively rather than next year’s study promotion [13].

The remaining statements of the questionnaire received a mixed response. The statement, ‘The amount of time devoted for teaching nursing-specific knowledge’ received participants’ 45.4% (64) neutral response. Teachers and students valued teaching nursing-specific knowledge because they assumed it was ‘the right thing to do’. It is sensed as a responsibility, and a pledge to engage in healthy interactions [15]. The responsible and self-managed teachers track students learning with a positive mind during the available time. It makes students sensitive as unbiased and indiscriminate progress being monitored [16].

For the statement, ‘teachers use problem-solving skills to track students’ learning outcomes’, participants’ neutrality (according to results) is alarming. An effective evaluation makes students proficient, and confident. Students’ perception of clinical placement

was ‘inadequate readiness. It encompassed insufficient knowledge, practical, and communication skills. These factors devalued professional practice [7]. A teacher mentors students through a variety of skills. S/He focuses on learning theories to re-energize demotivated individuals. Through appropriate examples and reasoning metaphors, a teacher guides and handles challenging situations. Therefore, learning theories are considered the main instrument for curriculum effectiveness [17].

In the end, participants’ neutrality for the statement, ‘Institution favors particular students’ could be out of fear of being victimized although students were assured of the confidentiality of the data. The alarming situation necessitates confidence-building measures between institutions and students. Feelings of being supported and respected are fundamental for building students’ confidence. Stress-free students hone and refine their skills easily. Stress demoralizes and demotivates them. They must realize that they are in safe hands and their hard work will earn them valuable professional identification [18].

CONCLUSION

Classroom teaching is fundamental for clinical practice. It is an attractive quote ascribed to Kant …. ‘Theory without practice is empty and practice without theory is blind’ . Both are significantly correlated. Teachers and students, both, must nurture the inseparable and indestructible union of both as necessary [19, 20]. For this, we need a healthy learning environment. The results of the study suggest truncating learning resources’ unavailability. The learning resources help students to grow professionally. Institutions should arrange continuous professional development workshops to update faculty teaching skills. Teachers should know that students don’t need the transfer of content merely for passing the examination. Teachers must adopt contemporary teaching methodologies to develop students’ critical thinking skills. Students’ learning must be examined and evaluated according to the specific objectives of the course and intended outcomes. Students need unbiased, timely, and proper feedback to track their progress. Finally, students must be given respect and autonomy. There is a need to build confidence between institutions and students. This will cease the alienation. We need a knowledgeable, skilled, and professionally groomed nurse workforce for the future.

LIMITATION

This study was conducted at a single nursing institute; therefore, the generalization of the study is limited. Nevertheless, the study is a welcome step as our institute is located in Rural Sindh. There is a dearth of nursing research, so, it is a good step for others to conduct more studies in this area. Lastly, the study was conducted only among female participants; therefore, the same study is warranted among male nurse students also.

ETHICS APPROVAL

The ethical approval was received by the ethical review committee of PUMHSW, SBA. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration.

CONSENT FOR PUBLICATION

The written informed consent forms were signed by the participants.

AVAILABILITY OF DATA

Not applicable.

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

ACKNOWLEDGEMENTS

We are all thankful to the student participants for their voluntary participation in this important study. We are also thankful for the administration of the institute who permitted us to conduct the study as a professional development gesture.

AUTHOR’S CONTRIBUTION

The first and second author conceptualized the study. The third author conducted a literature review. The fourth and sixth author collected data and the fifth author received an ethical review letter and did correspond for article publication. All the authors contributed in data management, analysis and compiling final report for publication.

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