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 2nd year international nursing students’ experiences on PBL as learning method in a university of applied sciences?
(2) What are the 2nd 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 international nursing students in a university of applied sciences in 2014.
Regarding the international nursing students in a university of applied sciences, PBL is implemented as one of learning method other than the learning style in traditional lectures for these students. The purpose of PBL is to cultivate students’ learning ability of solving real-life problems. PBL based studies has been implemented on international nursing students in the second academic year. The potential participants (N=45) was divided into two groups (Group 1 and Group 2). The students in Group 1 started applying PBL in the course named Medical & Surgical during the autumn semester of 2013. The students in Group 2 also used PBL to start the same course from the spring semester of 2014.
4.2 Data collection
Questionnaire was applied as the method for collecting data from the purposive sampling in this study. Questionnaire is a self-report form designed to extract the information from participants directly in the written manner. The second year international nursing students could write down individual answers to each question in the questionnaire. The written information from these participants can be considered as the data for this study. (see Grove et al. 2013.)
There were 14 questions set in the questionnaire composed of three dimensions (background of participants, experiences of PBL and perceptions on tutors’ roles). In this study, questionnaire was composed of two types of questions: closed-ended questions and open-ended questions. The closed-open-ended questions were purposed to collect the background of the participants. (see Grove et al. 2013.) In order to collect data more efficiently in this study, using open-ended questions was regarded as appropriate way for receiving the students’
perceptions and experiences concerned with PBL in small samples. The questionnaire consisted of eight closed-ended questions for acquiring background and five open-ended
questions related to students’ experiences and perceptions as well as one general open-ended question was targeted for participants to share opinions and suggestions freely. The content of questions was formulated based on the results from the studies in the literature review.
The pilot test was executed for identifying the appropriate level for the participants in understanding and language fluency to the questionnaire. The content validity of questions in the questionnaires were evaluated through proceeding pilot test on three second-year international nursing students with previous learning experience related to PBL in the same university of applied sciences, which was useful for evaluating the understanding level of questionnaire’s content. In the pilot test, three participants were also asked to fill in the feedback chart for assessing the time-using and degree of acceptance. In addition, content of questionnaires was evaluated and identified with the assistance of the specialists of nursing PBL method in the same university of applied sciences.
The questionnaires were collected from May to October in the year of 2014. Besides 15 pieces of questionnaires answered by the second academic year students, three questionnaires from pilot test were also included. Altogether 18 questionnaires (n=18) were selected to continue data analysis.
4.3 Data analysis
The qualitative content analysis was used in data analysis. Firstly, the researcher reviewed all texts line-by-line answered by all the participants to understand the context of these nursing students’ responses on PBL, which is beneficial for the researcher to look for the repeated ideas in the whole manner. (see Grove et al. 2013.)
Secondly, according to Grove et al. (2013), it was necessary for the researcher to convert the data into smaller and more manageable units by taking certain part of the participants’
original phase or words. The answers from the participants were broken down into smaller segments for careful combination of similarities and comparison between differences. The participants had their own opinions for answering the questions in the questionnaire. All of the opinions were reorganized into different groups according to key meanings in the students’ responses.
Thirdly, the reorganized data groups were labeled with new titles. In addition, further coding level continued for relabeling the codes into the level of abstraction and formulating the common theme. The researcher extracted more concentrated themes from the labeled data groups. (see Grove et al. 2013.) The related tables in the attachments were applied by the researcher to illustrate how to form the coding and themes in order to show the process of content analysis (see Pilot & Beck 2014).
5 RESULTS
5.1 Students’ background
All the female and male participants included into this study were the second year nursing students in the international nursing program from a university of applied sciences.
According to the requirements of participants' compulsory curriculum, problem-based learning (PBL) courses were conducted both in the semester of 2013 Autumn and 2014 Spring respectively for two groups of participants, which meant that each participant was required to take the application of PBL method in one semester in same academic year. The age of participants ranged from 20 to 35 years old in the study. Quite few participants mentioned previous learning experiences pertaining to PBL in the previous education organizations before their admission into this university of applied sciences. Each participant was required to have three PBL cycles in the course of surgical operation in two months either in 2013 autumn or 2014 spring. Each participant was required to finish three essays pertaining to peri-operative nursing care based on three PBL cycles in one semester.
5.2 Students’ experiences on PBL
The students’ answers regarding learning experiences on PBL were made up of three portions that were students’ experiences of knowledge and skills development, students’ experiences of individual interaction and students’ experiences in the mechanism of PBL.
5.2.1 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
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