The purpose of this study was to describe the experiences and perceptions of international nursing students regarding PBL as learning method and to explore better application of PBL for the international nursing students in a university of applied sciences in Finland. The aim of this study was to increase the understanding from students’ experiences and students’
perceptions related to the roles of tutors and to use the results to further development of PBL in the international nursing education in Finland.
Students’ experiences of knowledge and skills development
The content of PBL case were defined as easy and helpful for participants to understand and explore more extensively related to clinical care of patients. The content of PBL case created the virtual clinical situation for students to imagine and consider out the clinical problems and
solutions, which made them feel proud of resolving the similar clinical problems under a virtual situation. There was no similar result further mentioned in the previous literature reviews. Furthermore, appropriate level of challenge settled in the case problems helped the students to decline the stress on the huge PBL problems. This result was consistent with the finding from Yuan et al. (2010) that students thought PBL as large workload. According to the results from Smith and Coleman, the students reflected larger course workload increased up due to proceeding critical thinking and cognitive activities (Smith & Coleman 2008).
Meanwhile, the participants in the study also pointed the limited contents of PBL case that could not represent other cases regarding various professional fields, because PBL cases supplied specific diseases. This reflected students’ eager to explore more extensive knowledge through PBL for allowing them to prepare for the clinical situation. The students’
learning need was aroused through this method. Based on the context of PBL, application of PBL should be regarded as a tool for observation, analysis and creation (Poikela & Poikela 2006). According to results by Smith and Coleman (2008), the students had more unsafe feeling in what they learned rather than how PBL process enable to learn. The key point was to induce the participants to be accustomed to PBL’s thinking process based with resolving the problem by independent observation, analysis and knowledge synthesis. Hence, it was essential for the tutor to deliver the purpose of PBL clearly and intensively to the participants for making them to catch the breakthrough in thoughts being different from the traditional learning manner. Moreover, there might be possible to modify the content of cases into progressive advanced levels in connection with the real progress of participants. The students’ adaption and acceptance to the complicated case should be evaluated carefully by the tutors in advance before the application of the specialized case.
Question synthesis was criticized into different ways. On the one hand, the students could freely share individual opinions and discussing the various aspects of topics covered by the equality of group learning environment. On the other hand, the students complained the utilization of democracy voting system used to decide the most appropriate question for the group, because it could decrease the possibility of identifying high-quality question especially leading to limitation in the knowledge exploration. It was not so clear criteria for students to evaluate the quality of questions. It is the necessary to clarify the criteria for formulating the
question. There were no further descriptions pertaining to the process of synthesizing PBL questions in previous academic articles.
Searching information as one of learning abilities was considered strongly to relate to the enhancement of learning efficiency. The students admitted that PBL was helpful to cultivate the ability of exploring knowledge in the process of searching information and arranging the cohesive knowledge selected from searched extensive information. The students expressed information collection part of learning process. In some researches, the students hold the opinions that PBL had the effects in promoting them to searching for information from textbooks to other journals and books (Williams 2004 & Rowan et al. 2009). This was similar with the results that participants’ ability to filter the effective and sufficient information was strengthened as well as the capacity of utilizing internet information portals as the academic assistant tools for professional knowledge. The ability of searching information could be also one of the elements influencing the individual’ own learning. The result from Yuan et al.
(2011) suggested that students with traditional teaching methods admitted PBL as more effective to activate their responsibilities for own learning. Then combined with the results in this study, interesting and vivid learning process experienced by the participants when playing the active role in the information search. When possible, we need to ask whether the learning responsibility or learning interest in PBL motivates students’ learning process. This will require further studies to identify the fact.
Simultaneously, challenges also existed in the information search process. Lack of background on the PBL topics and being acquainted with professional terms for the students was to some extent to lead to the results of inadequate information resources. Additionally, there were conflicts among the different references in the students’ individual reports for group task, which challenged the students’ capacity for assessing the validity of searched knowledge. In the study of Rowan et al. (2008), the students still worried about receiving incorrect information and felt unprepared for the practice. The students concerned about the insecurity on what they learn rather than how the PBL process enable them to learn (Smith &
Coleman, 2008). It was worth to consider whether the students were provided extra training for searching information before the starting of PBL. In addition, the supply from tutors in the information search was not clearly described in this study. Being unfamiliar with professional terms should be conquered, which will be helpful to widen the options of key
words used for the major concepts and receive more extensive information for making further selection. Besides the students themselves being involved in preparing for exploring information by checking with related reference books, the tutors could also attempt to supply related interpretation as additional assistance if necessary.
The communication skill was developed in PBL. The research indicated that students could catch the opportunities to pursue effective communication with group members as well as the advancement of communication in delivering presentation. The similar results in the study by Yuan et al. (2011) showed that PBL was effective for fostering communication skills.
Meanwhile, it was thought that PBL cycle could cultivate open communication and mutual trust with group members (Eccott et al. 2012). The nursing students will also face the similar situation in clinical practice in their careers and health communities. In hence, the PBL is beneficial for the nursing students to prepare the competence of communication for the requirements under the multi-professional working environment.
The critical thinking skill was required in the adjustment of group dynamics in PBL. The participant described that PBL provided the chances to practice and reinforce critical thinking skills especially used when facing conflicts among group members’ opinions. In addition, it was interesting to notice the participants stated that application of critical thinking skills influenced the growth and progress of the whole group. Similarly, in the results from previous research, as Yuan et al. (2009) mentioned, the students were encouraged to analyze the situation critically and frame the issue in different ways. Martyn et al. (2014) also emphasized that application of PBL could promote the development of critical thinking and application of evidence in the practice. In this study, the participants did not mention whether the PBL had connection with clinical practice. Besides this, the students’ background pertaining to clinical practice was not shown in the data. It would be suggested to implement further study in PBL’s effects on the students with clinical practice.
Students’ experiences of individual interaction
Independence and cooperation occurred in the PBL simultaneously for the participants. The participants were accustomed to learning and cooperating under a group working atmosphere that was facilitated by PBL. The group members also intensified that there was the intentions for them to supply own ideas and make personal efforts to complete the group tasks.
Similarly, PBL as learning method could provide encouragement for group members to participant effectively in the open-discussion and share individual learning results with other group members (Williams 2004). The PBL group members explored the various perspectives to analyze the problem (Yuan et al. 2011). However, we could not view the conception of cooperation superficially or in isolation from independent learning. Based on this study, the finding showed that independence and cooperation were twisted together intensively to formulate the success of group work. In another words, group cooperation and individual independence should be in the relationship of inter-dependence with each part, which was not mentioned in the previous reviewed articles. It might be helpful for the students to involve the individual independence into the cooperation gradually in the purpose for creating more efficient study atmosphere. In order to contribute a better understanding of PBL, the learning goals of self-study and cooperation need to be organized clearly for the participants to pursue and evaluate themselves.
Group members had different characteristics in this study. The participants’ active participation was influenced by their interest and passion. The participants considered that worse learning experience was also connected to other students’ little interest on the learning.
Meanwhile, it was mentioned that participants’ learning motivation was affected negatively by other group members with minor attention and irritation. Lack of motivation was regarded as another characteristic for group members. In the previous studies, it was confirmed that learning motivation was enhanced by PBL (Hwang & Kim 2006, Alkasawneh et al. 2008, Chikotas 2009, Lin et al. 2010, Chan 2014). By Klunklin et al. (2011), the ability of assigning and sharing group tasks were improved by the PBL first session of working as a group member. Compared with the results in the previous studies, it was relatively new phenomena described in the present study that group members’ motivation would be still negatively affected by other members, even though PBL’s role in promoting learning motivation was suggested by some previous studies. Besides the characteristics group members, there are also the relationships between group members. It seemed that relationships among the group were not mentioned in the previous researches and this study.
Students’ experiences in the mechanism of PBL
The time arrangement for students in the process of PBL was considered as appropriate duration. On the other hand, part of the students expressed that the timetable was settled to
limit the students’ time for reading materials and arrangements for group meeting face by face. In addition, this study indicated that meeting time for group members to achieve agreements on the group decisions was another challenge to deal with. As Yuan et al. (2009) suggested that application of PBL was considered as time-wasting for the students. PBL was thought as the kind of learning process consuming time and increasing stress (Yuan et al.
2011). Tiwari (2006) also stated that much students’ personal time was arranged for information searching and exploration of learning resources. Compared with the previous research findings, the students in the present study seemed to focus on the requirement for learning time but without the complaint of opinions related to PBL’s time wasting.
Impression on PBL was positive by the participants. The participants admitted the impression on PBL as fresh and successful. The participants considered PBL as connection between practical aspects and theoretical knowledge for motivating students to discover clinical problems. The findings in this study also showed that the participants considered this kind of learning as a fantastic process. As Tiwari (2006) mentioned, students described the learning process of PBL as enjoyable and stimulating. The findings from Mete and Sari (2008) showed that the students felt pleased with the opportunity for learning about real patient problems in a more interesting and meaning manner. The PBL was a useful strategy for nursing degree programme and especially for a small group (Samantha et al. 2009).
The feeling of anxieties and concerns were expressed little in the duration for adapting the learning manner of PBL. Even if there were varieties of difficulties recognized in the PBL process, it seemed that the participants had the tendency to reveal the troubles and identify the problems instead of only paying attention on the emotional expression. The finding seemed not to be agreement with the results from Klunklin et al (2011) that uncertainty stress and worry could existed during the adaptation to PBL. Moreover, these sophomore students already had one year experiencing learning atmosphere in the university of applied sciences.
These learning experiences might build the basis and capacity for the students to accept and adapt the new learning method with calm attitude in the new courses. In contrast, compared with the results from Mete and Sari, especially for the first year students, it could lead to uncomfortable learning experience due to tutors’ specialized questions and information with unfamiliar professional terms (Mete & Sari 2008).
Students’ perceptions of tutors’ role of guiding
The guiding roles of tutors in the PBL was described to guide the students to combine and modify the questions synthesized from case into appropriate manners. The tutors were also responsible to guide the students with learning directions and certify the students learning range maintained on the correct track. This study mentioned the consistence of tutors. The students required the tutors to supply the clear instructions and achieve the consistency for making guidance in the group work. The student also displayed the requirements of formulating more clear outlines and limits in order to relatively restraint for searching information within the defined boundaries. The results from Landeen et al. (2013) provided the opinion that unclear instruction for topics of assignment and grading rubrics were viewed as lack of consistency. The students expressed their needs for more guidance from the tutor due to their less confidence on the individual abilities (Poskiparta et al. 2013). Good structure of PBL might enhance the level of effectiveness in students’ self-learning. Furthermore, in this study, the students recommended the tutor to provide multiple learning manner involved into the PBL process. The finding of research by Chan (2013) also suggested to several classroom activities to make the students have better insight of critical thinking.
Tutors’ participation affected students’ satisfaction with PBL process. The participants claimed to require tutors’ closer participation within the PBL process. The results from Mete and Sari (2008) indicated that eye contact with tutors promoted the self- esteem and good group dynamics. In addition, students would have good feeling when the tutor could differentiate students’ various attribution in the group discussion (Yang & Yang 2013). It was also identified by the results from Poskiparta et al. (2013) that there were disappointed feeling on the shortage of tutors’ support in the discussion part. Hence, these results might contribute to a better understanding of the function of tutor’s participation within the PBL.
Regarding tutors’ participation, it would not be defined to suggest the tutors replacing the participants’ own learning roles and withdrawing their learning opportunities. It would be more acceptable for the students to accommodate themselves with the tutors who could give full play to students’ capabilities and timely supports.
Students’ perceptions of tutors’ roles of supporting
The supporting role of tutors was necessary to the students in the PBL. The participants described vast professional nursing experience of tutor made good impression on the students due to tutor’s assistance in sharing concepts and approaches with advanced views. The
participants also placed emphasis on that tutors’ skills in explanation was also beneficial to assist for figuring out the thoughts. Cooper and Carver (2012) concluded that tutors’
enthusiasm for the subject could increase the motivation for the effective function in the PBL groups. Tutors’ behaviors and clinical experience could promote the students’ understanding and activate their interest to explore (Mete & Sari 2008). Combined these studies, it was considerable that tutors should make individual exploration in the professional field for the purpose to attract the students to follow the learning tract. Yuan et al. (2011) recommended that tutors should maintain the balance on different nursing field rather than relying on their own specialized professional fields. The students also preferred the tutors to trigger them to find out the correct information by themselves instead of being provided directly (Mete &
Sari 2008). Individually, there was possible to influence the feedback supplied for the students in the tutor’s evaluation on the group work and independent work based on tutor’s professional background. Multiple perspectives from tutors might attract the students’
attention and assist them to be exposed with new ideas.
Group presentations by students were paid little attention by the tutors in this study. The students thought that tutors monitored the content of group presentations with fewer comments. Furthermore, the participants expected presentation assessments to be part of individual evaluation. The students hoped that the system for grading criteria in presentation could be refined into the manner included into the individual grading system. Additionally, the participants suggested to create more positive learning atmosphere in the group presentation for the students to express the learning results actively, such as, rewards of little prizes.The similar situation seemed to be discovered also in the results from Rowan et al.
(2008) that the presentation was not regarded as a discussion under the spirit of exploring, which was more likely a performance. Yang & Yang (2013) provided the opinion that the students preferred the tutors who could share the comments on the presentation for the students to help them make advance in the presentation of the next PBL cycle. In my opinion, the factor for this phenomena was related to students’ eager to receive the recognition and approval as well as encouragement from the tutors. The process of PBL itself was considered as method for promoting the students’ skill of self-exploration in the knowledge world and making preparation for undergoing the crisis and challenges in the professional fields.
Correspondingly, students might search for affirmation and supports regarding their working in exploration of knowledge.
The feedback from tutors were expected continuously by the students especially the feedback regarding students’ individual reports and final group outcomes. The students required more suggestions rather than grading numbers. These suggestions were expected to have profound influence on the students’ advancement in the followed PBL process and other PBL cycles. In this study, the students also expected timely feedback regarding previous group tasks and independent assignments, which could influence the students’ progress in the following PBL activities. According to the results from Anderson and Reid (2012), the tutors
The feedback from tutors were expected continuously by the students especially the feedback regarding students’ individual reports and final group outcomes. The students required more suggestions rather than grading numbers. These suggestions were expected to have profound influence on the students’ advancement in the followed PBL process and other PBL cycles. In this study, the students also expected timely feedback regarding previous group tasks and independent assignments, which could influence the students’ progress in the following PBL activities. According to the results from Anderson and Reid (2012), the tutors