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Supporting Students in the First Year of an Undergraduate Nursing Programme: The Enhance Project

In response to the current QAA Scotland (2005a) enhancement theme, focussing on the first year experience in higher education, a team of academics at the School of Nursing, Midwifery and Community Health (NMCH), Glasgow Caledonian University, have introduced a comprehensive approach to induction in the first year of learning. The Enhance Project, although not a conventional research project, is an action-based approach that utilises a multi-method approach to data collection and evaluation. The project currently supports the academic skill development of over 600 first year nursing students and is now focussing on the first year of practice-based learning; promoting enhanced theory/practice integration. This paper discusses the importance of getting it right in the first year of higher education and provides an overview of the project detailing the findings of the primary spiral of activity. The project is an evolving practice-based initiative that aims to enhance student learning in the areas of academic and clinical practice.

Keywords: first year experience, academic skill building, action research/action learning, evaluation

In Scotland, within the post ‘92’ sector, there is a diverse student population on campus, with common requirements and specialised, discipline related needs (QAA 2005a). The Quality Assurance Agency (QAA 2005a) identifies key issues in first year, including integration, preparation, perception and personal characteristics.

The landscape of Scottish higher education is changing and the student population increasingly diverse. In order to respond to a growing number of non-traditional students, Universities have to equip first year students with the skills and knowledge required to act as ‘autonomous and independently motivated learners’ (QAA 2005b p1). Induction should provide both generic information and take account of the needs of sub-groups within the wider first year such as school leavers, international and mature students.

In 2006, a small team based in the School of Nursing, Midwifery and Community Health (NMCH), Glasgow Caledonian University, introduced an academic skill building project aimed at all first year undergraduate nurses. The Enhance Project although not a conventional research study, is an action research project that incorporates aspects of action learning. Dick (2006), in a review of action research literature, observes that ‘action research and action learning continue to grow closer together’ (p446). Both involve periods of reflection, a learning or project team and both approaches evaluate change in practice. Action learning is a process traditionally associated with organisational change in industry; however, this approach has also been successfully used in education to implement or revisit an aspect of practice (Mead et al 2006). In common with action research, action learning involves periods of action and reflection within a collaborative and supportive group environment. Mead et al (2006), state that in action learning, new knowledge emerges through problem identification and questioning, leading to ‘new insight and the re-interpretation of existing knowledge’ (p177). The Enhance Project borrows from both these approaches; it is a hybrid, adapting over time to meet the evolving aims of an applied, pedagogical practice development agenda.

The project aims to identify and respond to the clinical/academic practice needs of first year nursing students in the area of professional and academic skill development. Waterman et al (2001) state that ‘knowledge may be advanced through reflection and research, and qualitative and quantitative research methods may be employed to collect data’ (p11). Reflecting this approach, a number of qualitative and quantitative evaluative interventions are in progress. These include focus groups with staff, students and clinical practitioners, simple questionnaires and critical debate and discussion. The focus of this article is the first spiral of activity, promoting academic skill development in the first year of nursing.

First impressions count and directly influence the ability of the student to adapt to a new learning environment. Life at University presents challenges for all students, however, the multi-factorial and complex needs of beginning students indicates that they should be regarded as a discrete population (Edward 2003). Edward (2003) believes that induction must ‘inform, involve and orientate the entrants and dispel the impersonal image’ (p227). The literature suggests that students, who do not adapt to the higher education environment in the early part of first year, are more likely to leave. Tinto (1993) initially identified the transitional induction period as key to retention, however Edward (2003) observes that since Tinto uncovered this as a ‘key factor in the students’ departure process’ little further research has been undertaken (p227). The CHERI (2004) report identifies three phases within first year: pre-entry, on-course and transition and highlights the need to provide the right information at the right time. Analysis of why individuals withdraw from University shows that, often it is not solely down to academic failure. Pitkeithly and Prosser (2001) suggest that many students leave from second and third year because of ‘events that occur in the first year’. They conclude that in order to minimise attrition rates in first and subsequent years of tertiary education ‘a process of social and intellectual change in first year teaching’ may be required (p186).

Ozga and Sukhnandan (1998) suggest that in the longer term, responsibility for non-completion lies with both the student, who fails to acclimatise either academically or socially and the institution which may not be suitable for the student either academically or socially. They maintain that preparedness for entry, not only to higher education (HE), but to the individual’s chosen institution is vital for a successful first year. This implies that a level of preparation should be ongoing prior to entry, ensuring that pre-entry information is accurate, timely, and most importantly realistic. Cook and Lowe (2000) suggest that while key interactions in first year are between students and university staff, there are also challenges associated with independent living and learning in HE.

Much of the work associated with the initial transition period has roots in the adaptation process. Progression to higher education represents a major transition for all new students ‘that often involves the development of new life-skills, new friends, new community and new approaches to learning’ Induction (QAA 20005c p5). In nursing, first year students have to become accustomed to new ways of learning and new communities in both the clinical area and the academic environment. Carr (2005) suggests that learning and teaching in the clinical area is both ‘complex and challenging’ (p333) and that in the first year students need to begin to develop and articulate practice knowledge. Durkin and Main (2002) suggest that induction should be subject related at all stages, to introduce the student to the discipline as well as to the academic expectations of the institution. Some students find adaptation more difficult than others. Students who fail to thrive both socially and academically in their first year may, at best, live with this unpleasant experience for their undergraduate years or at worst, withdraw from HE altogether (Cook and Lowe 2000).

Associated, specifically tailored assimilation programmes are crucial to students’ success and to their sense of belonging to the institution (QAA 2005c). Student motivation is also essential for a successful undergraduate experience. The desire to learn for reward (extrinsic motivation) rather than for learning for immersion in the learning process (intrinsic motivation), is an acknowledged challenge noted in the literature as motivation traits influence student learning behaviours (Seale et al 2000). Entwhistle et al (1974) discuss the effect of this factor on student success, suggesting that a student who is extrinsically motivated will focus on what is required to achieve a satisfactory assessment, resulting in restricted and narrow learning. A student who is intrinsically motivated however, is interested in the broad subject area and therefore more likely to engage in a wider learning agenda.

The student profile is changing; a greater percentage of the population access HE than when Entwhistle et al discussed motivational theory in 1974, many have outside commitments and an increasing number have outside employment. Extrinsic motivation therefore may now be a student survival technique. Seale, Chapman and Davey (2000) maintain that relevance of learning is important, indicating that students value content that is of direct relevance to them, such as material that underpins the development of clinical skills. Such skills are directly linked to the successful completion of mandatory academic and clinical assessment.

The QAA (2005a) highlight the need to identify and support sub-groups within first year, such as, school leavers, international and mature students. The first year in the School (NMCH September 2006 intake) represent a broad range of backgrounds. These include School, Further Education, University (not necessarily post-graduate), second career and entrants (mainly mature), from the general population. Their ages range from 17-55, the majority are female, aged between 17-25 (65%), enter from School (30%) or Further Education (28%), however an increasing number are mature entrants (22%).

Wingate (2007) expresses the view that despite the change in the student population, ‘traditional expectations towards students have not changed: they are to manage their learning and acquire academic literacy independently’ (p392). Taking the example of academic wiring, a key measure of success in many courses, Wingate finds only patchy provision and limited additional support within the UK sector. She comments that although research studies have tended to focus on non-traditional students, the National Audit Office (2002) finds that conventional students also lack preparedness for university life.

Edward (2003) comments that many study skills programmes form part of ‘freshers week’, held before the beginning of term. These sessions however focus more on organisational aspects of studying and are likely to be delivered in large lecture hall or theatre. Wingate (2007) comments that:

‘Clearly, more interactive and student centred induction activities that help students bond with peers, to meet their lecturers and feel accepted by them, and to gain a sense of belonging are needed’ (p399).

The Enhance Project moves academic skills out of the lecture theatre and into small interactive groups led by subject lecturers (Wingate 2007). The project evolved from school-based debate and discussion on the status of students as independent learners. Academic support is provided for all learners; however, the amount and time dedicated to this activity often lacks consistency. Macdonald (2004) believes that within a traditional University setting, encouraging students to develop the skills of independent learning and self-leadership is a gradual and developmental process.

To identify the needs of first year nursing students in the area of academic skill development, to respond to those needs with the implementation of a skills development programme and to evaluate the effectiveness of this programme.

Action research is grounded in practice; involves change and enhancement and is founded on collaborative working. The process builds from an initial period of critical self or peer focussed reflection and progresses to cycles of reflection, evaluation and action (Hart and Bond 1995, Holter and Schwartz-Barcott 1993, Hope 2003). It is an approach to, rather than a specific method of, research. It is primarily concerned with development of an applied research agenda (Meyer 2006). Action research is commonly used in applied professions, such as nursing and teaching, to challenge, change or improve practice (Tolson et al 2005). It involves collaboration between the researcher and the researched. In contrast to traditional approaches, action research is a democratic and participatory process, involving collaborative working with service users and providers. The researcher is not the expert and all views are of equal importance. An eclectic approach to data collection is acceptable and researchers use whatever methods best address the problem to be solved (Meyer 2006).

The project team, reflecting the philosophy of action researchers worked in a flexible, responsive and collaborative way. The project researcher was a member of lecturing staff and as such, immersed, professionally in the first year environment. The relationship between the researcher and the researched is at times criticised within this framework as too close, robbing the researcher of objectivity (Karim 2001). Conversely, the very closeness of the relationship may result in more upfront, honest and valid data (Karim 2001). Ravitch and Wirth (2006) discuss the dual role of the practitioner/researcher and maintain that difficult choices may need to be made. The researcher has to constantly evaluate their role within both settings, an ongoing state of negotiating priorities in a complex situation, where issues of ‘identity, positionality, power, social location and institutional politics’ constantly change and unfold (Ravitch and Wirth, 2006, p77).

The Enhance Project reflects a mutual-collaborative and interpretivist action approach, brining together students, academics, clinicians and managers to discuss, develop, trial and monitor potential interventions and solutions (Meyer 2006). The process followed three main phases. Firstly the project team explored the nature of the problem through discussion and focus groups with both staff and students. The programme that evolved from these discussions was implemented with all first year undergraduate nurses and the intervention was evaluated in the light of the students’ perspective on change effectiveness and achievement (Meyer 2006). There are parallels between action research and action learning. Raelin and Raelin (2006), writing on contemporary approaches to action learning in practice, describe a process where the first stage of initial group discussion leads to the (second stage) formation of a learning team and then to the launch (third stage) of a project that makes use of new knowledge and practices.

The School Research Ethics Committee granted initial ethical approval for the project. Reflecting the issues raised by Meyer (2006), ethical approval has been secured over time, in a staged and planned manner as the activity spirals have evolved.

The project team began with a period of reflection and critical dialogue, questioning the status of undergraduate nursing students as independent learners. Their primary aim was, to incrementally make sense of and begin to understand the academic needs of the first year student nurses and those staff who supported their development. Informal discussion and debate with both staff and students indicated that there was a general desire to build in a more structured approach to academic skill building.

From 2005-2006, the project researcher and project leader collaborated with colleagues, at team meetings /academic forums and with students (at all levels) within the School, to explore the nature and extent of the current support for first year nursing students The following subject areas were identified as important in discussions with both students and staff.

Based on these identified areas, a programme of twelve student-centred, interactive, small group sessions was developed and piloted with two groups of first year undergraduate health/nursing students. The programme of was facilitated by first year academic staff (Andrew et al 2007).

The perceived effectiveness of the pilot programme was evaluated using focus groups with involved academic staff (2) and students (1). Attendance at the focus groups ranged from 5-10 per group (Andrew et al 2007). Focus groups have been used as a tool to collect qualitative data for over 20 years and their advantage is described as ‘the dynamic nature of the interaction achieved with little input from the facilitator’ (Millar et al 1996 p195).

The contents of each group was discussed and agreed in advance by the project team. Appendix 1 details the content of the student focus group schedule. The project research advisor the project worked with the group facilitator to ensure the questions were both valid and appropriate. The facilitator had previous experience of group work in both clinical and educational settings. The team had to implement an evaluation strategy in a very short space of time and within a limited budget. Focus groups presented as an ideal vehicle as they are time, resource and financially effective (Gray-Vickery 1993).

The results of the preliminary focus groups were encouraging. Students reported positively on the majority of facilitated sessions, finding them useful and informative. Staff members were also positive, discussing characteristics of and challenges for first year students in relation to the pilot sessions (Andrew et al 2007). The report focussing on responding to student needs (QAA 2005a) identifies issues of adaptation, independent learning and culture change at a national (Scottish) level. The project focus groups corroborated these findings at a local level (QAA Scotland 2005a). From the findings, it became clear that both staff and students thought that adjusting to a higher education culture was an important factor. Students identified the need to acquire skills to help them fit into and cope with student life. Academic staff identified the need for a culture shift, moving towards a culture of independent learning. They identified this process as a challenge for both students and themselves.

The student and staff responses influenced the final content and delivery format of all sessions. The project researcher spent time with all first year academic staff and attended team and module meetings to ensure that those involved were comfortable with the content and delivery format of the material. The findings of the focus groups highlighted the need to build academic skills and indicated the importance of linking theory to practice (Andrew et al). The sessions were adapted and changed to incorporate student and staff observations.

From September 2006-May 2007 a programme of twelve activity-based interactive sessions were delivered weekly, over one academic year (six per semester). They were facilitated by first year undergraduate lecturers to groups of (approximately) 20 students. Throughout this process the project researcher worked as part of the first year teaching team, attending team meetings facilitate discussion and ensure that both staff and students had access to appropriate resources required to underpin and sustain a student centred approach.

In recognition of the need to link theory and practice, the project researcher worked with staff teams to discuss and decided on key learning landmarks within the first year. The sessions were constructively aligned with identified curricular benchmarks (Biggs 1999).

Educational evaluation is described as the ‘systematic appraisal’ of teaching and learning (Wilkes and Bligh 1999 p1271). Leathwood and Philips (2000), argue that action research is a beneficial approach to educational evaluation, as it is relevant to both subject and learning contexts. As previously noted, the project researcher is also a member of academic staff. Throughout the period of implementation, working collaboratively with peers and students, she continuously gathered data in both formal and informal ways, ranging from team based discussions and critical debate, to formal educational evaluation.

To establish the overall effectiveness of the programme a simple, satisfaction questionnaire was distributed to all first year students; this is shown in appendix 2. The questions were straightforward, seeking only the information needed for the first action spiral (Murphy-Black 2006). The questions sought to establish whether or not, the students found the overall programme useful and to ascertain if they thought it would be of continuing use. Of the 480 questionnaires distributed to first year students, through the network of lecturers, 349 were returned. The data was analysed using SPSS (statistical package for the social sciences). The response rate was 70%. Although 80% is the general aim, the response rate was large enough for the findings to be useful (Murphy-Black 2006).

Students were asked to evaluate and rank the sessions from two opposing positions. In Table 1, students were asked to rank sessions as most useful (most useful is defined as the greatest number of students agreeing). In table 2 they were asked to rank sessions as least useful (least useful defined as the greatest number of students agreeing). The inconsistencies in the results provide an insight into the way that the students completed the questionnaire.

		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	PBL	4	1.1	1.1	1.1
	Adult Learning/Mind Mapping	10	2.9	2.9	4.0
	Learning/Time Management/Organisation	17	4.9	4.9	8.9
	Listening/Reading/Note Taking	10	2.9	2.9	11.7
	Literature/Referencing/Annotation	45	12.9	12.9	24.6
	Reflection	13	3.7	3.7	28.4
	Intro/support services	20	5.7	5.7	34.1
	Plagiarism	30	8.6	8.6	42.7
	Critical Thinking	27	7.7	7.7	50.4
	Academic Writing	105	30.1	30.1	80.5
	PDP	39	11.2	11.2	91.7
	Transition	8	2.3	2.3	94.0
	No Response	4	1.1	1.1	95.1
	All Useful	17	4.9	4.9	100.0
	Total	349	100.0	100.0

		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	PBL	32	9.2	9.2	9.2
	Adult Learning/Mind Mapping	56	16.0	16.0	25.2
	Learning/Time Management/Organisation	31	8.9	8.9	34.1
	Listening/Reading/Note Taking	25	7.2	7.2	41.3
	Literature/Referencing/Annotation	10	2.9	2.9	44.1
	Reflection	6	1.7	1.7	45.8
	Intro/support services	73	20.9	20.9	66.8
	Plagiarism	33	9.5	9.5	76.2
	Critical Thinking	11	3.2	3.2	79.4
	Academic Writing	5	1.4	1.4	80.8
	PDP	5	1.4	1.4	82.2
	Transition	10	2.9	2.9	85.1
	No Response	49	14.0	14.0	99.1
	All Unhelpful	3	.9	.9	100.0
	Total	349	100.0	100.0

In table 1, academic writing is considered, by a clear majority (105 students), to be the most useful. In table 2 however, this not the case, as academic writing scores jointly with personal development planning, a session introducing the development of a clinical portfolio, integral to the first clinical placement (5 students). Although there are inconsistencies across the findings, (the response to the session introducing the support services is again inconsistent), the most popular sessions shown in both tables, are those aligned with immediacy. The least popular, (with the exception of personal development planning) are more general and less focussed.

Overall, the majority of students found the sessions to be effective (Figure 1), 75% stated that they found all sessions to be effective or very effective, only a minority were unsure (18%) or thought that they were not effective or not very effective (7%).

These percentages changed moderately when the students were asked about their perceptions of usefulness of the sessions in the future (Figure 2).

Only 68% thought that the sessions would be very useful or useful, the remainder thought that they would not be very useful (14%) in the future. Again 18% remained unsure. These findings largely reflect CHERI (2004) and QAA (2005c), highlighting the need to respond to student needs appropriately, providing the right information at the right time.

The QAA (2005c) states that an induction period should include the development of both computing and e-learning skills. In addition to the programme of academic activities, a virtual Learning Environment (VLE) was designed to complement the face-to face activities. All sessions were posted after delivery and the project researcher posted recorded video and audio presentations. To encourage the students to access the website and to launch the project, prizes such as study skills handbooks, memory sticks and pens were raffled at the start of first year. Students were asked to log on to the website to establish whether they had won. The questionnaire revealed that 46% accessed the VLE; the remainder either had not accessed it at all, or were unsure whether they had accessed it successfully (54%).

A major limitation, identified at the outset, was that of facilitator consistency. There were twenty small groups and a similar number of facilitators involved. To ensure a basic level of continuity, the project researcher coordinated all the sessions and delivered them to each facilitator in the same format, at the same time. All materials and comprehensive facilitator prompt notes were included. The project researcher was also a member of academic staff and involved with first year teaching. This dual role, as previously discussed, can be challenging to manage. To promote openness and clarity, the researcher spent time with all first year lecturers in groups and individually, explaining any implications of this dual position. The issue of role duality is also something that the project team had not really considered at the outset of the project and the difficulties of maintaining a foot in both camps, although outwith the scope of this article merits further investigation.

The project team could not regulate the actual delivery of the sessions. It is acknowledged that the evaluation of both the sessions and the overall programme may have been directly influenced by the approach and method of individual facilitators. The project was also constrained by the demands of the curriculum. The timings and delivery of the sessions were designed to be simultaneous, however it was difficult to regulate this as facilitators had to respond to the demands of both the time-table and the student body.

The data collection approach was also a limitation. A simple questionnaire can only provide basic information and no data, on this occasion was collected on the supportive nature of interactivity with peers or lecturers.

The students did not consistently rank the sessions and that is evident in the findings. They did however demonstrate sufficient consistency to allow some key points to emerge. The main findings in this study relate to immediacy, and focus and motivation. Firstly students were aware, from the beginning of their programme of study, that they would have to start preparing and submitting written assignments within a short time period. The sessions that were more favourably evaluated were those that connected directly to preparation of assignments. The exception to this was the session that focussed on personal development planning (PDP).PDP was however linked to the development of the mandatory integrated clinical/academic portfolio which was again of immediate relevance to the first clinical placement and this finding directly reflects that of Seale et al (2000).

Secondly, those sessions less favourably evaluated tended to be more general and less focussed, such as adult learning and time management. This may have occurred because at the point of delivery students could not see the immediate relevance. Although the majority of students found the sessions both effective and generally useful, those that were linked to assessment were rated most useful. This finding would appear to support the idea of extrinsic motivation, where learning is valued chiefly because it is directly linked to assessment and immediacy. This finding also indicates that extrinsic motivation starts in the first year of an undergraduate programme, suggesting that encouraging students to value learning and look at the bigger picture, characteristics of intrinsic motivation, requires a supportive and developmental academic framework.

The supportive nature of small group working, in relation to motivation, interactivity and peer support was not investigated as part of this evaluation. This omission meant that an opportunity to further explore the findings and expand on the important areas of motivation, peer and lecturer support that are identified in the literature was, on this occasion missed.

First year is challenging for students in HE and the evidence appears to indicate that although withdrawal is a complex mix of both social and academic issues, the use of programmes, such the Enhance Project do have something to contribute to the creation of a positive initial experience. The literature indicates that all students, not just those from non traditional backgrounds, require help to develop academic skills. The need to use academic skill sessions as more than just information giving in large groups has also been highlighted. The sessions should be facilitated in small groups to encourage interaction with both peers and lecturing staff from the start of the undergraduate journey. There is also an argument to be made for a more thoughtful approach to the delivery of skill development sessions. To begin to relate theory to practice, key sessions could be integrated into the first year curriculum, over a sustained period of time, avoiding induction overload.

The Enhance Project has arisen from an identified need to promote the growth and development of independent learning skills. Underpinned, by an action research framework and borrowing from action learning, ongoing development is informed and guided by the findings of focus groups, questionnaires and critical debate and discussion. The results of the evaluation of the programme although at times inconsistent, identify the input and subjects most valued by the students. The issue of student motivation is discussed frequently in the literature, mainly concluding those who are largely extrinsically motivated may be less fulfilled by their university experience. However further work is required to investigate this in the light of changing student profiles, external work commitments and wider access policies.

Recognising the need to expand on this work, the project team have organised events where students, academic staff and clinical colleagues collaborate to identify wider academic/practice based needs of first year student nurses. Students need to feel academically and professionally involved and they identify heavily with the practice role. Stakeholders from both academic and clinical backgrounds have clearly identified integrated clinical/academic support as a first year priority. The project team have continued to work collaboratively with students, peers, clinical and academic colleagues to further identify and address the academic and clinical needs of nurses in their first year of undergraduate education.

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Now that you have completed Enhanced Induction, the Project Team would like to evaluate the sessions delivered; this evaluation will include the sessions from both Semester A and B 2006/7. Please note that the information from this evaluation may be used by the Project Team in any or all of the following:

With this in mind we would be very grateful if you would complete the attached questionnaire.

It should be made clear that completing this evaluation is not compulsory however, please be assured that we value your comments and hope you will contribute. Please also be assured that all submitted evaluations will remain anonymous and with this in mind please do not enter any personal information on the form.

Should you wish to discuss this matter further please contact a member of the Enhance Project Team at any time.

When completing this evaluation please choose the most appropriate answer for you.

………………………………………………………………………………

* Corresponding author

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