Orientation to higher education: the challenges and rewards

Orientation to

higher education: the challenges and rewards Yvonne Hill, Kate Dewar and Janet MacGregor A new 'starter' course for qualified nurses entering higher education is discussed in this article. The background and aims of this course, which enables traditionally trained nurses to enter a pathway of professional and academic development, are presented. Learning outcomes of the course, identified through a formal evaluation procedure, were categorized into product and process components. Course teachers anticipated that the product outcomes would be evaluated most highly but the participants reported that the process outcomes were more important to them. They believed these process outcomes would empower them not only to undertake further academic studies but also to take a greater part in clinical decision-making. The results of this evaluation demonstrate that for many nurses, who seek to launch themselves into higher education, a 'bridging' programme is necessary to support this transition.

Yvonne Hill RGN, RNT, BA, MA, Senior Lecturer in Nursing Studies

Kate Dewar RGN, RNT, MSc, Senior Lecturer in Nursing Studies

Janet MacGregor RGN, RNT, BEd, MSc, Senior Lecturer in Nursing Studies, Canterbury Christ College, Canterbury, Kent CT I I QU, UK

(Requests for offprints to YH) Manuscript accepted 28 April 1995

INTRODUCTION Peelo (1994) suggests that late returnees to formal education have often experienced failure in the past and have built their lives around a non-academic self-image. They return to study with old anxieties and painful memories. To overcome these feelings they may set themselves unrealistic learning targets. An orientation course was developed to help registered nurses overcome these anxieties and feelings o f inadequacy. It provided an impetus to partici-

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pants' continuing professional development through pathways within a modular post-registration programme. It also introduced them to the academic requirements associated with studying at diploma/degree levels. The background to the course and its content are now outlined, followed by an analysis of the planned course outcomes as well as the unexpected benefits identified by the participants.

ORIGINS OF THE COURSE The introduction o f Project 2000 ( U K C C 1986) fuelled dramatic changes in nurse education, not just for those about to embark on a career but also for those currently in the profession. A development which arose as a consequence o f Project 2000 initiatives is contained within the Post-Registration Education and Practice Proposals (PREP, U K C C 1990). Those who qualified under the pre-Project 2000 registration system thought they might be 'out-classed' by the new diplomates w h o were perceived as fasttracking on the career pathway ahead o f them. In addition, in a workforce which is reducing in size in some areas ( D O H 1994, Wells 1994), qualified nurses may find themselves scrambling for fewer available jobs. It could be argued that the new competitive National Health Service (NHS) environment will favour Project 2000 diplomates in the promotion stakes. Davis (1990) also argues that organizations are moving towards contractual arrangements o f employment which will alter the pattern and delivery o f care. This is likely to demand a shift in resources and a questioning o f the roles o f each group o f health professionals within the organization. If it could be shown that one grade o f nurse is relatively more expensive than another, then managers will choose the most cost-effective option. As a consequence, managers may consider that diplomates, whose course emphasizes the importance o f knowledge-based practice, would give greater value for money. Furthermore, Beardshaw & R o b i n s o n (1990) state that nurses must n o w demonstrate their ability to provide quality care but for the same, or less cost than before. To achieve this, there is a need for nurses to be educated appropriately so they will be able to meet the new care standards demanded. This course was therefore developed, primarily, for those nurses w h o qualified under the 'traditional system' w h o may be in mid- or late career and w h o are seeking to upgrade their o w n qualifications to match those o f the new entrants.

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COURSE STRUCTURE The course spans 10 weeks and consists of 5 tutorials, totalling 10 hours on campus, as well as distance learning material. The distance learning component, comprising 90 hours of total course time, requires participants to work through a study skills book published by the University of South Bank (Gillett et al ]990) and an individual learning text prepared locally by the teaching team. The sessions on campus were used to examine issues identified as important by the participants, for example essay writing skills, reflective processes and library referencing techniques. To identify participants' initial academic essay writing abilities they are required to submit a formative essay at the beginning of the course. The success in this course is .judged by an essay submitted at the end which is assessed using standard academic criteria. The students are also required to keep a reflective log of critical study-related incidents, larom these they submit a reflective summary identifying issues important in their learning process.

COURSE AIMS W h e n planning this course, the teachers' main aim was to facilitate a smooth transition into post-registration study for potential participants. The approach taken was one that would gently shift individuals from their belief that high value learning results from teacher-led sessions to an awareness of the benefits of a more student-centred approach. The course was entitled 'orientation' rather than 'study skills' as the teachers wished to recognize the students' present skills and expand these, rather than assume that potential course members lacked any academic expertise.

COURSE EVALUATION The course has attracted over 300 nurses so far. They hold a variety of positions ranging from staff nurses and enrolled nurses to senior managers. Interestingly, when each group meets for the first time, course members rarely mention their professional status when introducing themselves. Within the course, however, this mix o f grade has proved to be beneficial since it has provided a particularly rich source of experiences as a basis for course members' discussions. The course has also enabled this mix o f nurses to meet and interact in the 'neutral'

environment o f the classroom. As a positive outcome of these c o m m o n learning experiences, participants found they were able to offer more social and emotional support to each other in their own workplace. Over the past year there has been a persistent demand from course members that the teachers should be more prescriptive, for example by providing 'model' answers to study and essay problems, and by using the lecture method throughout. This demand arises from participants' past school learning experience. Historically, schools in the U K demanded maximal acquisition o f facts tested by examination which encouraged participants to adopt a 'surface' approach to study (Morgan et al 1982). However, although the team has been aware o f these demands, it has resisted the pressure to change its style o f teaching and has continued to promote androgogical 'deep' learning (Knowles, 1984). Different techniques and strategies for learning are offered, with the participant making the ultimate choice as to which suits his or her particular situation. At the end of the course, in addition to the teacher evaluations of the course, participants were invited to provide evaluative comments. Course members were universally interested in this exercise and willingly agreed to take part. Information was gathered using two evaluative instruments. The first was a semi-structured individual interview with each participant, lasting 30 minutes. The interview structure was derived from evaluative comments from previous course participants. The second evaluative tool was the individual's reflective summaries. The team have now analysed interview and reflective summary information obtained from the first two cohorts (n=126). Through an initial process of content analysis, several recurring themes emerged from this material. Following this, in the final stage of the analysis, the themes were incorporated into an integrated evaluative model of course outcomes. The two main components of the model consist of course processes and course products. The product comments relate to the course learning outcomes (Fig. 1), and therefore consist of evaluative components which had been anticipated by the course teachers. However, the teachers were surprised by the process outcomes (Fig. 2) which had not been foreseen, and which turned out to be the most highly valued by participants. The product and process findings, presented in percentage term& are discussed below.

Product outcomes The most frequently occurring comments related to course outcomes were: study and writing skills; library techniques; levels o f study;

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Fig. I Productoutcomes. strategies for learning; preparation for professional development. O f these, the most frequently cited benefit arose from the study and writing skills content (71%). Many commented on the changed requirements associated with essay writing now when compared with their 'old nurse training days'. They found the increased level of sophistication required to satisfy current higher education requirements disconcerting. Stephenson (1985) argues that academic essays are valued for attributes such as the quality of ideas, arguments, problem solutions and research components, in other words high level cognitive abilities, whereas Snyder (1993) suggests that nurses are not by nature critical thinkers and, moreover, have not had experiences within the traditional curriculum which enabled the development of a range of problem-solving strategies. The orientation course participants had little previous experi-

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Fig. 2 Processoutcomes.

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ence of academic essay writing and lacked opportunities to develop enhanced cognitive competences. This perhaps explains why the study and writing skills component of the course were evaluated so highly. When comparing formative and summative results, 83% of participants were found to have increased their grade. The skill of essay writing was felt to be the major 'gateway' aspect of the course; individuals reported that they would have given up future study plans had they failed in the essay writing component of the course (Dewar et al 1994). Similarly, clinical managers considered that this essay writing skill is the most important course outcome. They are now using these results as a basis on which to counsel their staff and support appropriate further professional development. Post-registration course teachers, likewise, view success in this outcome as a

40 50 60 Pemen~ge of Sample

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predictor of satisfactory progress in future academic courses. The second most frequently cited product outcome (68%) related to the value placed on acquisition of library skills. This seemed to provide participants with access to a greater range of source material than that available in a hospital-based nursing library. They anticipated that their future academic work would require the quick referencing facilities provided by the college computerized system and its associated access into a global literature network. Information retrieval skills were thus seen to be highly relevant to the achievement of future career goals. As an unexpected bonus associated with this learning experience, some course members commented that they were more often confident in using computer hardware. They felt they could begin to transfer these skills into their own area of practice, for example in computerized care planning and standard setting which Kemp & Richardson (1991) consider are becoming essential skills in planning patient care. Academic levels of study and associated assessment were concepts discovered for the first time by 67% of respondents. In the past, traditional nurse training programmes did not identify or categorize learning in terms of a hierarchy of achievement. Participants therefore had little idea of their level of learning. It is apparent, however, that descriptive skills acceptable then, have now been superseded by the need to apply a more analytical approach both academically and in day-to-day practice. Snyder (1993)considers that a move towards consumer-focused care is dependent upon a concurrent shift in nursing perspectives from traditional to creative problem-solving strategies. Participants welcomed the opportunity to clarify these academic levels and to identify with their colleagues the range of potential applications to their personal and professional academic future. Rather than highlighting individual elements of the course as particularly important, 66% of respondents found the 'total package' of new strategies for learning to be extremely useful. For example, more efficient time management, note taking and essay planning enabled those with family responsibilities and/or full time work commitments to fit in their study activity (Northedge 1993). Finally, preparation for professional development was identified as a useful course outcome by 56% of individuals. In particular, participation in the course was felt to offer insight into P R E P requirements ( U K C C 1990) and possibilities of career developments through competency-based educative programmes ( U K C C 1993). Although course

members had been superficially aware of P R E P and 'competency', the enormity of their potential consequences to nursing and to themselves was not fully understood prior to commencing the course. They became aware that P R E P is mandatory and that evidence of continuing academic development supporting an improved clinical competency is a prerequisite for re-registration from 1995. Process o u t c o m e s

These outcomes concern the processes within the programme which, participants believed added immense value to their learning experience. The most significant aspects of the course for them involved confidence and motivation, enjoyment in the gaining of new skills, a feeling of sense of worth and achievement, self-awareness, ability to reflect on practice, and a hope that it would give a change of professional destiny (Fig. 2). Most of the course members (92%) believed the programme had given them increased confidence and motivation. An increased level of confidence, in conjunction with reduced amxiety, increased participants' willingness to experiment with novel study strategies. Since they felt the course was non-threatening, it enabled them to swim more securely into deeper academic waters, Casdedine (1992) suggests that taking risks of any kind means accepting the possibility of failure or ridicule from colleagues, and Dobos (1992) supports this view, asserting that occasional failure is an inevitable accompaniment to creativity and critical thinking. However, Masters & Masters (1989) indicate that taking risks is essential to any strategy for increasing professional and personal power and for enhancing career prospects, job satisfaction and patient advocacy. The respondents believed that their increased confidence had motivated them to take a greater part in clinical decisionmaking and problem-solving activities while accepting the risks this involves. The teaching team noted a change in course members' approach to their learning experiences as the course progressed. Whereas individuals initially displayed signs of grim determination, later, a more relaxed involvement was apparent. These observations are supported by 87% of respondents who evaluated the experience of learning as enjoyable and interesting despite the challenges it involved. As one individual said: I discovered the pleasure as well as the pain o f learning. There is a general agreement among authors of study techniques that enjoyment is an essen-

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NurseEducationToday tial feature o f a sound learning process (Marshall & R o w l a n d 1989, Fairbairn & W i n c h 1991, Northedge 1993). Moreover, the course provided learning opportunities which bolstered participants' selfimage and gave them a positive sense o f achievement, according to 71% o f the group. As one individual stated in her reflective summary:

demic study as a necessary component o f enhanced professional status, they could see more clearly h o w to plan for their future in nursing.

I feel so much better about myself n o w and I think this has helped me succeed. I hope the effects will carry on in m y diploma course.

Formal evaluation o f this orientation course has p r o v e d to be extremely valuable. For both teachers and course members, it has confirmed the view that such a course is necessary. It has provided an easily accessible o p p o r t u n i t y for traditionally trained nurses to enter the w o r l d o f higher educatiom In addition, success in the course has raised participants' expectations o f future academic achievement which in turn may open up wider career prospects. The enabling, process outcomes o f the course turned out to be o f prime importance in supporting and sustaining the more productoriented components o f the course. These 'value-added' process outcomes seemed to trigger a paradigm shift in the way that many individuals thought about themselves. By the end o f the programme they perceived themselves as academically capable, and professionally as a 'marketable' product.

This awareness o f self was achieved by participants' examination o f their actions, thoughts and feelings, through a rewarding, though sometimes pailff'nl and difficult, p r o cess of'individual reflection. T h e knowledge gained from such exposure can, however, be a very powerful basis from which to develop critical understanding according to D u k e & Copp (1994). O f the respondents, 68% believed that they had acquired insights into their own study problems and capabilities as a result o f the degree o f active participation required o f them in the course, both in the group tutorials and through their individual learning pack. These outcomes are consistent with the participatory and collaborative ethos o f the course and seem to have a positive effect on individuals' study skills acquisition (Jacques 1984). As Jacques suggests, student involvement in the learning process has a positive effect on individual study skills acquisition. As a result o f the reflective processes encouraged within the course, 58% recognized that opportunities to reflect on the course issues not only improved their study skills but also produced beneficial effects on their practice. Insights achieved through reflection increased individuals' awareness o f their capabilities and produced a sense o f personal power. This, in turn, gave these nurses more confidence in taking professional decisions, not only individual patient care decisions, but also strategic planning decisions at ward and directorate level (Dobos 1992). Finally, 52% o f respondents found the course, particularly the group discussion opportunities, had the effect o f broadening their p r o fessional career horizons. These discussions provided a rich source o f information from which they could measure their progress and degree o f individual achievement. As a result, individuals who had been in their present position for several years began to see opportunities that had previously eluded them. For some, this resulted in frustration, as a career change was not possible. For others it offered exciting new opportunities. By recognizing the role o f aca-

CONCLUSION

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Orientation to higher education

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