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Nursing Students’ Perception Regarding Quality of Nursing Courses and Its Relation to Their Academic Achievement

Aziza Zakaria Farmawy Ali*, Ehsan Saad Soliman Saad

Nursing Administration, Benha University, Egypt

Abstract: Background: Checking of students’ perception of quality of nursing courses is one of main items that can help the success of the educational nursing courses and beneficial for course development and improvement to achieve the desired intended learning outcomes and enhance academic achievement of nursing students. Aim: This study aimed to assess nursing students' perception of quality of nursing courses and its relation to their academic achievement. Research Design: A descriptive correlational research design was utilized to conduct this study. Setting: The study was conducted at Faculty of Nursing-Benha University Sample: Non probability quota sample consisted of 752 from total student number 10438 students whom formerly registered in the Faculty and were in different academic study levels in academic year 2015/2016 and studied nursing courses. Tools of data collection: Three tools were employed in this study namely: Personal data of nursing student questionnaire, Quality of nursing courses questionnaire, and auditing checklist of nursing student's academic achievement. Results: The study yield that about nearly half of nursing students (49.1%) had low level of perception regarding quality of nursing courses dimensions of. objectives of the nursing course and (40.5%) of them had low level of perception regarding students-teacher interaction and communication, but more than two thirds of them had moderate level of perception regarding courses evaluation process and more than half (50.7%) of them had high level of perception regarding clinical setting. Also the highest level of total academic achievement (52.0%) of all nursing students were very good. Conclusion: There was a strong positive statistical significant correlation between nursing students` perception of quality of nursing courses and their academic achievement, also there was significant correlation between students' perception of quality of nursing courses and their academic study level. Recommendations: Nursing students' perception regarding quality of nursing courses should be considered and discussed by academic teaching staff and faculty of nursing administrators to make needed development to motivate the nursing students to highly academic achievement. Clarifying the objectives of nursing courses for nursing students and encourage teaching strategy of students-center.

Keywords: quality of nursing courses, nursing students, academic achievement

Received August 19, 2016; Revised October 20, 2016; Accepted December 27, 2016

Citation: Aziza Zakaria Farmawy Ali, Ehsan Saad Soliman Saad, Nursing Students’ Perception Regarding Quality of Nursing Courses and Its Relation to Their Academic Achievement. American Journal of Nursing Research, 4 (3). 91-99. January 2016. doi:10.12691/ajnr-4-3-6

1. Introduction

Education is a creative and dynamic process that is a fundamental human right and the basic building block of every society. Within the education process, opportunities are provided for learners to attain desired goals through variety of both structured and unstructured learning experience [1]. Education is a learning process that increase students' knowledge and awareness about the surrounding environment and identifies life challenges to create the required skills and knowledge to deal with faced challenges and, enhance attitudes [2]. In the context of quality of education, learner-centered education is one vision of best practice that improves quality of education [3]. The aim of higher education is to foster multi-phases for development, guiding students toward achievement and encouraging them to adapt with constant change in their professional and personal lives [4].

Educational process depend on several interrelated factors includes those related to student, educator and educational environment. Hierarchy of needs for motivating learning addressed that student must feel comfort, safe and sense of belonging to their faculty environment for being able to learn. Nursing education encompasses the three domains of learning; cognitive, affective, and psychomotor. Development of nursing education can be achieved through the evaluation of the effectiveness of teaching in nursing programs [5]. Nursing students are students who receive theoretical and practical education to enable them establish a link between the patient and the complex healthcare environment. They will deliver caring and establish relationships with all members of the health care team [6].

Universities strive to promote student engagement and active learning, they are moving progressively towards student centered learning Much of the research in higher education has recognized the importance of student-centered learning, this approach emphasis on student rather than on teacher control as a content-developer [7]. Nursing students, no longer seen as passive recipients of knowledge but they should be contributing and engaging in teaching, learning and assessment processes. Student`s transition from passive to active learners can be difficult for teachers and education systems [8]. Teaching and learning processes requires equal participation of both students and the teachers [9]. Nurse educator has a responsibility to society and to students for providing quality education, maintaining the highest academic standards, effective use of teaching strategies and ensuring adequate support to learners. Teachers help students to achieve their education and career goals, and solve their problems cause's barriers to educate and encourage them to utilize their strengths [10].

Over the past decade, the need for evaluation of the quality of nursing education has been growing. Therefore, the American Association of Colleges of Nursing has developed multiple measures of Nursing Education Assessments to evaluate the effectiveness of undergraduate nursing programs based on students’ perspectives [11]. Nursing education is important to practice and this education needs to respond to changes in healthcare created by scientific and technological advances in Egypt, the current nursing education system consists of three main programs level, technical diploma nursing schools, technical associated degree and the baccalaureate degree [12]. Nursing education has a significant impact on the knowledge and competencies of the nurse clinician, there are three routes to becoming a registered nurse a three year diploma program , a three year associate degree and a five year baccalaureate degree [13] .

The idea for baccalaureate program that it contains course work, enhances the students' professional development, prepares the new nurse for a boarder scope of practice experiences are embedded in baccalaureate nursing programs to prepare students to care for variety of patients a cross the life span and cross the continuum of care [14]. Educating nursing students is the responsibility of nursing school and faculty to enable them facing the future tasks safely and competency [15].

Nursing student, able to gain the educational experiences from internalizes the knowledge, skills and values regarding nursing. This internalization occurs with acquiring knowledge and skills through a combination between a formal basic training process and socialization process. It is important to provide students adequate space when taught material because it helps them to engenders ownership of the taught knowledge [16]. Therefore, nurse students need for a supportive environment to receive their educational process [17] Nursing student’s perceptions about their educational environment should examine due to it important role in planning and implementing the educational program and applying the corrective measures to ensure a high quality educational environment [18].

The general goal of nursing education is to prepare nursing student to function properly in society according to health needs. Quality assurance (QA) is one of the mechanisms developed to ensure that graduates attain adequate standards of education and training. The scope of assessment of QA includes curriculum; student guidance, teaching and learning environment, available resources and procedures. Curriculum design is one of the exciting intellectual challenges that the field of education can offer. Curriculum design is put in consideration what to teach, why to teach it, and how to teach it. At the same times, curriculum design ultimately depends on the purpose of the institution [19]. Quality assurance is considered a major concern in the society especially in higher education and the health services. Checking of nursing students’ perceptions is one of main items that can help the success of the nursing courses and beneficial for nursing course development and improvement. Keeping of quality in higher education especially in nursing courses is an integral responsibility of both academic and assistance staff [20].

Nursing students’ perceptions about quality of nursing courses should examine due to it important role in planning and implementing the educational program and applying the corrective measures to ensure a high quality educational environment [18]. Nursing students' perception should be assessed because it is effect on the quality of learning at any educational institution. [21]. Therefore, it is important to take feedback from student about their perception toward the educational environment to pinpoint more specific strength and weakness within the educational environment. The objectives of the nursing courses are to qualify nursing students to function independently as nurses and to participate in cross-disciplinary cooperation. The education shall give the students skills in theoretical and clinical nursing in accordance with social, scientific and technological developments as well as society’s needs for nursing. Concerning course plan and evaluation, Students‟ expectations have a great value on self-efficacy, learning, knowledge and skills [22].

Quality of nursing education is currently facing challenges related to the application of nursing knowledge in clinical environments and inability of students in application of nursing procedures in clinical settings. Nursing students themselves represent the best means of identifying these challenges. The nursing students’ perception of nursing education quality regarding theoretical, clinical, and the gap between theoretical education and clinical skills demonstrated a need to pay careful attention to standards and validation of education quality. The investigation of students‟ perspective prior planning program can provide useful information for teachers and courses to design and implement of educational courses and to improve the teaching process as a whole to get the desired achievement of program outcomes and students‟ overall educational and professional goals [23].

Quality of nursing courses must ensure the training of competent nursing students who will be professionals to provide safe and quality care, To achieve this, it is necessary to ensure the efficiency and quality of educational nursing courses and nursing professors through the accreditation programs. [24]. Educational organizations must seek ways to address students’ individual learning styles in the classroom in order to prepare students to become safe and competent practicing nurses [25]. To evaluate the quality of education the learners (nursing students) considered the most important elements of education which should be evaluated. It is very important for any evaluation to include the learners. Evaluation of educational programs provides data that supports learning experiences that have positive effects on students’ growth and development [26].

Reducing nursing students’ exposure to risk factors and promoting positive youth development for students that becomes more favorable to student, that helping in increase student motivation, engagement, reducing student absences and improvements in academic achievement across grade levels [27]. Academic achievement is very important in higher education as a means of measuring the effectiveness of the transfer of knowledge. Academic status refers to academic achievement or decline, and various means, such as grade point average and the amount of passed or failed credits, are used to measure it. Recognition of learning styles and modifying education accordingly will cause lecturers to make use of appropriate methods of teaching and pay attention to personal differences [28] and [29]. Academic achievement defined as an ability of knowledge attainment or skill development in school subjects (faculty courses) usually determined by test scores or by marks assigned by faculty [30]. Academic achievement factors is commonly measured through examinations or continuous assessments but there is no general agreement on how it is best evaluated or which aspects is most important procedural knowledge such as skills or declarative knowledge such as facts [31].

1.1. Significant of the Study

Nursing education in turn will influence the future development of the nursing profession so researchers interested to conduct this study in Egypt. This study is a featured study about the quality of nursing courses as perceived by nursing students. Evaluating and keeping quality of higher education is the first step for educational institution development. Faculty of Nursing-Benha University is a higher educational institution where nursing student enrolled formally in it. Quality of nursing courses play a crucial role in students’ academic achievement so the researchers hopes together to obtain information from nursing students that help to assess quality of nursing courses. Nursing students should be involved in assessing anything related to their education according to student–center approach. Limited studies handle likes this topic at Faculty of Nursing-Benha University. Assessing academic achievement of nursing students to know where they are and to determine weakness and strengths points and apply corrective actions if needed. The study results could help in initiating needed change regarding the nursing courses, teaching process, clinical practice and clinical setting to enhance academic achievement of nursing students.

1.2. Aim of the Study

This study aimed to assess nursing student's perception of quality of nursing courses and its relation to their academic achievement.

1.3. Research Questions

1. What are the nursing students’ perceptions of the quality of their nursing courses?

2. Is there a relation between nursing student’s perception regarding quality of nursing courses and their academic achievement?

2. Subject and Methods

Research design: Descriptive correlational design was used for conducting this study.

Research setting: The study was conducted at Faculty of Nursing- Benha University. It was established in 1992 and it got accreditation in 25/ 8/ 2014 from National Authority for Quality Assurance and Accreditation of Education (NAQAAE). There are six academic departments in the faculty including: Nursing Administration Department, Psychiatric and Mental Health Nursing Department, Community Health Nursing Department, Pediatric Nursing Department and Medical and Surgical Nursing Department.

2.1. Sample

The study sample were included (752) nursing students from total student number (1438) in the first, second, third and fourth academic levels in academic year 2015/2016 and whom formerly registered in the faculty of nursing and studied and pass exams of the following nursing courses; fundamentals of nursing, community nursing, pediatric nursing, maternity nursing, mental health & psychiatric nursing and nursing management in first or second semester in academic year 2015/2016.

Sample type: It was non probability quota sample.

Sample size: It was consisted of 752 from the total student’s number 1438 sample of the study was calculated according to the following sample size equation:

Where "n "was sample size

"N" was total number of nurse students. N = (1438)

"e" was coefficient factor =0.005 (Yamane, 1967)

2.2. Inclusion Criteria

Nursing students who formerly registered in the Faculty of Nursing-Benha University and were in different academic study levels as Table 1, in academic year 2015/2016 whom studied nursing courses and pass exams during the first or second semester according to the Faculty policy.

Table 1. Distribution of studied nursing students according to their academic study level (n=752)

2.3. Tools of the Study

Data of the study was collected by using three tools: Personal data of nursing student questionnaire, quality of nursing courses questionnaire, and auditing checklist of nursing student's academic achievement.

Tool 1- Personal data of nursing student Questionnaire:

This tool was developed by the researchers, it concerned with personal data of nursing student such as age, gender, academic level, semester and the current nursing course name. characteristics.

Tool 2 - Quality of nursing courses questionnaire

This tool was adapted from [32] and was utilized by the researchers. This tool intended to assess nursing students' perception regarding quality of the nursing courses. It was consisted of eighty-seven (87) items categorize into (9) dimensions as the following table;

Table 2. Dimensions of Quality of nursing courses questionnaire and number of its items

2.4. Scoring System

Nursing student’s perception of the quality of nursing courses was scored on a five point Likert scale ranged from (0) strongly disagree to (5) strongly agree. Overall scores will fall within the 87 to 435 range. The total score for each dimension was calculated. Scores of each lea dimension was summed up and mean &standard deviation was calculated and converted into percent scores that reflecting their perception regarding quality of nursing courses. Nursing students' perceptions have been classified into three levels of perception of quality of the nursing courses according to the following: high level (>100% => 85%), average level range from (= 70 – 85%), and low level (= < 70 %.).

2.5. Content Validity

Content validity was reviewed before the pilot study and the actual data collection, through distribution of the first tool to five experts in different nursing specialties, to ensure appropriateness, relevancy, clarity and completeness of the tool.

Reliability: Reliability was measured by using Alpha Chronbach's Coefficient of total (87) questions which was equal to (0.972).

Tool 3 - Auditing checklist of nursing student's academic achievement: This tool adapted from [33], and used by the researchers to review student’s final total grades of their nursing courses that mentioned before and indicate their academic achievement, and included student number/code, academic grade, semester, nursing course name, and student’s grades/ marks of the nursing course that taught at Faculty of Nursing-Benha University in academic year 2015/2016.

2.4. Operational Design

The operational design for this study included three stages, namely a preparatory phase, a pilot study, the field work.

2.5. Preparatory Phase

This phase started from February 2016 to April 2016 It included the following: Reviewing the national and international related literature using journals, periodicals, textbooks, internet and theoretical knowledge of the various aspects concerning the topic of the study for modifying the tools. All tools: personal data of nursing student questionnaire, quality of nursing courses questionnaire and auditing checklist of nursing student's academic achievement were translated into Arabic and tested for face and content validity by 5 experts from nursing administration department.

2.6. Pilot Study

Pilot study was carried out in June 2016 to ascertain the clarity, feasibility and applicability of the study tools. 75 nursing students were included in the pilot study representing 10 % of total study subjects. Also it has served in estimating the time needed for filling the tools. It ranged between 15-20 minutes. No modification was needed. The pilot study was excluded from the study results.

2.7. Field Work

Data collection took about three months from beginning in May 2016 to end of July 2016 to evaluate student’s perception regarding courses which taught to students and they pass exams for these courses. The researcher met students and explained the aim and the nature of the study and the method of filling questionnaire. This was done individually or through group meetings. The researcher distributed the questionnaire sheets to the participated students to fill it. The number of collected questionnaire from students per day ranged from 5 to 20 sheets. It took from 15 to 20 minutes to complete the questionnaire sheet. Data collected three days /week in Sunday, Monday and Thursday from 10 am to 1 pm in the presence of the researcher to clarify any ambiguity. The researcher also collects data to assess academic achievement of nursing students by checking the mark lists of nursing students which were in student affair department after formal announce of the results of the students of their formal exams.

2.8. Administrative Design

Permission was obtained from dean of Faculty of Nursing of Benha University to get the required information we need and collect data from the students.

2.9. Ethical Considerations

Oral informed consents were obtained from the students. They were informed about their rights to refuse or withdraw from the study with no consequences. They were reassured about the anonymity and confidentiality of the information collected, and would be used only for the purpose of scientific research. No harmful maneuvers were performed or used and no foreseen hazards were anticipated from conducting the study on participants.

After completion of data collection, the data were organized and tabulated and statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version (20.0). Descriptive statistics were applied in the form of means, standard deviation for quantitative variables and frequency and percentages for qualitative variables. Pearson correlation coefficient was used as a measure of the strength of a linear association between two quantitative variables. Statistical significance was considered at p-value P<0.05, and considered highly statistical significance at p-value P<0.001.

3. Results

Table 3 shows that age of studied nursing students range was 20-22 years, and 75. % of the nursing students was females. The highest percentage 26.1% of the nursing students were enrolled in the third academic study level, while the lowest percentage 23.1% were in the fourth academic study level. The nursing students who enrolled in the medical and surgical nursing represented 25.9%, while who enrolled in the nursing management were 5.7% of the total study subjects.

Table 3. Distribution of nursing students according to their personnel characteristics (n= 752)

Table 4 shows that about nearly half of nursing students (49.1%) had low level of perception regarding quality of nursing courses dimensions of. objectives of the nursing course and (40.5%) of them had low level of perception regarding students -teacher interaction and communication, but more than two thirds of them had moderate level of perception regarding courses evaluation process and more than half (50.7%) of them had high level of perception regarding clinical setting.

Table 4. Nursing students' perception level of quality of nursing courses dimensions (n=752)

Table 5. Total mean of nursing students’ perceptions of the quality of nursing courses dimensions (n = 752)

Table 6. Distribution of nursing students according to their academic achievement of nursing courses (n=752)

Table 5 illustrated that the total score of nursing student’s perceptions of the dimensions of quality of nursing courses was with average level (Mean = 64.1218), The dimension of teaching methods had high mean level (66.40956) of perception from nursing students, while objectives of the course had low mean level (59.694).

Table 6 shows the highest academic achievement level (44.0%) for nursing students who were excellent in community health nursing course and 54.% were very good in mental and psychiatric nursing course while the lowest level of total academic achievement (2.0%.) of nursing students were pass but the highest level of total academic achievement level (52.0%) of nursing students were very good.

Table 7. Correlation between nursing students' perception of quality of nursing courses, academic level and academic achievements (n = 752)

Table 7 shows that there was a strong positive significant correlation between the students' perception of quality of nursing courses and students' academic achievement. while there was significant correlation between students' perception of quality of nursing courses and students' and academic study level.

Figure 1. Shows that more than half (57.0%). of nursing students had moderate level of perception while one third (32.6%) of them had low level of perception

Figure 2. Shows that the lowest level of total academic achievement (2.0%.) of nursing students were pass but the highest level of total academic achievement level (52.0%) of nursing students were very good

4. Discussion

4.1. Personnel Characteristics of Studied Nursing Students

According to the study findings the demographic characteristics for the participated students represents that the majority of them were females. This is due to the fact that the Faculty of Nursing was only accepting females first and then started to admit both sexes in nursing education, due to the need of the Egyptian society for both sexes from nursing specialty in different health settings. The Benha faculty of Nursing accepts each year students of both genders, who have general secondary school education. Then they are classified into male and female classes. This is in contrary of what was been carried out before those male nurses were dominating. This finding come in agree with [34] who noted that about two third of the students were female. Also [35] who reported that the majority of students were females. On the other side

This finding not agree with the results of [36] who reported that increasing the number of male nurses were a community aim as in such a college female nurses were dominating.

The study revealed that less than half percent of students age were ranged from 20-22 years, this may be the college majority of the students were regular and normally upgrading. This result is consistent with the findings of [36] who found that the age of students in the study "gender and career: female and male nursing students' perceptions of male nursing role in Turkey" was ranged between 20-22 years. Also this come in agree with [34] who noted that about half of participated students‟ age, were ranged from 20 - 22 years, this may be the participated students were regular and normally upgrading.

4.2. Regarding Students' Perceptions of the Quality Dimensions of All Nursing Courses

The study revealed that, students at Benha faculty of Nursing perceived the nursing courses as having more than half of the nursing courses was clinical setting had high level of the quality dimensions for all nurses courses. This could be because the college appoints clinical setting according to criteria, which assures their competency and consequently the quality of the clinical setting. The students perceived their knowledge and training from having good clinical setting and good training characteristics as create a positive and comfortable learning environment, good methods of training, correlating theory with practice in clinical settings and use good role model.

The study findings were supported by many researchers, [37] reported that the most important characteristics of effective clinical setting as the highest ranking as corrects student’s mistakes without criticizing them, were available, well prepared for teaching, a good role model, and encouraged a climate of mutual respect. Also [35] reported that clinical setting the highest dimension of students courses.

Generally, Objectives of the nursing course have been perceived by students as having the least level score (49.1%) of the dimensions of all nursing courses. This could be because most of teachers using a limited teaching strategies, as they depended on lectures, and power points presentations only. Other teaching methods like role play, group discussions, problem solving, simulations, self-learning…etc. we're not used because of the unavailability of facilities, both manpower and materials. While [38] found that teaching methods were chosen by students as the next most frequent characteristics of effective teacher/instructor after personality attributes.

4.3. Regarding Students Perceptions of the Overall Quality Level of all Nursing Courses

The study findings revealed that the students perceived the whole nursing courses as having average level of perception of quality of nursing courses. While there is, some differences of scores. among nursing courses The Teaching Methodology had high mean level of quality (66.40956) while Objectives of the Course had low mean level of quality (59.694).

This may be because the first two courses were taught for students at the fourth level, where the students have higher expectations, maturity, more experience, and more knowledge and can assess and evaluate matters 18 better than lower levels. Other factors could the quality of teachers/instructors, contents taught, and teachers/instructors interactions. This result is consistent with [39] who found that students of upper level classes evaluate their instructors with higher ratings scores, this finding supported by [3] who found that, students’ reactions and interactions related to the development of the course can give a positive effect to the course development specially at initial stage. In this regard, investigating issues related to students’ expectations and experiences can be a significant guide for developmental of the overall educational process. Also this findings agree with [30] who reported that teaching methodology was lowest mean of quality dimension

4.4. Students Achievement Levels

The study results revealed that students’ grades in the theoretical part of the course were ranged from average level, the highest grade level were very good level, for 52.0%, while the lowest grade was pass for 2.0%. This could be because the theoretical grades were obtained through year work such as many tests during the semester, as quizzes, midterm, writing assignments, attendance, participation and final exam; through this process many grades may be lost. Another cause may be due to difficult exams, and students stress. What mentioned may affect the students' final theoretical achievement levels. This is consistent with [39] who reported that nursing educators can use many assessment strategies for given course like doing tests, assignments, quizzes, projects, presentations and contribution of discussions. Also [40] who reported that that students’ grades in the theoretical part of the course were ranged from average level, the highest grade level was very good.

4.5. Relation between Nursing Students' Perception of Nursing Courses and Students' Academic Achievement

There was a strong positive significant correlation between the student’s perception and students' achievement. while there was significant correlation between students' perception and their academic year .and the following quality dimensions such as explaining objectives of the course at the beginning of the course, the contents of the course, teacher characteristics, student’s/teacher interaction, course evaluation, teacher competencies, and teaching methodology and students’ achievements.

This could be because the courses objectives, were clear, logic, explained at the beginning of the course and relevant to the course topics, courses contents were interested, covered all topics and subjects of the course and delivered in a way that convenient to students, satisfactory courses evaluation process, fair evaluation, comprehensive exams and covered most of the course topics, teachers were competencies, efficient and well prepared. Where students’ achievements reflect their understanding and knowledge acquired through course taught. This is in agreement with [41] who reported that grades provide students with information related to how well they understand course material. This result was supported by [42] who reported that investigating student’s perception can be useful for improvement of academic achievements. This findings contrast with [43] who reported that no significant correlation between the student’s perception and students' achievement.

5. Conclusion

There was a strong positive significant correlation between nursing students' perception of quality of nursing courses and nursing students' academic achievement. Also nursing students had low level of perception of quality of nursing courses regarding the following quality dimensions; explaining objectives of the nursing course at the beginning of the course, the contents of the course, teacher characteristics, students/teacher interaction, course evaluation, teacher competencies, and teaching methods and. More than half of students had high level of perception of quality of nursing courses dimensions for clinical Setting.

6. Recommendation

In the light of the findings of the study, the following recommendations are proposed:

- For future studies, we recommend regular qualitative follow-up study with the participants to understanding the aspects that need to be improved. In addition, it would be important for future studies to evaluate the relationship between students’ perceptions of their quality of studying courses and their academic achievement.

- Improve the academic achievement of nursing students through different teaching strategies and applying of skills mastery experiences, vicarious experiences, and social persuasions in education.

- Periodic assessment of needs of nursing students regarding nursing courses by academic teaching staff and faculty administrators and achieving these needs based on scientific base.

- The nursing courses should combine activities that support nursing students in developing their knowledge, skills and attitudes.

- Therapeutic relationship among nursing students and their academic teaching staff through active listening and good communication.

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