Students’ experiences of knowledge and skills development

The students’ experiences of knowledge and skills development consisted of three categories:

1) PBL case, 2) problem and information, and 3) skills in PBL tasks (Figure 2). PBL case was divided into two parts named contents of PBL case and limits of PBL case. Problem and information mainly described students’ experiences related to question synthesis, benefits of information search and difficulties within the process of information search. The third category named for skills in PBL tasks included advanced attention and motivation, advanced comprehension, and skills development.

PBL case included contents of PBL case and limits of PBL case. Based on the description of the participant, contents of PBL case were easy for the students to understand and helpful to

explore furthermore which were related to the clinical care of patients, diagnoses and diseases, and medications as well as the patient education including surgical procedures, and treatments and monitor for patients during the peri-operation.

“Personally I learned a lot because we broke down the surgical procedure. In the pre-operation, I learned about the gallstones disease and the feelings that nurses need to know before and during operating. Also about patient educating about the surgery and what illnesses or medication … what to monitor during the procedure”

Participant 1

At the same time, contents of PBL was considered as the connection between theoretical knowledge and practical aspects for stimulating students to discover the problems and make appropriate nursing care plans to patients. Meanwhile, content of different PBL cases provided the connection among each other to support students’ learning efficiently and comprehensively.

“PBL gets me much closer to the practical aspects while learning, allowing me to learn more effectively.” Participant 5

“Students feel proud that they were actively involved in solving an operating theater problem.” Participant 7

“When we have PBL, the different topics were supporting each other.” Participant 6 Case problem being divided into smaller parts really helped the students to decline their stress on the formulation of huge PBL problem. PBL assignments should be designed into an appropriate size and level of difficulty instead of large project or lots of small piece of tasks.

“It made learning easier in a way that one did not need to concentrate and stress about huge problems but focus on few clear questions at the time.” Participant 8

In contrast to the earlier mentioned results, the participants also pointed the limitations in the contents of PBL. The limited PBL contents restricted the students’ learning range regarding advanced exploration to other diseases and treatments. Lack of opportunity to know about other cases was considered as another factor resulting in the limited learning field for students. The participants concerned that the supplied case with specific disease and related

treatments could not represent other cases coming from various fields of practical nursing care, which were regarded as weak points by the participants. The participants thought this weak point might hinder the learning opportunities of developing and advancing other professional knowledge with forward movement. In addition, it was required to provide more clear and sufficient case content related to patients’ objective information for improving the exploration of the students’ learning range.

“Based on the problem case we maybe don’t get to explore other areas of relevance and subject matter. We learn specific diseases and treatment, while we lose out of other cases.” Participant 10

“The case should be clear and factors affecting vital signs should be clear.”

Participant 1

Problem and information consisted of question synthesis, benefits of information search and difficulties of information search. PBL supplied the possibilities for the students to synthesize their own questions based on the content of PBL. In the process of formulating appropriate group question, students intended to consider together and discuss within own group through inspecting the various aspects of PBL case and sharing individual opinions under the environment filling with the humanity value of equality. The participant also recognized, in some groups, that voting round implemented as a democratic-like policy took place for encouraging and triggering each member among the group to maintain their own rights and roles for expressing opinions, which influenced the decisions on the formulation of group question.

“Problem-based learning is giving everyone the chance to formulate their own questions, be deliberated by whole team and voting according to what is best for the whole team.” Participant 16

The democratic voting was one of the manners for students to select the appropriate group’s PBL question from different choices, but it was considered as one obstacle for expanding the learning scope. The participants hold the view that there was a potential tendency among the group members towards avoiding selection of the learning topic with more time use.

Important questions might be extracted out of the question list by democratic voting. It was

also possible to lead the students to lose the opportunities to identify high-quality questions for exploring more professional knowledge.

“Some students voted only to study easy aspects of the case rather that study relevant aspects.” Participant 10

“With PBL one is limited to the case and should not focus on other feeling affecting the problem. We focused only on the pre-operative, intra-operative and post-operative procedures and not on the genesis or the causes behind gallstones formation.” Participant 1

Besides the formulation of problem, dealing with the information within PBL process was another considerable part for students. The students mentioned several benefits of information searching within the PBL. The participant added that skills of searching information were developed with advancement of the ability to filter the effective and sufficient information within the learning tasks. The participants also mentioned the strengthened capacity of using internet information portals as the academic assistant tools of information search. Meanwhile, interesting and vivid learning process had been experienced by the participants when playing the active role in the information searching regarded as one of necessary phases of PBL cycle. Furthermore, the process of information collection was also the progressive manner of learning knowledge in the process to become one specialist commanding the ability of dealing with clinical situations.

“Learning how to search for information and understanding what information is relevant. I have learnt to use information portals to search for specific information in a timely manner.” Participant 17

“I am involved myself in finding out information rather than listening lectures all the time, I am more active and feel more free to learn which never let me fell boring.”

Participant 18

“When knowing the problem or in this case the disease it helps you to find out information and when gathering information you learn as well. During the PBL process one becomes a master of the certain problem.” Participant 15

As one of the characteristics of PBL case content, the students also mentioned that PBL case enhanced the learning efficiency in the information search. The PBL learning method was useful to cultivate the ability of exploring knowledge in the process of searching information in order to think about and deal with the synthesized tasks in the PBL. Meanwhile, it could influence the student to arrange the extensive information for resolving the formulated question in the PBL. In addition, it was meaningful to encourage each student to participate into the group work actively by sharing self-explored knowledge with other group members.

“It widens your knowledge in the process of information searching and encourages everyone’s participation in a group.” Participant 11

Simultaneously, difficulties in information selection emerged also in the participants’

answering. Searching adequate and efficient resources was considered by some participants as challenge in the PBL period, especially the searching keywords in the conjunction with unfamiliar medical terms, which increased the difficulties for them to select appropriate resources for resolving problems. To some extent, experienced students noticed that each individual report referred to different sorts of academic resources, and these resources might formulate the conflicts among the knowledge pertaining to nursing practice. Additionally, insufficient knowledge background on the discussed PBL topic was regarded by the student as an obstacle of exploring the related information in the beginning period of PBL.

Inadequate information resources were also relevant to being less acquainted with professional terms emerged in the PBL.

“Students using different sorts of references: some are using national recommendations and others single research papers that might contradict. Difficult for the mentor to correct false or outdated information when the group was already

‘processed’ it.” Participant 12

“In the beginning it felt a bit difficult since I don’t have any background information about the topic.” Participant 4

“Sometimes it was difficult to find adequate resources to some strange medical words.” Participant 2

The third category named for skills in PBL tasks contained several parts, including enhancement of attention and motivation, advanced and abroad understanding, as well as skills development. The PBL supplied opportunities of incorporating the new learning rules into the nursing courses for the students with first time to come across PBL. The students were encouraged to face the challenges in the competence for responding new learning method and building thinking process in knowledge analysis. As the participant mentioned, group members were motivated to actively participate in learning process independently and cooperatively to adapt to this kind of learning method.

“PBL is a relatively new learning experience for me. I have never come across it before until we used it to study operative nursing. It makes every student active member of the group and for that matter, the class.” Participant 7

Regarding PBL’s large amount of information, this learning method made the students to be accustomed to face larger amount of various type of reading materials, which was considered as difference from traditional learning method requiring relatively smaller range for reading.

“It was good to familiarize yourself in different texts and I read more than I would probably here to different kinds of methods (f.ex. normal lesson).” Participant 2 Additionally, the PBL supplied the chances for promoting learning skills how to deal with knowledge, such as, making knowledge accumulation, building linkages among the professional knowledge and making judgments on group members’ obtained knowledge.

Furthermore, PBL method provided the opportunity for the participant to utilize the received PBL knowledge into developing more extensive comprehension in other learning fields.

“I have increased my knowledge on the task and I was able to discuss with group members what I have learnt. I was also able to relate the new knowledge to other courses.” Participant 17

Besides the fair opportunity provided in the PBL’s learning atmosphere, the students could also facilitate social interaction skills to improve effective communication with other group members, which could be considered as the skills serving throughout the whole life, for example, keeping higher quality of presentation and delivering more clear and pervasive presentation in the next PBL cycle.

“It will also boost your public presentation skills in a way bolstering your communication skills in future presentation.” Participant 16

Besides the advancement of social interaction skills, several required skills for learning also emerged in the PBL, such as, critical thinking skills, time-management skills and ability for group dynamics adjustment. The participant admitted PBL provided the opportunity to practice and reinforce these skills and capacities especially when facing conflicts among the different viewpoints in the group discussions.

“It felt challenging as it will hone your critical thinking skills, time-management skills and group dynamics and see how ideas clash and become one without compromising the main thought of the discussion.” Participant 16

Figure 2. Students’ experiences of knowledge and skills development

Class Subcategory

Main category

Student’s experiences of knowledge and skills

development

PBL case

Contents of PBL case Limits of PBL

case

Problem and information

Question synthesis Benefits of information

search Difficulties of

information search

Skills in PBL tasks

Skills development Enhanced attetion

and motivation Advanced comprehension