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Category: Professional practice

Teaching and Learning Forum 2011 [ Refereed papers ]
Strategy to educate nurses for the profession

Keith McNaught and Selma Alliex
University of Notre Dame Australia
keith.mcnaught@nd.edu.au, selma.alliex@nd.edu.au

One of the Objects of the University of Notre Dame Australia is the provision of excellent standard of training for the professions and pastoral care for its students. An identified area of need was the literacy skills of students. Towards this end, the University recently created its Academic Enabling and Support Centre (AESC). One of the Centre's goals is to diagnose and implement strategies to strengthen literacy skills of students entering courses at the University. The School of Nursing in conjunction with AESC decided to pilot a project that would identify 'at risk' students and support them in keeping with the University's Objects. The following paper addresses the diagnosis of inadequate literacy skills and the support mechanisms implemented to deal with this issue. The paper fits in perfectly with the theme of this Teaching and Learning Forum, Developing student skills for the next decade. The focus of our strategy is to prepare students not just for the next decade but to prepare them to work in the Nursing Profession.


Introduction and background

Across a range of professions, there is broad acceptance of the importance of early diagnosis and treatment. For example, the earlier health issues receive treatment, the less likely it is that escalation will occur; the premise is that the earlier intervention occurs, the more effective it will be, and there is a long history of research into this efficacy across a range of disciplines. Moreover, early intervention is associated with reduced costs over time. Early intervention in an academic setting is ethically responsible behaviour (Briguglio & Howe, 2006), and there is solid evidence that proactive work is far less 'expensive' and more effective than remediation (Tumen, Shulruf & Hattie, 2008).

Some individuals arrive at higher education without the necessary prerequisite skills, support structures, role models and cultural capital which is essential for success. Lau (2003, p. 2) notes that "Students who lack the basic and fundamental skills, especially in mathematics and writing, are finding it difficult to cope with the normal course workload". These students are 'at risk' of experiencing course difficulty and are less likely to be retained in their chosen course of study (Boud, 2007). Two of the common characteristics of students likely to drop out in their first year of studies are (i) students with a low GPA and (ii) students who did not make substantial academic progress (Tumen, Shulruf & Hattie, 2008). The student body within the university sector has become increasingly diverse, culturally and linguistically, and this has a major impact on teaching within the sector (Lawrence, 2005). In interpreting the results of the University of Auckland's diagnostic screening tool, Elder and von Randow (2008) note that students identified as 'mainly satisfactory', are unlikely to obtain high grades in their first-year subjects. Furthermore, they note that students identified as being 'at risk' are "at risk of failure in one or more subjects" (p. 176).

Adding to the complexity, students who lack skills may lack the self-awareness of their lack of skills (Huxham, 2006). Often, students who lack self-awareness become aware of their needs only when their first assessments are returned to them; very often this can be later in their first semester of studies, and past the point where assistance should and could have been sought. Formative assessment has the capacity to increase student self-awareness (Boston, 2002). The use of a diagnostic assessment tool, early in a student's first semester of study, offers the potential to be valuable to both teaching and learning (Alderson, 2005). Colburn (2009) suggests that formative assessment is diagnostic, using the metaphor of a medical test. He adds that it is designed to "understand what a student knows or can do in order to figure out what should come next" (p. 10).

Scaife and Wellington's (2010) research indicates that students do value assessments which do not carry academic marks, and yet notes that formative and diagnostic assessment have received relatively little attention in higher education. Formative assessment is designed to identify student strengths and weaknesses, unlike summative assessment which is linked more to grading and reporting (Blansford et al, 2000). To undertake formative assessment, and then fail to provide support mechanisms would be professionally negligent for higher education providers. The work of Candy et al (1994) emphasised the importance of services to assist students to realise their academic potential and to become independent learners. Universities have a moral and ethical obligation to support and assist students they have enrolled to do well, and persevere with their studies (Peach, 2005). The emotional and financial costs of academic failure are high for both individual students and institutions (Wimshurst & Allard, 2008).

The School of Nursing context

The issue of inadequate literacy levels was first discussed at length at an external curriculum review of the Bachelor of Nursing in 2007. The review committee recommended that the School devise and implement a strategy that would identify and provide remedial education to students who lacked University level literacy skills. This appears to be an obvious skill nurses should have, because the expectation is that nursing practitioners provide safe and collaborative care to patients and clients and are involved in policy writing and other administrative work. This imperative is highlighted in the National Competency Standards for the Registered Nurse (2008), the Code of Ethics for Nurses (2008) and the Code of Professional Conduct for Nurses (2008). As graduate nurses, documentation and interpreting data is a significant component of the nurse's role if they are not to compromise patient care. It is therefore imperative that any shortcomings in literacy skills are addressed during the undergraduate degree.

The issue of students struggling with literacy standards is also one that has troubled the University because the ability to communicate, critical and reflective thinking and lifelong learning are some of the University's graduate attributes. To be able to prove that students were able to achieve these attributes at the end of the course meant that strategies to address the issues of literacy had to be implemented.

When the Academic Enabling and Support Centre (AESC) was established on the Fremantle campus of the University of Notre Dame Australia (UNDA) in 2010, one of the remits for the Centre was to provide literacy assessments and related support courses to incoming students. The University implemented a trial project diagnostic assessment of all incoming students across six Schools - Arts and Sciences, Business, Law, Nursing, Education and Health Sciences; a total of 269 students were assessed, representing close to 80% of mid-year entrants commencing their studies in those six schools in semester two, 2010. Mid-year entry numbers are significantly smaller than beginning-year entry, and for this reason were chosen for this trial. As there was historical anecdotal evidence that mid-year Nursing entrants struggled as they commenced their studies, collegial discussions pondered the reasons for this, and sought to clarify, with data, whether this was valid. A plan to pilot an idea specific to students entering nursing undergraduate studies in semester two, 2010 was developed and implemented in July 2010.

Students entering Nursing mid-year, semester two, 2010, were classified by 'entry point', using five categories (Table 1).

Table 1: Entry points into the School of Nursing


%Notes
ATAR23%Australian Tertiary Admissions Ranking
TEP23%The University's "Tertiary Enabling Program", a semester-long bridging course
STAT15%Special Tertiary Admissions Testing
Certificate IV4%TAFE qualification
Other35%Includes: previous university studies; transferring students, diploma level studies, enrolled nurses.

It is noteworthy that 77% of students entering mid-year are some form of alternative entry, rather than the standard 'Year 12 school leaver' who represent more than 50% of beginning year entrants to Nursing at this University. The historical anecdotal concerns about mid-year entrants may exist, at least in part, due to their diverse entry point backgrounds.

Methodology

It was planned that all new students to Nursing would be informed, at interview and in writing, that part of their course will include an "Academic Study Skills for Nursing" course. (All entrants to UNDA complete an application for enrolment and are interviewed by staff within their School to assess suitability and discuss various course options and opportunities). The letter, prepared by the Director of AESC and the Dean of Nursing, was designed to promote this trial project as a key way to help incoming students achieve success in their first semester. Staff appreciated that students might be reluctant to complete the assessment, albeit that it was very clear that course entry was granted prior to the assessment occurring, eliminating potential fears that the assessment might influence enrolment. The course was planned as a 20 hour intensive, delivered in the week prior to semester commencing. On their enrolment day, scheduled a fortnight prior to semester commencing, all these students were to complete a short literacy assessment task. The performance of students was to have been ranked, and the top performing students, who demonstrated an appropriate skill level, were to be exempted from this support course. The assessment involved three components - a reading comprehension task; a vocabulary assessment task; and a writing task, involving writing the first two paragraphs of an essay.

The administration of the assessment task proved problematic in several ways. Letters did not go out to incoming students until after they had attended their enrolment session, and at their enrolment session, the lack of communication created apprehension and anxiety. Not all students enrolled on the same day, and test administration became more complex, as students enrolled on an individual basis over a period of two weeks, making the provision of invigilated test settings difficult.

Of the 55 students enrolled to commence in semester two, 34 had completed the testing program before semester commenced. A further 12 completed the test by the end of the first week of classes, and 9 students did not complete the testing, despite encouragement and opportunities to do so.

At the point where 34 (of 55 students; 62%) had been tested, it was decided that it would be unfair to encourage those who had completed the test with low results, to undertake the 20 hour course, when the same was not expected of other potentially low-achievers who had not been tested. Given that nearly 40% had not been tested, this was an issue.

The tight time line resulted in a decision being made to vary the process. All students who were entering the Nursing degree in semester two were offered the opportunity to complete the course, regardless of their test results. Enrolled and enrolling students were contacted via email and text-message, with course details and a strong encouragement to consider the benefits that could be obtained through a preparatory program.

Diagnostic tool

The reading component of the test required the students to read an excerpt of popular fiction text, and answer six multiple choice questions. The vocabulary task involved identifying two words, from a selection of 5 options, to correctly complete a sentence. There were 10 questions within this section. The writing task used a sample table, which provided a nutritional analysis of a serve of fish. The writing task was open ended, with the students to write the first two paragraphs of the essay from any perspective they wished, but using the table data.

A planned 70% benchmark as a minimum standard was derived, allowing an error rate in both reading and vocabulary sections. By constructing a marking rubric for the writing task which would return a result of 70% or greater for papers which met basic requirements, this allowed for some errors in spelling, grammar and form.

Findings

The reading comprehension task, with six questions, proved problematic. The benchmark of 70% required a student to achieve 5/6, to reach 83%; 4/6 results in a mark of 67%. Therefore, the benchmark was changed to 65% for the reading section. The mark range for the reading test was from 2/6 to 6/6.

Table 2: Results for the reading test

Mark (6)PercentageNumber of
students (raw)
Percentage
of students
233%24%
350%817%
467%1635%
583%1226%
6100%817%

The reading test was taken from fiction, and was not complex; the same test was completed on a total of 269 semester 2 entrants across the university, and the Nursing students were the lowest performing group in this section. Over the 269 students, 12% were below 50%, whereas 21% of nursing entrants were below 50%. Staff had envisaged that most students would score either 5/6 or 6/6; it was both surprising and perplexing that only 43% of the Nursing students achieved that standard.

The vocabulary section was not complex; high marks, with an average of 86% were recorded over the 269 semester entrants. Nursing students marked ranged from 5/10 to 10/10.

Table 3: Results from the vocabulary test

Mark (10)PercentageNumber of
students (raw)
Percentage
of students
550%12%
660%49%
770%24%
880%1226%
990%1737%
10100%1022%

In the writing section, marks ranged from 4/10 to 8/10.

Table 4: Results from the writing test

Mark (10)PercentageNumber of
students (raw)
Percentage
of students
440%511%
550%1022%
660%1022%
770%1328%
880%817%

All students were informed of their results, within 48 hours of completing the test. They were given their score for each section, and if below the benchmark, were flagged as 'at risk' and encouraged to seek additional assistance. The four lowest achieving students were personally contacted by the Director of the Academic Enabling and Support Centre, to encourage them to take up the option of the 20 hour course. Two did not return repeated telephone calls or emails; two took up the course. However, in both those cases, these students attended only part of the program. One of the two attended 50% of the course (two days) and the other attended 75% (three days).

Remedial course

Of the incoming group, 18 took up the offer of a place in the course. Of the 18 to commence the course, 12 (66%) had already completed the test. The results of those 18 students can be compared to the results of the 46 students who were tested.

Table 5: Comparison of course students with the rest of the participants


Percentage
Reading <65, whole group21%
Reading <70, 18 course participants41%
Vocabulary <70, whole group11%
Vocabulary <70, 18 course participants17%
Writing <70, whole group55%
Writing <70, 18 course participants58%

Whilst acknowledging the statistical issues around the conversion of raw data to percentage data, it was interesting, and deemed positive, to note that the group who took up the course were students with identified needs in the areas tested. Prior to the administration of the test, there was staff concern that students most likely to need assistance might be the least likely to enrol for a support course, based on our professional experience of self-enrolment in support programs and courses during the first semester of 2010. However, this was not demonstrated in the group who did choose to enrol and participate in the course. The 6 (18%) of bottom performing test participants, were evenly split across course attendance and non course attendance. Three of the bottom performing students who took the test, enrolled in the course. Of those three, one student did not attend the whole course, and was not particularly engaged when present at the course.

Fifteen of the 18 course participants agreed to complete a student audit, to create a demographic profile, and a self-assessment task. Within the demographic data, students were asked to identify their gender and how they met entry requirements; if relevant, they were asked to provide details of entry requirements - for example, if they entered on the basis of STAT testing, their score was also requested. With the self assessment, ten statements were used, around core academic literacies. All statements were positively expressed (e.g. "I would feel confident interpreting statistical data from a table or graph") and students ranked themselves a 1 (strongly agree) through to 4 (strongly disagree).

Figure 1

Figure 1: Self-assessment of core literacy competencies

Overall, students in the course indicated a lack of confidence and/or competence with the academic literacies listed. Three topics were identified as causes of concern in the self-assessment data: confidence with essay writing; reading text within a journal; and, writing a thesis statement and presenting a written argument. This was aligned to the assessment results of the cohort group in particular, they had experienced difficulty with the writing task. The students' lack of confidence in comprehending text within a journal article was initially surprising, albeit aligned to the test results, but better understood by staff as the coursework was completed. Students had positive perceptions of their grammar knowledge, use of Word documents, time management skills, and capacity to take good notes in a lecture setting. The group was evenly divided on IT skills and the interpretation of statistical data.

Mature age students from an alternative entry pathway stood out in the self-assessment as ranking themselves in the 'disagree' and 'strongly disagree' responses to prompts. They averaged 74% of their responses in those two categories. The two students who had completed a full time six month university enabling course were highly confident in their self-assessment, scoring less than 10% of their responses in the 'disagree' and 'strongly disagree' responses. As the sample group was small, and the groups within very small, and subject to a wide range of variables (for example, age and gender), only a cursory inspection occurred with regard to this particular data. These factors warrant greater research.

Course participants completed a 20 hour intensive course, positioned over 4 days, Monday to Thursday, in the week prior to semester commencing. Classes ran from 9 am to 2 pm each day, with intentionally short breaks (10 minutes for morning tea and 30 minutes for lunch) to maximise learning time; a hot and cold drink station enabled students to take refreshments throughout the day and this worked well.

The course was well received by participants. It was reviewed using three open ended questions:

  1. What has been valuable/useful over these 20 hours?
  2. What recommendations would you make for the next time this course is run?
  3. Any comments you would like to make?

Table 6: Course structure

Monday July 19Tuesday July 20Wednesday July 21Thursday July 22
Introductions
Welcome
Attributes for success at University
Self assessment
Blackboard - what is it, how do I use it?Essay writing task
Essay writing: quotes and references
SQ3R - managing complex text!
Academic Literacies

An Academic Vocabulary
Navigating the UNDA websiteEssay writing taskThe one page article summary - how to keep up with the reading load
Online learning links

Essay writing: the 4 C's
Sample essays - what does a distinction essay look like?

Essay writing: A thesis statement and supporting points
Essay writing: Editing and proof readingAccess to services:

Academic Support Program

Academic Help Desk
What is "academic writing"?

Using a template method to structure your writing

Essay writing: Paragraphs and topic sentences
The basics of APA referencingThe Student Life Office

Library tour and the use of e-journals
Self paced IT - learning to use "Atomic Learning"

Navigating your way around the campus

Course review

Course review

The responses to question one, on aspects which were valuable, were categorised by common themes, two standing out in particular. Firstly, students overwhelmingly found being trained in the use of an academic essay template valuable, with 100% of survey responses including comments on this being of value. As this had been the first time the presenters had utilised a template with a group, this was further explored in informal discussion with participants. Participants commented that the structure had enabled them to see academic writing as a having a particular style and approach, and many commented that the structure had enabled them to see that academic writing was not completed in presentation order; rather, that writing was completed in sections and that the sections were brought together rather like pieces of a jigsaw. This was a powerful metaphor for academic writing for a number of participants. Secondly, and directly related to the first point, students found reading strategies such as SQ3R enabled them to deconstruct academic text, as through the template writing, they understood the text conventions and styles. Finally, anything with the course related to information technology had been well received by participants.

Recommendations for future courses (question two) were trivial when made. A number of students made no comment in this section; comments made suggestions about having low-fat milk available, or having lunch breaks earlier in the day. There were no significant suggestions related to course design.

The third question, providing for general comments tended to elicit course affirmations: "Thank you, I feel a lot less nervous about starting uni next week and I really enjoyed your course"; "Thank you for everything, I would have been lost without this course"; "Enjoyed the course, helpful tips, time well spent". Those participants who had commenced university study previously, noted that a course like this would have had a positive impact on their first attempt at study.

Over the semester following the course, several participants continued to provide unsolicited feedback, as they achieved good results in their assessments. Emails included the following examples of this:

I would really like to say thank you for the academic orientation you did at the start of this semester. Before that course I had never written an academic essay or referenced and I learnt so much in that week. I recently received my first major essay back and achieved a High Distinction and would not have done this without your guidance and the essay writing material you provided us with, which I used throughout writing my whole essay. I very much appreciate having the course available and all your help.
And
I just got my result for my first ever Uni essay and got a D! Just wanted to say thank you so much for teaching me how to write academically, I know I would not have got that mark without the skills you taught me.
Interestingly, one of the weakest participants, who had achieved very low results in the testing, sought leave of absence early in the semester. She expressed a personal determination to continue the course, but recognised that she needed to enhance her skills prior to returning to the Nursing degree. She has taken up several of the suggestions made to her, and pursued other courses to improve her skills and English. It was considered a far better outcome for a student to take leave and develop her skills, rather than continue with a course in which failing units was highly likely.

Conclusion

Whilst the review of the initial results of the testing was a disappointment in that achievement was less than expected, the provision of a 'reality check' on the skills of mid-year entrants proved of great value. The diagnostic assessment provided two distinct values. Firstly, it provided staff with an understanding of individual and collective skills and weaknesses for course entrants. This enabled staff to provide specific points of focus, and to better monitor commencing students, providing referral to other services immediately, and in a proactive way. Secondly, the testing provided students with an understanding of their skill level, and both their strengths and weaknesses. This increased their desire and interest in gaining academic support to assist their development and progress. The increased self awareness was seen as a key value in their project.

The course was well received by students. The course participants will be tracked over their first year of studies, to analyse whether this course was of value to their progress. Early indications are that for several, it was of great value, for a wide range of reasons. Further exploration and research is required to validate the initial trends and feedback, and to quantify student progress.

References

Alderson, C. (2005). Diagnosing foreign language proficiency: The interface between learning and assessment. London: Continuum.

Australian Nursing and Midwifery Council. (2008). Code of Ethics for Nurses. Dickson, ACT. (http://www.anmc.org.au/)

Australian Nursing and Midwifery Council. (2008). Code of Professional Conduct for Nurses. Dickson, ACT. (http://www.anmc.org.au/)

Australian Nursing and Midwifery Council. (2008). National Competency Standards for the Registered Nurse. Dickson, ACT. (http://www.anmc.org.au/)

Boston, C. (2002). The concept of formative assessment. Practical Assessment, Research & Evaluation, 8(9).

Boud, D. (2007). Reframing assessment as if learning were important. In Rethinking assessment in higher education, ed. D. Boud and N. Falchikov, 14-25. London: Routledge.

Bransford, J.D., Brown, A.L. and Cocking (2000). The Design of Learning Environments: Assessment-Centered Environments. In How People Learn: Brain, Mind, Experience, and School. Washington, DC, National Academy Press, pp. 131-154. http://www.nap.edu/openbook.php?record_id=6160

Briguglio, C. & Howe, J. (2006). Critical perspectives: Students' expectations of difficulties they may face in undertaking their degree. In Critical Visions, Proceedings of the 29th HERDSA Annual Conference, Western Australia, 10-12 July 2006: pp 50-56.

Candy, P., Crebert, G. & O'Leary, J. (1994). Developing lifelong learners through undergraduate education. Commissioned Report No. 28. NBEET. Canberra: AGPS.

Colburn, A. (2009). An Assessment Primer. Science Teacher, 76(4), 10.

Elder, C., & von Randow, J. (2008). Exploring the utility of a web-based English language screening tool. Language Assessment Quarterly, 5(3), 173-194.

Huxham, M. (2006). 'Extended induction tutorials for 'at risk' students' In Cook A, Macintosh K A and Rushton B S (eds) (2006) The STAR (Student Transition and Retention) Project: Supporting Students: Tutorial Support. University of Ulster, Coleraine.

Lau, L. K. (2003). Institutional factors affecting student retention. Education, 124(1), 126-136.

Lawrence, J. (2005). Addressing diversity in higher education: Two models for facilitating student engagement and mastery. In A. Brew & C. Asmar (Eds.), Higher Education in a changing world. Research and Development in Higher Education, 28. Proceedings of the 2005 HERDSA Annual Conference (pp. 243-252). Sydney: HERDSA.

Peach, D. (2005). Ensuring student success - the role of support services in improving the quality of the student learning experience. Studies in Learning, Evaluation, Innovation and Development, 2(3), 1-15.

Scaife, J. & Wellington, J. (2010). Varying perspectives and practices in formative and diagnostic assessment: A case study. Journal of Education for Teaching: International research and pedagogy, 36(2), 137-151.

Tumen, S., Shulruf, B., & Hattie, J. (2008). Student Pathways at the University: Patterns and Predictors of Completion. Studies in Higher Education, 33(3), 233-252.

Wimshurst, K. & Allard, T. (2008). Personal and institutional characteristics of student failure. Assessment & Evaluation in Higher Education, 33(6), 687-698.

Please cite as: McNaught, K. & Alliex, S. (2011). Strategy to educate nurses for the profession. In Developing student skills for the next decade. Proceedings of the 20th Annual Teaching Learning Forum, 1-2 February 2011. Perth: Edith Cowan University. http://otl.curtin.edu.au/tlf/tlf2011/refereed/mcnaught.html

Copyright 2011 Keith McNaught and Selma Alliex. The authors assign to the TL Forum and not for profit educational institutions a non-exclusive licence to reproduce this article for personal use or for institutional teaching and learning purposes, in any format, provided that the article is used and cited in accordance with the usual academic conventions.


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