Nursing students’evaluation and reflection on p roblem-based learning in Macao

Haobin Yuan,Beverly A W illiams,Lei Y in,M ing L iu,Jinbo Fang,Dong Pang (Macao Po lytechnic Institute,Macao,China)

·英文論文·

Nursing students’evaluation and reflection on p roblem-based learning in Macao

Haobin Yuan,Beverly A W illiams,Lei Y in,M ing L iu,Jinbo Fang,Dong Pang (Macao Po lytechnic Institute,Macao,China)

Objective:The purpose of this study was to describe nursing students’experience of p roblem-based learning(PBL)in M acao.M ethod: The descrip tive study was conducted w ith fourth year students w ho com- p leted a one-semester PBL nursing course in M acao.Participantswere voluntary and comp leted a researcher developed PBL Evaluation Scale. Students also w rote a reflective paper about their learning experience.Results:Students considered PBL to be moderately effective overall(item mean 3.35±0.53).They considered PBL to be highly effective in stim ulating group discussion(item mean 3.93±0.81),p romoting open discussion of differing opinions(item mean 3.89±0.74),sharing w hat they had learned,interp reted and synthesized w ith entire group(item mean 3.79± 0.74),and increasing their ability to wo rk effectively on a team(item mean 3.61±0.69).However,almost one half of the students exp ressed uncertainty in acquiring know ledge,the stressful learning p rocess and the wo rkload.A few students felt f rustrated w ith poor group cooperation of some colleagues.Conclusion:PBL can be effective in helping studentsassume active responsibility fo r their learning.PBL is most effective if faculty can p rovide the studentsw ith suppo rt in developing their understanding of PBL,and help students develop app rop riate strategies for coping and engaging in the PBL learning p rocess.

M acao;baccalaureate nursing students;p roblem2based learning;evaluation;reflection

1 Introduction

Higher education in nu rsing should p repare g raduates w ith the capability to take on the increasingly challenging ro les required of the nursing p rofession[1].Since nursing is a p ractice discipline,it is impo rtant that students have oppo rtunities to app ly the know ledge they are learning in both the classroom and the clinical setting.Graduates need to have the ability to discern and focuson relevant aspectsof various situations in o rder to define and so lve p roblems and make decisions fo r nursing care[2].Nursing education is critical in assisting nursing students to integrate the theo ry and p ractice of nursing w hile helping them transform into p rofessional nurses[3].The linking of theory w ith p ractice can be attained through active learning,in w hich students are encouraged to focus on p roblem so lving,critical thinking,and team wo rk[4].

Problem2based learning(PBL)is a student2centered app roach to learning w hich enables the students to wo rk cooperatively in small groups to determine app roaches to specific nursing situations[5].Students encounter each real nursing p ractice situation asa small group.The group decides w hat info rm ation they need and how they w ill use the inform ation to deal w ith the specific situation.Th rough peer teaching, students achieve a deep understanding of app licable know ledge and are more likely to reach their highest potential w ithin the p rofession[3]. Students aremo re active in learning since they generally value theopportunity to handle the situations and the comments given to them fo r their work[6].A pp lication of PBL to nursing education can p repare students to dealw ith real patient situations by helping them develop the key skills of effective and efficient self2directed learning,critical thinking,communication and p roblem2solving[7].Currently traditional teaching and learning app roaches (lecture,seminar,debate,case study and group discussion)are themainstay in nursing classroom s in Macao.Recently PBL has been introduced as a relatively new method of nursing education. When a new teaching app roach is introduced it is impo rtant to understand the student experience w ith the innovation.The purpose of this study was to describe nursing students’experience of PBL in the nursing faculty in Macao.

2 Methods

A descrip tive study was designed and executed.

2.1 Samp le and Setting Twenty2eight fourth year baccalau reate nu rsing studen ts w ho had comp leted a one2semester PBL nursing course at one institute in Macao vo lunteered to participate in the study.

2.2 Instruments The PBL Evaluation Scale was developed by Yuan[8]to evaluate studen ts’perspectives on the effectiveness of PBL in term sof constructing p rofessional know ledge,developing p roblem2so lving skills and self2directed learning,increasing motivation to learn,and p romoting effective group co llabo ration.It w as a 202item self2repo rt Likert scale w ith a 52point response choice(1=ineffective to 5=very effective).The higher the score the more likely students considered PBL to be effective.The content validity index(CV I)was calculated as one.The internal consistency established using Cronbach’s alpha w as 0.80 and the test2retest reliability w ith a twoweek interval was 0.89.

2.3 Data co llection A t the end of the course the PBL Evaluation Scale was completed using a self2repo rt technique.A ll participants were asked to w rite reflective papers w ith comments about know ledge attainment,communication, self2directed learning, team wo rk,and critical thinking.

2.4 Data analysis The sco res of the PBL Evaluation Scale were described in terms of item mean and standard deviation using the Statistical Package fo r Social Science SPSS 13.0(Software package,Chicago,Illinois,USA).Two researchers individually repeatedly read the reflective papers line by line to become immersed in the content,and then the datawere catego rized based on themeanings.The two researchers compared their results and differences were discussed until consensus was achieved.Finally,all reflection papers were reviewed again to ensure that all data had been included and analyzed.

2.5 Ethical considerations Ethical app roval was obtained f rom the Departm en tal Research Comm ittee of the Macao Polytechnic Institute.Participation was entirely voluntary.Info rm ation about the study w as given to every participant to assure the p rotection of human rights.Students had oppo rtunity to determine their w illingness to participate in the study.A signed, info rmed consent w as obtained f rom each student befo re data collection.Students were free to refuse to participate o r w ithd raw f rom the study at any time. Confidentiality was ensured through the use of code num bers.The list of code numbers and names was sto red separately from the actual data.The obtained data from the participants were used only for the study.Students were app rised that all findings would be reported as group results and be submitted fo r publication.

3 Results

3.1 Students’evaluation of PBL A ll participants comp leted all item s of the questionnaires fo r a 100% response rate.Overall,students considered PBL to be moderately effective(item mean 3.35±0.53).A sevident in Table 1,students indicated that PBL was highly effective in stim ulating group discussion(item mean 3.93±0.81),p romo ting open discussion of differing opinions(item m ean 3.89±0.74),sharing w hat they had learned,interp reted and synthesized w ith the entire group(item mean 3.79±0.74),and increasing their ability to wo rk effectively as a team (item mean 3.61±0.69).

3.2 Students’reflections on PBL

3.2.1 Know ledge The majority of students(60.71%) exp lained that PBL imp roved their understanding of course content,and helped them app ly theo retical know ledge to a real situation:“Info rmation exp lained in our ow n words is easier to understand than info rmation straight f rom books”;“When I teach others,I should tend to understand mo re”;“We found many p roblem s in the scenario through group discussion, and then we search fo r info rmation fo r solving them”;“Iusually review w hat I learned and try to app ly the know ledge to the scenario”;“Iam able to app ly new know ledge to p ractice situations”.However some students(46.43%)were concerned about the amount of know ledge acquired,and the vaguenessof info rmation gained:“Iam usually unsu re about w hat exactly I have learned”:“Sometimes Igain am biguous info rmation”;“Iwonder w hat I learned”.A nd a smaller number(21.43%)mentioned concern about the quality of learning depending on classmates’contributions:“The absences of group mates influenced our learning since we did not get the info rmation searched by them”;“Two of our group mates devoted less contribution to our learning.We got inco rrect o r irrelevant info rmation from their handouts.”;“Iam not satisfied w ith some members’perfo rmance…their less participation inf luenced ou r discussion,and w e learnt less f rom them”.

Table 1 Description of PBL evaluation

3.2.2 Communication Students indicated that PBL fostered communication skills(60.71%),and encouraged them to exp ress their ow n opinion in the group(32.14%):“I share my opinion w ith others, and can to lerate others’perspectives”;“I can accep t different opinionsw hile reserving ow n viewpoint”;“I am respected w hen Iexp lain my opinion in group”;“I learn how to respond to criticism”;“Iam better able to exp ressmy view s”;“Mo re opportunities for talking fostermy courage to speak outw hat Ithink”;“I learn how to makem y exp lanation understandable”.On the other hand,one student mentioned how a classmate might hinder communication w ithin the group:“One of group mates cannot exp ress her opinion clearly so we usually don’t understand w hat she is talking about”.Two students felt uncomfortable about challenging their classmates:“Ihad a huge difficulty w hen group mates argued w ith my p resentations,especially w hen they were w rong about some issues.I knew they had w rong ideas,but I would not argue w ith them,because I feel uncom fo rtable w hile arguing w ith people”.

3.2.3 Self2directed learning The majo rity of students(89.28%)indicated that PBL p romoted self2directed learning and lifelong learning:“I am m uch more responsible fo r m y ow n learning”;“Learning new know ledge through searching let me devote myself in learning”;“I learn how to find information and get the answer”;“Iget really good p ractice at finding info rmation and using internet database”.However, about half of the students considered PBL to be timeconsuming and stressful.They commented on the increased wo rkload:“I spent too m uch time and energy in searching the info rmation and p reparing the handouts fo r group discussion…I felt tired”;“I experienced a heavy workload during the learning p rocess”;“Iusually have insufficient time to comp lete the tasks…Iam stressed”.

3.2.4 Team wo rk Mo re than one third of students (35.71%)suggested that PBL fostered group collaboration and conflict reso lution:“I am more invo lved w ith my classmates”;“We contribute to teaching each other in group”;“I learn how to deal w ith conflict in the group”;“The p rocess help s us imp rove relationships w ith group mates and build f riendships”;“Team wo rk is a different type of learning.I learn from o thers,share resources,and bounce ideasoff of each o ther”;“I enjoy cooperative climate in group”;“Time control w as imp roved w ith learning p rog ress”;“The efficiency of learning w as imp roved th rough good co2 operation”.A very sm all m ino rity of students(n=2) felt f rustrated because classmates lacked responsibility,participated less and sometimes p resented poor info rmation:“Ifelt frustrating because few group mates usually may not be as well p repared and responsible fo r their learning.Discussion is surface and rush so that I knew less from them”;“The absence of group mates has an impact on team wo rk”.

3.2.5 Critical thinking The majo rity of students (71.43%)indicated that PBL stimulated them to think critically and ex tend their thinking:“I could think of more possibilities fo r solving p roblem s”;“I could look at p roblems f rom many different angles”;“Group discussion help s us analyze situations in different ways”;“M y thinking area is extending w hen I get the new perspectives f rom o thers”.How ever,a small number of students(10.71%)had difficulty in thinking critically and felt uncertain about decision making:“I find it difficult to think critically”;“Too many solutions w ere p resen ted after discussion,it is so hard for us to assess them critically and select one fo r so lving p roblem co rrectly”;“PBL p rocess w as a headache since we usually were no t sure w hich solution should be chosen co rrectly and realistically”.

4 Discussion

Studen ts considered PBL to be effective in helping them construct p rofessional know ledge,develop p roblem2so lving skill and ability and self2directed learning skills,imp roving their motivation to learn and p romo te group collabo ration.Students thought PBL fostered communication skills,imp roved their understanding of know ledge,and helped them app ly theo retical know ledge to real p ractice situation.PBL engaged students in active participation th rough a co llabo rative learning environment.It can p rovide an oppo rtunity fo r students to become accountable fo r their ow n and o thers’work[1].In collabo rative learning environments,students were able to learn w hile interacting w ith others.They were encouraged to brainsto rm concerning the situations and p roblem s,analyze the situation critically,f rame the p roblem in different w ays,and seek out the resources they needed. They saw that p roblems could be tackled in different w ays and they could compare different results and app ly the know ledge to real situation for so lving p roblem s[5].These findings are supported by p revious studiesw here students indicated that PBL encouraged them to synthesize large amounts of information for discussion w ith the group,and to analyze the relevant research and critically app ly w hat they found[9].In PBL,students were motivated to try a more active learning mode,and their responsibility fo r ow n learning w as imp roved.Friendship,m utual suppo rt,and understanding are built up among group mates.The positive effects of PBL were repo rted as discussing different opinions and perspectives w ith regard to learning content,sharing opinions w ith others,analyzing situations in different ways,and thinking in different ways[10212].A quasi2experimental study in Shanghai indicated that PBL facilitated sharing opinions w ith others,analyzing situations in different ways,thinking in different ways and thinking of more possibilities fo r solving p roblem s[13].

In this study,some negative feelingswere reported in students’reflection papers.Half of the students exp ressed uncertainty in acquiring know ledge,concern about how stressful the learning p rocess was, and the deg ree of w o rk involved.A very few students felt frustrated w ith poor group cooperation.It could be that although students had experience on cooperative learning,it was their initial experience w ith PBL.PBL is different from o ther cooperative learning.In most cooperative learning app roaches,the students are first p resented w ith the material,usually in the fo rm of a lecture,and then are given p roblem s to so lve.The teacher typically leads the class in a discussion of the case and asks p robing questions. The teacher evaluates the student’s analysis and so lution[14].In the PBL app roach,studentsare at the center of the learning p rocess.Students should engage in discussion of situations w ith all the comp lexity and am biguities of real life p roblem s,determine their learning needs,and develop app rop riate app roaches to solving p roblem s.Students direct the discussion and receive feedback from their peers.Teachers serve as facilitato rs.They stim ulate students tow ards selfdirected learning,and ensure that all students were involved in the p rocess.They do no t transm it expert know ledge to students,but p robe students’know ledge by asking questions and encouraging specific kindsof cognitive activities.PBL requires students to spend mo re time and energy on conducting research, searching for info rmation,sharing info rmation,and commenting on info rmation shared by their peers[5]. It is not surp rising that initial experiences w ith PBL may cause feelings of uncertainty,stress,confusion, and comp laints about poo r cooperation w ithin the group.Published studies indicate that nursing students commonly experience anxiety and f rustration related to the lack of guidance,uncertainty of know ledge required,and possible reinfo rcement of the w rong information.They are not comfortablew ith the accuracy of the information they learn f rom peers in an often nonjudgmental atmosphere.Students exp ress concern about the tim e2consuming and stressful nature of PBL,as well as the wo rk overload.They often find it difficult to cope w ith the heavy wo rkload[9,11,13].

5 Recommendation

PBL is effective in assisting students to take on active participato ry ro les w ith responsibility for their ow n learning.The initial imp lementation of PBL is not easy.To minimize negative feelings,tutors can initially p rovide the students w ith substantially mo re suppo rt in developing their understanding of w hat PBL is about,and help students develop app rop riate strategies for coping and engaging in learning p rocess.Tuto rs w ho facilitate and nurture the group p rocess w ithin the studen t2centered app roach assist students to maintain m utual trust since an open and suppo rtive learning clim ate is crucial to the success of p roblem2based learning[15].Tuto rs w ho are w illing to share power in the classroom facilitate co llaborative relationship s w ith students.Tutors can still participate in choosing paper topics,assignment due dates and class organization.Students feel valued and their contributions welcomed when tuto rs attend to the power structure and group p rocess in the classroom. W hile students value interactions w ith tuto rs,they also app reciate the oppo rtunity to direct their ow n learning.Tuto rsw ho facilitate and nurture the group p rocess and assist students to maintain m utual trust since open and suppo rtive learning climate is crucial to the success of PBL[9].Du ring the PBL p rocess, some studentsm ay be less responsible and contribute less to the group.Tutors,w ho are attentive to these issues,are able to help other group members engage in meaningful consultation w ith those students individually,and assist them to p romote their ow n learning and the learning of others.In some cases the student in difficulty might be encouraged to set personal learning goals related to engaging in more effective p reparation and participation w ithin the group.It is essential that adequate learning resources and sufficient time should be allowed for students to do the self2directed learning required fo r PBL.Tuto rs also should be effective in giving and encouraging students to p rovide effective and personal feedback.

6 Conclusion

PBL is effective in encouraging students to assume responsibility for their ow n learning.However initial imp lementation of PBL is not always a smooth p rocess.Students do experience uncertainty and stress,an increased wo rkload,and sometimes poo r cooperation of classmates in the group.Tutors should be p repared to p rovide students w ith substantial suppo rt in developing their understanding of PBL,and help students develop app rop riate strategies for coping and engaging in the PBL learning p rocess.

A cknow ledgements we wish to acknow ledge the M acao Po lytechnic Institute(code RP/ESS25/2008) for p roviding funding for this research.

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澳門護理學生對以問題為基礎學習的評價與反思1)

袁浩斌,Beverly A Williams,殷 磊,劉 明,方進博,龐 冬

[目的]研究描述澳門護理學生以問題為基礎的學習(PBL)的學習經歷。[方法]對接受一學期PBL課程學習的28名澳門四年級護理本科生進行評價,學生自愿參與本研究并完成由研究者研制的PBL評價表,并書寫關于學習經歷的反思報告。[結果]澳門護理學生認為PBL總體上中等度有效(3.35分±0.53分),認為PBL在于激勵小組討論(3.93分±0.81分),促進不同觀點的開放式討論(3.89分±0.74分),分享在小組內所學到的、所解釋和分析的(3.79分±0.74分)以及增進團隊有效工作能力(3.61分±0.69分)等方面高度有效。近半數學生表示知識獲得不確定、有壓力的學習過程和超負荷的工作,部分學生因差的小組合作而感到沮喪。[結論]PBL能有效促進學生積極參與學習,若教師給予學生充分的支持以促進他們對PBL的理解,并幫助他們發展適合的策略以應對并融入PBL學習過程,PBL效果將會更好。

澳門;護理本科生;以問題為基礎學習;評價;反思

G424

B

10.3969/j.issn.100926493.2011.01.042

100926493(2011)1A20086205

袁浩斌(1966—),女,上海人,副教授,博士,澳大利亞Joanna B riggs循證中心認證的系統評價培訓師,從事護理教育和循證護理研究,工作單位:澳門理工學院高等衛生學院;Beverly A Williams工作單位:T6G2G3,加拿大A lberta大學護理學院;殷磊工作單位:澳門理工學院;劉明工作單位:澳門理工學院高等衛生學校;方進博工作單位: 610041,四川大學華西醫院;龐冬工作單位:100191,北京大學護理學院。

2010-08-23;

2010-12-22)

1)本項目得到澳門理工學院資助,編號:RP/ESS25/2008。

Author introductionHaobin Yuan,Associate Professo r,School of Health Science,Macao Polytechnic Institute,Macao,China;Beverly A. Williams,University of A lberta,Canada;Lei Yin,Macao Polytechnic Institute,Macao,China;M ing Liu,School of Health Science,Macao Polytechnic Institute,M acao,China;Jinbo Fang:Huaxi Hospital,Sichuan University,Sichuan,China;Dong Pang,Schoolof Nursing,Peking University,Beijing,China.

(本文編輯 李亞琴)