Learning and study strategies of baccalaureate nursing students during first semester nursing courses
2 Table of Contents Chapter Page I. INTRODUCTION Introduction 4 Background and Significance of Problem 5 Conceptual Framework 13 Purpose 18 Specific Aim 19 Research Questions 19 Assumptions 20 Definitions 20 II. REVIEW OF RELATED LITERATURE Introduction 23 Nursing Shortage and Impact on Society 23 Attrition and Retention in Nursing Programs 25 Nonmodifiable Learner Characteristics 27 Academically At-risk Students and Learning and Study Strategies 32 Strategic Learners and Learning and Study Strategies 33 Learning and Study Strategies: Skill Component 35 Information Processing Selecting Main Ideas Test Strategies Learning and Study Strategies: Will Component 35 Anxiety Attitude Motivation Learning and Study Strategies: Self-Regulation Component 36 Concentration Self Testing Study Aids Time Management Learning and Study Strategies Inventory (LASSI) 36 University Students Learning and Study Strategies 41 Nursing Students Learning and Study Strategies 42 Summary 45 III. METHODOLOGY Introduction 47 Research Purpose 47 Research Questions 48 Research Design 49 Study Variables 50 Instruments 51 Setting 67 Sample and Sampling Plan 68 Human Subjects Protection 71 Data Collection Procedure 73 Data Analysis 74
3 IV. Limitations Summary MANUSCRIPT #1 ABSTRACT V. MANUSCRIPT #2 ABSTRACT REFERENCES APPENDICES Appendix A: Learning and Study Strategies Inventory (LASSI) Appendix B: Permission Letter to Use Photocopy of LASSI Appendix C: Demographic Data Questionnaire Appendix D: Letter Requesting Permission Appendix E: A Priori Logistic Regression Power Analysis Appendix F: Post Hoc: Calculation of Achieved Power for Logistic Regression Appendix G: Post Hoc: Calculation of Achieved Power for f-Test Appendix H: Informed Consent Cover Letter 81 83 84 86 88 97 104 105 108 109 110 111 112 VI. DISSERTATION ABSTRACT
4 Chapter 1: Background Introduction By 2016, approximately 3.1 million nurses will be needed to care for the United States' (U.S.) aging population (Bureau of Labor Statistics, 2007). Current trends do not foresee that number being realized. The nursing shortage is estimated to reach a deficit of up to one million nurses by the year 2025 (Buerhaus, Staiger, & Auerbad, 2009; Bureau of Labor Statistics, 2007; HRSA, 2006). The Council on Physician and Nurse Supply (2007) determined that 30,000 additional nursing graduates are needed annually to meet the nation's healthcare needs, which is a 30 percent expansion over the current annual rate of nursing graduates (Miller & Mclntyre, 2007). Despite attempts by nursing programs to increase available nurses by increasing student enrollment over the past several years, loss of students through attrition has also risen, resulting in a negligible increase in graduation rates. Nursing programs report attrition rates of 3 to 55 percent or higher, despite the use of strict admission criteria such as higher grade point averages (GPAs) and aptitude test scores to screen for the most qualified applicants (Ellis, 2006; Gardner, 2005; Jeffreys, 2007; Prymachuk, Easton, & Littlewood, 2008). The admission screening criteria are not consistently reliable predictors of early academic ability and are ineffective in identifying the academically at-risk students. Academically at-risk nursing students are those who frequently fail a required nursing course or drop out of school during the first year of the nursing program. It is essential to identify nursing students who are at risk for involuntary attrition early in the program so
5 nurse educators can provide educational support to enhance the student's potential for academic success. Nursing student success or retention programs, designed to assist academically at-risk students to become expert learners, are proving to be successful when used with one-on-one mentoring from nursing faculty members (Gardner, 2005; Symes, Tart, & Travis, 2005; Symes, Tart, Travis, & Toombs, 2002). The severe shortage of nursing faculty (AACN,2005; Rosseter, 2009) makes it difficult to commit to providing this type of time and resources to academically at-risk students (Symes et al., 2002). Identifying the learning and study strategies of these academically at-risk students early in the nursing program will allow nursing educators to create resources for students to become effective, self-regulated, strategic learners. Strategic learners are proficient in using learning and study strategies and can self-regulate to remedy their own academic deficiencies in order to be successful in the nursing courses. Identifying, retaining, and graduating academically at-risk baccalaureate nursing students will help lessen the severity of the nursing shortage. Background and Significance of Problem Expert projections show no promise of the nursing shortage resolving any time soon. In fact, a worsening shortage in all 50 states is expected for several more decades due to the increasing health care demands of an aging U.S. population and a large number of nurses leaving or retiring from the profession (Buerhaus et al., 2009; Bureau of Labor Statistics, 2007; HRSA, 2006). The
registered nurse (RN) workforce, at 2.5 million, constitutes the largest health care occupation; nevertheless the American Hospital Association (AHA) reported that U.S. hospitals still need approximately 116,000 RNs to fill vacant positions (AHA, 2007). The Bureau of Labor Statistics projected that more than 587,000 new RN vacancies will be created through 2016 (AACN, 2008a; Bureau of Labor Statistics, 2007). Current vacancies are not being filled and if the situation does not change, there will not be enough new and replacement nurses to fill the new jobs being created. The current economic downturn may temporarily camouflage the problem of the nursing shortage. Older nurses are delaying retirement and younger nurses who work part-time are returning to full-time work and working extra shifts to ease financial difficulties brought on by situations such as a spouse job loss (Buerhaus, 2008). The U.S. Bureau of Labor Statistics (2009) reported that, even though 681,000 jobs were eliminated in February 2009, nationwide in that same month, hospitals, long-term care facilities, and other ambulatory care settings added 27,000 new health care jobs. RNs were recruited to fill many of these new positions. Once the economic situation starts to resolve, the nurses who returned to work, delayed retirement, or worked extra shifts may decide to either retire or return to part-time work. At that time the nursing shortage will reoccur and be as severe as or worse than previously projected. Nursing education programs should view this short-term resolution as temporary and continue to increase admission and graduation rates to prevent a more severe rebound effect later.
7 Colleges and universities offering nursing degrees have experienced increased enrollment every year since 2000 but cannot admit enough students to meet the increased yearly demand for registered nurses. The shortage of nursing faculty, clinical placement sites, classroom space, and financial resources are factors that restrict schools from admitting the students needed to positively affect the nursing shortage (AACN, 2008a). The efforts made by schools to increase enrollment increased graduation rates, but not as much as expected because student attrition rates also increased. Nursing studies, focusing on attrition in nursing courses and programs, reported attrition rates of 3 to 55 percent (Ellis, 2006; Gardner, 2005; Jeffreys, 2007; Pryjmachuk et al., 2008). Twenty to 80 percent of student attrition is due to academic reasons such as failure of required nursing courses, which is involuntary attrition (Gardner, 2005; Glossop, 2001; Richardson 1996; White, Williams, & Green, 1999). The Southern Region Education Board (SREB) Council on Collegiate Education for Nursing reported attrition rates from 15 to 21 percent with 27 to 30 percent of that related to academic reasons (SREB, 2007). Nursing programs try to limit involuntary attrition by using screening criteria with the intent of selecting the students who will be academically successful in the nursing program. Most programs rely heavily on pre-admission GPAs and aptitude test scores to screen for qualified applicants. Pre-admission GPAs are important predictors of first semester nursing grade point averages (Newton, Smith, Moore, & Magnan, 2007). The problem with using pre-admission GPA to rank applicants for admission is that grade inflation, differences in
8 grading methods, and the quality of nursing prerequisite courses can affect scores (Murray, Merriman, & Adamson, 2008). Aptitude tests screen for skills and abilities needed to be successful in college courses. Reading comprehension, math skills, verbal and written communication, and other measurements on aptitude tests are predictive of nursing course success (Alden, 2008; Porter, 2008; Hopkins, 2008; Symes et al., 2002). Unfortunately, the problem of using these types of tests as admission criteria is that some applicants, such as students with English as a second language (ESL), score low, and as a result may not be admitted. In addition, while GPAs and aptitude test scores may predict program completion, they do not consistently identify students who will have academic difficulties once admitted. Nurse educators must have objective assessment measures to identify students at risk for failing nursing courses because these academically at-risk students rarely seek help from nursing faculty or use other available resources (Shelton, 2003; Crow et al., 2004; Symes et al., 2005). Academically at-risk students may search for help from, or try to form study groups with others who are struggling academically (Childs, Jones, Nugent, & Cook, 2004). It is usually too late for faculty to provide adequate support when academically at-risk students realize their strategies are not successful and finally ask for help. (Furr & Elling, 2002; Ofori & Charlton, 2002). Discovering the learning and study strategies and the nonmodifiable student characteristics (see Table 1.1) of
academically at-risk baccalaureate nursing students is the first step toward identifying strategies to assist these students to be successful in nursing courses. Table 1.1 Modifiable and Nonmodifiable Learner Characteristics Variable Definition Modifiable Learner Characteristics Learning and Study Strategies The "behaviors and thoughts that a learner engages in during learning and that are intended to influence the learner's encoding process. The goal of any particular learning strategy may be to affect the learner's motivational or affective state, or the way in which the learner selects, acquires, organizes, or integrates new knowledge" (Weinstein & Mayer, 1984, p. 315). Nonmodifiable Learner Characteristics Age Race English as a Second Language Chronological age in years Ethnic affiliation resulting from racial or cultural ties English is not the first language spoken fluently Grade Point Average (GPA) Number of Transfer credit hours The average grade earned by a student, figured by dividing the grade points earned by the number of credits attempted Academic credits granted to students on admission for work done at another institution
10 Modifiable Learner Characteristics - Learning and Study Strategies Effective learning and study strategies relate to successful academic performance (Hoveland, 2006; Keane, 1993; Khadivezadeh, Saif, & Valae, 2001; Primus, 2003; Yip, 2007; Yip & Chung, 2005). Attitude and motivation often are equally as important as study strategies when predicting academic achievement (Chacko & Huba, 1991; Yip, 2007). Students who use learning and study strategies effectively are referred to as strategic learners (Weinstein & McKeachie, 2003). Strategic learners set realistic educational goals, realize learning is an active process, recognize when they do and do not understand new content, seek help for difficulties, and self-regulate studying and learning (Weinstein & McKeachie, 2003). Conversely, academically at-risk students lack good study habits, have poor test-taking skills, and do not use learning and study strategies effectively (Childs et al., 2004; Yip & Chung, 2005). Research studies focusing on university students' knowledge about and use of strategic and self- regulated learning show identification of at-risk students, in order to provide remediation of learning and study strategies, can lead to increased academic success (Weinstein & McKeachie, 2003). There is a lack of nursing research regarding learning and study strategies of academically at-risk baccalaureate nursing students in the first semester nursing courses. Several investigators examined the learning and study strategies of Associate Degree in Nursing (ADN) students (Daniel, 2002; Hoveland, 2006; Primus, 2003; Smith, 1995). While the learning requirements may be similar for programs preparing graduates to become registered nurses,
11 the demographic characteristics and learning and study strategies of students in ADN programs may not be consistent with those students in baccalaureate nursing programs. These differences make it difficult to establish generalizations from these studies to students in baccalaureate nursing programs. A few investigators were able to identify models that predicted success in nursing courses or programs, but they did not do as well identifying the students who lacked the academic aptitude needed for success or who failed nursing courses early in the program (Hopkins, 2008; Newton et al., 2007). Academically at-risk students are often not identified until they are failing or have failed a course. These academically at-risk students, who often are members of underrepresented groups in nursing, are in jeopardy of being unsuccessful in nursing courses the first semester and first year of the program (Alden, 2008; Ellis, 2006; Hopkins, 2008; Jeffreys, 2007; Newton et al., 2007; Tipton et al., 2008). Nonmodifiable Learner Characteristics Nonmodifiable learner characteristics of academically at-risk students include age, race, and English as a second language (ESL), grade point average (GPA), and number of transfer credit hours brought to the baccalaureate nursing program. Several studies conducted in the United Kingdom and in United States Associate Degree in Nursing (ADN) programs explored the effect age has on student success in nursing programs but their findings were inconsistent. Older students performed better than younger students in studies in the United Kingdom (Mulholland, Anionwu, Atkins, Tappern, & Franks, 2008; Pryjmachuket
12 al., 2008). Younger students performed better than older students in U.S. ADN programs (Alden, 2008; Jeffreys, 2007). Other studies found that age was not a contributing factor to attrition or success (Byrd, Garza, & Nieswiadomy, 1999; Hopkins, 2008). Across the U.S., efforts to increase the admission rates of minority students into university study have amplified. Even with the increase in minority students' admissions to nursing education programs, the numbers of registered nurses from minority groups are still below the minority population rates (NLN, 2006). If minority students are not successful in completing their nursing education and attaining licensure, then the diversity of the registered nurse workforce will not change (Lewis & Lewis, 2000). Nursing students who are at risk for involuntary attrition are often members of minority groups or groups that are underrepresented in nursing. Therefore increasing retention of these students will decrease the nursing shortage. Nursing students lost to involuntary attrition have histories of repeated courses, lower cumulative and pre-nursing GPAs, higher numbers of transfer credit hours, and transfer credit hours from community colleges (Jeffreys, 2007; Newton et al., 2007; Newton et al., 2007; Tipton et al., 2008). Students who transfer credit hours from community colleges are often economically and/or socially disadvantaged and may experience "transfer shock" that manifests itself in lower nursing GPAs the first semester or first year of the baccalaureate nursing program (Newton, 2008). Grade inflation from transferring institutions is a
13 concern since grade point averages are often the major factor contributing to admission into the nursing program. Identifying and retaining academically at-risk students who are admitted to baccalaureate nursing programs is one solution to increase graduation rates, increase diversity in the registered nurse workforce, and ultimately decrease the nursing shortage. Nurse educators must find ways to determine which students are most at risk for involuntary attrition early enough to help these students become self-regulated, strategic learners. A conceptual model developed by Claire Weinstein may help nurse educators to identify academically at-risk baccalaureate nursing students early in the baccalaureate nursing program. Conceptual Framework Model of Strategic Learning Claire Weinstein and her associates developed and refined the model of strategic learning (Weinstein, 1994) using three decades of research in how students become more strategic, motivated, and self-regulated learners. The model of strategic learning (see figure 1.1) has four components, (a) skill, (b) will, (c) self-regulation, and (d) the academic environment. When used together, these components can facilitate motivation, achievement, retention, and application of knowledge, the development of cognitive and behavioral processes, and the development of study and thinking skills (Weinstein & McKeachie, 2003). While each component is important and can be viewed separately, it is the interactions among these components that results in effective and successful learning (Weinstein & Palmer, 2002).
14 Figure 1.1 Model of Strategic Learning Model of Strategic Learning NATURE OP THE LEARNING ACTIVITY, ASSIGNMENT, PROJECT OR TEST/ TIME CONSTRAINTS • Niton of Aerimit Tub • Lemhi SMOJIN ad SkJUi •Contiot (Prior KDOHWK) WE • StttBf, AoilflBf, ft (MBI Ooali • IbiratiB to i dknont (U. Aadnk Lostac Wo, bUmUodVoha) • AflKtTbisdLMBtaf (•*, Cmtofcy, Wony. Apafty, Aafs.uiAndiBkftMi) . pniiffr («| lhMHh|/ Sd/AhdMJat Midi. itaJoek Mf.gflap nd Attribolfani fa iadnieOntHBM) • Voltin (at.. Canunltamt sod lntentM • Cmt&r • ftrthi Mnd&t Tomod Umfai «d AnUmc PUisi&tliiiDUHvUBlWnf •nipinBt tend Ti nt Two Unt BOMBJBI nd PnUm SohmfSUk SElfREGUlAJION TlMMiaii^Mit/DwllaiwflhftMattfatifaB Byttmtic Asuotch to LmtBt nd Aouuiiukf ActdawTub (•«•, 3it (VaKiX ROHMC, Flo. S»kct.| Trnphnnfflti Unt o nd Fnuhnif Bnutti ftogwj Modify (if iiumm jh md Sromrtwly &what» UBtOOBM Copsf i»i(ii Andume Stan • Mmifof lUntaoB to Lnmtaf nd Achinunt 09 AVAILABLE RESOURCES FIGU R E 1 The Model of Strategic Learning. © C. E Weinstein, 1994.
15 Skill Component. The skill component of the model of strategic learning involves five types of knowledge, strategies, and tactical skills that are needed to become a strategic learner (Weinstein & McKeachie, 2003). These include knowledge of: 1) self as a learner, 2) academic tasks, 3) learning strategies and skills, 4) content, and 5) learning context. These sets of knowledge, strategies, and skills develop over certain periods of the life span and are dependent upon considerable self- discipline. Adults who lack this self-discipline will not develop self awareness to a level needed for strategic learning (Cornford, 2002; Zimmerman, 1989). Strategic learners have the self discipline necessary to schedule their time, use resources and study strategies, apply new learning, and use existing knowledge to build meaning for new content (Weinstein & McKeachie, 2003). The skill component elements are necessary for learning but are not adequate without the motivation to learn. Effective learning requires the integration of skill and will components of the model of strategic learning (Weinstein, 1994). Will Component. The will component of the model of strategic learning involves the student's motivation to learn. The central elements of motivation are: 1) setting, analyzing, and using goals, 2) maintaining motivation for achievement, 3) analyzing the affect toward learning, 4) possessing positive beliefs regarding learning potential, 5) maintaining volition toward learning, and 6) creating a positive mind set toward learning and avoiding self-sabotaging thoughts and behaviors (Weinstein, 1994). Strategic learners set attainable and challenging
16 goals for their learning, possess the thoughts, behaviors, attitudes and beliefs needed to obtain their goals, and have the self-belief that their efforts will make a difference in their learning outcomes (Weinstein & McKeachie, 2003). Skill and will component elements cannot be managed without self-regulation. Self-Regulation Component. The self-regulation component of the model of strategic learning involves the self management of learning. The elements of self-regulation include: 1) managing time, including controlling procrastination, 2) monitoring concentration, 3) monitoring comprehension, 4) using a systematic approach to learning and accomplishing academic tasks, 5) coping with academic stress, and 6) managing motivation for learning and achievement (Weinstein, 1994). Strategic learners are able to self-regulate thoughts, beliefs and actions that are necessary for positive learning outcomes. The skill and will factors are managed through self-regulation in the context of the academic environment. Academic Environment Component. The academic environment component in the model of strategic learning contains the resources available to the learner. These include: 1) instructor expectations, 2) nature of the learning activity 3) assignment, project, or test 4) time constraints, and 5) nature of social contexts and level of social support" (Weinstein & McKeachie, 2003, p. 13). These elements are external to the learner but are used by the learner to acquire knowledge. Strategic learners control their skill and will elements, taking into account their learning environment through self regulation. When students value the outcomes of learning and
17 translate their motivation into action, they can then apply the learning strategies to develop the best ways to think, process information, and engage in problem solving (Weinstein & Mayer, 1985). Not all aspects required to become a strategic learner can be taught; however, teaching strategies and learning situations requiring the use of self-reflection can provide the development of students' abilities to think about their own personal strengths and weaknesses as a learner. Identifying successful learning strategies and helping students become self-regulated, strategic learners not only will help them be successful in the nursing program but will make them self-reflective practitioners (Kuiper, 2005). Nursing educators must identify the strategic learning behaviors and study strategies that are weakest in beginning nursing students so interventions for successful learning and retention strategies can be initiated in order to assist academically at-risk nursing students to become self-regulated, strategic learners. The Model of Strategic Learning guided the development of the Learning and Study Strategy Inventory (LASSI) (Weinstein & Palmer, 2002). Strategic learners use learning strategies, are motivated for success, are responsible for their learning, and seek out resources for success (Weinstein & McKeachie, 2003). These attributes of the strategic learner lead to positive academic outcomes and high academic achievement. There also are nonmodifiable learner characteristics that affect academic outcomes (see Figure 1.2 Conceptual Model).
18 Figure 1.2 Conceptual Model ACADEMIC ENVIRONMENT LEARNING AND STUDY STRATEGIES Information Processing Selecting Main Idea Test Strategies Anxiety Attitude Motivation Concentration Self-Testing Study Aids Time Management LEARNER CHARACTERISTICS MODIFIABLE SKILL WILL SELF-REGULATION NONMODIFIABLE AGE RACE ESL GPA TRANSFER CR.HOURS ACADEMIC OUTCOMES Purpose The purpose of this study was to identify the learning and study strategies and learner characteristics of nursing students with and without academic risk during first semester nursing courses in the baccalaureate nursing program. Determining the characteristics of academically at-risk nursing students compared to those who are not at risk for involuntary attrition may help nurse educators identify these students earlier in the program. An examination of nursing students' strategic learning behaviors may provide insight into students' skill, will, and self-regulation in nursing courses and expand understanding about why some students are not as successful in nursing courses as others. Identifying the deficiencies in learning and study strategies of academically at- risk nursing students early in the program will allow enough time for the students
19 to develop awareness of their learning and study strategy deficiencies and to learn, practice, and use study strategies that are effective in learning nursing content. Identifying academically at-risk nursing students soon after admission will enable nursing programs and nurse educators to enhance the students' potential for academic success by providing educational support. Specific Aim Identify strengths and weaknesses in learning and study strategies of baccalaureate nursing students during their first semester of nursing courses. Research Questions The research questions guiding this study were: 1. What are the differences in learning and study strategies (10 subscale scores on LASSI) of baccalaureate nursing students with academic risk factors and those without academic risk factors during the first semester of nursing courses? 2. What are the differences in nonmodifiable learner characteristics (age, race, ESL, GPA, and number of transfer credit hours) of baccalaureate nursing students with academic risk factors and those without academic risk factors during the first semester of nursing courses? 3. What is the predictive value of the learning and study strategies (10 LASSI subscale scores) and the nonmodifiable learner characteristics (age, race, ESL, current GPA and number of transfer credit hours) on the academic performance of baccalaureate nursing students during the first semester of nursing courses?
20 Assumptions It was assumed that students' learning and study strategies could be assessed by means of a written, self-report, rating scale instrument and that the students would provide an accurate self-report while completing the Learning and Study Strategies Inventory (LASSI). It was also assumed that explaining to the students that all of their responses would be anonymous would result in more accurate self-reporting. This would reduce the probability that the students would answer the questions in a way they thought was expected rather than as an accurate measurement of their true behavior and abilities. Definitions Academic Performance: The student's test grades in the theory portion of the first semester nursing concepts course. Academically At-Risk Student: The student who has the potential for failing the nursing course(s). Operational Definition: Having one or both of the following risk factors: 1) Scoring at or below 70% (10 point grading scale) on 1 or more objective tests in the first semester baccalaureate nursing concepts course. 2) Having a test average below 80% (10 point grading scale) prior to the final exam of the nursing concepts course. Attrition: Leaving the nursing program. First semester nursing students: Nursing students who are enrolled in the first nursing course(s) offered in the baccalaureate nursing program.