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Biomedical Journal of Scientific & Technical Research

November, 2019, Volume 23, 2, pp 17274-17280

Research Article

Research Article

Dynamics of Nursing Education; a Key Factor in Student Satisfaction: A Qualitative Study

Zohreh Vanaki1 and Ashrafalsadat Hakim2**

Author Affiliations

1Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. School of Medical Sciences, Tarbiat Modares University, Tehran, Iran

2Nursing Care Research Center in Chronic Diseases, Department of Nursing, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Received: November 18, 2019 | Published: November 27, 2019

Corresponding author: Ashrafalsadat Hakim, Nursing Care Research Center in Chronic Diseases, Faculty member, Department of Nursing, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

DOI: 10.26717/BJSTR.2019.23.003877

Abstract

Background and Aims: The interest and satisfaction of the field of study is one of the most important factors affecting the education and success of the students. In relation to student satisfaction, a research was conducted with the aim of explanation of understanding the satisfaction of undergraduate nursing students.

Methods: This study is a qualitative approach and content analysis method which was conducted with ten students of nursing studying at the second to fourth year. Results: The findings of the study showed that the students are dissatisfied because the education does not have the necessary dynamics. The most important factor in students’ dissatisfaction is “lack of teachers’ competence in planning education and learning.

Conclusion: According to the findings, managers of nursing education need to pay attention to educate students with professional competence, improving the learning environments and empowering nursing teachers.

Keywords: Satisfaction, education, Nursing, student

Introduction

Satisfaction is the customer’s response to the success of the organization. Indeed, satisfaction represents the level of desirability in the customer in reaction to the characteristics of the services provided by organization Gupta et al. [1]. In a competitive environment where organizations are competing to attract customers, their satisfaction is a key element in the acquisition of excellence and an important factor for the success of any organization because it leads to profitability and customer loyalty to the organization Manuel [2]. However, in the case of dissatisfaction, this experience can be used as a form of negative propaganda against the organization Saad Andaleeb et al. [3]. Therefore, evaluating satisfaction concerning the field of study in each faculty is one of the fundamental problems of that faculty and an integral component of its activities in the field of organizational behavior and performance. Moreover, considering that the interest and satisfaction of the field of study is one of the most important factors affecting the education and success of the students; attention to this issue should be placed on the top of the educational planning priorities Fattahi et al. [4].

There is a relationship between the level of satisfaction concerning the field of study and academic achievement in the students’ Edraki, et al. [5]. Another important factor that causes students’ interest and motivation in their field of study as well as the satisfaction of the graduates from their relevant jobs is the level of satisfaction concerning the field of study and the relevant job, social status, income and the difficulty level of the field and job. Borjian Borujeni, et al. [6]. On the other hand, studies have shown that over 90% of students are satisfied with their field of study and have a positive attitude toward their educational field Rejali, et al. [7]. Among causes of these differences; it can be referred to university education programs and the role of faculties, educational groups and professors on the improvement of attitude toward the field of study and satisfaction concerning the field of study Behnampour, et al. [8]. In this regard, Löfmark, et al. [9] declared that educators and university professors are valuable resources in preparing students for the reality of their professional role.

Numerous studies have shown that students’ previous knowledge concerning the field of study, social prestige, job description, job prospects, the relationship of educators, university professors and hospital staff with the student, the type of university, the educational facilities of faculty and relevant management techniques are the most important factors in satisfying students concerning their field of study. According to the results of researches, there is a positive relationship between the management process and customer satisfaction. As functional quality plays an important role in customer satisfaction; Customer satisfaction is dependent on consumers’ experience and their reaction to the behavior of provider during service encounter Abdullah, et al. [10]. It is worth mentioning, by examining quantitative studies in nursing students’ satisfaction, it was determined that providing data in this context is ambiguous and limited. Therefore, the researchers decided according to their experiences about satisfaction of nursing students to perform a qualitative study aimed at assessing the satisfaction of nursing students. Because eventually the implementation of this research leads to qualitative improvement of cares and improving community health as well as the relevant authorities’ awareness from the existing deficiencies in nursing education system.

Methods

This research is a qualitative study with content analysis method in which ten students of nursing studying (the second to fourth year) of School of Nursing and Midwifery in Ahvaz were enrolled based on purpose with maximum variety of choices. The reason for choosing this method is the capability of qualitative method to provide researchers with a deep insight into the understanding and experiences of individuals Thomas Silverman, et al. [11]. Also, qualitative methods can specify subtle details of phenomena which are slightly difficult to present them with quantitative methods Corbin, et al. [12]. Inclusion criteria in this study were studying, studying at the second to fourth year, being satisfied to participate in the study, and completing the individual’s demographic questionnaire. Exclusion criteria were lack of tendency to participate in the study or educational leave at the time of the research.
The mean age of participants was 20.5 years and 98% were single. Data was collected using semi-structured interviews. This kind of interview is appropriate for qualitative researches because of its flexibility and depth Polit, et al. [13]. The sampling method in this goal-based study was continued to saturate the data so that the researcher was saturated with eight interviews in this interview, but for sure, she also performed 2 more interviews which the obtained data were the repetition of the previous data. The interview with nursing students was conducted in a place which was suitable for interviewing.

Ethical Approval

At the beginning of the interviews, the purpose of the study, being free to participate as well as freedom of action in withdrawing from participating in the study were explained. Meanwhile, written informed consent form was given to the students for participating in the study and recording interviews. They also were assured that the obtained data would remain confidential. The Ethics Committee approved this study under the code of ethics (IR.AJUMS. REC.1395.251). While recording interviews with a digital device, the student’s behavior and state and also what was observed during the interview were registered by the researcher as a note form Speziale, et al. [14]. The duration of each interview was varied between 45 minutes to 80 minutes. After completion of each interview, the participants’ speeches were carefully heard and the words were handwritten and due to the necessity of qualitative research for data immersion, the manuscripts were reviewed by the researcher several times. In order to analyze the data, the conventional content analysis method was used, and it was carried out simultaneously with data collection. Content analysis is beyond the extraction of objective content derived from textual data. In this way, latent themes and patterns can be identified from the content of the data of the participants in the research Spannagel, et al. [15].

For analyzing qualitative data, five steps are presented with this method:

1) To write the entire interview immediately after each interview;
2) To read the entire interview text for a comprehensive understanding of its content;
3) To determine the units of meaning and initial codes. 4) To classify the similar initial codes in more comprehensive classes.
5) To determine the latent content in the data and extract the main theme Graneheim, et al. [16].

So, in this study, the handwritten texts of the interviews were read and coded line-by-line. Then the codes with same meanings were placed under the categories and themes were placed within sub-themes based on similarity, matching, fit and relevance and eventually the analysis process was completed by identifying patterns. To assure data trustworthiness, researchers retained a continuous mental conflict with data. The verification method was also used by experts to validate the data. Then the obtained results of their opinions were compared with each other. Also, member check method was used so that the initial code taken from the interviews were presented for approval by participants in the study.
It should be noted that corrections were made in case of codes discrepancies with their viewpoint. The researcher also used a constant comparative analysis of data to assess the validation of data and tried to obtain validity and reliability of the data. Transferability was also examined by verifying the data obtained by two out-of-research students who had similar conditions to those who participated in the research. Interviews and initial encodings and themes were also re-examined by the researchers. To control the consistency of the data, the supervisors’ review method was used. For this purpose, some of the interview text was sent to several supervisors along with the relevant codes and classes to analyze the data and declare their viewpoint on the accuracy.

Results

Table 1: Process of forming categories related to theme of dissatisfaction factors of nursing students.

In the present study, the students’ dissatisfaction is included by the analysis of students’ interviews concerning the satisfaction with the field of study or main theme (Table 1). Overall, the results showed that students are not satisfied and the most important factors which lead to their dissatisfaction are university professors and educational environments. Therefore, it explains the main theme which determines these factors.

Students’ Dissatisfaction Factors

This category has two themes, professor’s performance and educational environments.

1. The performance of professors and educators included sub-themes such as lack of proper use of teaching methods, lack of proper use of evaluation methods, lack of guidance and educational supervision, lack of planning for content of education, lack of planning for student learning and lack of being update the information of professors.

2. One of the participants explains about the teaching method “Some professors, especially internal surgery professors’ words are not similar with the introduced books and exam questions. Their teaching method is not good and the teaching topics of some [professors] are different from books.” (No. 4).

3. Students believe that they do not have clear criteria for evaluating their professors. In the field of using evaluation methods, one student says “some of the professors do not have a proper evaluation method for the students, and instead of forcing them to read the books, their evaluation method is to make questions and says that the professor will take the exam from these questions.” (No. 1).

4. One of the most important factors affecting students’ satisfaction is the way of educational supervision by professors and generally at the faculty. Quote from one of the participants in this regard “In the clinical environment, educators (some) do not have a slight control on the students.” (No. 2)

5. In the field of planning for the student’s educational content, a student says, “The disparity between theoretical and clinical courses has prevented us from using internship courses.” (No. 3). Also, for planning programs, no comments are taken from the students and a predetermined program is performed which has been in existence for many years. “(No. 4).

6. Lack of being update the information of professors, in addition that they are not under control of school’s educational system make them (professors) to be inefficient for educational performance.

Educational Stagnation Environments

Educational environments are the result of establishing interconnections between professors and students and, in general, communication culture and other environmental features, including equipment, educational and disciplinary rules and regulations, etc. Interview results indicate that these environments have been stagnated and are not updated in accordance with the communication features. Regarding the lack of respectful communication with the students, A student states that “the amount of professional respect, what respect?? .................. ... with wonderment that what question is asked with looking of dissatisfaction.” Also, the student expresses about the satisfaction with the relationship status with them and with education personnel of the school? .... “(No. 8) Limited physical conditions also cause students’ dissatisfaction; one of them says that “all the students, including midwifery, medical and ... have a separate environment for the conference, except nursing students.” (No. 4). They believe that there is no special rule for the selection and replacement of managers.

Discussion

The purpose of this research is to understand the satisfaction of undergraduate students from nursing. The results show that students’ dissatisfaction of nursing education is due to its lack of effectiveness and dynamism because a dynamic educating environment is the result of effectiveness of teaching and playing the role of professor in educational management for acquiring the students’ competence. Education and learning of medical sciences at various levels require the existence of a regular educational program, qualified professors, appropriate educational environment and equipment and necessary technical facilities. The above factors interact with each other and effect on each other Hakim, et al. [17]. In this regard, nursing education has been developing rapidly in recent decades in the world as a part of the higher education system, which has been led to concern about the quality of education in this field Kim et al. [18]. In the world, nursing education faces challenges such as students’ competence, quality of education, and nursing curriculum Salminen et al. [19].
Although in Iran nursing education has a growth and development; it faces with some challenges. The existence of these challenges increases the importance of attention to the evaluation requirements khodaveisi, et al. [20]. Improving the quality of nursing education requires continuous review of the current situation to reform the weak points, and students as recipients of educational services are the best source for identifying the educational problems Kermansaravi, et al. [21]. Result’s content analysis of this study indicate that students are dissatisfied with the provision of educational services with appropriate quality, so that the inadequate use of teaching methods, the inadequate use of evaluation methods, lack of guidance and educational supervision, lack of planning for the content of education, lack of planning for student’s learning and lack of being update the information of professors were some cases which determined the problems of nursing education.
A study which was conducted by Splen et al showed that in general 70 percent of students expressed their dissatisfaction with the quality of nursing education programs; however, they were satisfied with clinical activities. The researchers concluded that it is necessary to use two standard questionnaires including student satisfaction with nursing education programs and clinical activities annually in nursing schools Espeland, et al. [22]. Other research’s results confirm that most of the studied units had low satisfaction with the conditions of the educational environment, clinical conditions, educators, social prestige, relationship with colleagues, and they had very low satisfaction or they were dissatisfied with nursing management domain. Therefore, in order to achieve more satisfaction of students in educational institutions, it should be strived to continuously improve the quality of service Hakim [23]. The findings of this study indicate that the participants were dissatisfied with the teaching methodology presented, as a student stated, “We are in the fourth semester and we do not have scientific knowledge with these teaching methods and we must enter to the hospital illiterately”. In the study of Kerman-Saravi, false teaching method, inadequate knowledge, inappropriate evaluation method and lack of sufficient clinical substrates, were some cases which revealed a defect or problem Kermansaravi, et al. [21].
The need to change the educational strategies in the classroom and clinical environment, the use of new teaching methods, the promotion of the level of educators, the appropriateness of the theoretical education with the professional needs, and the use of active educational methods were some cases which was emphasized to improve the quality of education in the studies Mooneghi, et al. [24]. Researchers have also suggested that teaching methods which increase critical thinking, especially active teaching methods such as group discussion and problem solving, should be paid attention more Navidian et al. [21]. Participants of this study expressed dissatisfaction with the process of implementing the assessment of theoretical and clinical courses and by the relevant instructors. “Some of the professors do not have a proper evaluation method for the student.” Research results also showed that 51.9% of the students were dissatisfied with the evaluation method and evaluated this domain as undesirable. It seems that most students believe that the existing evaluations are tentative and have multiple deficiencies and that the evaluation process is inappropriate in most cases and has many ambiguities Hakim, et al. [17].
In the study of Jacob, it has been indicated that major concerns were about the evaluation process, fears of discrimination, injustice and artificiality. The researcher also suggests that the educators directly involve the students and engage with them in order to overcome this problem Jacobs [25]. In this regard, paying attention to the effective evaluation of patterns and approaches, reviewing the dimensions and implementation of the assessment, improving the evaluation of theoretical and clinical education, paying attention to the criteria for admission of students, continuous evaluation of students, paying attention to the capabilities of teachers and clinical educators also were the results of khodaveisi, et al. [20]. The researchers also state that the condition of clinical education of nursing requires the provision of clinical facilities and equipment, reviewing tools and clinical evaluation processes, and not being available the precise and objective criteria to measure students’ practical skills may be one of the main reasons for their unexpected looking at monitoring and evaluation factor. Because evaluation is the determining level of learning and the essential pillar for the future planning Hakim, et al. [17].
The results of this study indicate the lack of precise supervision on educational activities so that the students express “Why do the education’s staff fail from handling the exam? Or, they don’t try enough to increase the information related to the ward, and in the clinical environment, we don’t do almost anything except blood sampling and TPR.” In some studies, the students expressed that their most actions in the sector was basic and routine actions such as taking medication and adjusting serum drops which they did them from the beginning of the first semester Hemmati, et al. [26]. In this study, participants’ remarks indicate the lack of supervision over the enforcement of disciplinary rules which led to students’ dissatisfaction. On the other hand, research results showed that although specific subjects were confirmed by the students in the domain of educator, the status of the domain of clinical environment and the monitoring and evaluation were not appropriate for the students Heidari, et al. [27]. In a study, Delaram et al emphasized that the effective evaluation in the clinical education requires a review on the clinical evaluation processes and their tools Delaram, et al. [28].

The results of the study indicate the lack of proper planning for the content of the education. In this regard, the results of the studies also suggest the existence of an insoluble problem of nursing education, which is the inconsistency between the faculty and the clinic, and a low correlation between theory and practice Kermansaravi, et al. [21,29]. Using new strategies and methods of teaching, providing theoretical information as a combination of clinical, education and basic sciences based on solving the problem, creating clinical situations for understanding the real clinical fields and teaching with the practice and creating the process of clinical reasoning can be used to prevent the separation of theory from practice Azemian [30]. Also, researchers emphasize in their study that evaluation of educational programs is another way of promoting and developing programs and leads to increase the efficiency and effectiveness of the programs khodaveisi, et al. [20]. The analysis of student interviews suggests that students are not planning for effective learning. “The goal of some professors is to teach only their booklet, not the students’ learning.” In traditional medical education systems, the time of the student will be spent to memorize a large amount of information, without being adapted this information to the goals of clinical work Kermansaravi, et al. [21].

Researchers recommend providing facilities and reviewing student evaluation systems due to the impact of nursing education on community health Heidari, et al. [27]. Therefore, it is important to pay attention to the effective factors in increasing the satisfaction of students such as the quality of theoretical education, clinical and evaluation processes, interactions and paying attention to the social prestige that ultimately lead to maintain the improving quality of education Hakim [31]. The results of the interviews indicate that there is no respectful communication with the students through the educational system. Professional communication helps to identify the person Saarikoski et al. [32]. Milzan’s results showed that 40.3% of the participants believed that the community has a negative view about nursing as well as a misunderstanding of the nursing profession. Also, the students stated that they felt disappointed and disturbed by this community’s view Milisen, et al. [33].

In the research of Kerman Saravi, unpleasant feelings, humiliating experiences, clinical experiences, and interpersonal communications respectively were the most important stressful factors in the clinical education environment from the students’ prospective Kermansaravi, et al. [34]. The results of a study in Hong Kong showed that one of the most important sources of nursing students’ stress in the clinical education environments is the way in which clinical instructors deal with them Chan So, et al. [35]. According to the students’ prospects, nursing staff support from students in new situations increases their self-esteem. According to researchers’ statements the nurses’ behaviors and physicians lead to satisfaction of the students to present a better job and increases the quality of care Poorghaneh, et al. [36-37]. Participation and coordination between educational and clinical collections needs creating an appropriate teaching and learning conditions, a sense of value, respect and consideration for nursing students in order to provide a safe, welcoming and supportive atmosphere in the clinical fields and make their acceptance possible as young forces of the profession. Responsibility of nursing educators and planners in effective management of educational and clinical fields is crucial for the support and guidance of nursing students Dinmohammadi, et al. [38].

Due to the analysis of students’ interviews, limited physical facilities have also caused their dissatisfaction. The results of the research also identified the lack of proper equipment and facilities in the clinical environment as an effective education barrier to the clinical environment. According to the students’ opinion, the lack of facilities in the clinical environment prevent providing quality services to patients Hemmati et al. [21,26,39]. However, the availability of clinical education facilities is one of the important factors for learning motivation, and the lack of these facilities causes disappointment and lack of goal in clinical learning Pourghane [29]. The results of the study confirm the lack of being updated the professors’ information and the effectiveness of clinical educators, as the students state, “We do not go to the internship to study, we are going to learn the work.” Undoubtedly one of the important factors in effective clinical education is the performance of educators. Because the educator is a bridge between theoretical and practical education. Implementing the education process through efficient educators can help students to achieve maximum clinical skills Kermansaravi, et al. [21].

Studies on clinical education show that these educations are not effective enough. For example, the quality of clinical education offered to nursing students can be effective on the students’ satisfaction on the provided education and will affect the provision of therapeutic services in the long term. Careful selection of people interested in practical and clinical education, evaluating and solving educational needs, organizing co-ordination meetings between instructors and faculty members, providing guidance and designing a clinical course plan can be effective in promoting clinical education and students’ satisfaction. Jaafar jalal et al. [40]. In this regard, the researchers have stated that inappropriate management of human resources and equipping them with nursing is one of the major organizational sources of organizational factors which can seriously damage the promotion of quality of care and nursing service and nursing professionalism Azemian [30]. In a research, the existence of repetitive issues in the clinical environment, the inefficiency of the clinical educator and the lack of being updated the information of some nurses were some cases of the students’ undesirable experiences in clinical learning, as the inadequate researches of clinical instructors were considered as one of the reasons for their undesirable learning experiences Pourghane [29].

On the other hand, the researchers state that by revising in the educational program in order to communicate between theoretical and practical education, the time interval is reduced between the lessons learned and the internship to give students enough opportunity to combine theoretical with practical issues Kermansaravi, et al. [21]. Learning in the clinical environments is an important part of the nursing student’s educational program. The effective and dynamic interaction of students with health care team members, educators, clinical environments and its elements leads to their professional development Dinmohammadi, et al. [38]. The results of the above studies were in line with the experiences expressed by the participants in the study. Education in nursing schools can be considered as an indicator of students’ dissatisfaction. If the causes of dissatisfaction are resolved, it will be expected that the education will be achieved to the effectiveness. In fact, it is estimated that the educational management structure and inadequate performance quality of nursing school’s educational managers affect the first group directly which are nursing students and their level of satisfaction.

Conclusion

According to the experiences of participants in this study who were dissatisfied with the educational programs (theoretical and clinical); it is necessary that the relevant systems are continually reviewed and evaluated in order to refine and promote the educational programs. However, it is obvious that this review and evaluation of the educational programs should be done regularly and annually to all clinical groups dealing with the client. Because the performance of these students and future graduates will have an important impact on the promotion and improvement of health services.

Acknowledgment

This qualitative study is part of a combined research project approved by Ahvaz Jundishapur University of Medical Sciences which with financial support that university is carried out (IR. AJUMS.REC.1395.251 / SDH -9507). Meanwhile, we appreciate the participation of students in this study.

Conflict of Interest Statement

Authors haven’t any potential conflict of interest.

References

Research Article

Dynamics of Nursing Education; a Key Factor in Student Satisfaction: A Qualitative Study

Zohreh Vanaki1 and Ashrafalsadat Hakim2**

Author Affiliations

1Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. School of Medical Sciences, Tarbiat Modares University, Tehran, Iran

2Nursing Care Research Center in Chronic Diseases, Department of Nursing, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Received: November 18, 2019 | Published: November 27, 2019

Corresponding author: Ashrafalsadat Hakim, Nursing Care Research Center in Chronic Diseases, Faculty member, Department of Nursing, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

DOI: 10.26717/BJSTR.2019.23.003877

Abstract

Background and Aims: The interest and satisfaction of the field of study is one of the most important factors affecting the education and success of the students. In relation to student satisfaction, a research was conducted with the aim of explanation of understanding the satisfaction of undergraduate nursing students.

Methods: This study is a qualitative approach and content analysis method which was conducted with ten students of nursing studying at the second to fourth year. Results: The findings of the study showed that the students are dissatisfied because the education does not have the necessary dynamics. The most important factor in students’ dissatisfaction is “lack of teachers’ competence in planning education and learning.

Conclusion: According to the findings, managers of nursing education need to pay attention to educate students with professional competence, improving the learning environments and empowering nursing teachers.

Keywords: Satisfaction, education, Nursing, student