Predictors of academic performance of nursing and paramedic students in first year bioscience

Descriptive study showing the effect of small differences in entry scores on retention and success in six courses in nursing

BACKGROUND

Undergraduate enrolments and completions in nursing are declining at the same time as requirements for registered nurses in the workforce is increasing. One way to increase enrolments is to lower entry requirements into nursing programs. This study determined the effect of a small lowering of entry scores on the retention and success rates. The study was undertaken at Griffith University, where identical bioscience and clinical courses run at three campuses, one with a lower- than normal-entry score and two with the normal-entry requirements.

METHODS

A comparison of the 62-148 students enrolled in the courses at the lower- than normal- (lesser) entry requiring campus with the 197-288 students enrolled in the courses in one normal-entry requiring campuses. For individual courses (4 bioscience and 2 clinical courses) retention rates were measured and compared between campuses/cohorts. For completing students, we measured success as (i) Academic outcomes; overall marks and marks for the exam and coursework and (ii) Failure rates in the examination and coursework. Data analysis was by Student's t-test and Odds ratio.

RESULTS

For all courses, there were few significant differences in measures of retention and success between the lower- and normal-entry campuses, and all differences were small. Comparing the campuses; (a) For all courses, progression rates were similar. (b) For completing students, passing rates were similar in the bioscience courses, but higher in the normal- than lower-entry campus for the clinical courses. (c) In the bioscience courses, the overall marks were similar, but in the clinical courses, the overall mark was slightly higher in the normal- than lower-entry campus. (d) The overall failure rates were similar for the biosciences, but higher for the lower- than normal-entry cohort in the clinical courses. (e) The failure rates in exams were similar between cohorts in all courses.

CONCLUSIONS

This study shows that small changes in entry requirements for a nursing program had minimal effects on retention. The differences in entry requirements also did not affect the success of students in the bioscience courses. Decreasing entry requirement for nursing programs may be a way to increase nursing graduates.

Theory-practice gap: Nursing students' self-reported depth of understanding of bioscience and its relevance to clinical practice

BACKGROUND

Bioscience subjects are essential as they allow nurses to have a clear understanding of the patient's condition and ultimately allow them to provide appropriate and timeous care. However, these subjects remain a significant problem in the endeavour to produce highly competent nurses.

AIM

The study aimed to investigate the nursing students' self-reported depth of understanding of bioscience and its relevance to clinical practice.

METHODS

A quantitative research approach using a descriptive survey design was employed. The sample (n = 211) included second-, third- and fourth-year undergraduate nursing students. A three-part self-administered questionnaire was adapted and used to collect the data. Data were analysed using IBM Statistical Package for Social Sciences software version 25.0 (IBM SPSS-25). Descriptive statistics and Chi-squared test were performed to describe the relationship among the study variables.

RESULTS

Participants rated their understanding of the application of Human Biology (n = 86, 40.76%) and Pharmacology (n = 88, 41.71%) as good, while Physics (n = 80, 37.91%) and Chemistry (n = 85, 40.28%) were rated as adequate. Most participants rated Human Biology (n = 175, 83.73%) and Pharmacology (n = 181, 86.19%) as essential, while Physics (n = 129, 61.72%) and Chemistry (n = 133, 63.64%) were rated as relevant to clinical practice. Physics (n = 112, 60.54%; n = 95, 50.53%) and Chemistry (n = 126, 68.85%; n = 113 61.41%) were rated as not relevant to monitoring a patient's heart rate and blood pressure. Participants' perception of the relevance of Chemistry in monitoring a patient's blood pressure was statistically significant (χ2 = 6.871 (df 2), p<0.05). Most participants (n = 57, 41.91%) performed at Task specific on Akinsanya's Bionursing model, suggesting an overall understanding of the foundational concepts and principles of bioscience.

CONCLUSION

The findings of the study provided evidence of the students' self-reported depth of understanding and perception of the relevance of bioscience and indicate a need for more emphasis on the importance of bioscience integration in clinical practice.

A team approach to delivery of contextually relevant bioscience: encouraging student connections between tacit knowledge and new content acquisition

BACKGROUND

Bioscience is essential knowledge for nursing practice and is an important component of undergraduate nursing education, however students commonly feel anxious about studying the subject. The purpose of this study was to develop appropriately scoped contextually relevant bioscience lesson resources to enhance student engagement and performance and reduce attrition and unit failures over a sustained period.

METHODS

Participants included students enrolled in the core bioscience unit for an undergraduate Bachelor of Nursing degree from a central campus and a widening participation (WP) campus. From 2016 to 2018, unit learning resources were progressively revised to include a structured learning and teaching manual, signposted lectures, and digital resources. Online surveys and formal institutional data collection metrics were used to assess the impact of the changes to unit learning resources.

RESULTS

Student attrition rates and failure rates for the unit were reduced over a two-year period across a diverse student cohort.

CONCLUSIONS

Scaffolded and diverse learning materials support the success of undergraduate bioscience students by improving student engagement and reducing cognitive load.

An eLearning module is comparable to face-to-face teaching in a nursing human pathophysiology subject

BACKGROUND

Human pathophysiology is important in undergraduate nursing education to help students develop clinical reasoning skills. Traditionally pathophysiology education in undergraduate nursing is taught face-to-face. However, eLearning in nursing curricula may provide flexible delivery options.

OBJECTIVE

With increased inclusion of technology enhanced learning in nursing curricula, a hematology eLearning module was evaluated in a pathophysiology subject to determine whether it was comparable to face-to-face learning.

DESIGN

Single-blind randomized pre-test/post-test controlled trial.

SETTING

School of Health and Behavioural Sciences, University of the Sunshine Coast.

PARTICIPANTS

A total of 271 second-year undergraduate students enrolled in Human Pathophysiology were included in the study. Students were from three bachelor programs: Nursing Science; Paramedic Science; and Clinical Exercise Physiology. Students were randomly allocated to either the experimental group (n = 85) or the control group (n = 186).

METHODS

A hematology eLearning module was designed to be self-directed and learner-centered, guided by constructivist learning theories for delivery in the human pathophysiology subject. The experimental "eLearning" group completed the module independently, and the control "face-to-face" group completed equivalent paper-based activities facilitated by a tutor. All students completed a pre-test assessment and two post-test assessments two weeks after the intervention and at the end of the subject.

RESULTS

There was no significant difference in assessment scores between the experimental and control groups, or between nursing and other programs.

CONCLUSION

eLearning was comparable to face-to-face teaching in this study. We recommend further research to strengthen the links between pathophysiology theory to clinical reasoning skills using eLearning.

The self-regulated learner, entry characteristics and academic performance of undergraduate nursing students transitioning to University

BACKGROUND

Although the importance of fostering students self-regulated learning is well known, little is known about the relationship between student entry characteristics, particularly students from disadvantaged backgrounds, self-regulatory strategy use and academic performance. The study aim was to examine undergraduate nursing students' entry characteristics, motivational behaviours and learning strategies, and academic performance after transitioning into the first unit of an undergraduate nursing course.

DESIGN

A cross-sectional survey.

SETTING

A university in Australia.

PARTICIPANTS

First-year undergraduate nursing students.

METHODS

The Motivational Strategies for Learning Questionnaire, including demographic information, was distributed to students in the fourth week of commencing University, consent was obtained for the use of student unit grades.

RESULTS

For the 448 eligible students, n = 282 (62.9%) completed the survey. Students were categorised by age into three groups: 18 years, 19-22 years, and 23+ years. Entry characteristics, motivation and learning strategies scores and academic performance were related to the age category with the greatest difference between 18 and 23+ student groups. 23 years+ had higher scores for 11 MSLQ scales (mean difference 0.78-0.31, p < 0.05) highest grades (F = 4.694, p = 0.010). Students 23+ years had the highest motivational behaviours and learning strategies. The international students' academic grades in this study were lower than the domestic student's grades (t = -2.212, p = 0.028).

CONCLUSION

This study highlights the need to address the tensions that exist between attracting quality students, the requirement to assess their quality efficiently and allowing students from disadvantaged groups the opportunity to enter nursing undergraduate degree courses. This study contributes new knowledge to the impact students' entry characteristics have on motivational behaviours, learning strategy use and academic performance. Knowing this would allow faculty to identify students at risk of failure early in the course and offer instructional support.

Second-Year Nursing Students' Retention of Gross Anatomical Knowledge

Human anatomy is a foundational course in nursing education, however, there is growing concern that students do not retain enough anatomical knowledge to successfully apply it in clinical settings. The aim of this study was to determine retention level of anatomy knowledge among second-year nursing students from their first-year anatomy class, and to determine if there is a difference in level of retention based on organ system. For each system, second-year students were asked to answer 9 to 11 multiple-choice questions (MCQs), and the scores from these quizzes were compared to matched test items from their first-year anatomy examinations. There was a significant decrease in the overall mean score from 83.05 ± 8.34 (±SD) in first year to 54.36 ±12.9 in second year (P = 0.0001). Retention levels were system specific. System-specific knowledge retention was highest for the gastrointestinal system (89.7%), respiratory system (88.5%), and genitourinary system (83.6%). This was followed by the integumentary system (80.1%), special senses (79.4%), nervous system (74.9%), and musculoskeletal system (69.3%). Retention was lowest for the lymphatic system (64.3%), cranial nerves (58.8%), vascular system (53.9%), and head and neck (42.6%). The present study shows that nursing students' anatomy knowledge retention was comparatively higher than rates reported by others in medical and allied-health students. The researchers are now investigating knowledge retention in third- and fourth-year nursing students. Further investigation into why retention is higher for specific systems and intervention strategies to improve knowledge acquisition and retention in nursing students is recommended.

A combination of active learning strategies improves student academic outcomes in first-year paramedic bioscience

Bioscience is a foundational unit (subject) of undergraduate allied health degree programs, providing students the scientific basis underpinning their clinical practice. However, despite its significance, bioscience is a difficult academic hurdle for many students to master. The introduction of active learning strategies, including small team-based guided-inquiry learning approaches, has been shown to significantly reduce this hurdle and improve assessment outcomes for the learner. Guided team-based activities can aid in this approach by also building broader skills and capabilities, like teamwork and communication, as well as subject-specific knowledge and skills, thereby positively influencing student assessment outcomes. This paper details the redesign and evaluation of two first-year Bioscience for Paramedics units with the introduction of guided-inquiry learning, as well as other active learning strategies, and assesses their impact on student performance. Results indicate that active learning used within a classroom and in the large lecture theater setting improved students' grades with positive student perception of their learning experience.

Shifting the load: Improving bioscience performance in undergraduate nurses through student focused learning

Background

Bioscience has a long history of being challenging to teach and learn within nursing courses and little has been published on new ways to assist students in their learning. The aim of this study was to determine which of three different interventions would assist student performance in a nursing bioscience unit.

Method

To begin, the contribution of recent prior learning in science was investigated by comparing the final exam marks of 182 students in the bioscience unit with the science marks they achieved at high (secondary) school. The effect of recent prior learning was then tested by investigating whether the first intervention, a pre-nursing bioscience workshop of 63 students, would substitute for recent high school science. Two further interventions were tested that used a stronger student-focused contribution to the teaching and learning within the bioscience unit. These were the Human Body Club which was composed of 44 under-performing students and an online learning platform known as LearnSmart that was used by a cohort of 263 students.

Results and discussion

Good and recent high school attainment in the sciences did improve student performance, whilst recent prior learning in the form of a bioscience workshop did not. Both student-focused interventions improved student performance. The longer a student spent using LearnSmart the more their mark increased. However, the Human Body Club which provided additional support and shifted the bulk of the teaching and learning to the students was the most effective of the three interventions in assisting students to pass the bioscience unit.

Nursing students collaborating to develop multiple-choice exam revision questions: A student engagement study

BACKGROUND

Nursing students find bioscience subjects challenging. Bioscience exams pose particular concerns for these students, which may lead to students adopting a surface-approach to learning.

OBJECTIVES

To promote student collective understanding of bioscience, improve their confidence for the final exam, and improve deeper understanding of bioscience.

DESIGN

In order to address exam anxiety, and improve student understanding of content, this student engagement project involved nursing students collaborating in small groups to develop multiple-choice questions and answers, which became available to the entire student cohort.

SETTINGS

This study was conducted at two campuses of an Australian university, within a first year bioscience subject as part of the undergraduate nursing programme.

PARTICIPANTS

All students enrolled in the subject were encouraged to attend face-to-face workshops, and collaborate in revision question writing. Online anonymous questionnaires were used to invite student feedback on this initiative; 79 respondents completed this feedback.

METHODS

Students collaborated in groups to write revision questions as part of in-class activities. These questions were made available on the student online learning site for revision. An online feedback survey was deployed at the conclusion of all workshops for this subject, with questions rated using a Likert scale.

RESULTS

Participants indicated that they enjoyed the opportunity to collaborate in this activity, and almost all of these respondents used these questions in their exam preparation. There was strong agreement that this activity improved their confidence for the final exam. Importantly, almost two-thirds of respondents agreed that writing questions improved their understanding of content, and assisted in their active reflection of content.

CONCLUSIONS

Overall, this initiative revealed various potential benefits for the students, including promoting bioscience understanding and confidence. This may improve their long-term understanding of bioscience for nursing practice, as registered nurses' bioscience knowledge can impact on patient outcomes.

Can active learning principles be applied to the bioscience assessments of nursing students? A review of the literature

OBJECTIVES

To explore if active learning principles be applied to nursing bioscience assessments and will this influence student perception of confidence in applying theory to practice?

DESIGN AND DATA SOURCES

A review of the literature utilising searches of various databases including CINAHL, PUBMED, Google Scholar and Mosby's Journal Index.

METHODS

The literature search identified research from twenty-six original articles, two electronic books, one published book and one conference proceedings paper.

RESULTS

Bioscience has been identified as an area that nurses struggle to learn in tertiary institutions and then apply to clinical practice. A number of problems have been identified and explored that may contribute to this poor understanding and retention. University academics need to be knowledgeable of innovative teaching and assessing modalities that focus on enhancing student learning and address the integration issues associated with the theory practice gap. Increased bioscience education is associated with improved patient outcomes therefore by addressing this "bioscience problem" and improving the integration of bioscience in clinical practice there will subsequently be an improvement in health care outcomes.

CONCLUSION

From the literature several themes were identified. First there are many problems with teaching nursing students bioscience education. These include class sizes, motivation, concentration, delivery mode, lecturer perspectives, student's previous knowledge, anxiety, and a lack of confidence. Among these influences the type of assessment employed by the educator has not been explored or identified as a contributor to student learning specifically in nursing bioscience instruction. Second that educating could be achieved more effectively if active learning principles were applied and the needs and expectations of the student were met. Lastly, assessment influences student retention and the student experience and as such assessment should be congruent with the subject content, align with the learning objectives and be used as a stimulus tool for learning.

Self-efficacy and relevance of bioscience for nursing, midwifery and healthcare students

AIMS AND OBJECTIVES

To examine nursing, midwifery and allied healthcare students' self-efficacy for science, perceived relevance of bioscience to their studies and expectations for academic success and the changes that occur after completing first-year introductory bioscience subjects.

BACKGROUND

Bioscience is a foundation subject that underpins nursing, midwifery and other allied health courses. Bioscience subjects continue to be source of anxiety for students in those courses. Raising students' self-efficacy and perceptions of the importance and utility of bioscience to practice may be a way of ameliorating students' expectations and confidence in this subject area.

DESIGN

A prospective correlational survey design.

METHODS

Students were surveyed in the first semester of first year and the commencement of the second year. Students were drawn from nursing, midwifery, public health and allied health courses. The surveys contained scales for self-efficacy for science, perceived relevance of bioscience to their course and personal expectations for success in their bioscience subject.

RESULTS

Ninety-seven and 82 students completed survey 1 and 2 respectively. Twenty-six surveys could be matched. Self-efficacy increased from survey 1 to survey 2, but expectations for academic success and task value, a measure for relevance, were lower. This was statistically significant for the matched pair sample. Using a mean split, students with high self-efficacy valued science more and had higher expectations for success in their bioscience courses than those with low self-efficacy.

CONCLUSION

Academic success in bioscience, confidence undertaking science tasks and perceiving bioscience as relevant to their course are interwoven concepts that are important for nursing, midwifery and applied healthcare students and ultimately for their professional practice.

RELEVANCE TO CLINICAL PRACTICE

Literature indicates practitioners may not feel confident in their bioscience knowledge. Assisting undergraduate students to develop confidence in and perceive the relevance of bioscience to their discipline may ultimately impact on clinical practice.

The 'bioscience problem' for nursing students: an integrative review of published evaluations of Year 1 bioscience, and proposed directions for curriculum development

BACKGROUND

The difficulties that nursing students have in learning human biosciences have given cause for concern for over 20 years but the problem remains.

OBJECTIVE

To conduct an integrative review of published primary research into the 'bioscience problem', evaluate their outcomes, and provide a contemporary analysis of potential directions for curriculum planners.

REVIEW METHODS

A systematic search of electronic databases CINAHL, Medline, British Nursing Index and Google Scholar was conducted for empirical research studies, published between 1990 and 2013, designed to either predict performance of students in bioscience assessments in Year 1 of their studies or identify in-course curriculum delivery issues.

RESULTS

The search generated nineteen papers that met inclusion criteria. Twelve papers involved predictive factors for bioscience attainment and seven surveyed student views on curriculum issues. Four others that surveyed reflections of later-year students or qualified nurses on Year 1 outcomes were also retained for additional context. Prediction based on pre-admission academic achievement was not reliable. Student factors including age at entry, self-efficacy in science, and having appropriate study skills in particular appear to be confounding factors. In-course influences such as teaching strategy or lecturer skills are also inconsistent and likely to represent confounders operating at local, institutional level.

CONCLUSIONS

The integrative review approach enabled analysis of incongruencies between studies that have been a barrier to curriculum development. Sound admissions criteria based on pre-university academic performance show promise in resolving the 'bioscience problem' but will likely be contingent on innovative support early in Year 1 for study skills and the fundamentals of human bioscience, plus attention to local quality assurance for curriculum delivery.

Frequency and predictors of courses repetition, probation, and delayed graduation in kashan faculty of nursing and midwifery

Background:

Course failing and delayed graduation are important concerns in educational systems. The reasons of these educational failures need to be clarified.

Objectives:

This study was designed to determine the academic failure rate and its predictors in Nursing and Midwifery Students in Kashan University of Medical Sciences.

Materials and Methods:

In this cross-sectional study, the records of all the students graduated in Nursing and Midwifery faculty during 18 years (1986 - 2003) were evaluated (1174 graduates). The demographic variables and the educational situation were recorded. The frequency of course repetition, probation, and delayed graduation were determined and the data were analyzed using the chi-square and logistic regression tests.

Results:

The frequency of course repetition, probation, and delayed graduation was reported to be 19.25%, 3.9% and 19.85%, respectively. Gaining Low grade in high school, transferring from other universities, having special quota, and transferring temporarily to other universities were mentioned as the risk factors of academic failure. The major had a significant relationship with academic failure. Day time students had more course failure and night time students stayed longer in the university.

Conclusions:

The individual characteristics, educational background and admission criteria had showed relation with academic failure. Vulnerable students should be identified and educational supports should be provided for these students.

The use of team-based, guided inquiry learning to overcome educational disadvantages in learning human physiology: a structural equation model

The study of human bioscience is viewed as a crucial curriculum in allied health. Nevertheless, bioscience (and particularly physiology) is notoriously difficult for undergraduates, particularly academically disadvantaged students. So endemic are the high failure rates (particularly in nursing) that it has come to be known as "the human bioscience problem." In the present report, we describe the outcomes for individual success in studying first-year human physiology in a subject that emphasises team-based active learning as the major pedagogy for mastering subject learning outcomes. Structural equation modeling was used to develop a model of the impact team learning had on individual performance. Modeling was consistent with the idea that students with similar academic abilities (as determined by tertiary entrance rank) were advantaged (scored higher on individual assessment items) by working in strong teams (teams that scored higher in team-based assessments). Analysis of covariance revealed that students who studied the subject with active learning as the major mode of learning activities outperformed students who studied the subject using the traditional didactic teaching format (lectures and tutorials, P = 0.000). After adjustment for tertiary entrance rank (via analysis of covariance) on two individual tests (the final exam and a late-semester in-class test), individual student grades improved by 8% (95% confidence interval: 6-10%) and 12% (95% confidence interval: 10-14%) when students engaged in team-based active learning. These data quantitatively support the notion that weaker students working in strong teams can overcome their educational disadvantages.

Biosciences within the pre-registration (pre-requisite) curriculum: an integrative literature review of curriculum interventions 1990-2012

BACKGROUND

The learning of biosciences is well-documented to be problematic as students find the subjects amongst the most difficult and anxiety-provoking of their pre-registration programme. Studies suggest that learning consequently is not at the level anticipated by the profession. Curriculum innovations might improve the situation but the effectiveness of applied interventions has not been evaluated.

OBJECTIVE

To undertake an integrative review and narrative synthesis of curriculum interventions and evaluate their effect on the learning of biosciences by pre-registration student nurses. Review methods A systematic search of electronic databases CINAHL, Medline, British Nursing Index and Google Scholar for empirical research studies was designed to evaluate the introduction of a curriculum intervention related to the biosciences, published in 1990-2012. Studies were evaluated for design, receptivity of the intervention and impact on bioscience learning.

RESULTS

The search generated fourteen papers that met inclusion criteria. Seven studies introduced on-line learning packages, five an active learning format into classroom teaching or practical sessions, and two applied Audience Response Technology as an exercise in self-testing and reflection. Almost all studies reported a high level of student satisfaction, though in some there were access/utilization issues for students using on-line learning. Self-reporting suggested positive experiences, but objective evaluation suggests that impacts on learning were variable and unconvincing even where an effect on course progress was identified. Adjunct on-line programmes also show promise for supporting basic science or language acquisition.

CONCLUSIONS

Published studies of curriculum interventions, including on-line support, have focused too heavily on the perceived benefit to students rather than objective measures of impact on actual learning. Future studies should include rigorous assessment evaluations within their design if interventions are to be adopted to reduce the 'bioscience problem'.