Phases of PBL

Poikela and Poikela (2006.) mention that tutors in tutorials are purposed to facilitate the process of problem solving. During the whole study module, the tutorials are held by group members one time in one or two weeks. Besides this, the students conduct self-directed study by using various information sources, for instance, libraries, scientific websites, and interviewing the experts. (Poikela & Poikela 2006.)

The implementation of PBL will be carried out according to eight phases. In the first phase, the students need to understand the situation and background of the problem, based on which, the second phase will be started by the brainstorm. The second phase is necessary for the group members to explore the previous knowledge related to the problem phenomena. The third step is to collect and classify the similar ideas into categories with different names.

Based on previous steps, the forth step is mainly to facilitate selection of the most important

area for asking the questions. In the fifth phase, the students need to determine their tasks and learning goals. After that, it is time for the students to collect and seek the professional knowledge and current information as the process of self-study in the sixth phase. In the seventh phase is a period for constructing the knowledge. During the eighth phase, the students need to compare the different learning results among groups according to the questions discovered in the starting point. (Poikela & Poikela 2006, Tuomi 2010.)

Figure 1. Eight phases of Problem-Based Learning cycle. (see Poikela & Poikela 2006.) 2.3 Learners’ experiences and perceptions on PBL

The learners’ experiences on PBL are mainly divided into positive experiences and negative experiences. Various learners’ perceptions on the tutors’ roles are illustrated in the literature review.

1. Understanding in background of problem

2. Brainstorming

3. Categorization of ideas

4. Question synthesis

5. Determinination of tasks and learning

goals 6. Self-study

7. Construction of knowledge 8. Comparison of

learning results

PBL Cycle

2.3.1 Positive experiences on PBL

The characteristics of PBL as a learning method are active, interactive and student-centered, which was mentioned in Tiwari’s study related to the effect of PBL on students clinical nursing education (Tiwari 2006). The nursing students were given the opportunity for learning about real patient problems in a more interesting and meaning manner, which made the students feel pleased on the questions relevant with the learned knowledge and real nursing experience (Tiwari et al. 2006, Mete & Sari 2008). As the study by Chan (2014) pertaining to teaching innovation for developing nursing students’ corresponding competence in providing health care services, the nursing students learning with PBL enjoyed the nursing problem-based learning class related to writing poems, composing songs and using role playing.

Increased possibilities of self-direction appeared during the process of PBL by Cooper and Carver (2012). The students developed many characteristics regarding self- directed learners, such as, sharing and summarizing information, being able to respond to questions and being confident to identify learning needs (Williams 2004). The students admitted that PBL had the effects in promoting them to have the skill for searching information (Rowan et al. 2009). As the research by Williams in 2004 mentioned, baccalaureate nursing students expanded the range of searching information from textbook to books and journals (Williams 2004). The third year nursing students used the libraries more often to study independently (AI-Kloub et al. 2014).

Asking questions and sharing different opinions on individual learning results with other group members were facilitated by applying the PBL as learning method for baccalaureate students in nursing (Williams 2004). Based on the research concerned students’ views on PBL between the students in Shanghai and Macao, Shanghai students responded PBL as the manner to foster them to analyze situations in different ways and encourage to share the opinions as well as consider more possibilities for resolving problems (Yuan et al. 2011).

The confidence of nursing students was mentioned in the study of Poskiparta et al. (2013) about Finish nursing students’ experiences of PBL in health promotion education. The results showed that the students needed more guidance due to their less confidence on the learning abilities (Poskiparta et al. 2013). The confidence of learners was enhanced by encouraging

them to share correct or wrong opinions within PBL (Anderson & Reid 2012). Furthermore, baccalaureate nursing students reflected that they had the abilities for summarizing and sharing searched information confidently, which was reflected by the study of Williams’

study about self direction in PBL nursing program (Williams 2004). In addition, it was reported that undergraduate nursing students increased the confidence in resolving problems appearing in the PBL case (Tiwari 2006). The study concerning mental health student nurses’

experience in PBL from Cooper and Carver in 2012 showed that post-graduate mental health nurses considered PBL as learning method increasing the confidence related to their practice (Cooper & Carver 2012).

The PBL generated high level of motivation for the third year nursing students in maternity nursing course (Alkasawneh et al. 2008). PBL motivated learning and encouraged teamwork (Chikotas 2009). The second year nursing students in PBL group had higher learning motivation compared with the students in traditional group (Hwang & Kim 2006). The students experiencing traditional teaching methods reflected that PBL was more effective method to encourage them to assume the learning responsibility for own learning, which was provided by the Yuan et al. (2011). The similar results found in the study by Lin et al. (2010) that nursing students educated by PBL had more satisfaction in the parts of self-motivated learning. According to Chan (2014), the motivation to learn and empathy to patient was enhanced for the nursing students in PBL courses.

PBL was helpful to promote the open communication and mutual trust with group members, which was evidenced by Eccott et al. (2012) in the study regarding the attitudes and perceptions of 24 students from medicine, pharmacy, nursing, physical therapy and occupational therapy in the PBL module. The post-graduate mental health nurses under second-year educational course with PBL agreed that limited group size might enhance the opportunity for offering mutual support and sharing knowledge (Cooper & Carver 2012, Poskiparta et al. 2013). Both students and teachers illustrated that PBL could connect the individuals to work together and overcome barriers and resolve the problems in a more flexible manner (Poskiparta et al. 2013). The results from Yuan et al. (2011) indicated that PBL was moderately effective from the students’ opinion for fostering communication skills.

The students mentioned their group work skills required in the contemporary health and social care system were enhanced by the influence of PBL, such as dealing with value

diversity and ambiguity (Smith & Coleman 2008, Cooper & Carver 2012, Poskiparta et al.

2013).

The ability of critical thinking and use of evidence in practice could be supported by PBL’ s application in nursing, which was suggested by Martyn et al. (2014) in the study to explore the relationship between teaching, approaches to learning and critical thinking in a PBL nurse course. PBL could cultivate the critical thinking for the nurses to receive the required competencies in clinical practice (Smith & Coleman 2008, Applin et al. 2011). Yuan et al.

(2009) mentioned that the students were encouraged to analyze the situation critically and frame the issued in different way, which would assist them to compare different potential results and critically apply what they found in the clinical practice. As a result of critical thinking and creativity developed by PBL, nursing students had the sensitivity and ability of reconstruction knowledge (Chan 2013). Thai nursing students agreed that their abilities for solving problems and critical thinking increased in the PBL (Klunklin et al. 2011). The critical thinking skills could be affected by classroom learning environment, characterized by personal relevance, uncertainty and critical voice (Martyn et al. 2014). The research results by Chan (2013) suggested that several classroom activities had the possibilities to arouse the students’ awareness to critical thinking, such as, composing songs, writing poems and role plays.

2.3.2 Negative experiences on PBL

Time-wasting in PBL was noted from the students in the research by Yuan et al. (2009). The process of PBL was considered as time-consuming and stressful process by half of Macao students and approximately 20 percent of Shanghai students (Yuan et al. 2011). Much personal time was applied by undergraduate nursing students so as to search for large amount of information (Tiwari 2006). Some students and teachers still need more time to accept learning outcomes of PBL in the health promotion issues (Poskiparta et al. 2013). In the study from Jones (2006), the time required for PBL can be problematic especially for the students with crowd curriculum. It was suggested by AI-Kloub et al. (2014) that adequate learning resources and sufficient time could be supplied for students in the PBL.

Besides the negative aspect of time-consuming, the large workload from the PBL was also considered as one of concerns for the students (Yuan et al. 2010). Although the students were

expected to search for the professional knowledge by themselves instead of receiving expert knowledge directly from the teachers, apparently, a larger course workload increased up, such as, proceeding critical thinking and related cognitive activities. (Smith & Coleman 2008).

Uncertainty stress and worry during the adaptation to PBL were also mentioned in the study by Klunklin et al. (2011), especially at the beginning of the programme (Rowan et al. 2008).

At the same time, the students had anxieties and concerns about the absence of teaching-led sessions (Cooper & Carver 2012). The feelings of uncertainty and anxiety were stimulated by the nursing students’ doubts of learning range in the PBL when they compared with previous conventional learning style (Smith & Coleman 2008, Yuan et al. 2011). The students concerned about the insecurity about what they learn rather than how the PBL process enable them to learn (Smith & Coleman 2008). Even if after owing the skills of retrieving and criticizing the information and worried about receiving incorrect information, the students still felt unprepared for the practice (Rowan et al. 2008). The students admitted that it was hard in the starting of PBL without previous knowledge or direction (Mete et al. 2008, Cooper & Carver 2012). Especially for the first year students, it could lead to uncomfortable learning experience because of tutors’ professional specialized questions and details with many new terms (Mete & Sari 2008).

Unclear instructions for topics of assignment and grading rubrics were viewed by the students as lack of consistency. Besides this, the students used to teacher-oriented learning felt confused with PBL’s self-directed learning. (Landeen et al. 2013.) Cooper and Carver (2102) described that mental health nursing students still had tendency to require the reassurances whether they proceeded correctly during the whole process when adapting to PBL. The lack of feedback and less reassurance about own studies could also result in the low level of dental nurses’ confidence in the self-directed learning process of PBL (Anderson & Reid 2012). The student expected the tutor to provide the relevant information when the problem could not be resolved by students themselves (Mete & Sari 2008). In addition, the students suffered uneasy when the tutors pointed out their insufficiencies in public, meanwhile, positive feedback was required by the students to afford from the tutors (Mete & Sari 2008).

Anderson and Reid also suggested in their study on dental nurse students’ participation in

PBL that students will be motivated by tutors’ encouragement and enthusiasm (Anderson &

Reid 2012).

2.3.3 Perceptions on tutors’ roles in PBL

According to Harendza et al. (2012), the role of tutor in the PBL was considered as a critical factor in leading to the success of students’ individual study and group work, such as, providing assistance and directions when students being short of previous knowledge, encouraging student learning by creating an open atmosphere. The facilitators were considered as resource of encouragement for relieving students’ anxiety and creating a collaborative learning atmosphere (Yang & Yang 2013). especially the active and inspirational facilitators were preferred by post graduate mental health nurse students (Cooper & Carver 2012). Cooper & Carver (2012) mentioned that facilitator’s enthusiasm for the subject could increase the motivation for the effective function in the PBL groups.

Besides character of tutors, the effectiveness of PBL also relies on the support of faculties by developing students’ understanding on PBL and strategies for coping PBL process (Yuan et al. 2011). The students indicated that learning motivation and success in PBL were influenced by the behaviors and clinical experience of tutors, such as, giving concrete example for promoting understanding, and activating students’ interests to explore (Mete &

Sari 2008). The students preferred the facilitator’s comments on the group presentation as the reference for progressing the next presentation (Yang & Yang 2013). Meanwhile, asking questions with high quality as one of the tutor’s abilities was required during the process of PBL, which would be helpful to the students to focus on the subject matter and make the connection between theoretical knowledge and clinical situation (Mete & Sari 2008).

In addition, the students had good feeling to the facilitators who could differentiate the students with more active contribution to the group discussion (Yang & Yang 2013). as well as the some students need special attention due to the individuals’ particular learning preference (Alkasawneh et al. 2008). The tutors also encouraged the silent students to participate discussion actively. The eye contact with tutors promoted the students’ self-esteem and positive group dynamics. (Mete & Sari 2008.)

The students have disappointed feeling on the lack of facilitator’s support in the discussion part (Poskiparta et al. 2013). The researched results indicated facilitator’s rigid critical evaluation could easily lead to the neglect on the students’ hard effort in PBL, which would not be beneficial for the students to build the trust with other members (Yang & Yang 2013).

In addition, boring tutorials and instructors had less contribution to the process of PBL (AI-Kloub et al. 2014).

The need for more guidance from facilitators was required by Finnish nursing students as a result of their less confidence on the personal abilities (Poskiparta et al. 2013). The nursing students tended to expect tutors to trigger them to find out the resolutions for correcting the wrong information instead of receiving the correct one directly from the tutor. The tutors were suggested to maintain the balance on different nursing field rather than relying on their own specialized professional fields. (Mete & Sari 2008.) The study of Yuan et al. (2011) suggested that PBL tutors for nursing students should play the role of assisting students to understand PBL, developing strategies in promoting students to cope and engage actively in participation and consultation in the process of PBL.

2.4 Summary for research perspectives

The learning process of PBL was described by the participants as enjoyable, active and student-centered learning manner, as well as the different activities in the PBL (Tiwari 2006, Mete & Sari. 2008, Chan 2014). The PBL can provide the opportunities and conditions for the students to interact actively with other group members and exchange the comments and opinions on individual learning results (Williams 2004, Smith & Coleman 2008, Yuan et al.

2011, AI-Kloub et al. 2014).

The motivation for active learning was enhanced by applying the PBL according to several researchers’ opinions, which could be resulted from skill of information search and PBL’s inspiriting atmosphere (Hwang & Kim 2006, Alkasawneh et al. 2008, Chikotas 2009, Lin et al. 2010, Yuan et al. 2011, Chan 2014). The advancement of the skills for working as a group in the PBL are also noticed by several articles, such as, communication skills, mutual trust and skills for overcoming barriers (Ecott et al. 2012, Poskipart et al. 2013).

Another important characteristic of PBL was to facilitate the capacity of self-directed learning through providing chances for students’ independent information searching and awareness of own responsibility in continuous learning as well as increase of self-confidence in the construction of personal learning goals (Williams 2004, Yuan et al. 2010).

Critical thinking as the required skills in the clinical practice was developed on the participants during the application of PBL (Smith & Coleman 2008, Applin et al. 2011).

Several articles showed the students’ opinions relevant to several factors of cultivating the ability of critical thinking in the PBL as well as the teachers’ advices for promotion of critical thinking (Ozturk et al. 2008, Klunklin et al. 2011, Chan 2013). The effect of PBL was also influenced by time-consuming, unclear objectives, overall design structure of PBL, increasing workload, large group size and facilitator issues as well as poor interaction among the group members (Wells 2009, Yuan et al. 2009, AI-Kloub et al. 2014). Different reasons for causing students’ stress and worries and related negative results were also mentioned in some researches (Mete et al. 2008, Anderson & Reid 2012, Landeen et al. 2013). In addition, unclear instructions for assignments and grading rubrics confused the students and made the difficulties on evaluating the learning effectiveness of PBL for the participants (Smith &

Coleman 2008, Landeen et al. 2013). The students admitted the tutors with positive attitude would help them to decrease the anxiety and facilitate the formulation of opened learning environment as well as motivate students’ to be the effective participant in the PBL learning groups (Cooper & Carver 2012, Yang & Yang 2013).

It was the phenomena that students required the tendency of the reassurance of searched knowledge by the tutor during the process of PBL and tutors’ further information on the unresolved problems as well as the manner of giving feedback (Mete & Sari 2008, Anderson

& Reid 2012). The tutors’ supports and related strategies for applying PBL could affect the students’ effective understanding on the utilized learning method, so that it would be helpful for the students’ to adjust the learning attitude and cope the challenges by applying this learning method (Yuan et al. 2011). The students’ learning motivation was enhanced with the tutors’ teaching behaviors and own clinical experiences through sharing the clinical examples stimulating the students to make further exploration (Mete & Sari 2008). Tutors’ appropriate comments and questions were regarded as the factors for promoting participants combining the theoretical knowledge with the concrete situations (Mete & Sari 2008, Yang & Yang

2013). The tutors with the ability of differentiating the students’ abilities had more possibilities to be welcomed by students, because students individually had the particular learning manner (Alkasawned et al. 2008, Yang & Yang 2013).

The students using PBL to study pediatric clinical course mentioned PBL with boring tutorials (AI-Kloub et al. 2014). Lack of sufficient supports from tutors resulted to the students’ negative emotion, such as, disappointed feeling (Poskiparta et al. 2013). Strict critical evaluation for the students could also interrupt the formulation of trust among the group members (Yang & Yang 2013).

The PBL students provided various suggestions and expectations for the tutors due to individuals’ needs for advancing their learning efficiency within the PBL. The tutors were recommended to trigger the students’ motivation of self study and active participation as well as provide the students with abroad professional knowledge in each nursing field (Mete &

Sari 2007, Mete & Sari 2008). Teaching strategies in the PBL should be also developed to promote students to understand the principles of PBL and then to engage into the process actively (Yuan et al. 2011).

3 PURPOSE, AIMS AND RESEARCH QUESTIONS

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.

This study included the following questions:

(1) What are the 2^nd year international nursing students’ experiences on PBL as learning method in a university of applied sciences?

(2) What are the 2^nd year international nursing students’ perceptions on the tutors’ roles in the PBL process in a university of applied sciences?

4 RESEARCH DATA AND METHODS 4.1 Sampling

The second year international students with PBL as purposive sampling were considered as the sources of providing the data for achieving the purpose of this study (see Grove et al.

2013). The opinions related to PBL were gathered from the second academic year

2013). The opinions related to PBL were gathered from the second academic year

In document International nursing students' experiences of problem-based learning in a university of applied scies (sivua 11-0)