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Baccalaureate Student Nurses' Study Habits Prior to Admission to Nursing Program: A Descriptive Qualitative Study
Baccalaureate Student Nurses’ Study Habits Prior to Admission to Nursing Program: A Descriptive Qualitative Study Rhea Faye D. Felicilda-Reynaldo, Jonas Preposi Cruz, Louise Bigley, Kathryn Adams PII: DOI: Reference:
S0260-6917(17)30078-3 doi:10.1016/j.nedt.2017.04.009 YNEDT 3522
To appear in:
Nurse Education Today
Received date: Revised date: Accepted date:
10 October 2016 24 February 2017 7 April 2017
Please cite this article as: Felicilda-Reynaldo, Rhea Faye D., Cruz, Jonas Preposi, Bigley, Louise, Adams, Kathryn, Baccalaureate Student Nurses’ Study Habits Prior to Admission to Nursing Program: A Descriptive Qualitative Study, Nurse Education Today (2017), doi:10.1016/j.nedt.2017.04.009
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT BACCALAUREATE STUDENT NURSES’ STUDY HABITS PRIOR TO ADMISSION TO NURSING PROGRAM: A DESCRIPTIVE QUALITATIVE STUDY
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Rhea Faye D. Felicilda-Reynaldo
Louise Bigley
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Kathryn Adams
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Jonas Preposi Cruz
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Author Notes
Corresponding Author: Rhea Faye D. Felicilda-Reynaldo is Associate Professor in the School of Nursing, Missouri State University, Springfield, MO. Mailing address: 901 S. National Avenue,
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Springfield, MO 65897, USA. Email: [email protected]. Co-Authors: Jonas Preposi Cruz is a lecturer in the Nursing Department, Applied Medical
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Sciences, Shaqra University in Saudi Arabia. Louise Bigley is Assistant Professor in the School of Nursing, Missouri State University, Springfield, MO. Kathryn Adams is Clinical Instructor in the School of Nursing, Missouri State University, Springfield, MO.
Acknowledgments
Funding: Data collection was funded through a faculty research grant sponsored by the Office of the Provost, Missouri State University.
Word Count: 4,930
ACCEPTED MANUSCRIPT Abstract Background: Faculty continue to observe students struggling as they adapt their study strategies to learn
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nursing core content.
to admission to the program.
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Design: This study used a descriptive qualitative research design.
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Objectives: This study described the study habits of Bachelor of Science in Nursing (BSN) students prior
Settings and Participants: A purposive sample of 19 BSN students (juniors [n=10] and seniors [n=9])
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from a 4-year public Midwestern university were included in this study.
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Methods: Two focus group sessions, using a semi-structured interview guide, were conducted in the spring semester of 2013.
Results: The four themes which emerged from the analysis of data were: “I just got it,” “I had a lot of
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time then,” “I studied alone” mostly, and “…a little struggle with the sciences.” Conclusions: The findings suggest the BSN students did not study much or employed poor study
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strategies during their years completing general education courses. Academic support is needed by students prior to admission to the nursing program so they can learn effective study skills and modify their study habits for easier adaptation to the rigors of nursing education. Keywords: nursing students, study skills, qualitative research, nursing education, pre-nursing, general education, biological sciences.
ACCEPTED MANUSCRIPT Baccalaureate Student Nurses’ Study Habits Prior to Admission to Nursing Program: A Descriptive Qualitative Study
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Educators widely recognize that students’ behaviors, skills, and approaches to learning are important factors of academic success (Bavi, Asilzadeh, & Haghighi, 2014). In a large scale meta-analysis
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of studies conducted in higher education settings, Crede and Kuncel (2008) found that study habits, skills,
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and attitudes rivaled performance with standardized tests and previous grades as predictors of academic achievement. At some point, students who have achieved academic success may find themselves having
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difficulty with school as they progress through higher levels, not because they lack ability but because of
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lack of study skills (Gettinger & Seibert, 2002). Developing effective study skills have been deemed as one of the most beneficial factors for students to achieve academic success (Aquino, 2011; Bulent, Hakan, & Aydin, 2015; Gettinger & Seibert, 2002).
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Study habits are developed throughout a student’s educational process. Research on readiness for college continues to show more and more students are entering college without the basic knowledge,
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skills, and habits of learning they need to succeed (Venezia & Jaeger, 2013). Colleges and universities place an importance on ensuring effective transition interventions are in place as student retention is a primary concern (Wernersbach, Crowley, Bates, & Rosenthal, 2014). Multiple resources are provided by colleges and universities (e.g. tutorial services for math and sciences, writing centers,a nd disability resources) to assist students in developing self-regulated learning skills and habits to help them in their transition to college-level learning. Furthermore, higher education institutions may provide students with preparatory courses that focus on developing study skills and critical thinking during their first semester. Wernersbach and colleagues (2014) found their preparatory course on academic skills improved college students’ study skill set and academic self-efficacy. As college students proceed to take upper-level courses, they may need to develop additional learning strategies and study habits to help them succeed in their chosen field, such as in nursing. In the United States, most Bachelor of Science in Nursing (BSN) students are not admitted to the program until late sophomore or early junior year. During the first two years of university studies, students are to
ACCEPTED MANUSCRIPT complete general education and nursing prerequisite courses (i.e., algebra, chemistry, nutrition, anatomy, physiology, microbiology), which then culminates to the formal application process for admission into the
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nursing major. Once admitted, students will then begin learning knowledge, skills, attitudes relevant to professional nursing practice. Due to the breadth and depth of knowledge students need to acquire in the
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nursing program, they should have information and numeric literacy skills (Forster, 2015; McMullan,
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Jones, & Lea, 2010), critical thinking and clinical decision-making skills (Hunter, Pitt, Croce, & Roche, 2014; Josephsen, 2014), a high reading comprehension level, effective methods for retaining information
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and retrieving information previously learned, grasp of test-taking strategies, and habits to manage time
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and stressful situations (Kaplan Nursing, 2016). Most of these skills should have been strongly developed during the first two years in college and, as such, should be considered learning habits of nursing students. However, faculty continually observe students struggling as they adapt their study strategies to learn
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nursing core content; thus, nursing faculty spend additional time helping students adapt new study skills and critical thinking strategies. To support faculty focus on teaching nursing core content, many nursing
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programs hire academic specialists whose role is to assist students in developing study skills and remediation. By providing academic support to students, pre-licensure nursing programs can increase nursing student retention and assist students in their goal of becoming a registered nurse. For nurse educators without academic specialist support, the initial action to effectively support students in their learning is to assess their study skills, habits, and academic behaviors. To researchers’ knowledge, there have been no published studies which described nursing students’ study strategies while completing general education and prerequisite courses. The purpose of this study is to describe study habits of BSN students prior to admission to the nursing program. To develop effective programs of academic support, faculty should assess not only students’ current study behaviors and habits, but also previous strategies used to have a holistic picture of the transition of learning (i.e., from general education to nursing specific)
ACCEPTED MANUSCRIPT Methods Research Procedures and Data Collection
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A descriptive qualitative research design was used to investigate the study habits of BSN students. The researchers interviewed the student participants once regarding their study habits, but decided to
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present study results in two parts due to volume of data analyzed. The two-part presentation of study
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findings provides scholarly audiences with a clear description of study habits used by US 4-year BSN nursing students in the two phases of their college life: pre-nursing and in the nursing program. In this
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manuscript, authors present the first part of the study results: BSN students’ study habits while they were
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in completing their general education courses and prerequisites as pre-nursing students. The study protocol was approved by the University Institutional Review Board. Junior and senior BSN students (N=107) from a 4-year public Midwestern university were recruited to participate in focus
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group sessions in the spring semester of 2013. First, an email invitation was sent out to all students admitted to the nursing program announcing the schedules of the focus group sessions. There were two
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schedules available: one for the juniors and one for the seniors. Both focus group sessions were scheduled during students’ lunch break between classes. The researchers also took measures to ensure the focus groups schedule would not be in conflict with any scheduled exam. Researcher contact information was provided in the email to encourage students to ask questions about the study or the participant’s role. The researchers visited each cohort during short breaks in their classes to recruit students to participate in the study. Specifically, information on the purpose of the study, research procedures (including audio recording of interviews), focus group session schedules, benefits and risks, and protection of participants’ rights were presented. After both email and in-person invitations, 19 BSN students (juniors [n=10] and seniors [n=9]) attended the scheduled focus group. Refreshments were provided as a courtesy to those who participated due to the lunch time schedule. Details about the informed consent were reiterated prior to the interview. All 19 students signed the informed consent and participated in the focus groups. A semi-structured interview guide (see Table 1) was used by the researchers to ask the participant questions.
ACCEPTED MANUSCRIPT Data Analysis and Ensuring Trustworthiness Both junior and senior focus group sessions were audio recorded with permission from
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participants. Immediately after the interview, the researchers listened to the audio recording two times for initial analysis of flow of conversation during the focus group. Transcription of the recording followed,
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which was organized according to the research questions presented to the students. Transcripts were read
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multiple times by the research team, and initial coding was completed to highlight the most common responses provided by students in both cohorts. These common responses were organized into a list
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according to the main topics of the interview questions: study patterns, time spent studying, studying in groups, accepting instructor support, and using supplemental instructional material. This list was sent to
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the participants for member checking. The participants confirmed researchers’ categorization of responses as valid.
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Further analysis of the interview transcript was completed by analyzing negative cases and narratives shared by the students to provide a more holistic picture of study habits. Four major themes
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emerged after in-depth examination of the transcript and discussion to confer data patterns found by researchers. The emerging themes were related to study strategies used by students, time spent studying, choices of socialization and setting for studying, and struggles faced during the pre-admission years. As students who were interviewed had already graduated from the nursing program, the research team decided to have current nursing students review the themes to determine if they were still relevant to the newer cohort of nursing students. Five nursing students (juniors [n=3] and seniors [n=2]) were recruited to complete additional member checking and were provided the list of themes and quotes for review. All students confirmed the themes were still relevant, and they too, had similar experiences as the original focus group participants. Based on the feedback provided, the research team finalized the thematic analysis. Due to the dual role of the researchers as both investigator and nurse educators, there is a possibility that prejudices formed regarding students' study habits. Researchers were encouraged to keep reflective journals to ensure that analysis is data-driven. Reflections were discussed during data analysis meetings to
ACCEPTED MANUSCRIPT compare whether researcher codes were data-driven or influenced by formerly formed notions of nursing students' study habits.
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Results The four themes which emerged from the analysis of data were: “I just got it,” “I had a lot of time
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then,” “I studied alone” mostly, and “…a little struggle with the sciences.”
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“I Just Got It [Understood]”
Both junior and senior BSN students were in general agreement that they did not do much
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studying prior to admission to the nursing program. The participants described studying general concepts
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of topics was the information they needed to succeed in their classes and assignments. Because they easily picked up information, they scheduled their study time to be as close to exam time as possible. Both junior and senior BSN students admitted to cramming during their pre-nursing years. Cramming is
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defined as “…the act of studying for an exam by memorizing facts at the last minute” (Arenas, 2014, p. 6). Some mentioned that they could study the night before and still successfully pass the test.
crammed.”
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“I crammed a lot for general education courses like history, English…I got an A even when I
“I really didn’t study much for those [general education] courses…general concepts were all I needed. I just got it and got a good grade” “I study a lot before an exam, usually the night prior to the exam. I did well [in those exams].” Study methods used prior to admission included: listening to lectures, skimming through the textbook, and rote memorization through the use of flashcards. A few students said they only needed to review information because it was covered in high school. Most students mainly used the professor's PowerPoint presentation notes to prepare for exams. A few students stated they wrote their own notes. Of those who mentioned note writing as a study strategy, they stated they used those notes to prepare for the class activities and exams. When asked how they took notes, all who wrote notes said “I wrote notes through my computer [or laptop].” One added: “My notes were added on professor’s notes [lecture presentations] in the PowerPoint.”
ACCEPTED MANUSCRIPT “Listening to the lecture was good. I learned a lot from it.” “I would come to class and some [of the lectures] were repeated from high school, especially for
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general education. I already knew those!” “PowerPoints were important. They were good study material and notes to prepare for the
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exams.”
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Most participants agreed their main reading strategy was skimming the textbook. A few students stated there were instances when they bought the books but did not open them. Reading as a study habit
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was dependent on the prompt of the instructor. They would ask their professor whether the exam would
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be based on information from the textbook or from lecture notes. The professor's response would determine which material they would read. Study guides provided by the professors prior to exams were also used by students to determine what to study. Supplemental instructional materials were not used by
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the students as they were considered “not needed” and “just additional expense.”
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“I literally [re]sold a book once for a general education course. I never opened it. It still had
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plastic on it when I took it to the bookstore.” “It was either the lecture notes or the book, they [professors] would tell us which to study if we ask them for guidance.”
The participants also mentioned how memorization was also commonly used. The nursing prerequisite sciences, specifically anatomy and microbiology, were courses most associated with the use of memorization. Flash cards were the most common memorization strategy. For others, they used web or phone applications, such as Quizlet, which use the same concept as the physical flashcards except for the electronic delivery of the study product. The students took turns asking and answering questions with a study partner if they had one. “I liked using them [flashcards] because they helped me, with like, remembering terms and definitions which are usually emphasized by the instructor in the class.” “Do you know Quizlet? It’s this really cool app where you can make questions to study the, like, major concepts of a class. It was most helpful for microbiology, anatomy and physiology.”
ACCEPTED MANUSCRIPT “I had a friend and we would trade questions [using flashcards]…she would ask, then I would answer. Really helped with anatomy.”
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It was interesting to note that when nursing students talked about how they studied prior to nursing school, the statements would either start with, “I just realized how…,” “I didn’t know it back
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then...,” or “I thought I was studying a lot then...” The researchers’ prompt of comparison of the study
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habits they used as pre-nursing students and while in the nursing program helped them realize how little effort was put into studying when they were still pre-nursing students.
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“I Had a Lot of Time Then.”
Every participant agreed that they spent so little time studying during their pre-nursing years
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compared to time they spend studying in nursing school. One participant described it as: “I thought I was [busy], but now I AM busy!” Another participant quipped, “I had a lot of time then.”
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When asked about the approximate number of hours to study for one course, the answer ranged from 30 minutes to an hour. Students indicated they had short study times because they already learned
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the material from attending class lectures. For most participants, completing assignments were also equivalent to study time. However, a few participants commented on how study times really varied depending on the class. For the prerequisite sciences, the students gave a range between two to five hours. “I would study for an hour or more if I had to do assignments…” “Well, depends on the class I’m studying for, I studied a little bit more for anatomy and physiology. Umm, 3 to 5 hours?” The participants also gave an estimate of the time they spent studying when multiple major exams were scheduled during a week, such as a midterm or final. The participants generally agreed on the following statement: “I would start studying two to three days when multiple exams were scheduled during the week.” The participants agreed they studied “…a little over seven hours” in total during finals week, when queried by the researchers. “During finals week, for anatomy and physiology, I studied a lot more than seven hours” was a response provided by another participant. When students were further
ACCEPTED MANUSCRIPT asked how many hours they would spend if course quizzes were scheduled for the week, a participant quipped: “Four to six hours is usually plenty of time to study”.
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“I Studied Alone” Mostly When asked regarding whether group studying was done during their pre-nursing years, students
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shared that they studied alone most of the time. The most common reason for not engaging in study
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groups was that they did not study for a long time and it was easier to study alone. The study location was not described as important. The participants shared that they could study wherever they would not feel
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distracted
“I would get distracted when I studied with somebody else because we would talk a lot. It became
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a socialization session so that’s why [I studied alone].”
“You could find me in the library or in the dorm for studying. Anywhere was ok, as long as I do
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not have distractions.”
The students were more likely to join study groups when they were taking the prerequisite
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science courses. They said they found it beneficial to discuss class content topics with other people because they would pick up information they did not know, and vice versa. Study groups were also a good way to study by testing each other. “Sometimes my classmates would pick up on things the professor said that I did not, and sometimes I would pick up things that they didn’t know…we would share information during study groups and we would learn. It was good [for everyone in the study group] in the long run [overall].” “My study buddy in physiology and I would quiz each other prior to an exam and it was such a help to me.” “…A Little Struggle with the Sciences…” In earlier themes, participants mentioned changes in habits when studying for prerequisite sciences, such as engaging in group study or increasing their study time. The reason most participants provided for these changes was they struggled a little bit learning the sciences. The BSN students likened the prerequisite sciences to their nursing courses, wherein some find they were having more difficulty
ACCEPTED MANUSCRIPT grasping information compared to general education courses. They realized they needed to change their study practices after they did poorly on the first exam in their prerequisite sciences.
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“I struggled a little with the sciences, especially physiology, so I studied harder for this course than all my other pre-nursing courses.”
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“I did poorly in my first physiology exam. I was a bit panicked because I know I needed to pass
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the course to get into the nursing program. When I was not doing well [in the course], I realized how I need to take more time studying for this.”
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“I would say, the nursing courses are like the sciences”. The level of difficulty is similar, except
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now we’re taking five sciences all at once.”
Students were also more likely to visit their instructors for help or clarification of lessons while completing the prerequisite sciences. One student shared how she never felt the need to visit professors
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during office hours when taking general education courses, but she visited her professor several times
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when she took physiology. Students said that they would visit professors when they “bombed their
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exams.” Bomb is an American slang verb which means ‘to fail’ (Cambridge Dictionary, 2017). Usually, professors would allow them to review their previous exams helped them determine what items they missed.
Discussion
Our study described the study habits of BSN students prior to admission to the nursing program. Participants interviewed for this study were admitted into a competitive, 4-year BSN program in a public Midwestern university. The average cumulative GPA of BSN students admitted in a cohort range from 3.5 to 3.7 on a 4.0 scale, which relates to a grade equivalent of B+ to A+; thus, participants have deemed themselves high-achieving students in their previous educational pursuits. Furthermore, a large percentage of the students bring in college-level courses from their freshman year through their high school’s dual credit program. With this student demographic, it may be understandable when participants relayed how they did not need to study in their general education and prerequisite courses because they thought they had learned information readily. Furthermore, some of the concepts in their general
ACCEPTED MANUSCRIPT education and prerequisite courses may have been repeat information from their high school courses. Thus, most students easily get a grade of A in the courses and labeled some assignments to be just “busy
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work,” instead of being substantial for future nursing courses. The students’ attitudes and behaviors towards studying led them to cram [study last minute]
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during examination time. Cramming is a technique often used to prepare for examinations and is a well-
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recognized study habit among students. While cramming may be seen as beneficial, it is not the best way to achieve the student's’ desired grade. This is because the neural connections being formed during the
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cramming process are temporary (Stafford, 2014). Therefore, cramming will not benefit the students for
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long-term memory, which is essential to learn advanced concepts from foundational information in nursing (Snelgrove, 2005). Our study findings are comparable to the results of the study conducted by Hartwig and Dunlosky (2012) on college students’ study strategies in the US, wherein 66% of the
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participants crammed information the night before the test. This is also similar to Alos, Caranto, and
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David’s (2015) findings wherein Filipino student nurses’ academic performance was highly impacted by
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the choice of studying randomly or when a quiz was scheduled. Our findings, however, is in contrast to the research on study behavior among US BSN students by Doll-Speck (2007). In her report, only 37% (n=397) of the students reported cramming before an exam, which implied that cramming as a study habit was deemed less favorable by the BSN students. The difference in the findings is due to the dissimilarities in the characteristics of the participants in each study as well as the purpose of the study. In our study, we interviewed junior and senior students and asked them to describe their study habits during their prenursing years, while the study of Doll-Speck (2007) surveyed 2nd to 4th-year students about their study behaviors during the nursing program. This difference may imply that pre-nursing students may be more likely to cram before examinations than those students in the nursing program. However, this assumption needs to be validated in future studies. The participants determined listening to lectures, skimming through the textbook, rote memorization through the use of flashcards, and, to a lesser frequency, taking notes as primary study methods were used during their pre-nursing years. They described that paying attention to their
ACCEPTED MANUSCRIPT professor’s lecture was an adequate way to grasp the main concepts of general education courses. Our findings are somewhat similar to Kiblasan, Abufayed, Sehari, Madamba, and Mhanna’s (2016) results
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that Libyan nursing students determined good lecture notes and presentations with visual aids from lecturers increase their motivation to study. While our participants found note taking during lectures less
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important, Sutherland (2003a) found first year nursing students from the United Kingdom (UK) valued
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copious note-taking. The nursing students would review their notes as soon as possible to make sense of the content (Sutherland, 2003a).
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The participants in our study also acknowledged the importance of memorization in pre-nursing
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courses. Most of the pre-nursing courses require memorizing terms, such as in anatomy and microbiology, which is foundational information to better understand advanced concepts in nursing. Students also tested each other when studying for prerequisite sciences. Previous studies have reported these methods as
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commonly used by college students completing general education courses and nursing students alike. For example, participants in the Hartwig and Dunlosky (2012) study reported some of their commonly used
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study strategies were testing one's self (71%) and using flashcards (62%). Another study reported reading competence, memory capability, and note taking as relatively desired study habits among nursing students in Iran (Bavi et al., 2013). However, the students in our study reported only skimming as their main reading strategy during their pre-nursing coursework. Our finding indicates poor reading strategies, such as skimming, is inadequate for nursing education. This is congruent with the findings of the study conducted in the UK which reported the ability to effectively read textbooks as the most inadequately developed study skill among nursing students. The nursing curriculum requires students to complete large amounts of reading to have a solid grasp of the extensive medical and nursing concepts. Nursing students must possess good reading skills to make sense of new knowledge, critically think, and provide safe and competent patient care during clinical rotations. Reading comprehension is essential for nursing students' preparation in providing independent, safe, and relevant nursing care for conditions not discussed in the classroom lectures (Oermann, 2007). Thus, our findings
ACCEPTED MANUSCRIPT suggest the students in the preparatory years should develop reading competence and use effective reading skills to succeed in the nursing major.
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Another theme that emerged in our study was “I had a lot of time then”. The participants spent considerably less time studying in their preparatory years than in the nursing major. A full-time student in
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the US registers for 12 to 15 credit hours per semester, which roughly translates to 4 to 5 classes,
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depending on the number of credit hours per course. Using this credit hour estimation and participants’ reported time spent studying per course, they spent 2.5 to 5 hours studying for general education courses
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per week and up to 10 hours per week for prerequisite sciences. The low numbers reported by our
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participants are similar to what were reported by Finnish college students. The Finnish students reported studying for an average of 8.03 hours per week and spending more time on the internet [19.36 hours per week] (Ludlum, Hongell, Tigerstedt, & Alsobrook, 2016). However, according to the National Survey of
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Student Engagement (NSSE, 2016) US freshman college students spend approximately 14 hours studying per week, which suggests that our findings are lower compared to the national norm. In the study of Doll-
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Speck (2007), about half of the nursing students reported studying ten hours per week, while the other half reported studying 11 to 30 or more hours per week. The same study had reported that students in the final year of the nursing program reported more time spent studying (around 11-15 hours) compared to sophomore or junior students (Doll-Speck, 2007). This indicates as students’ progress to higher levels in the nursing program, they require more time allotted in studying. A paper written by a nursing student highlighted the importance of study time in navigating in the nursing program (Chancellor, 2013). Thus, students should develop a more positive attitude towards studying outside the school to be prepared for the nursing core content courses. Our findings also suggest pre-nursing students often study alone because they only need a short time to study, and perceived that studying alone is easier. Most nursing students prefer to study in a fairly quiet place where they can concentrate, which is consistent with our findings (Doll-Speck, 2007). While some of our participants preferred studying in the library, Sutherland’s (2003a) participants preferred studying from home as the library was considered a distracting place.
ACCEPTED MANUSCRIPT The students in our study verbalized they usually join study groups when studying in prerequisite science classes, to help clarify content for better understanding. Changes in study technique, in our
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participants’ case transitioning from individual to group study, suggest the students are aware of the importance of these courses to nursing core content, hence placing a higher degree of importance in these
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subjects. Our participants found how studying among other people and picking what they learned gave
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them more learning benefits than when they were to study on their own. This finding is similar to Rybczynski and Schussler’s (2010) study studied the relationship between participation of out-of-class
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group studying and gains in performance exam in a biology course. The researchers found no significant
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relationship between the variables, However, students who participated in out-of-class group studying reported it being beneficial because they prepared well for the exams using the shared learning they acquired from the out-of-class group studying sessions (Rybczynski & Schussler, 2010).
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It was important for us to present students' struggles in their prerequisite sciences as a negative case as students seemed to deviate from their usual study strategies to be able to cope with academic
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demands in these courses. A study conducted in Ireland among first-year nursing students found the main reason for students’ struggles in biological sciences were due to poor study skills and attendance in class (McKee, 2002). The participants in our study specifically mentioned physiology to be the prerequisite science where they struggled the most. Physiology is a foundational science for nursing students as it helps them understand how different organ systems function. McKee (2002) stated how biological sciences would continue to be difficult for nursing students unless appropriate strategies to improve study skills are in place within the course and prior to entry to these courses. If students pass prerequisite courses using poor study skills, they may be lacking in knowledge and comprehension of foundational science concepts related to human function. A poorly constructed foundation will result in difficulty applying the basics to advanced nursing concepts, such as in pathophysiology, pharmacology, and medical-surgical nursing; thus, leading to detrimental outcomes in clinical practice (Mayner, Gilham, & Sansoni, 2013).
ACCEPTED MANUSCRIPT The BSN students interviewed showed reflection regarding their poor study habits during their pre-nursing days. Although the students verbalized a change in their study habits as a need to perform
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better in the prerequisite sciences, they remained unaware of the challenges and demands of the rigorous nursing program until they were admitted to the major. Students who relied on poor preparatory study
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habits such as cramming, skimming content, rote memorization or relying on instructor’s comments find
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themselves at a learning threshold when faced with the challenge of applying and analyzing nursing information. These are the students who suggest they have studied vigorously only to fail the first major
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examination. When students are confronted with this learning threshold within the pre-nursing phase, they
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begin to realign their study behaviors and seek academic support. This realignment of study behaviors could have been motivated by the desire to gain acceptance into the nursing program. Our findings support the need to provide assistance to students in developing effective study skills and habits during
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their pre-nursing years.
Implications to Nursing Education and Conclusion
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Our research showed the BSN students did not study much or employed poor study strategies during their years completing general education and prerequisite science courses. The students’ attitudes and behaviors may be related to their previous academic achievements and repeat of information from primary and secondary education. However, students started experiencing academic struggles once they enrolled in the prerequisite science courses. Requiring they adapt study strategies as they are confronted with the learning threshold. to achieve a satisfactory grade in the course and gain admission to the nursing program. Academic support is needed by students prior to admission to the nursing program so they can learn effective study skills and modify their study habits for easier adaptation to the rigors of nursing education.
ACCEPTED MANUSCRIPT References Alos, S.B., Caranto, L.C., & David, J.J.T. (2015). Factors affecting academic performance of the student
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nurses of BSU. International Journal of Nursing Science, 5(2), 60-65. Aquino, L.B. (2011). Study habits and attitudes of freshmen students: Implications for academic
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intervention programs. Journal of Language Teaching and Research, 2(5), 1116-1121.
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Arenas, C.J.M. (2014). The testing effect and cramming: Investigating the presence of the testing effect in a shorter retention interval (Bachelors thesis, University of Oregon). Retrieved from
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https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/17992/Thesis%20Final-
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Bavi, E., Asilzadeh, L., & Haghighi, S. (2014). A survey on students’ study habits in nursing and midwifery faculty of Ahvaz Jundishapur University of Medical Sciences in 2012.
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Jentashapir Journal of Health Research, 5(2), 45-51.
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Bulent, A., Hakan, K., & Aydin, B. (2015). An analysis of undergraduates’ study skills. Procedia- Social
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and Behavioral Sciences, 197, 1355-1362. Cambridge University Press. (2017). Bomb. Cambridge Dictionary. Retrieved from http://dictionary.cambridge.org/dictionary/english/bomb Chancellor, J. (2013). Effective study habits for nursing students. Nursing2015, 43(4), 68-69. Crede, M., & Kuncel, N.R. (2008). Study habits, skills, and attitudes: The third pillar supporting collegiate academic performance. Perspectives on Psychological Science, 3(6), 425-453. Doll-Speck, L. (2007). Study behavior of nursing students (Doctoral dissertation, Bowling Green State University). Retrieved from https://etd.ohiolink.edu/!etd.send_file?accession=bgsu1182687105&disposition=attachment Forster, M. (2015). Six ways of experiencing information literacy in nursing: The findings of a phenomenolographic study. Nurse Education Today, 35(1), 195-200. Gettinger, M., & Seibert, J.K. (2002). Contributions of study skills to academic competence.
ACCEPTED MANUSCRIPT School Psychology Review, 31(3), 350-365. Hartwig, M.K., & Dunlosky, J. (2012). Study strategies of college students: Are self-testing and
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scheduling related to achievement? Psychonomic Bulletin & Review, 19, 126-134. Hunter, S., Pitt, V., Croce, N., & Roche, J. (2014). Critical thinking skills of undergraduate
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nursing students: Description and demographic predictors. Nurse Education Today,
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34(5), 809-814.
Josephsen, J. (2014). Critically reflexive theory: A proposal for nursing education. Advances in Nursing,
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2014, article ID 594360. DOI: http://dx.doi.org/10.1155/2014/594360
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Kaplan Nursing. (2016). Nursing school success: How to study. Retrieved from https://nursing.kaplan.com/student/User_Home.aspx# Kiblasan, J. I. A., Abufayed, B. F., Sehari, A. A., Madamba, F. U., & Mhanna, K. H. (2016). Analyzing
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the learning style and study habit of students in the faculty of nursing of Al Jabal Al Gharbi University, Gharyan, Libya. Clinical Nursing Studies, 4(2), p48.
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Ludlum, M., Hongell, L., Tigerstedt, C., & Alsobrook, L. (2016). The study habits of Finnish college students: A two sample investigation. College Student Journal, 50(2), 212-218. Mayner, L., Gilham, D., & Sansoni, J. (2013). Anatomy and physiology for nursing students: Is problem-based learning effective? Professioni Infermieristiche, 66(3), 182-186. McKee, G. (2002). Why is biological science difficult for first-year nursing students?. Nurse Education Today, 22(3), 251-257. McMullan, M., Jones, R., & Lea, S. (2010). Patient safety: Numerical skills and drug calculation abilities of nursing students and registered nurses. Journal of Advanced Nursing, 66(4), 891-899. National Survey of Student Engagement. (2016). Summary Tables (NSSE 2016). Retrieved From http://nsse.indiana.edu/html/summary_tables.cfm Oermann, M. H. (Ed.). (2007). Annual review of nursing education, Volume 6, 2008: Clinical Nursing Education. Springer Publishing Company.
ACCEPTED MANUSCRIPT Rybczynski, S.M., & Schussler, E.E. (2010). Student use of out-of-class study groups in an introductory undergraduate biology course. CBE-Life Science Education, 10(1), 74-82.
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Snelgrove, S. (2005). A consideration of memory in relation to information giving. Nursing Times, 102(9), 26-28.
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Stafford, T. (2014, November 18). Memory: Why cramming for tests often fails. Retrieved from
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http://www.bbc.com/future/story/20140917-the-worst-way-to-learn
Sutherland, P. (2003a). Case studies of the learning and study skills of first year students. Research in
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Post-Compulsory Education, 8(3), 425-440.
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Sutherland, P. (2003b). The adequacy of the study skills of a cohort of first-year nursing students: An investigation of attitudes. Journal of Adult and Continuing Education, 9(1), 22-31.
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Children, 23(1), 117-136.
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Venezia, A., & Jaeger, L. (2013). Transitions from high school to college. The Future of
Wernersbach, B.M., Crowley, S.L., Bates, S.C., & Rosenthal, C. (2014). Study skills course
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impact on academic self-efficacy. Journal of Developmental Education, 37(3), 14-33.
ACCEPTED MANUSCRIPT Table 1. Interview Guide for Focus Groups (Part 1). Questions Posed to Students During Focus Group Interview (Part 1)
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1. Prior to admission to the nursing program, how did you study to prepare for classes and exams? 2. How many hours did you spend studying for classes and exams before being admitted to the nursing program? Did you have a specific pattern for studying (i.e., reading textbooks before class, immediately reviewing notes after class, etc.)? 3. Did you participate in study groups or study buddies? What advantages and disadvantages did you experience studying in groups? 4. In what situations did you visit your instructors during their office hours or by appointment? 5. What other instructional materials did you use to supplement your learning in the general education and prerequisite courses?
ACCEPTED MANUSCRIPT Highlights
The study described the BSN students’ study habits while completing pre-nursing
The students had poor study habits during years they were completing general
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courses.
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education courses.
Students needed to adapt their study habits to be successful in prerequisite
Strategies should be implemented to support students to develop better study
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habits.
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sciences.
S0260-6917(17)30078-3 doi:10.1016/j.nedt.2017.04.009 YNEDT 3522
To appear in:
Nurse Education Today
Received date: Revised date: Accepted date:
10 October 2016 24 February 2017 7 April 2017
Please cite this article as: Felicilda-Reynaldo, Rhea Faye D., Cruz, Jonas Preposi, Bigley, Louise, Adams, Kathryn, Baccalaureate Student Nurses’ Study Habits Prior to Admission to Nursing Program: A Descriptive Qualitative Study, Nurse Education Today (2017), doi:10.1016/j.nedt.2017.04.009
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT BACCALAUREATE STUDENT NURSES’ STUDY HABITS PRIOR TO ADMISSION TO NURSING PROGRAM: A DESCRIPTIVE QUALITATIVE STUDY
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Rhea Faye D. Felicilda-Reynaldo
Louise Bigley
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Kathryn Adams
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Jonas Preposi Cruz
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Author Notes
Corresponding Author: Rhea Faye D. Felicilda-Reynaldo is Associate Professor in the School of Nursing, Missouri State University, Springfield, MO. Mailing address: 901 S. National Avenue,
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Springfield, MO 65897, USA. Email: [email protected]. Co-Authors: Jonas Preposi Cruz is a lecturer in the Nursing Department, Applied Medical
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Sciences, Shaqra University in Saudi Arabia. Louise Bigley is Assistant Professor in the School of Nursing, Missouri State University, Springfield, MO. Kathryn Adams is Clinical Instructor in the School of Nursing, Missouri State University, Springfield, MO.
Acknowledgments
Funding: Data collection was funded through a faculty research grant sponsored by the Office of the Provost, Missouri State University.
Word Count: 4,930
ACCEPTED MANUSCRIPT Abstract Background: Faculty continue to observe students struggling as they adapt their study strategies to learn
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nursing core content.
to admission to the program.
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Design: This study used a descriptive qualitative research design.
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Objectives: This study described the study habits of Bachelor of Science in Nursing (BSN) students prior
Settings and Participants: A purposive sample of 19 BSN students (juniors [n=10] and seniors [n=9])
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from a 4-year public Midwestern university were included in this study.
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Methods: Two focus group sessions, using a semi-structured interview guide, were conducted in the spring semester of 2013.
Results: The four themes which emerged from the analysis of data were: “I just got it,” “I had a lot of
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time then,” “I studied alone” mostly, and “…a little struggle with the sciences.” Conclusions: The findings suggest the BSN students did not study much or employed poor study
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strategies during their years completing general education courses. Academic support is needed by students prior to admission to the nursing program so they can learn effective study skills and modify their study habits for easier adaptation to the rigors of nursing education. Keywords: nursing students, study skills, qualitative research, nursing education, pre-nursing, general education, biological sciences.
ACCEPTED MANUSCRIPT Baccalaureate Student Nurses’ Study Habits Prior to Admission to Nursing Program: A Descriptive Qualitative Study
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Educators widely recognize that students’ behaviors, skills, and approaches to learning are important factors of academic success (Bavi, Asilzadeh, & Haghighi, 2014). In a large scale meta-analysis
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of studies conducted in higher education settings, Crede and Kuncel (2008) found that study habits, skills,
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and attitudes rivaled performance with standardized tests and previous grades as predictors of academic achievement. At some point, students who have achieved academic success may find themselves having
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difficulty with school as they progress through higher levels, not because they lack ability but because of
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lack of study skills (Gettinger & Seibert, 2002). Developing effective study skills have been deemed as one of the most beneficial factors for students to achieve academic success (Aquino, 2011; Bulent, Hakan, & Aydin, 2015; Gettinger & Seibert, 2002).
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Study habits are developed throughout a student’s educational process. Research on readiness for college continues to show more and more students are entering college without the basic knowledge,
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skills, and habits of learning they need to succeed (Venezia & Jaeger, 2013). Colleges and universities place an importance on ensuring effective transition interventions are in place as student retention is a primary concern (Wernersbach, Crowley, Bates, & Rosenthal, 2014). Multiple resources are provided by colleges and universities (e.g. tutorial services for math and sciences, writing centers,a nd disability resources) to assist students in developing self-regulated learning skills and habits to help them in their transition to college-level learning. Furthermore, higher education institutions may provide students with preparatory courses that focus on developing study skills and critical thinking during their first semester. Wernersbach and colleagues (2014) found their preparatory course on academic skills improved college students’ study skill set and academic self-efficacy. As college students proceed to take upper-level courses, they may need to develop additional learning strategies and study habits to help them succeed in their chosen field, such as in nursing. In the United States, most Bachelor of Science in Nursing (BSN) students are not admitted to the program until late sophomore or early junior year. During the first two years of university studies, students are to
ACCEPTED MANUSCRIPT complete general education and nursing prerequisite courses (i.e., algebra, chemistry, nutrition, anatomy, physiology, microbiology), which then culminates to the formal application process for admission into the
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nursing major. Once admitted, students will then begin learning knowledge, skills, attitudes relevant to professional nursing practice. Due to the breadth and depth of knowledge students need to acquire in the
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nursing program, they should have information and numeric literacy skills (Forster, 2015; McMullan,
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Jones, & Lea, 2010), critical thinking and clinical decision-making skills (Hunter, Pitt, Croce, & Roche, 2014; Josephsen, 2014), a high reading comprehension level, effective methods for retaining information
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and retrieving information previously learned, grasp of test-taking strategies, and habits to manage time
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and stressful situations (Kaplan Nursing, 2016). Most of these skills should have been strongly developed during the first two years in college and, as such, should be considered learning habits of nursing students. However, faculty continually observe students struggling as they adapt their study strategies to learn
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nursing core content; thus, nursing faculty spend additional time helping students adapt new study skills and critical thinking strategies. To support faculty focus on teaching nursing core content, many nursing
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programs hire academic specialists whose role is to assist students in developing study skills and remediation. By providing academic support to students, pre-licensure nursing programs can increase nursing student retention and assist students in their goal of becoming a registered nurse. For nurse educators without academic specialist support, the initial action to effectively support students in their learning is to assess their study skills, habits, and academic behaviors. To researchers’ knowledge, there have been no published studies which described nursing students’ study strategies while completing general education and prerequisite courses. The purpose of this study is to describe study habits of BSN students prior to admission to the nursing program. To develop effective programs of academic support, faculty should assess not only students’ current study behaviors and habits, but also previous strategies used to have a holistic picture of the transition of learning (i.e., from general education to nursing specific)
ACCEPTED MANUSCRIPT Methods Research Procedures and Data Collection
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A descriptive qualitative research design was used to investigate the study habits of BSN students. The researchers interviewed the student participants once regarding their study habits, but decided to
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present study results in two parts due to volume of data analyzed. The two-part presentation of study
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findings provides scholarly audiences with a clear description of study habits used by US 4-year BSN nursing students in the two phases of their college life: pre-nursing and in the nursing program. In this
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manuscript, authors present the first part of the study results: BSN students’ study habits while they were
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in completing their general education courses and prerequisites as pre-nursing students. The study protocol was approved by the University Institutional Review Board. Junior and senior BSN students (N=107) from a 4-year public Midwestern university were recruited to participate in focus
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group sessions in the spring semester of 2013. First, an email invitation was sent out to all students admitted to the nursing program announcing the schedules of the focus group sessions. There were two
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schedules available: one for the juniors and one for the seniors. Both focus group sessions were scheduled during students’ lunch break between classes. The researchers also took measures to ensure the focus groups schedule would not be in conflict with any scheduled exam. Researcher contact information was provided in the email to encourage students to ask questions about the study or the participant’s role. The researchers visited each cohort during short breaks in their classes to recruit students to participate in the study. Specifically, information on the purpose of the study, research procedures (including audio recording of interviews), focus group session schedules, benefits and risks, and protection of participants’ rights were presented. After both email and in-person invitations, 19 BSN students (juniors [n=10] and seniors [n=9]) attended the scheduled focus group. Refreshments were provided as a courtesy to those who participated due to the lunch time schedule. Details about the informed consent were reiterated prior to the interview. All 19 students signed the informed consent and participated in the focus groups. A semi-structured interview guide (see Table 1) was used by the researchers to ask the participant questions.
ACCEPTED MANUSCRIPT Data Analysis and Ensuring Trustworthiness Both junior and senior focus group sessions were audio recorded with permission from
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participants. Immediately after the interview, the researchers listened to the audio recording two times for initial analysis of flow of conversation during the focus group. Transcription of the recording followed,
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which was organized according to the research questions presented to the students. Transcripts were read
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multiple times by the research team, and initial coding was completed to highlight the most common responses provided by students in both cohorts. These common responses were organized into a list
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according to the main topics of the interview questions: study patterns, time spent studying, studying in groups, accepting instructor support, and using supplemental instructional material. This list was sent to
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the participants for member checking. The participants confirmed researchers’ categorization of responses as valid.
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Further analysis of the interview transcript was completed by analyzing negative cases and narratives shared by the students to provide a more holistic picture of study habits. Four major themes
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emerged after in-depth examination of the transcript and discussion to confer data patterns found by researchers. The emerging themes were related to study strategies used by students, time spent studying, choices of socialization and setting for studying, and struggles faced during the pre-admission years. As students who were interviewed had already graduated from the nursing program, the research team decided to have current nursing students review the themes to determine if they were still relevant to the newer cohort of nursing students. Five nursing students (juniors [n=3] and seniors [n=2]) were recruited to complete additional member checking and were provided the list of themes and quotes for review. All students confirmed the themes were still relevant, and they too, had similar experiences as the original focus group participants. Based on the feedback provided, the research team finalized the thematic analysis. Due to the dual role of the researchers as both investigator and nurse educators, there is a possibility that prejudices formed regarding students' study habits. Researchers were encouraged to keep reflective journals to ensure that analysis is data-driven. Reflections were discussed during data analysis meetings to
ACCEPTED MANUSCRIPT compare whether researcher codes were data-driven or influenced by formerly formed notions of nursing students' study habits.
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Results The four themes which emerged from the analysis of data were: “I just got it,” “I had a lot of time
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then,” “I studied alone” mostly, and “…a little struggle with the sciences.”
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“I Just Got It [Understood]”
Both junior and senior BSN students were in general agreement that they did not do much
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studying prior to admission to the nursing program. The participants described studying general concepts
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of topics was the information they needed to succeed in their classes and assignments. Because they easily picked up information, they scheduled their study time to be as close to exam time as possible. Both junior and senior BSN students admitted to cramming during their pre-nursing years. Cramming is
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defined as “…the act of studying for an exam by memorizing facts at the last minute” (Arenas, 2014, p. 6). Some mentioned that they could study the night before and still successfully pass the test.
crammed.”
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“I crammed a lot for general education courses like history, English…I got an A even when I
“I really didn’t study much for those [general education] courses…general concepts were all I needed. I just got it and got a good grade” “I study a lot before an exam, usually the night prior to the exam. I did well [in those exams].” Study methods used prior to admission included: listening to lectures, skimming through the textbook, and rote memorization through the use of flashcards. A few students said they only needed to review information because it was covered in high school. Most students mainly used the professor's PowerPoint presentation notes to prepare for exams. A few students stated they wrote their own notes. Of those who mentioned note writing as a study strategy, they stated they used those notes to prepare for the class activities and exams. When asked how they took notes, all who wrote notes said “I wrote notes through my computer [or laptop].” One added: “My notes were added on professor’s notes [lecture presentations] in the PowerPoint.”
ACCEPTED MANUSCRIPT “Listening to the lecture was good. I learned a lot from it.” “I would come to class and some [of the lectures] were repeated from high school, especially for
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general education. I already knew those!” “PowerPoints were important. They were good study material and notes to prepare for the
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exams.”
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Most participants agreed their main reading strategy was skimming the textbook. A few students stated there were instances when they bought the books but did not open them. Reading as a study habit
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was dependent on the prompt of the instructor. They would ask their professor whether the exam would
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be based on information from the textbook or from lecture notes. The professor's response would determine which material they would read. Study guides provided by the professors prior to exams were also used by students to determine what to study. Supplemental instructional materials were not used by
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the students as they were considered “not needed” and “just additional expense.”
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“I literally [re]sold a book once for a general education course. I never opened it. It still had
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plastic on it when I took it to the bookstore.” “It was either the lecture notes or the book, they [professors] would tell us which to study if we ask them for guidance.”
The participants also mentioned how memorization was also commonly used. The nursing prerequisite sciences, specifically anatomy and microbiology, were courses most associated with the use of memorization. Flash cards were the most common memorization strategy. For others, they used web or phone applications, such as Quizlet, which use the same concept as the physical flashcards except for the electronic delivery of the study product. The students took turns asking and answering questions with a study partner if they had one. “I liked using them [flashcards] because they helped me, with like, remembering terms and definitions which are usually emphasized by the instructor in the class.” “Do you know Quizlet? It’s this really cool app where you can make questions to study the, like, major concepts of a class. It was most helpful for microbiology, anatomy and physiology.”
ACCEPTED MANUSCRIPT “I had a friend and we would trade questions [using flashcards]…she would ask, then I would answer. Really helped with anatomy.”
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It was interesting to note that when nursing students talked about how they studied prior to nursing school, the statements would either start with, “I just realized how…,” “I didn’t know it back
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then...,” or “I thought I was studying a lot then...” The researchers’ prompt of comparison of the study
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habits they used as pre-nursing students and while in the nursing program helped them realize how little effort was put into studying when they were still pre-nursing students.
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“I Had a Lot of Time Then.”
Every participant agreed that they spent so little time studying during their pre-nursing years
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compared to time they spend studying in nursing school. One participant described it as: “I thought I was [busy], but now I AM busy!” Another participant quipped, “I had a lot of time then.”
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When asked about the approximate number of hours to study for one course, the answer ranged from 30 minutes to an hour. Students indicated they had short study times because they already learned
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the material from attending class lectures. For most participants, completing assignments were also equivalent to study time. However, a few participants commented on how study times really varied depending on the class. For the prerequisite sciences, the students gave a range between two to five hours. “I would study for an hour or more if I had to do assignments…” “Well, depends on the class I’m studying for, I studied a little bit more for anatomy and physiology. Umm, 3 to 5 hours?” The participants also gave an estimate of the time they spent studying when multiple major exams were scheduled during a week, such as a midterm or final. The participants generally agreed on the following statement: “I would start studying two to three days when multiple exams were scheduled during the week.” The participants agreed they studied “…a little over seven hours” in total during finals week, when queried by the researchers. “During finals week, for anatomy and physiology, I studied a lot more than seven hours” was a response provided by another participant. When students were further
ACCEPTED MANUSCRIPT asked how many hours they would spend if course quizzes were scheduled for the week, a participant quipped: “Four to six hours is usually plenty of time to study”.
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“I Studied Alone” Mostly When asked regarding whether group studying was done during their pre-nursing years, students
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shared that they studied alone most of the time. The most common reason for not engaging in study
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groups was that they did not study for a long time and it was easier to study alone. The study location was not described as important. The participants shared that they could study wherever they would not feel
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distracted
“I would get distracted when I studied with somebody else because we would talk a lot. It became
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a socialization session so that’s why [I studied alone].”
“You could find me in the library or in the dorm for studying. Anywhere was ok, as long as I do
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not have distractions.”
The students were more likely to join study groups when they were taking the prerequisite
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science courses. They said they found it beneficial to discuss class content topics with other people because they would pick up information they did not know, and vice versa. Study groups were also a good way to study by testing each other. “Sometimes my classmates would pick up on things the professor said that I did not, and sometimes I would pick up things that they didn’t know…we would share information during study groups and we would learn. It was good [for everyone in the study group] in the long run [overall].” “My study buddy in physiology and I would quiz each other prior to an exam and it was such a help to me.” “…A Little Struggle with the Sciences…” In earlier themes, participants mentioned changes in habits when studying for prerequisite sciences, such as engaging in group study or increasing their study time. The reason most participants provided for these changes was they struggled a little bit learning the sciences. The BSN students likened the prerequisite sciences to their nursing courses, wherein some find they were having more difficulty
ACCEPTED MANUSCRIPT grasping information compared to general education courses. They realized they needed to change their study practices after they did poorly on the first exam in their prerequisite sciences.
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“I struggled a little with the sciences, especially physiology, so I studied harder for this course than all my other pre-nursing courses.”
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“I did poorly in my first physiology exam. I was a bit panicked because I know I needed to pass
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the course to get into the nursing program. When I was not doing well [in the course], I realized how I need to take more time studying for this.”
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“I would say, the nursing courses are like the sciences”. The level of difficulty is similar, except
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now we’re taking five sciences all at once.”
Students were also more likely to visit their instructors for help or clarification of lessons while completing the prerequisite sciences. One student shared how she never felt the need to visit professors
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during office hours when taking general education courses, but she visited her professor several times
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when she took physiology. Students said that they would visit professors when they “bombed their
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exams.” Bomb is an American slang verb which means ‘to fail’ (Cambridge Dictionary, 2017). Usually, professors would allow them to review their previous exams helped them determine what items they missed.
Discussion
Our study described the study habits of BSN students prior to admission to the nursing program. Participants interviewed for this study were admitted into a competitive, 4-year BSN program in a public Midwestern university. The average cumulative GPA of BSN students admitted in a cohort range from 3.5 to 3.7 on a 4.0 scale, which relates to a grade equivalent of B+ to A+; thus, participants have deemed themselves high-achieving students in their previous educational pursuits. Furthermore, a large percentage of the students bring in college-level courses from their freshman year through their high school’s dual credit program. With this student demographic, it may be understandable when participants relayed how they did not need to study in their general education and prerequisite courses because they thought they had learned information readily. Furthermore, some of the concepts in their general
ACCEPTED MANUSCRIPT education and prerequisite courses may have been repeat information from their high school courses. Thus, most students easily get a grade of A in the courses and labeled some assignments to be just “busy
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work,” instead of being substantial for future nursing courses. The students’ attitudes and behaviors towards studying led them to cram [study last minute]
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during examination time. Cramming is a technique often used to prepare for examinations and is a well-
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recognized study habit among students. While cramming may be seen as beneficial, it is not the best way to achieve the student's’ desired grade. This is because the neural connections being formed during the
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cramming process are temporary (Stafford, 2014). Therefore, cramming will not benefit the students for
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long-term memory, which is essential to learn advanced concepts from foundational information in nursing (Snelgrove, 2005). Our study findings are comparable to the results of the study conducted by Hartwig and Dunlosky (2012) on college students’ study strategies in the US, wherein 66% of the
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participants crammed information the night before the test. This is also similar to Alos, Caranto, and
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David’s (2015) findings wherein Filipino student nurses’ academic performance was highly impacted by
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the choice of studying randomly or when a quiz was scheduled. Our findings, however, is in contrast to the research on study behavior among US BSN students by Doll-Speck (2007). In her report, only 37% (n=397) of the students reported cramming before an exam, which implied that cramming as a study habit was deemed less favorable by the BSN students. The difference in the findings is due to the dissimilarities in the characteristics of the participants in each study as well as the purpose of the study. In our study, we interviewed junior and senior students and asked them to describe their study habits during their prenursing years, while the study of Doll-Speck (2007) surveyed 2nd to 4th-year students about their study behaviors during the nursing program. This difference may imply that pre-nursing students may be more likely to cram before examinations than those students in the nursing program. However, this assumption needs to be validated in future studies. The participants determined listening to lectures, skimming through the textbook, rote memorization through the use of flashcards, and, to a lesser frequency, taking notes as primary study methods were used during their pre-nursing years. They described that paying attention to their
ACCEPTED MANUSCRIPT professor’s lecture was an adequate way to grasp the main concepts of general education courses. Our findings are somewhat similar to Kiblasan, Abufayed, Sehari, Madamba, and Mhanna’s (2016) results
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that Libyan nursing students determined good lecture notes and presentations with visual aids from lecturers increase their motivation to study. While our participants found note taking during lectures less
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important, Sutherland (2003a) found first year nursing students from the United Kingdom (UK) valued
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copious note-taking. The nursing students would review their notes as soon as possible to make sense of the content (Sutherland, 2003a).
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The participants in our study also acknowledged the importance of memorization in pre-nursing
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courses. Most of the pre-nursing courses require memorizing terms, such as in anatomy and microbiology, which is foundational information to better understand advanced concepts in nursing. Students also tested each other when studying for prerequisite sciences. Previous studies have reported these methods as
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commonly used by college students completing general education courses and nursing students alike. For example, participants in the Hartwig and Dunlosky (2012) study reported some of their commonly used
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study strategies were testing one's self (71%) and using flashcards (62%). Another study reported reading competence, memory capability, and note taking as relatively desired study habits among nursing students in Iran (Bavi et al., 2013). However, the students in our study reported only skimming as their main reading strategy during their pre-nursing coursework. Our finding indicates poor reading strategies, such as skimming, is inadequate for nursing education. This is congruent with the findings of the study conducted in the UK which reported the ability to effectively read textbooks as the most inadequately developed study skill among nursing students. The nursing curriculum requires students to complete large amounts of reading to have a solid grasp of the extensive medical and nursing concepts. Nursing students must possess good reading skills to make sense of new knowledge, critically think, and provide safe and competent patient care during clinical rotations. Reading comprehension is essential for nursing students' preparation in providing independent, safe, and relevant nursing care for conditions not discussed in the classroom lectures (Oermann, 2007). Thus, our findings
ACCEPTED MANUSCRIPT suggest the students in the preparatory years should develop reading competence and use effective reading skills to succeed in the nursing major.
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Another theme that emerged in our study was “I had a lot of time then”. The participants spent considerably less time studying in their preparatory years than in the nursing major. A full-time student in
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the US registers for 12 to 15 credit hours per semester, which roughly translates to 4 to 5 classes,
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depending on the number of credit hours per course. Using this credit hour estimation and participants’ reported time spent studying per course, they spent 2.5 to 5 hours studying for general education courses
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per week and up to 10 hours per week for prerequisite sciences. The low numbers reported by our
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participants are similar to what were reported by Finnish college students. The Finnish students reported studying for an average of 8.03 hours per week and spending more time on the internet [19.36 hours per week] (Ludlum, Hongell, Tigerstedt, & Alsobrook, 2016). However, according to the National Survey of
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Student Engagement (NSSE, 2016) US freshman college students spend approximately 14 hours studying per week, which suggests that our findings are lower compared to the national norm. In the study of Doll-
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Speck (2007), about half of the nursing students reported studying ten hours per week, while the other half reported studying 11 to 30 or more hours per week. The same study had reported that students in the final year of the nursing program reported more time spent studying (around 11-15 hours) compared to sophomore or junior students (Doll-Speck, 2007). This indicates as students’ progress to higher levels in the nursing program, they require more time allotted in studying. A paper written by a nursing student highlighted the importance of study time in navigating in the nursing program (Chancellor, 2013). Thus, students should develop a more positive attitude towards studying outside the school to be prepared for the nursing core content courses. Our findings also suggest pre-nursing students often study alone because they only need a short time to study, and perceived that studying alone is easier. Most nursing students prefer to study in a fairly quiet place where they can concentrate, which is consistent with our findings (Doll-Speck, 2007). While some of our participants preferred studying in the library, Sutherland’s (2003a) participants preferred studying from home as the library was considered a distracting place.
ACCEPTED MANUSCRIPT The students in our study verbalized they usually join study groups when studying in prerequisite science classes, to help clarify content for better understanding. Changes in study technique, in our
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participants’ case transitioning from individual to group study, suggest the students are aware of the importance of these courses to nursing core content, hence placing a higher degree of importance in these
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subjects. Our participants found how studying among other people and picking what they learned gave
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them more learning benefits than when they were to study on their own. This finding is similar to Rybczynski and Schussler’s (2010) study studied the relationship between participation of out-of-class
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group studying and gains in performance exam in a biology course. The researchers found no significant
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relationship between the variables, However, students who participated in out-of-class group studying reported it being beneficial because they prepared well for the exams using the shared learning they acquired from the out-of-class group studying sessions (Rybczynski & Schussler, 2010).
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It was important for us to present students' struggles in their prerequisite sciences as a negative case as students seemed to deviate from their usual study strategies to be able to cope with academic
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demands in these courses. A study conducted in Ireland among first-year nursing students found the main reason for students’ struggles in biological sciences were due to poor study skills and attendance in class (McKee, 2002). The participants in our study specifically mentioned physiology to be the prerequisite science where they struggled the most. Physiology is a foundational science for nursing students as it helps them understand how different organ systems function. McKee (2002) stated how biological sciences would continue to be difficult for nursing students unless appropriate strategies to improve study skills are in place within the course and prior to entry to these courses. If students pass prerequisite courses using poor study skills, they may be lacking in knowledge and comprehension of foundational science concepts related to human function. A poorly constructed foundation will result in difficulty applying the basics to advanced nursing concepts, such as in pathophysiology, pharmacology, and medical-surgical nursing; thus, leading to detrimental outcomes in clinical practice (Mayner, Gilham, & Sansoni, 2013).
ACCEPTED MANUSCRIPT The BSN students interviewed showed reflection regarding their poor study habits during their pre-nursing days. Although the students verbalized a change in their study habits as a need to perform
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better in the prerequisite sciences, they remained unaware of the challenges and demands of the rigorous nursing program until they were admitted to the major. Students who relied on poor preparatory study
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habits such as cramming, skimming content, rote memorization or relying on instructor’s comments find
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themselves at a learning threshold when faced with the challenge of applying and analyzing nursing information. These are the students who suggest they have studied vigorously only to fail the first major
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examination. When students are confronted with this learning threshold within the pre-nursing phase, they
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begin to realign their study behaviors and seek academic support. This realignment of study behaviors could have been motivated by the desire to gain acceptance into the nursing program. Our findings support the need to provide assistance to students in developing effective study skills and habits during
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their pre-nursing years.
Implications to Nursing Education and Conclusion
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Our research showed the BSN students did not study much or employed poor study strategies during their years completing general education and prerequisite science courses. The students’ attitudes and behaviors may be related to their previous academic achievements and repeat of information from primary and secondary education. However, students started experiencing academic struggles once they enrolled in the prerequisite science courses. Requiring they adapt study strategies as they are confronted with the learning threshold. to achieve a satisfactory grade in the course and gain admission to the nursing program. Academic support is needed by students prior to admission to the nursing program so they can learn effective study skills and modify their study habits for easier adaptation to the rigors of nursing education.
ACCEPTED MANUSCRIPT References Alos, S.B., Caranto, L.C., & David, J.J.T. (2015). Factors affecting academic performance of the student
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nurses of BSU. International Journal of Nursing Science, 5(2), 60-65. Aquino, L.B. (2011). Study habits and attitudes of freshmen students: Implications for academic
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intervention programs. Journal of Language Teaching and Research, 2(5), 1116-1121.
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Arenas, C.J.M. (2014). The testing effect and cramming: Investigating the presence of the testing effect in a shorter retention interval (Bachelors thesis, University of Oregon). Retrieved from
Arenas.pdf?sequence=1&isAllowed=y
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https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/17992/Thesis%20Final-
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Bavi, E., Asilzadeh, L., & Haghighi, S. (2014). A survey on students’ study habits in nursing and midwifery faculty of Ahvaz Jundishapur University of Medical Sciences in 2012.
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Jentashapir Journal of Health Research, 5(2), 45-51.
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Bulent, A., Hakan, K., & Aydin, B. (2015). An analysis of undergraduates’ study skills. Procedia- Social
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and Behavioral Sciences, 197, 1355-1362. Cambridge University Press. (2017). Bomb. Cambridge Dictionary. Retrieved from http://dictionary.cambridge.org/dictionary/english/bomb Chancellor, J. (2013). Effective study habits for nursing students. Nursing2015, 43(4), 68-69. Crede, M., & Kuncel, N.R. (2008). Study habits, skills, and attitudes: The third pillar supporting collegiate academic performance. Perspectives on Psychological Science, 3(6), 425-453. Doll-Speck, L. (2007). Study behavior of nursing students (Doctoral dissertation, Bowling Green State University). Retrieved from https://etd.ohiolink.edu/!etd.send_file?accession=bgsu1182687105&disposition=attachment Forster, M. (2015). Six ways of experiencing information literacy in nursing: The findings of a phenomenolographic study. Nurse Education Today, 35(1), 195-200. Gettinger, M., & Seibert, J.K. (2002). Contributions of study skills to academic competence.
ACCEPTED MANUSCRIPT School Psychology Review, 31(3), 350-365. Hartwig, M.K., & Dunlosky, J. (2012). Study strategies of college students: Are self-testing and
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scheduling related to achievement? Psychonomic Bulletin & Review, 19, 126-134. Hunter, S., Pitt, V., Croce, N., & Roche, J. (2014). Critical thinking skills of undergraduate
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nursing students: Description and demographic predictors. Nurse Education Today,
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34(5), 809-814.
Josephsen, J. (2014). Critically reflexive theory: A proposal for nursing education. Advances in Nursing,
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2014, article ID 594360. DOI: http://dx.doi.org/10.1155/2014/594360
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Kaplan Nursing. (2016). Nursing school success: How to study. Retrieved from https://nursing.kaplan.com/student/User_Home.aspx# Kiblasan, J. I. A., Abufayed, B. F., Sehari, A. A., Madamba, F. U., & Mhanna, K. H. (2016). Analyzing
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the learning style and study habit of students in the faculty of nursing of Al Jabal Al Gharbi University, Gharyan, Libya. Clinical Nursing Studies, 4(2), p48.
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Ludlum, M., Hongell, L., Tigerstedt, C., & Alsobrook, L. (2016). The study habits of Finnish college students: A two sample investigation. College Student Journal, 50(2), 212-218. Mayner, L., Gilham, D., & Sansoni, J. (2013). Anatomy and physiology for nursing students: Is problem-based learning effective? Professioni Infermieristiche, 66(3), 182-186. McKee, G. (2002). Why is biological science difficult for first-year nursing students?. Nurse Education Today, 22(3), 251-257. McMullan, M., Jones, R., & Lea, S. (2010). Patient safety: Numerical skills and drug calculation abilities of nursing students and registered nurses. Journal of Advanced Nursing, 66(4), 891-899. National Survey of Student Engagement. (2016). Summary Tables (NSSE 2016). Retrieved From http://nsse.indiana.edu/html/summary_tables.cfm Oermann, M. H. (Ed.). (2007). Annual review of nursing education, Volume 6, 2008: Clinical Nursing Education. Springer Publishing Company.
ACCEPTED MANUSCRIPT Rybczynski, S.M., & Schussler, E.E. (2010). Student use of out-of-class study groups in an introductory undergraduate biology course. CBE-Life Science Education, 10(1), 74-82.
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Snelgrove, S. (2005). A consideration of memory in relation to information giving. Nursing Times, 102(9), 26-28.
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Stafford, T. (2014, November 18). Memory: Why cramming for tests often fails. Retrieved from
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http://www.bbc.com/future/story/20140917-the-worst-way-to-learn
Sutherland, P. (2003a). Case studies of the learning and study skills of first year students. Research in
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Post-Compulsory Education, 8(3), 425-440.
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Sutherland, P. (2003b). The adequacy of the study skills of a cohort of first-year nursing students: An investigation of attitudes. Journal of Adult and Continuing Education, 9(1), 22-31.
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Children, 23(1), 117-136.
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Venezia, A., & Jaeger, L. (2013). Transitions from high school to college. The Future of
Wernersbach, B.M., Crowley, S.L., Bates, S.C., & Rosenthal, C. (2014). Study skills course
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impact on academic self-efficacy. Journal of Developmental Education, 37(3), 14-33.
ACCEPTED MANUSCRIPT Table 1. Interview Guide for Focus Groups (Part 1). Questions Posed to Students During Focus Group Interview (Part 1)
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1. Prior to admission to the nursing program, how did you study to prepare for classes and exams? 2. How many hours did you spend studying for classes and exams before being admitted to the nursing program? Did you have a specific pattern for studying (i.e., reading textbooks before class, immediately reviewing notes after class, etc.)? 3. Did you participate in study groups or study buddies? What advantages and disadvantages did you experience studying in groups? 4. In what situations did you visit your instructors during their office hours or by appointment? 5. What other instructional materials did you use to supplement your learning in the general education and prerequisite courses?
ACCEPTED MANUSCRIPT Highlights
The study described the BSN students’ study habits while completing pre-nursing
The students had poor study habits during years they were completing general
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courses.
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education courses.
Students needed to adapt their study habits to be successful in prerequisite
Strategies should be implemented to support students to develop better study
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habits.
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sciences.