Improving Indonesian Nursing Students’ Self- Directed Learning … · 2010-06-09 · The purpose...
Transcript of Improving Indonesian Nursing Students’ Self- Directed Learning … · 2010-06-09 · The purpose...
Queensland University of Technology
School of Nursing
Centre for Health Research
Improving Indonesian Nursing Students’ Self-
Directed Learning Readiness
Djenta Saha
BN, MHA
Submitted for the award of Doctor of Philosophy
May 2006
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KEYWORDS
Educational intervention program
Indonesia
Lifelong learning
Nursing education
Nursing students
Self-directed learning readiness
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ABSTRACT
Introduction
The purpose of this study was to improve Indonesian nursing students’ self-directed
learning readiness. An educational intervention program (EIP) was developed,
implemented and evaluated.
Background to the study
Many studies have documented the need for nursing students to be prepared for the
rapidly changing and complex health care environment. Lifelong, self-directed
learning (SDL) has been identified as an important ability for nursing graduates.
However, no study has documented the needs of, or preparation required for, nursing
students to function effectively in the rapidly changing health care system in
Indonesia. The Indonesian diploma nursing schools still use a teacher-centred
approach with little emphasis on a student-centred approach.
Method
The study used a mixed method involving both quantitative and qualitative design.
Simple random sampling was used to select an intervention school and control
school. The sample was 2nd year nursing students with 47 in the intervention group
and 54 in the control group. A pre-post test questionnaire, using the Self-Directed
Learning Readiness Scale (Guglielmino, 1978), was used to collect quantitative data
and focus group discussions (FGD) were used to collect qualitative data regarding
students’ perceptions of SDL prior to and at the completion of study. The
intervention group received an EIP. The Staged Self-Directed Learning Model
(Grow, 1991) and the Teacher Student Control Continuum (D’A Slevin & Lavery,
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1991) were used as the organising framework. A self-learning module and learning
plans were used as learning strategies to operationalise SDL concepts alongside
teacher-centred methods. The control group received the existing teacher-centred
methods. At the completion of the intervention, clinical instructors from both the
intervention and control groups participated in FGD to explore their perceptions of
students’ activities during the EIP.
Results
For the majority of students, readiness for SDL was ‘below average’. The mean for
the Indonesian nursing students was significantly lower than established norms
(Guglielmino, 1978). The introduction of SDL concepts through an EIP improved the
level of readiness for SDL in the intervention group from ‘below average’ to
‘average’ compared to the control group who remained in the ‘below average’ range.
Higher SDL readiness was reported by female students and students who completed
the educational intervention.
The FGD before the intervention revealed that students perceived SDL as a ‘self-
activity’. Perceptions of students in the intervention group changed during the EIP
compared to students in the control group. Students in the intervention group viewed
SDL as a ‘process of learning’. Increased self-confidence, incremental learning, and
having direction in learning were identified as benefits of SDL. Knowledge and skills
in SDL, learning materials and communication were identified as important issues
that needed to be improved. Clinical Instructors’ perceptions of students’ clinical
activities confirmed that students in the intervention group were ‘more active’
compared to the control group who were ‘still inactive’.
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Conclusion
The study confirmed the expected effect of the EIP on students’ SDL readiness. The
EIP improved nursing students’ readiness for SDL and had a positive impact on
students’ perceptions of SDL. Introducing the concept of SDL through the EIP was
found acceptable by the sample and was deemed feasible to implement within the
Indonesian nursing education system. The study has potential to make a significant
contribution to nursing education in Indonesia by promoting lifelong learning and
SDL in nursing students and in curricula through the development of innovative
curricula and teaching and learning practices. The study also has potential wider
benefit to nursing practice and global health practice.
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TABLE OF CONTENTS
Keywords ............................................................................................................................ i
Abstract.............................................................................................................................. ii
Table of Contents .............................................................................................................. v
List of Tables .................................................................................................................... ix
List of Figures.................................................................................................................... x
Statement of original authorship .................................................................................... xi
Acknowledgements.......................................................................................................... xii
Chapter One ...................................................................................................................... 1
Introduction....................................................................................................................... 1 1.0 Introduction........................................................................................................... 1
1.1 Background ...................................................................................................... 3 1.1.1 Nursing education in Indonesia..................................................... 3 1.1.2 Diploma Nursing Curriculum........................................................ 5 1.1.3. Nursing education in Central Kalimantan..................................... 6
1.2 Significance of the study.................................................................................. 8 1.3 Purpose and objectives of the study ................................................................. 9 1.4 Research questions ........................................................................................... 9 1.5 Hypotheses ..................................................................................................... 10 1.6 Overview of methodology.............................................................................. 10 1.7 Definition of key terms .................................................................................. 12 1.8 Structure of the thesis..................................................................................... 13
Chapter Two.................................................................................................................... 15
Literature Review............................................................................................................ 15 2.0 Introduction......................................................................................................... 15
2.1 Overview of teaching and learning ..................................................................... 15
2.2 Students’ approaches to learning ........................................................................ 19
2.3 Self-directed learning.......................................................................................... 22
2.3.1 Definition .................................................................................................. 22 2.3.2 Conceptual model of self-directed learning .............................................. 27 2.3.3 Instructional methods to improve self-directed learning .......................... 36
2.3.3.1 Learning plans ............................................................................. 37 2.3.3.2 Learning module ......................................................................... 42
2.3.4 Measuring self-directed learning............................................................... 45 2.3.4.1 Oddi’s Continuing Learning Inventory (OCLI) .......................... 46 2.3.4.2 Self-Directed Learning Readiness Scale (SDLRS)..................... 47
2.4 Summary ............................................................................................................. 52
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Chapter Three ................................................................................................................. 53
Methodology .................................................................................................................... 53 3.0 Introduction......................................................................................................... 53
3.1 Research design .................................................................................................. 54
3.2 Population and sample ........................................................................................ 58
3.3 Sampling technique............................................................................................. 58
3.3.1 Quantitative sampling ............................................................................... 58 3.3.2 Qualitative sampling ................................................................................. 60
3.3.2.1 Student participants ..................................................................... 60 3.3.2.2 Clinical instructor participants .................................................... 61
3.4 Ethical considerations ......................................................................................... 61
3.5 Dependent and independent variables ................................................................ 62
3.6 Instrument ........................................................................................................... 63
3.6.1 Self-Directed Learning Readiness Scale (SDLRS)................................... 63 3.6.2 Demographic questionnaire ...................................................................... 67
3. 7 Procedure of data collection................................................................................ 67
3.8 Pilot study ........................................................................................................... 71
3.9 Educational intervention ..................................................................................... 71
3.10 Data analysis ....................................................................................................... 72
3.10.1 Quantitative data analysis ......................................................................... 72 3.10.2 Qualitative data analysis ........................................................................... 73
3.11 Summary ............................................................................................................. 75
Chapter Four ................................................................................................................... 76
Pilot study ........................................................................................................................ 76
4.0 Introduction......................................................................................................... 76
4.1 Design ................................................................................................................. 77
4.2 Sample................................................................................................................. 78
4.3 Instruments.......................................................................................................... 79
4.4 Procedure ............................................................................................................ 80
4.5 Data analysis ....................................................................................................... 81
4.6 Results................................................................................................................. 82
4.6.1 Demographic characteristics of the pilot sample ...................................... 82 4.6.2 Readiness for self-directed learning.......................................................... 83 4.6.3 Internal consistency................................................................................... 85 4.6.4 Temporal stability ..................................................................................... 86 4.6.5 General comment on the SDLRS.............................................................. 87
4.7 Discussion ........................................................................................................... 87
4.8 Summary ............................................................................................................. 90
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Chapter Five .................................................................................................................... 91
Educational Intervention Program ............................................................................... 91 5.0 Introduction......................................................................................................... 91
5.1 Conceptual framework of the Educational Intervention Program ...................... 93
5.2 Overview of traditional curriculum structure ..................................................... 99
5.3 Traditional teaching and learning activities........................................................ 99
5.4 Control group activities..................................................................................... 101
5.5 Overview of intervention group activities ........................................................ 103
5.6 Organisation of Educational Intervention Program .......................................... 105
5.6.1 Step 1: Preparation .................................................................................. 108 5.6.1.1 Workshops................................................................................. 108 5.6.1.2 Skills practice ............................................................................ 117 5.6.1. 3 Body fluid module..................................................................... 119
5.6.2 Step 2: Implementation ........................................................................... 120
5.7 Evaluation of Educational Intervention Program ............................................. 124
5.8 Summary ........................................................................................................... 124
Chapter Six .................................................................................................................... 125
Quantitative Results...................................................................................................... 125 6.0 Introduction....................................................................................................... 125
6.1 Demographic characteristics............................................................................. 126
6.2 Level of readiness for SDL............................................................................... 129
6.3 Differences in pre-test scores............................................................................ 130
6.4 Impact of the educational intervention program............................................... 132
6.5 Influence of educational intervention and demographic variables ................... 134
6.6 Summary ........................................................................................................... 135
Chapter Seven ............................................................................................................... 136
Qualitative Findings...................................................................................................... 136 7.0 Introduction....................................................................................................... 136
7.1 Data collection .................................................................................................. 136
7.2 Data analysis ..................................................................................................... 139
7.3 Findings............................................................................................................. 142
7.3.1 Students’ perceptions of SDL before the intervention............................ 142 7.3.2 Students’ perceptions of SDL after the intervention............................... 147
7.4 Clinical instructors’ focus group discussions ................................................... 156
7.4.1 Clinical instructors from the control group............................................. 157 7.4.2 Clinical instructors from the intervention group..................................... 161
7.5 Summary ........................................................................................................... 167
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Chapter Eight ................................................................................................................ 168
Discussion and Recommendations............................................................................... 168 8.0 Introduction....................................................................................................... 168
8.1 Research Question One..................................................................................... 169
8.2 Research Question Two .................................................................................... 174
8.3 Research Question Three .................................................................................. 175
8.4 Research Question Four.................................................................................... 177
8.5 Research Question Five .................................................................................... 180
8.6 Research Question Six ...................................................................................... 183
8.7 Limitations of the study .................................................................................... 184
8.8 Implications....................................................................................................... 186
8.9 Recommendations............................................................................................. 188
8.10 Conclusion ........................................................................................................ 189
Appendix 1 SDLRS-A............................................................................................... 192
Appendix 2 Demographic questionnaire ................................................................ 197
Appendix 3 Fluid and Electrolyte Balance (Self-directed learning module)....... 198
Appendix 4 Information for participants (pilot study) ......................................... 212
Appendix 5 Information for participants (intervention group) ........................... 214
Appendix 6 Information for participants (control group).................................... 216
Appendix 7 Consent form ........................................................................................ 218
References ...................................................................................................................... 223
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LIST OF TABLES
Table 2.1 Different approaches to learning................................................... 20 Table 2.2: Staged Self-Directed Learning Model (SSDL) ............................. 33 Table 2. 3: Instruments identified as assessing self-directed learning ............ 45 Table 2.4: Levels of readiness for self-directed learning ............................... 48 Table 3.1: Modification of focus group protocol ........................................... 68 Table 3.2: Student focus group script before intervention ............................. 69 Table 3.3: Student focus group script after intervention ................................ 70 Table 3.4: Clinical instructor focus group script ............................................ 71 Table 3.5: Modification of Stages of Thematic content Analysis .................. 74 Table 4.1: Demographic data of pilot sample ................................................ 82 Table 4.2: Means and standard deviations of SDLRS scores at Time 1 ........ 84 Table 4.3: Level of readiness for self-directed learning at Time 1 ................ 85 Table 5.1: Control group activities............................................................... 102 Table 5.2: Intervention group activities ....................................................... 105 Table 5.3: The workshop activities .............................................................. 110 Table 5.4: Stem/guided questions ................................................................ 115 Table 5.5: Skill activities in the nursing laboratory ..................................... 119 Table 5.6 Implementation of SDL concepts................................................ 122 Table 6.1: Frequency of demographic variables of sample.......................... 127 Table 6.2: Demographic differences between intervention and control
groups.......................................................................................... 128 Table 6.3: SDLRS scores at pre-test ............................................................ 130 Table 6.4: Different levels of readiness for SDL at pre-test......................... 131 Table 6.5: Mean and Standard Deviations of SDLRS by group .................. 132 Table 7.1: Themes developed from FGDs before the intervention.............. 143 Table 7.2: Category development from FGDs before intervention.............. 144 Table 7.3: Themes developed from the control group after the
intervention ................................................................................. 148 Table 7.4: The category development from the control group after the
intervention ................................................................................. 149 Table 7.5: Themes developed from the intervention group after the
intervention ................................................................................. 153 Table 7.6: Category development for intervention group after
intervention ................................................................................. 154 Table 7.7: Themes development from control group clinical instructors .... 158 Table 7.8: Category development from control group clinical instructors .. 159 Table 7.9: Themes development from clinical instructor in intervention
group ........................................................................................... 162 Table 7.10: Category development from intervention group clinical
instructors .................................................................................... 163
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LIST OF FIGURES
Figure 2.1: Influence of cultural attitudes to knowledge on teaching and learning strategies.......................................................................... 17
Figure 2.2: The teacher-student control continuum (TSCC) ........................... 35 Figure 3.1: Research design used in the study................................................. 55 Figure 4.1: Bland-Altman plot for reproducibility of SDLRS Scores............. 86 Figure 5.1: Conceptual framework integrating Staged Self-Directed
Learning (SSDL) and Teacher-Student Control Continuum (TSCC) .......................................................................................... 94
Figure 5.2: The activities of the educational intervention program............... 107 Figure 5.3: Learning plan format used in this study...................................... 117 Figure 6.1: Graph of SDLRS scores for intervention and control groups at
pre- and post- test ........................................................................ 133
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STATEMENT OF ORIGINAL AUTHORSHIP
“The work contained in this thesis has not been previously submitted to meet
requirement for an award at this or any other higher education institution. To the best
of my knowledge and belief, the thesis contains no material previously published or
written by another person except where due reference is made”.
Signature _______________________ Date _______________________
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ACKNOWLEDGEMENTS
The undertaking of this thesis was not a solitary effort. I appreciate all my
supervisors, colleagues, family and friends who helped me in so many ways; without
them this thesis would not have been completed. I wish to gratefully acknowledge
the support and kindness of the following individuals and organisations:
Firstly, I express my deep and sincere thanks to my supervisors Professor Helen
Edwards and Ms. Robyn Nash who encouraged me through the PhD journey. Their
continued guidance, support and critical comments were a source of great
encouragement. Thank you both.
I would like to thank the participants in the study, the nursing schools, staff, nursing
students and clinical instructors. Without their commitment this study would not
have been undertaken. It was a great pleasure and opportunity to work with them.
Thank you to all of you.
I would also like to recognise the financial support given to me by the World Bank
through the Health Professional Project V (HPV). This scholarship was invaluable
assistance to undertake this study.
I would also like to acknowledge and thank the Department of Health Central
Kalimantan Province and Palangkaraya Health Polytechnic for their financial
assistance. This financial assistance was invaluable support to finish my study.
I would like to thank Tina Thornton, Principal Academic Editorial Service for her
hard work towards the editing of this thesis.
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Finally, I would dedicate my thesis to my family: my husband E. J. Inso; and my
three loving daughters who were always waiting for their mum to come back home,
Florence Felicia (FF), Joanita Jalianery (JJ) and Maureen Marsenne (MM). Their
unending patience and unwavering belief in my ability to complete this thesis made
me realised how blessed I am.
Djenta Saha
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CHAPTER ONE
INTRODUCTION
1.0 Introduction
The rapid changes in the health care environment have many implications for nursing
education and nursing practice. Some of the significant changes facing nurses
include the expansion in technology, decreased length of stay in hospitals and the
ageing of the population. More changes are predicted in the coming decades—such
as increasing complexity of modern healthcare, technology prolonging an
individual’s life-span, and the increasing burden of healthcare expenditure
(Boychuck & Duchscher, 1999; Dexter et al., 1997). The rapidity of knowledge
changes have also resulted in knowledge becoming obsolete. Thus, nurses need to
keep learning in response to the rapidly changing healthcare environment so they can
keep abreast of technological changes, expectations of patients and the health care
system (Studdy, Nicol & Fox-Hiley, 1994).
Lifelong learning is important in rapid global changes (OECD, 2000). Self-directed
learning (SDL) is an essential strategy for lifelong learning (Glen, 1999; Harvey,
Rothman & Richards, 2003) and it can be used to prepare students to adapt with
rapidly changing knowledge and technology (Rossi, 2000). There is a growing
acceptance of the relationship between SDL and learners’ ability to cope with
changing knowledge and technology. Nursing educators in developed countries
including Australia, USA, Canada and United Kingdom have already adopted SDL
in their teaching and learning approaches, and have used a range of technologies in
learning, such as e-learning.
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Many authors in nursing education state that nursing students today are not only
required to know more about a topic, but this information will change within the
period that they complete their formal learning. Nursing graduates will work in many
different situations and contexts during their professional careers. Furthermore, the
role of nurses increasingly requires that they are able to critically reflect and apply
their knowledge in different ways, in response to changing technology and healthcare
contexts (Fisher, King & Tague, 2001; Hewitt-Taylor, 2002; Iwasiw, 1987; Levett-
Jones, 2005; Lunyk-Child, et al., 2001; McAllister, 1996; Nicol & Glen, 1999,
O’Shea, 2003; Regan, 2003; Williams, 2004).
Rapid changes in the health care environment have forced the Indonesian
government to make changes in health care regulations—nursing is no exception.
The minimum standard for nursing entry to practice in the health care system in
Indonesia is diploma level. The Indonesian government is committed to increasing
the quality of nursing care through improvements in nursing education. The health
services need nurses with quality knowledge and skills who are able to cope with the
increasing complexity of health care (Health Professional Project V, 1998). Thus,
nursing education must provide students with a firm foundation for lifelong learning
on which nurses can continue to build throughout their professional careers.
However, at present there is a gap between nursing education and health care needs
because the improvement in the nursing educational level has not been followed by
improvement in the quality of teaching and learning. Although nursing education in
developed countries has adopted SDL in teaching and learning approaches, the
teaching and learning in nursing education in Indonesia has not adapted to changes
and developments. Traditional methods of teaching and learning are predominantly
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used in all diplomas in nursing education in Indonesia. These methods of teaching
and learning do not prepare students to meet rapidly changing scientific and
technological advances in health care (Health Regional Office of Central
Kalimantan, 1998). Thus, the challenges for nursing education in Indonesia,
specifically in Central Kalimantan, are to prepare nursing students to be professional
nurses who can meet the increasing complexity of health care demands.
This chapter provides an overview of the background and significance of the study,
followed by the purpose and objectives of the study. Research questions and
hypotheses are then presented and an overview of the methodology is provided with
the definitions of key terms. The structure of the thesis is outlined at the end of the
chapter.
1.1 Background
1.1.1 Nursing education in Indonesia
Nurses comprise the largest health worker category in Indonesia, accounting for
roughly 44 per cent of health staff in government hospitals, 35 per cent in health
centres and sub health centres and 39 per cent in private hospitals. Approximately
113,000 nurses work in government hospitals, health centres and sub health centres
(World Bank, 1994). Around 50 per cent of Indonesia’s nurses graduate from
‘Sekolah Perawat Kesehatan’ (a three-year basic nursing course at senior high school
level), which they enter following completion of junior high school. This three-year
basic nursing program was initiated in 1975 as the successor to diverse training
activities that produced over 20 different types of nurses.
Until 1997 there were three types of nursing education in Indonesia, namely:
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• The Bachelor of Nursing (tertiary degree): this is a four-year nursing course
that students enter from senior high school and is offered at selected
government universities in Indonesia. Admission is based on a national
examination and all the bachelor programs use the same core curriculum. The
Bachelor of Nursing degrees were established in 1985 and they are
administered by the Department of Education and Culture. The graduates of
bachelor nursing courses account for 10 per cent of the nursing workforce
(Pusdiknakes, 1997).
• Diploma nursing program: this is a three-year nursing course that is conducted
in schools of nursing and students come from senior high schools. The
diploma nursing program was initiated in 1965 and most nursing schools are
in the large cities and regional capitals. Graduates from the diploma of nursing
are the second largest group of nurses and account for 40 per cent of all
nursing graduates. Diploma nurses are heavily concentrated in hospitals
throughout Indonesia, including private hospitals (Pusdiknakes, 1997).
• Secondary high school level school of nursing: this is a three-year nursing
course, which students enter from junior high school. Students from the course
account for 50 per cent of nurses in Indonesia (Pusdiknakes, 1997).
In 1997 minimum educational standard for nursing entry to practice was established
as the diploma of nursing. Consequently, all nursing schools offering below diploma
level education were upgraded to offer diploma level courses by 1997, so currently
only two types of basic nursing education exist in Indonesia. These are: Bachelor of
Nursing and Diploma of Nursing.
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The education within the Diploma of Nursing aims to produce graduates who fulfil
the need for beginning professional nurses and who are able to have a rational,
professional and ethical attitude in the implementation of nursing care. Graduates of
the diploma of nursing are expected to be able to fulfil the demands and needs of the
community for qualified nursing care, to function as sources of information and to be
able to compete in the era of globalisation (Pusdiknakes, 2002, p.2). Thus, diploma
nursing education is now expected to produce nurses who can function effectively
and efficiently in health care settings. The nursing education that is discussed in this
chapter relates to the diploma level of nursing education.
1.1.2 Diploma Nursing Curriculum
All diploma nursing programs in Indonesia are based on a national nursing
curriculum for diploma nursing courses. The content of the diploma nursing
curriculum is 80 per cent of the national content, which means that all nursing
schools in Indonesia provide the same content and 20 per cent of local content so
each school can provide different content depending on local/regional needs. The
diploma nursing curriculum document states that the curriculum is guided by the
goal of national education, rules, norms and ethics of science, community needs, and
considerations of personal interest, capability and initiative (Sister School project,
2002). The diploma nursing curriculum is used for all nursing education in
Indonesia, including Central Kalimantan. The aim of the specification is to
standardise nursing education to a certain level throughout the country (Pusdiknakes,
2002, p.1).
The diploma nursing curriculum is a very specific document that describes the
number of credit points, subjects, objectives and structure of the courses. This
curriculum is six semesters in length and consists of 40 subjects. There are no
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elective subjects and every semester has a different number of subjects. The first
semester comprises nine subjects, the second semester consists of nine subjects, the
third semester comprises five subjects, the fourth semester contains five subjects, the
fifth semester comprises seven subjects, and the last semester consists of five
subjects (Pusdiknakes, 2002). The subjects in the nursing curriculum can be divided
into three major areas: supporting theoretical science, professional nursing subjects,
and clinical nursing subjects (Sister School Project, 2002). Each nursing subject is
divided into a number of topics and skills to learn.
The semesters are 20 weeks in duration, including the examination period. The
semesters are structured such that the first two semesters have a higher theoretical
load than clinical load, with students spending about six to eight hours a week in
clinical learning. However, much of the clinical learning in these two semesters
occurs in the laboratory. In the third and fourth semester the clinical load begins to
increase (20 hours theory compared to 15 hours of clinical learning) and by the fifth
and sixth semester the majority of the student activity is clinical learning (25 hours a
week) compared to 10–12 hours of theory per week. Much of the theory is given
prior to the clinical component.
1.1.3. Nursing education in Central Kalimantan
There are four nursing schools in Central Kalimantan: Palangkaraya nursing school
(funded by the central government), Eka Harap nursing school (private nursing
school), Sampit nursing school (funded by the local government), and Kuala Kapuas
nursing school (funded by the local government). All these nursing schools offer a
diploma level program.
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According to the Sister School Project (2002, p.15), the implementation of the
diploma curriculum at nursing schools in Central Kalimantan, Indonesia, appears to
have minimal emphasis on clinical judgment, self-directed learning and application
of theory to practice in individual subject descriptions. The teaching at schools of
nursing in Central Kalimantan also appears to be teacher-centred rather than student-
centred. Lectures as a method of teaching and learning are used almost exclusively in
all teaching and learning activities. Although self-directed learning (SDL)
approaches are used as a framework for the Indonesian diploma nursing curriculum,
this emphasis does not translate directly into particular curricula requirements. The
application of the general principles of SDL is not in actual practice. The
interpretation and application of SDL approaches is dependent on individual nursing
schools. However, most nursing schools in Indonesia, especially in Central
Kalimantan, are using traditional patterns of nursing education that is teacher-centred
approaches focusing on the transfer of knowledge.
It is assumed that the basis behind teachers and students in Central Kalimantan who
do not use SDL methods is that they have not been introduced to, or prepared for,
SDL. In Indonesia, most teachers in nursing education can communicate only in the
official language of the country and therefore to explore professional innovation in
nursing education beyond the country’s borders depends on translated information
being available. This influences the diploma nursing education courses to continue
applying traditional approaches. It relies on presenting factual information using a
rigid curriculum (developed at a national level). In Indonesia and in Central
Kalimantan students have only been exposed to teacher-directed learning in their past
and current studies, and the teachers have only used traditional teaching approaches
within curriculum constraints.
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McAdams, Rankin, Love, and Paton (1989) state that this type of teaching may have
been justifiable in an era of limited technology gradual change and relative stability.
However, the times have already changed, and today students must possess skills to
achieve knowledge under rapidly changing conditions where knowledge quickly
becomes obsolete.
It seems that teachers take the responsibility for students’ learning and students only
achieve a superficial understanding; as a result students are passively waiting to be
taught (Health Regional Office of Central Kalimantan, 1998). It is likely that nursing
education in Central Kalimantan has failed to prepare students to become
professionals capable of working in a rapidly changing health care environment by
continuing to use predominantly traditional teaching approaches.
As Central Kalimantan nursing education wants their students prepared as
successfully as those within western nursing education systems, significant
improvements are needed in teaching and learning approaches. These are needed to
better prepare students to be professional nurses and to meet the needs of the
community for quality nursing. Introducing SDL approaches in nursing education in
Central Kalimantan has been chosen as the focus of this research as it has not yet
been applied in everyday teaching and learning activities in nursing courses.
1.2 Significance of the study
To date, no research has been done to improve nursing students’ self-directed
learning readiness in Indonesia. This study will be useful in two ways. The study is
significant for nursing students because an educational intervention program will
assist students to be more active in their learning. It is assumed the students will take
more responsibility for their own learning and that this will benefit their professional
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and personal development. This study is significant also for nursing schools in
Central Kalimantan, as a cultural change is needed and will be introduced through
the study. The nursing school culture has been providing ‘factual knowledge’ and it
uses rote learning techniques. Clearly, a shift to more contemporary and life-long
learning strategies is required.
1.3 Purpose and objectives of the study
The primary purpose of the study is to improve readiness for self-directed learning in
nursing students in Central Kalimantan, Indonesia.
The objectives of the study are to:
1. Examine nursing students’ perceptions of self-directed learning;
2. Determine nursing students’ level of readiness for self-directed learning;
3. Identify factors affecting students’ readiness for self-directed learning;
4. Examine the impact of an educational self-directed learning program on
nursing students’ readiness for self-directed learning;
5. Examine clinical instructors’ perceptions of nursing students’ clinical
activities during the educational self-directed learning program.
1.4 Research questions
The research questions for the study were:
1. What were students’ levels of readiness for self-directed learning (SDL)
before the educational intervention, as measured by the Self-Directed
Learning Readiness Scale (SDLRS)?
2. Was there a difference in students’ readiness scores for SDL between the
intervention and control groups?
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3. Was there a difference in students’ readiness scores for SDL following the
educational intervention?
4. What factors contributed to students’ readiness for SDL?
5. What were the students’ perceptions of SDL before and after the educational
intervention?
6. What were clinical instructors’ perceptions of students’ clinical activities
during the educational intervention?
1.5 Hypotheses
In order to answer the research questions, the study set out to test the following
hypotheses that were developed from the first four research questions:
• Hypothesis 1: The students’ level of readiness for SDL as measured by
SDLRS would be lower than established group norms (Guglielmino, 1978).
• Hypothesis 2: There would be no significant difference between the
intervention and control group SDLRS scores at pre-test.
• Hypothesis 3: Self-directed learning readiness scores of students who
participated in the educational intervention program over fourteen weeks
would be significantly increased compared to scores of students who did not
participate.
• Hypothesis 4: Variables such as group (intervention-control), gender, birth
order, father’s educational background and mother’s educational background
would significantly contribute to students’ readiness for SDL.
1.6 Overview of methodology
A non-equivalent control group, pre-post test design was used in the study. The study
involved a pilot and the main study. The pilot study aimed to evaluate the Self
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Directed Learning Readiness Scale (SDLRS) that was used in the main study. It was
piloted to test it in an Indonesian setting, to trial recruitment methods and to identify
students’ level of readiness for SDL. The length of time it took to administer the
SDLRS was noted. In addition, any issues such as ambiguity and misinterpretation of
the SDLRS were also noted. Participants for the pilot study came from a different
nursing school to the main study. There was 54 second-year students who
participated in the pilot study.
Participants for the main study were all students in the second year of a nursing
diploma course from two selected nursing schools in Central Kalimantan. One of
these nursing schools became the “intervention school” and the other was the
“control school”. There was 101 second-year students who participated in the main
study. Second-year students from the intervention school participated in an
educational intervention program designed for this study.
The educational intervention program (EIP) comprised four days of workshops, four
days of clinical skills’ practice in the nursing laboratory, and a 12-week
implementation period. Participants were asked to attend three tutorial meetings
during the implementation period at weeks three, six, and nine. Students from both
the intervention and control schools were asked to complete a pre-test prior to
commencement of the study and post-test questionnaires after the study finished.
Data were summarised using SPSS® version 12.
Focus group discussions (FGD) were conducted pre and post intervention for
students. Focus group discussion for clinical instructors was conducted after the
intervention for both groups. Qualitative data from FGD were content analysed using
12
Burnard’s guidelines (Burnard, 1991). The details of the methodology are presented
in Chapter Three.
1.7 Definition of key terms
For the purpose of this study, the following terms needed to be clearly defined, both
conceptually and operationally. They are: self-directed learning, educational
intervention program, and readiness for self-directed learning.
Self-directed learning:
Conceptual definition: “Self-directed learning is a process in which the learner takes
the initiative in diagnosing his/her learning needs, formulating goals, identifying
human and material resources, and evaluating learning outcomes. This may be done
with or without the help of others” (Knowles, 1975, p.18).
Operational definition: Self directed-learning was a process by which second-year
nursing students in Central Kalimantan who participated in the study took initiative
for their own learning, with or without the help of others, by identifying their
learning needs, formulating goals, resources and evaluating learning outcomes.
Readiness for self-directed learning
Conceptual definition: Readiness for self-directed learning is the degree (to which)
the individual possesses the attitudes, abilities and personal characteristics necessary
for self-directed learning (Wiley, 1983, p.182).
Operational definition: Readiness for self-directed learning was the degree (to
which) the second-year nursing students possessed the attributes of self-directed
learning as measured by the self-directed learning readiness scale (SDLRS).
13
Educational intervention program
Conceptual definition: an educational intervention program is a planned process to
modify attitudes, knowledge, skills or behaviour through a learning experience to
achieve effective performance in an activity or range of activities (Smith, 1992, p.2)
Operational definition: The educational intervention program was the planned
process to improve the knowledge, skills and attitudes for self-directed learning of
second-year nursing students in Central Kalimantan.
1.8 Structure of the thesis
Chapter One has given an overview of the teaching and learning approaches in
nursing education in Indonesia and Central Kalimantan. The diploma nursing
curriculum used in Central Kalimantan was outlined. The significance of the study to
nursing education has been outlined and the research questions, hypothesis, aim and
objectives of the study have been presented.
Chapter Two reviews the literature on self-directed learning. Teaching and learning
approaches relevant to SDL are presented and intervention studies in SDL in nursing
education are highlighted. Definitions of SDL are presented, as well as conceptual
models of SDL and teaching strategies. Instruments to measure SDL are also
presented.
Chapter Three outlines the methodology used in the quantitative and qualitative part
of the study. SDLRS and demographic questionnaires were used to collect
14
quantitative data. Chapter Three develops the conceptual framework grounded in the
Staged Self-Directed Learning model (SSDL) developed by Grow (1991) and
Teacher-Student Control Continuum model (TSCC) developed by D’A Slevin and
Lavery (1991) to operationalise the educational intervention. Focus group
discussions were used to provide qualitative data to improve understanding about
participants’ perceptions of self-directed learning.
Chapter Four presents the pilot study, which was conducted to determine relevant
information to ensure the feasibility and appropriateness of the method and tools for
the main study. Chapter Five describes the educational intervention program which
was developed to increase nursing students’ SDL readiness in Central Kalimantan,
Indonesia. Chapter Six presents the results from the quantitative data and Chapter
Seven presents the qualitative data—both of these results are discussed in Chapter
Eight. Limitations of the current study are also outlined in Chapter Eight as well as
recommendations from the study. It also highlights the implications for nursing
education, and future research.
15
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
Many authors state that culture has influenced teaching and learning approaches
(Ballard & Clanchy, 1997; Biggs, 1999a; Ramsden, 2003). Self-directed learning
(SDL) was the method of learning that was introduced into nursing education in
Central Kalimantan to improve nursing students’ readiness for self-directed learning.
The concept of self-directed learning was formulated in western culture and has been
widely used in English-speaking countries, where the educational system and cultural
background is different from that of Indonesia. It is, therefore, important to review
the concept of teaching and learning and to assess the perception of teaching and
learning within the Indonesian context. This chapter begins with an overview of
conceptions of teaching and learning followed by a description of student approaches
to learning. Definitions of self-directed learning are presented and a conceptual
model of self-directed learning is discussed. The literature review focuses on two
instructional strategies utilised to develop self-directed learning in nursing students
in Central Kalimantan. The characteristics of instruments most frequently used to
assess self-directed learning are also discussed. The chapter concludes with a
summary.
2.1 Overview of teaching and learning
The aim of teaching is simple—to enable students to learn—and teaching always
involves attempts to change students’ understandings (Ramsden, 2003). Ramsden
further states that learning occurs because of what the students do, and that skilled
16
teaching and the design of teaching and learning activities can encourage student
activity. According to Merriam (1993), learning includes concept knowledge and
behaviour changes. However, attitude to knowledge influences individual teachers
about what teaching is, and what learning is (Ballard & Clanchy, 1997). Assumptions
about what learning is, and how it occurs, will influence the selection of activities
teachers use to facilitate their students’ learning. According to Biggs (1999b),
teaching influences students’ approaches to learning.
Ballard and Clanchy (1997) state that knowledge and learning vary along a
continuum (Figure 2.1). At one end of the continuum, knowledge is seen as a
relatively fixed and circumscribed form of ‘wisdom’ and learning is about
conserving and transferring the wisdom. Teachers who perceive that knowledge is
fixed will view teaching as the transmission of information and skills. This form of
teaching encourages students to memorise and simply replicate the knowledge
provided by teachers. Both the students and the teachers perceive the teacher as the
exclusive or main source of knowledge. This certainly leads to a teacher-centred
approach.
At the other end of the continuum, knowledge is not bounded but is constantly being
created. Learning in this context is seen as an extension and applying of knowledge
in new and different ways. Ballard and Clancy (1997) make the point that those
teachers who place a greater emphasis on knowledge creation will perceive problem
solving, critical thinking and reflection to be of greater importance than simple
imitation and replication. Those teachers also perceive self-directed learning to be
essential and will encourage students to question and to seek out sources of
17
information and knowledge for themselves. Teachers who adopt this approach are
more likely to encourage a student-centred approach.
Attitude to knowledge Conserving Extending
Learning approaches Reproductive Analytical Speculative
Teaching strategies
Role of teacher
Almost exclusive source of: Knowledge Direction/guidance Assessment
Coordinator of learning recourses Questioner, critical guide, gadfly Principal source of assessment
More experienced colleague & collaborator Preliminary critic & adviser patron
Source: Ballard & Clanchy (1997, p. 12)
Figure 2.1: Influence of cultural attitudes to knowledge on teaching and learning strategies
18
According to Ballard & Clanchy, many Asian cultures place greater emphasis on the
conserving attitude to knowledge than western culture. Indonesia has emphasis on
conserving attitude to knowledge.
Biggs (1999b) and Ramsden (2003) state that if learning is perceived to be a
qualitative change in students’ understanding of a subject that such students are able
to understand important concepts, and their related facts and procedures in the
subject. For the purpose of this study definition of learning was adopted from Biggs
and Ramsden that students are able to relate concepts, organise principles, integrate
information and skills, and apply this to new and different situations.
According to Nicol and Glen (1999) new nursing knowledge is being created at an
increasingly rapid pace. Long and Barnes (1995) stated that the emphasis in nursing
education internationally has changed from the simple transfer of knowledge to
students having the skills to extend and apply their knowledge, and to become
lifelong independent learners. These skills are necessary because of the rapid
innovations in health care and increased access to information. Teaching and
learning activities should encourage nursing students to problem solve, critically
analyse, make clinical decisions based on evidence and evaluate those decisions
(Nicol & Glen, 1999). Students should be encouraged to identify their own learning
needs and be able to find sources of information and knowledge. The teacher is not
the only source of information. Many other sources, such as written resources,
experts in the clinical field, patients, colleagues, the internet, and their own
experience should also be used (Sister School Project, 2002).
19
2.2 Students’ approaches to learning
Student factors such as attitude, motivation, and experience can influence their
approaches to learning (Ballard & Clanchy, 1997; Biggs, 1999b; Ramsden, 2003).
Learning research has identified two main types of approaches students adopt when
they attempt to learn new information and skills. These approaches have been
described as ‘deep’ and ‘surface’ According to Ramsden (2003), students are more
likely to take a surface approach to learning when they have an intention only to
achieve a minimal pass, have insufficient time to learn, are unclear about the
requirements of a course and think that rote learning will be enough to pass. In
contrast, students are more likely to take a deep approach to learning when they have
intention to engage meaningfully, have the necessary background knowledge about
subject materials, and have the ability to work conceptually and to make abstract
connections. Furthermore, Biggs (1999b) and Ramsden (2003) cite research that
indicates that students who look for deeper understanding and meaning and
connections in their methods for learning will have better learning outcomes, are
more able to understand scientific conceptions and get higher academic grades than
students who simply memorise and replicate the information with which they are
provided.
A student’s approach to learning is not only influenced by individual characteristics
but it can also be modified by curriculum and teaching/learning approaches in which
learning occurs. Research also indicates that course design can influence the
approach students have to learning (Ballard & Clanchy, 1997; Biggs, 1999a; Biggs,
1999b; Ramsden, 2003). For example, high course contact hours and excessive
amounts of course materials can mean the students lack the opportunity to pursue the
20
subject in depth. By contrast, subjects whose coordinators have identified the need
and motivation for learning provide clear goals and have a well-linked and structured
knowledge base, give students choice and control over learning. It has also been
found that providing students with interaction with peers is a factor that can facilitate
a deep approach to learning (Ramsden, 2003).
Ramsden (2003) states that while the inherent ability of the student cannot be
changed; teachers can influence student motivation, expectation and experience to
encourage them to have a deep approach to learning. Teachers can facilitate students
to take deeper approaches to learning when they provide teaching and learning
activities that encourage students to take such an approach. The difference between
deep and surface approaches to learning is shown in Table 2.1.
Table 2.1 Different approaches to learning Deep approach Intention to understand Student maintains structure of task
Surface approach Intention only to complete task requirement Student distorts structure of task
• Focus on ‘what is signified’ • Relate previous knowledge to new knowledge • Relate knowledge from different course • Relate theoretical ideas to everyday
experience • Relate and distinguish evidence and argument • Organise and structure content into a coherent
whole • Internal emphasis: ‘A window through which
aspects of reality become visible, and more intelligible’ (Entwistle & Marton, 1984)
• Focus on ‘the signs’ • Focus on unrelated part of the task • Memorise information for assessments • Associate facts and concepts
unreflectively • Fail to distinguish principles from
examples • Treat the task as an external imposition • External emphasis: demands of
assessments, knowledge cut off from everyday reality
Source: Ramsden (2003, p. 47)
According to Brown and Cooke (2002) the concept of teaching and learning, as
described in this chapter e.g. those of encouraging a deep approach, is implicit in the
21
Indonesian national nursing curricula objectives. For example, the documentation
objectives include (Pusdiknakes, 1997):
• Encourage active self-development in practicing by considering scientific
evidence;
• Continuously improve own professional competence;
• Function as a member of community who is creative, productive, and open to
any changes, has orientation to the future;
• Develop initiative and leadership.
However, the teaching program, institutional practices and cultural understandings of
teaching practice put teachers in the position of having the responsibility for
students’ learning. According to Brown and Cooke (2002), the focus of teaching and
learning activities in nursing schools in Central Kalimantan is the transfer of
knowledge. As part of this project, teachers identified and described their
assumptions about teaching and learning. The teachers believed learning was a
quantitative increase in knowledge, and they perceived that learning was about
memorising and storing information, and that students needed to acquire facts and
skills which can be used when required. The teachers also believed that if they used
the correct teaching techniques they could transfer the concepts and skills required
by students to the practice of nursing. Brown and Cooke (2002) further explained
that these conceptions of teaching and learning are teacher-centred and represent the
conserving/reproductive level of Ballard and Clancy’s model as presented in Figure
2.1. The focus is on what the teacher is doing, rather then what the student is doing,
and the outcomes are likely to be imitation or surface learning rather than the desired
critical thinking (Ballard & Clanchy, 1997).
22
Within the current curricula, nursing students in Central Kalimantan were more
likely to use surface approaches to learning than deep approaches. The students
memorised and reproduced only the information provided to them by teachers, and
they did not question the statements and ideas that teachers presented to them. They
also did not seek out additional information (Brown and Cooke, 2002). The course
design of the diploma nursing curriculum that is currently used may encourage
students to take a surface approach to learning. The curriculum appears to emphasise
a breadth of coverage rather than a depth of understanding as described by Ramsden
in Table 2.1. As Central Kalimantan nursing students desire to be as successful as
nurses educated in western systems, significant improvements are needed in teaching
and learning approaches to better prepare the students to be professional nurses. Self-
directed learning (SDL) is essential for lifelong learning and professional
development; however, it has not been emphasised in Indonesian nursing education.
SDL requires students to be more active in their learning; instructional methods to
improve SDL such as reflection, learning plans and asking critical questions can
encourage students to take a deep approach to learning. Therefore, deep learning is
more likely if students are more self-directed in learning. The next section presents a
review of self-directed learning as one strategy to be used to move nursing students
in Central Kalimantan away from their past style to a more self-directed approach.
2.3 Self-directed learning
2.3.1 Definition
Self-directed learning is not a new concept in adult learning (Grow, 1991). The
unique aspect of adult learning rests in its methods of delivery to accommodate the
characteristics of adult learners. Adults are different from children in learning.
23
Knowles (1984) emphasised that adults are self-directed and able to take
responsibility for their decisions. Adults have been found to learn more effectively
by doing or experiencing. Knowles (1984, p.9) further explained the characteristics
of adult learners as being (a) adults need to know why they need to learn something;
(b) adults approach learning as problem solving, and (c) adults learn best when a
topic is of immediate value.
An early writer, Houle (1961), first introduced the term of self-directed learning
when he described a study of adults who had engaged in learning activities without
support or assistance. The works of Knowles (1975) and Tough (1979), who
popularised the concept, have had a major influence on self-directed learning
practice.
The definition of self-directed learning varies throughout the literature. Self-directed
learning is generally defined in terms of either a personal attribute of a learner, or as
a process of learning (Brockett & Hiemstra, 1991; Caffarella & O’Donnell, 1989;
Candy, 1991; Fisher, King & Tague, 2001, Hiemstra, 1992). The most common
definition of self-directed learning is that described by Knowles (1975, p.18):
Self directed learning is a process in which the learner takes the initiative in diagnosing his/her learning needs, formulating goals, identifying human and material resources, and evaluating learning outcomes. This may be done with or without the help of others.
Based on the work of Knowles (1975), Iwasiw (1987) considers self-directed
learning to be a form of study in which individuals have responsibility for planning,
implementing and evaluating their own work. Furthermore, Iwasiw (1987, p.222)
outlined five characteristics of self-directed learning and suggests students are
responsible for:
24
• identifying their own learning needs;
• determining their learning objectives;
• deciding how to evaluate learning outcomes;
• identifying and pursuing learning resources and strategies; and
• evaluating the end product of learning.
Knowles’ definition of self-directed learning is cited by many authors to form the
basis of other self-directed learning definitions, such as that of Spencer and Jordan
(1999, p.1281) who define self-directed learning as: “when students take the
initiative for their own learning, designing needs, formulating goals, identifying
resources, implementing appropriate activities and evaluating outcomes”. Bonham
(1989) suggests that when a person chooses his/her own learning goal, his/her own
learning methods, the context and process, and the resource they will use, they are
being self-directed learners. According to Merriam (1993), what also appears
common to most definitions is the notion of some individual control by the learner
over the planning, implementing and evaluating of their own learning. It can be
assumed that no matter how self-directed learning is conceptualised, it has come to
be seen as an integral part of the adult learning process.
The literature indicates that self-directed learning can take multiple forms. The
synonyms found for self-directed learning include independent study, self-instruction
packages, guided study, group work, learning plans (learning contracts), computer-
assisted learning, distance study, teleconferencing, and e-learning (Hamilton &
Gregor, 1986; Iwasiw, 1987; O’Shea, 2003; Piskurich & Piskurich, 2003). Brockett
and Hiemstra (1985) emphasise three important keys of teaching strategies to
promote self-directed learning: using a variety of teaching and learning resources;
25
using a teaching role that is facilitative rather than didactic; and encouraging an
active role by students during the entire teaching and learning process.
All of the documented approaches to self-directed learning reflect the stages put
forward by Knowles (1975) in setting up a student-centred learning environment,
such as creating a climate for learning, identifying learning needs and learning
resources, carrying out the learning activities, evaluating learning and identifying
future needs. According to O’Shea (2003, p.16), these activities can be concluded
into a number of stages, as follows:
• Assessment: characteristics of participants such as: readiness for self-directed
learning, demographic data, learning needs and resources;
• Planning: explaining self-directed learning;
• Implementing self-directed learning; and
• Evaluating self-directed learning.
Grow (1991) also reports that a wide variety of learning activities and approaches are
used to encourage students to take personal responsibility for their own learning.
These include developing strategies for learning, goal setting, making learning plans
and practising these strategies until they are automatic. Through self-directed
learning the ability of students to acquire information retrieval skills, whether
individually or in a group, is enhanced.
According to Gibbons (1994, p.5) the practice of the self-directed learning method
requires three stages, including:
• Stage 1: ‘Learning how to learn from a teacher’. In this stage, course content
is carefully taught, and studies are carefully managed by the teacher. Students
26
learn the assigned subject matter, how to identify what to learn, how to
organise content for learning, and how to recall what has been learnt.
• Stage 2: ‘Learning how to teach a course to oneself’. Students are guided
through the process of learning and how to learn course content by the teacher.
Students learn how to pursue course outcomes independently, how to develop
a personal learning style, how to plan and organise a unit, how to work with
others, how to take action, check progress, and get things done. The purpose
of this stage is to empower students to find the most interesting and successful
way to achieve the course goal.
• Stage 3: ‘Learning how to direct one’s own learning’. Students learn how to
decide what is important to learn, do or become, and how to pursue it. Each
student sets their own goals and explores how to pursue them. For example,
how to visualise future desires, how to set ambitious personal goals, and how
to organise time, effort and resources, how to evaluate and redirect progress.
The purpose of this stage is to empower students for a life of successful
learning, achievement and personal development.
According to Gibbons (1994, p.115) there are nine skills required to be self-directed
learners—self-awareness skills, planning skills, management skills, study skills,
practice skills, action skills, evaluation skills, interaction skills, and attitude skills.
These skills are similar to the set of competencies identified by Areglado, Bradley
and Lane (1996, p.18) as necessary for students to be self-directed learners:
• The ability to diagnose learning needs realistically with the help from others
such as teachers, peers and prescribed materials;
27
• The ability to transform learning needs into learning behaviours and
objectives, and then to practice them;
• The ability to identify effective learning strategies, the ability to identify
material resources for information to help choose objectives, and
• The ability to use the appropriate skills and behaviours.
Despite the proposed advantages of self-directed learning, Brookfield (1986)
suggests self-directed learning might not be the best approach for all adults.
Darbyshire (1993) argued that self-direction is a motivational factor which people
exhibit to varying degrees, with some people being more self-directed than others.
Darbyshire (1993) also suggests that the differences between adults and children are
insufficient grounds for distinct educational approaches. A similar argument comes
from Burnard and Morrison (1992) who refute Knowles’s claim and suggest that not
all students may want or be able to be independent.
Knowles (1990) acknowledges that adults might not be familiar with self-directed
learning and require time to adapt to self-directed learning, and he also acknowledges
that andragogy and pedagogy need not be mutually exclusive.
2.3.2 Conceptual model of self-directed learning
Self-directed learning models can be categorised into three types: a linear model; an
interactive model, and an instructional model (Merriam & Caffarella, 1999, p.293).
The early model of self-directed learning was the linear model, similar to that
proposed by Tough (1971) and Knowles (1975). Learners move through a series of
steps to reach their goals in a self-directed manner. Tough (1971) outlined a
comprehensive description of self-directed learning, which he termed self-planned
learning. Tough found that learners used thirteen steps in self-planned learning
28
projects, representing key decision making about choosing what, where and how to
learn (Tough, 1971, p.94). Numerous research studies have used Tough’s model of
self-directed learning. A range of specific populations have been studied using
Tough’s original or modified interview schedule, such as: farmers (Bayha, 1983),
pharmacists (Johns, 1973), nurses (Kathrein, 1981), clergy (Morris, 1977), and
physicians (Richards, 1986).
Knowles (1975) proposed six steps for self-directed learning and the steps are
somewhat similar to those proposed by Tough (1979). Knowles’s (1975) description
of six steps of self-directed learning included: climate setting, diagnosing learning
needs, formulating learning goals, identifying human and material resources for
learning, choosing and implementing appropriate learning strategies, and evaluating
learning outcomes. Knowles included numerous resources for both learners and
teachers for completing each of these tasks, such as learning contracts (learning
plans). Although the work of Tough and Knowles has provided the concepts and,
more importantly, the descriptive terms for key elements and the process of self-
planned learning, other writers have conceptualised different models (Kasworm,
1992).
The interactive model is the second category. There are five interactive models
reported in the literature, namely: Spear’s model (Spear, 1988), Cavaliere’s model
(Cavaliere, 1992), Personal Responsibility Orientation (PRO) model (Brockett and
Hiemstra, 1991), Danis’s framework (Danis, 1992), and Garrison’s model (Garrison,
1997).
Spear’s model was based on three major elements—the opportunities people find in
their own environments, past or new knowledge, and chance occurrences. Spear
29
(1988, p.212) found that the process of self-directed learning could be reduced to
seven principal components—residual knowledge, acquired knowledge, directed
action, exploratory action, fortuitous action, consistent environment and fortuitous
environment. Spear concluded that self-directed learning projects do not generally
occur in a linear fashion. Only a few studies have been conducted using all or parts
of Spear’s framework, for example, those by Berger (1990) and Padberg (1994).
Cavaliere (1992) proposed elements and observations as a result of her case study of
how the Wright brothers learned to fly. Five specific stages of their learning project
were identified: inquiring (a need to solve a problem), modelling (observing similar
phenomena and developing a prototype model), experimenting and practicing
(continuous refinement and practice with the model), theorising and perfecting
(perfection of their skills and product), and actualising (receiving recognition for the
product of their learning efforts. According to Merriam and Caffarella (1999)
Cavaliere’s model is especially useful in that it describes both the stages of the
learning process and the cognitive processes used throughout a major learning
endeavour. No published studies have been found to test this model (Merriam &
Caffarella, 1999, p.298)
The Personal Responsibility Orientation (PRO) Model, developed by Brockett and
Hiemstra (1991), provides a framework for what they term self-direction in learning,
which comprises both instructional method processes and personality characteristics
of the individual learner (learner self-direction). In the instructional process
dimensions, learners assume primary responsibility for planning, implementing, and
evaluating their learning experiences. In this facilitation role, instructors must
possess skills in helping learners do need assessments, locate learning resources, and
30
choose instructional methods and evaluation strategies. The second dimension is
related to the personality characteristics of individual learners. Brockett and Hiemstra
(1991) have further described various aspects of using self-directed learning as an
instructional method; however, according to Merriam and Caffarella (1999, p.299)
no studies have tested the PRO model of self-direction.
Danis (1992) has proposed a ‘map of the territory’ that researchers could use to study
the major components of self-directed learning and explain how the various
components of the model interact. This model is grounded in the notion of what
Danis terms ‘self-regulated learning’, referring to the various process components of
the learning cycle and not to the internal cognitive aspects. No studies were found
using Danis’s model (Merriam & Caffarella, 1999, p.300).
Garrison’s model (1997) is the recent multi-dimensional and interactive model of
self-directed learning. His model, grounded in a collaborative constructive
perspective, integrates self-management (contextual control), self-monitoring
(cognitive responsibility) and motivational (entering task) dimensions to reflect a
meaningful and worthwhile approach to self-directed learning. The first dimension,
self-management, acknowledges the social milieu in which learners are interacting,
whether they are in formal or informal settings. It involves learners taking control of,
and shaping, the contextual conditions such that they can reach their stated goals and
objectives. The next two dimensions, self-monitoring and motivation, represent the
cognitive dimensions of self-directed learning. According to Garrison, self-
monitoring is synonymous with responsibility to construct meaning and the
motivational dimension involves what influences people to participate in a self-
directed learning activity and what keeps them participating in the activity.
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Garrison’s model is not further explored in the literature (Merriam & Caffarella,
1999, p.302).
The third category of self-directed learning models represents frameworks that
instructors in formal settings use to integrate self-directed methods of learning into
their programs and activities. Three models are described in the literature that is
designed for educational settings. These were developed by Grow (1991), Hammond
and Collins (1991) and D’A Slevin and Lavery (1991). According to Merriam and
Caffarella (1999, p.304), Hammond and Collins’ (1991) model is the only model that
explicitly addresses the goal of promoting emancipatory learning and social action as
central tenets of SDL. In this model, learners take the initiative for building a
cooperative climate; analysing and critically reflecting on themselves and the social,
economic, and political contexts in which they are situated; generating competency
profiles for themselves; diagnosing their learning needs within the framework of both
the personal and social context; formulating socially and personally relevant learning
goals that result in learning agreements; implementing and managing their learning;
and reflecting on and evaluating their learning. According to Merriam and Caffarella
(1999), what makes this model different from the other process models is the
purposeful inclusion of the critical perspective through the examination of the social,
political, and environmental contexts that affect their learning, and the emphasis on
developing both personal and social learning goals. No research has been published
that has used Hammond and Collins’s model as their conceptual framework.
The Staged Self-Directed Learning (SSDL) model proposed by Grow (1991) and the
Teacher-Student Control Continuum (TSCC) model developed by D’A Slevin and
Lavery (1991) were used as the framework for the educational intervention in this
32
study. These two models were chosen as they propose how teachers can move
students through stages of increasing self-direction in a classroom setting; possible
roles for teachers and students and how they are related; and promoting students’
responsibility for their own learning in the time constraints dictated by curriculum.
These two models will be discussed in more detail below.
The Staged Self-Directed Learning (SSDL) model proposed by Grow (1991) outlines
how teachers can assist students to become more self-directed in their learning. The
self-directed learning in SSDL model is referring to “the degree of choice that
learners have within an instructional situation” (Grow, 1991, p.128). According to
Grow the SSDL model proposes a way teachers can be vigorously influential while
empowering students toward greater autonomy. The teacher’s purpose is to match
the learner’s stage of self-direction and prepare learner to advance to higher stage.
The model is grounded in the situational leadership model of Hersey and Blanchard
(1988), and describes four distinct stages that learners pass through (see Table 2.2).
• Stage 1: learners of low self-direction who need an authority figure (a teacher)
to tell them what to do;
• Stage 2: learners of moderate self-direction who are motivated and confident
but largely ignorant of the subject matter to be learned;
• Stage 3: learners of intermediate self-direction who have both the skill and the
basic knowledge and view themselves as being both ready and able to explore
a specific subject area with a good guide; and
• Stage 4: learners of high self-direction who are both willing and able to plan,
execute, and evaluate their own learning with or without the help of an expert.
33
Within each of these stages, Grow (1991) outlines a possible role for the teacher or
facilitator. However, Grow (1991) states that fully self-directed learning is not
possible in an institutional setting as it is constrained by curriculum. Rather, self-
directed, lifelong learning is the most important outcome of a formal education.
Table 2.2: Staged Self-Directed Learning Model (SSDL) Stage
Student
Teacher
Examples
Stage 1
Dependent learner
Authority coach (teacher centred)
Informational lecture, Structured drill, intensive individual tutorial.
Stage 2
Interested learner
Motivator, guide
Teacher-led discussion. Demonstration and follow by guided.
Stage 3
Involved learner
Facilitator
Seminar, learning contract, evaluation check list
Stage 4
Self-directed learner
Consultant, delegator
Independent study, student directed discussion
Adapted from Grow (1991) Problems may arise when there is a mismatch between the role or style of the teacher
and the learning stage of the learners. Grow emphasises that the teacher should
individualise their teaching strategies to match the learner’s stage of self- direction
and allow the students to become more self-directed in their learning. Grow (1991)
also highlighted the weakness of the SSDL model, as the model does not contain any
method for reliably ascertaining the degree of students’ self-direction. However,
according to Grow (1991), some clues can be used when estimating a student’s
degree of self-direction, these include: signs of the student’s level of motivation,
such as coming to class on time, doing assignments, and participation in class
discussion.
34
Tennant (1992) has criticised Grow’s model and offered a number of observations
and questions about the utility and explanatory power of the model. For example,
who is the best person to judge which stage a student is at? How should this be done
if there is a mismatch between the learner’s ability and the willingness to use self-
directed methods? What, in the learning process, should teachers change from one
stage to another?
In response to Tennant’s comments about the staged self-directed learning model
(SSDL), Grow (1994) highlighted that the SSDL model is a concept where the
teachers lead students from being ‘less independent’ to ‘more independent’ in their
learning. According to Grow, the teacher’s task is first to work with the students
‘comfortable’ learning style and then introduce a creative mismatch that can promote
growth in self-directed learning. According to Merriam and Caffarella (1999),
Grow’s thoughts on integrating the notion of self-direction into formal instruction are
very similar to those of Pratt (1988), Long (1989) and Hiemstra and Sisco (1990).
The Teacher Student Control Continuum (TSCC) model was developed by D’A
Slevin and Lavery (1991). It identifies and focuses upon various levels of control
over the learning process. The TSCC model proposes to maximise SDL through a
sharing of control in learning between students and teacher. In the role relationships
there is an implied shift away from the traditional role in which the teacher is
superordinate and students subordinate, toward a more equal partnership. The TSCC
model comprises four types of interaction. The first type involves total teacher
direction and the teacher makes all program decisions and controls both planning and
evaluating. In the second type, partnership control is shared by the teacher and
students. The third type is when students have a high control of learning, and the
35
teacher enables but does not lead; and, the last type is student self-direction. There is
no teacher influence at all, students plan and control the program. The TSCC model
can be seen in Figure 2.2.
Total self-direction Facilitator Partnership Total teacher
direction
• Complete student control
• No teacher influence at all
• Student plans and controls the program
• Self-assessment only
• Always individualised.
• Student-centred & with high control
• Teacher enables but not does lead.
• Student still makes decision on program plan & content
• Self-assessment with Teacher advice on request.
• Usually individualised
• Control is shared equally by student & teacher
• Essentially a transactional model.
• Student & teacher agree program plan & content.
• Learning contract is a common feature.
• Self- assessment & teacher assessment.
• May be individualised or in a group.
• Complete teacher control.
• The teacher makes all program decisions.
• The student is not consulted
• Teacher assessment only
• Almost always group of. students.
Source: Adapted from D’A Slevin and Lavery (1991)
Figure 2.2: The teacher-student control continuum (TSCC)
According to D’A Slevin and Lavery, the TSCC model requires students to be
proactive in organising and undertaking the required study. The teacher has an
important role in terms of providing direction, support and advice, as required, and
monitoring their progress. The importance of promoting students’ responsibility for
36
their own learning should be balanced with the teacher’s responsibility for ensuring
that specified outcomes have been achieved. The TSCC model was incorporated into
the intervention within this study by using the first two types of teacher-direction on
the learning process, and then gradually moving to partnership and shared control for
learning by students and teachers. These two types were applied across the
educational intervention with the partnership approach being applied gradually as the
program progressed.
2.3.3 Instructional methods to improve self-directed learning
A variety of teaching and learning strategies can be vehicles to achieve self-directed
learning, and a number of tools can be used to facilitate the self-directed learning
process (Atkins & Murphy, 1993; Garrison, 1987; Knowles, 1990; Margetson, 1994;
O’Shea, 2003; Parker, 1995; Taylor, 1997). Knowles (1986) cites learning plans
(learning contracts) as an ideal method to facilitate self-directed learning. Reflection
has also been suggested as a way to achieve self-directed learning as it requires
individuals to learn throughout the experience (Parker et al., 1995), with the outcome
a changed perspective of self and the world (Atkins and Murphy, 1993). Crooks et al.
(2001) state that reflection is integral to SDL. It helps students to attribute meaning
to the learning experience and the outcome of reflection is to explore learning
experiences and develop deeper understandings.
Problem-based learning has also been linked to self-directed learning, with
Margetson (1994) illustrating problem identification followed by students engaging
in self-directed learning to solve the problem. Taylor (1997) also linked problem-
based learning and self-directed learning in so far as students can set their objectives
based on a relevant scenario, access material and receives feedback on their learning.
37
Garrison (1987) describes written materials or modules that can also be used to
promote self-directed learning.
Learning plans (learning contracts) and modules are seen as appropriate tools to
facilitate self-directed learning in this research study. The reason for choosing these
tools is based on the feasibility and applicability of these tools in the Central
Kalimantan setting. The limited human resources, funding, teaching and learning
materials, and access to contemporary information technology influenced the
decision to choose these tools. It can be assumed that through the combination of
these tools to fit the local conditions, participants in this study would get maximum
benefit to increase their readiness for self-directed learning. These two tools, learning
plans and modules, are further discussed below.
2.3.3.1 Learning plans
The use of learning plans (Learning contracts) has become increasingly widespread
in recent years to operationalise SDL. According to Knowles (1986) one of the
predominant methods teachers have used to assist adult learners to be more self-
directed in formal instructional situations is the learning plan. Knowles (1986, p. 38),
defines a learning plan as “a written plan in which the individual documents in
varying detail, what and how she/he intends to learn in a given learning experience”.
The learning plan has several benefits (Knowles, 1990, p. 139), including:
• Being a tool for communication between learner and facilitator;
• Guiding learners in planning the learning experience;
• Solving the problem of the wide range of backgrounds in education,
experience, interest, motivation and ability that is characteristic of most adult
groups;
38
• Providing a way for individuals or sub-groups to tailor their own learning
plans;
• Providing the learner with a sense of ownership of the objectives he or she
will pursue;
• Identifying a wide variety of resources so that different learners can go to
different resources for similar learning content;
• Providing each learner with a visible structure for systematising their
learning, and
• Providing a systematic procedure for involving the learner in evaluating the
learning outcomes.
According to McAllister (1996), many authors believe that learning plans
individualise the learning process and assist students to develop habits related to
lifelong learning. These habits include independence, self-direction, and active
engagement with the subject matter (Dart & Clarke, 1991; de Tornyay & Thompson,
1987; Richardson, 1987). According to de Tornyay and Thompson (1987) the use of
learning plans can promote problem-solving skills, foster a desire for lifelong
learning, and enhance creative and critical thinking. The learning plans (learning
contracts) develop autonomy because they increase student’s internal locus of control
(Knowles, 1984; Tompkins & McGraw, 1988). This is based on the assumption that
to achieve objectives, students must rely on their own learning skills and not on
teachers to give them knowledge.
Dart and Clarke (1991) state that learning plans help students achieve greater self-
direction in their learning by allowing them to control their learning experiences, to
meet their own learning needs, and develop skills to educate themselves. Moreover,
39
Dart and Clarke (1991) indicate that learning plans can promote deep learning and
deep learning always involves gaining understanding through strategies such as wide
reading, use of a variety of resources, discussion, as well as reflection. Learning
plans also have benefits for teachers because they are free to use creative approaches
and students tend to be more self-motivated requiring less external motivation from
teachers (Dart & Clarke, 1991).
Several studies have demonstrated that learning plans have a positive correlation
with self-directed learning (Chan & Chien, 2000; Dyck, 1986; Hamilton & Gregor,
1986; Mazhindu, 1990; McAllister, 1996; Richardson, 1987; Waddell & Stephens,
2000). The assumption has been made that learning plans enable learners to achieve
competency in all the areas required for self-directed learning.
McAllister’s (1996) study used learning plans in a Bachelor of Nursing course in an
Australian university for a unit titled “Preparation for professional practice”. This
course was offered in the final semester of a three-year course. By the third week of
semester all students were proceeding to learn through their learning plans and by the
15th week the learning plans were competed. The findings of this study identified
several benefits, including:
• Students commented upon a greater sense of control in using learning plans;
• Learning plans also appeared to promote deeper learning; and
• Creativity also appeared to be promoted in the use of learning plans.
Another study conducted by Waddell and Stephens (2000) used learning plans in a
Registered Nurse (RN) leadership course. The diversity of RN students was the
reason for using learning plans in this study. Nominal group process was used as a
strategy during the first class session to determine content for the course. Waddell
40
and Stephens (2000) found that learning plans were favourably rated as an effective
strategy for the leadership course in the RN program.
Chan and Chien (2000) conducted a study using learning plans as a learning tool in
students’ clinical placement in mental health nursing. Students had 42 hours of
theory input and 18 days of clinical placements during the course in mental health
nursing. The sample for this study comprised 47 third-year students. The action
research cycle consisted of three phases: planning and learning plan making;
implementing learning plans, and evaluating the effectiveness of learning plans. A
questionnaire ‘Perceived benefit of Contract Learning’ was used to obtain students’
views on the benefits of the learning plans. Results of the study showed that there
was an increase in students’ autonomy and motivation in learning, as well as sharing
between students and clinical instructors. However, the study found the lack of
experience in using learning plans and limited time in clinical areas created
difficulties for both students and clinical instructors.
Contrary to other studies that learning plans have a positive correlation with self-
directed learning, is the work of Clark (1990). Clark (1990) conducted a study
comparing a traditionally taught and learning plan taught, course for nursing
students. The aims of the study were to see the impact of teaching method on self-
directed learning skills and clinical performance. The sample for the study comprised
86 junior and senior nursing students. At the end of the semester, students’ clinical
performance scores and post self-directed learning readiness scores were obtained.
The study found there was a significant relationship between teaching method and
dependent variables. The traditionally taught groups had better self-directed learning
and clinical skills. However, data contamination may have affected the result.
41
Caffarella and Caffarella (1986) also found that the use of learning plans in formal
education had little effect on students developing readiness for self-directed learning
within formal settings. This view is supported by Caffarella and O’Donnell (1989),
who note that there is little research or other evidence to support the use of learning
plans to facilitate self-directed learning. Other factors that limit the usefulness of
learning plans include:
• Discomfort by learners who use the learning plans, since it is often a new
experience;
• The quality of the learning may be questionable/problematic, since it is
directed by the learner rather than the teacher;
• Time pressures of using this method over more traditional forms of class
organisation, and
• Unsuitability of the plan form of learning for certain content areas. (Caffarella
& O’Donnell, 1989, p.17 )
In her study, McAlister (1996) found that despite the benefit of learning plans there
were also limitations, including the format of learning plans being confusing for
students. Some students did not know what their learning needs were. Another issue
about learning plans was their ability to trigger student anxiety. Some students were
uncertain about using learning plans and made too many learning objectives that they
could not accomplish in the time constraints of the study. Based on these findings
McAllister (1996) suggested future studies should prepare teachers, simplify the
format, help students to set realistic goals, and share ideas on quality learning.
In conclusion, learning plans can be a challenging, effective way for students to
learn, and can foster deep learning. In addition, use of learning plans promotes the
42
concept of becoming a self-directed, independent, lifelong learner. Therefore
effective use of learning plans can help students learn content that is context-specific,
relevant and applied. Moreover, by promoting independent learning the students are
better prepared to be independent learners. However, since the learning plans may be
only partially useful in developing the skills or competencies required for self-
directed learning many researchers (Caffarella & O’Donnell, 1989; McAllister,
1996) suggest that learning plans should be used in conjunction with other methods
to promote self-directed learning and to get maximum benefit from learning plans.
2.3.3.2 Learning module
Learning modules are frequently identified as an essential resource for self-directed
learning. Learning modules are one type of written material widely used in education
specifically for distance learning. The use of modules as resources for pro-active
learning in self-directed modes has very important implications for adult learning,
continuing professional education and programs in rural and isolated settings
(Brockett & Hiemstra, 1985: 35). Many authors have previously demonstrated that
learning modules can promote self-directed learning (Brunt & Scott, 1986; Davis &
Pearson, 1996; Donaldson, 1992; Huckabay, 1981; Jones & Jones, 1996; Kang,
2002; Pedley & Arber, 1997; Willock, 1998).
Jones and Jones (1996) conducted a study using a self-learning package compared to
a conventional lecture. The study aim was to investigate students’ preference for
conventional lecture or self-learning package. The sample of this study was 66 first
year students divided into a conventional lecture group and self-learning package
group, followed by a six-week implementation. Two questionnaires were used in the
study; “Study Process Questionnaire” (SPQ) and “Attitude Questionnaire” (AQ) to
examine their level of understanding. The result of the study that was there was no
43
correlation between students’ study approach and their preference for different
teaching methods when measured by test performance. Jones and Jones (1996)
suggested a need to review independent study packages to better match students’
needs.
Another study conducted by Davis and Pearson (1996) used a self-learning module
in a primary health care course. The sample was 103 nursing students who enrolled
in the Primary Health Care course, 69% generic students and 31% registered nurses
(RN). Age of the sample ranged from 21–56 years, modal age 22 years. Two
instruments were used in the study, Guglielmino’s SDLRS (1978) and Affective
Measure (Huckabay, 1981). The results of the study revealed significant differences
in course evaluation related to self-directed learning readiness. However, the results
of the study cannot be generalised due to the particular nature of the sample who
reported a high degree of self-directed learning readiness scores, which may be
atypical.
Pedley and Arber (1997) conducted an exploratory qualitative study using Jarvis’
(1992) experiential framework to evaluate student-centred module learning.
Following a nine-month module of study, a convenience sample of 135 students
completed a questionnaire with fixed choice and open-ended questions. The nine-
month implementation of the self-learning module was supplemented by group
discussion and feedback. A key theme that emerged was the beneficial learning
experience. The reported benefits included more choice, autonomy and taking
responsibility. However, no pilot test was conducted for the questionnaire and
questions remain regarding its reliability and validity, therefore the finding cannot be
transferred to other settings.
44
A study conducted by Willock (1998) compared performance outcomes of entry-
level nursing students who were taught selected psychomotor skills by traditional
lecture method versus self-learning modules. Students were divided into two groups:
self-learning module group for urine catheterisation and lecture/discussion for sterile
dressing change; self-learning module group for sterile dressing change and
lecture/discussion for urine catheterisation. The performance outcomes were a
paper/pencil test and skill demonstration. The finding of the study revealed no
significant difference in the performance outcomes. Data contamination is suspected
to have influenced the results.
A recent study conducted by Kang (2002) used a self-learning module to teach
nurses caring for hospitalised children with tracheostomies, with a sample of 85
nurses—74 RNs and 11 Licensed Practical Nurses (LPN). Pre- and post- tests using a
self-developed questionnaire contained eight questions about current practice
regarding tracheostomy care including skills, knowledge, and critical thinking. The
results of the study revealed a statistical difference on post-test scores compared to
pre-test scores after four months implementation of the program. Furthermore, Kang
(2002) suggested improvements to self-learning modules by adding other teaching
methods to increase learning and retention, such as, educators discussing the topic
and demonstrating the skills, as well as using video.
Brunt and Scott (1986) suggested that many factors need to be considered when
developing and implementing self-learning module, including appropriate planning
and assessment, which can provide a mechanism to assist in the development and
implementation of quality self-learning modules. It is suggested by many authors that
modules, together with other self-directed learning tools, can improve self-directed.
45
2.3.4 Measuring self-directed learning
The need for instruments to effectively evaluate readiness for self-directed learning
has been a recurring theme throughout the literature. In reviewing the literature,
Cormick (1995) identified 17 instruments used to measure readiness for self-directed
learning; one instrument is found in the literature developed by Fisher, King and
Tague in 2001 giving a total 18 instruments used to measure SDL readiness. Of
these, 13 require the student to respond to questions or statements, two assess
teachers’ self-directed learning behaviour, two study students’ behaviour from an
educator’s viewpoint, and one rates programs for self-direction. These instruments
are displayed in Table 2.3.
Table 2. 3: Instruments identified as assessing self-directed learning
Source: Cormick (1995, p.51)
46
According to Walker and Long (1997), two of these instruments are widely used—
the Guglielmino’s Self Directed Learning Readiness Scale (SDLRS) and Oddi’s
Continuing Learning Inventory (OCLI).These two instruments are presented below.
2.3.4.1 Oddi’s Continuing Learning Inventory (OCLI)
The Oddi Continuing Learning Inventory was developed to measure the personality
dimensions that characterise self-directed adult learners. These items were developed
after reviewing the literature on the type of personality characteristics that adult self-
directed learners possess (Oddi, 1986, p.98). The OCLI is a 24-item self-report scale
in which an individual records the extent of agreement along a seven point Likert
Scale. The response categories on the scale are arranged as follows: 1 = strongly
disagree, 2 = moderate disagree, 3 = slightly disagree, 4 = undecided, 5 = slightly
agree, 6 = moderately agree, 7 = strongly agree. The 24 items are summed to obtain a
score reflecting the extent to which an individual’s personality characteristics lead
him or her to initiate and persist in learning through various modes (Oddi, 1986,
p.105). An internal consistency coefficient of 0.85 (Oddi, 1984); 0.77 (Six, 1989),
and 0.79 (McCoy & Langenbach, 1989) was estimated for Oddi’s Continuing
Learning Inventory.
Oddi (1986) found the instrument to have both convergent and discriminant validity
and described moderate relationships with several psychological outcome measures.
Furthermore, Six (1989) found that the three factors identified by Oddi remained
consistent across study samples. However, McCoy and Langenbach (1989, p.84)
failed to find any difference in OCLI scores between those who felt they were
required to participate in self-directed learning activities and those who did not.
McCoy and Langenbach (1989) recommended additional items be added to the OCLI
in order to provide a more thorough understanding of the characteristics of self-
47
directed learners. Few studies used OCLI compared to Self-Directed Learning
Readiness Scale (SDLRS).
2.3.4.2 Self-Directed Learning Readiness Scale (SDLRS)
This instrument is a self-report questionnaire designed to measure the degree to
which an individual perceives his or her willingness and capacity to engage in self-
directed learning (Guglielmino, 1978). The SDLRS instrument scores an individual
on eight factors, namely:
• Openness to learning opportunities;
• Self-concept as an effective learner;
• Initiative and independence in learning;
• Informed acceptance of responsibility for one’s own learning;
• Love of learning;
• Creativity;
• Positive orientation to the future; and
• Ability to use basic study and problem solving skills.
According to Guglielmino (1978), these factors define attitudes, values, and abilities
associated with the preparedness or readiness of learners for self-directed learning.
The SDLRS is used to collect information about students’ level of readiness for self-
directed learning. More than 40,000 adults and 5,000 children have taken the
SDLRS. The instrument has been translated into more than 17 languages including
Indonesian and has a 27-year history of usage (Guglielmino & Guglielmino, 2005).
To design the SDLRS, Guglielmino (1978) obtained a pool of items for the inventory
from the literature and submitted them to a panel of experts in self-directed learning.
48
A final set of items was confirmed using a Delphi technique, the purpose of which
was to reach a consensus on the characteristics essential and distinct to self-directed
learning. The set of items was then tested with a sample of college students and later
revised to form the version in common usage since 1978.
The SDLRS is a 58-item Likert scale designed to assess the degree to which
individuals perceive themselves to possess skills and attitudes frequently associated
with self-directed learning. Individuals respond to each item on the scale as follows:
1 = Almost never true of me; I hardly ever feel this way; 2 = Not often true of me; I
feel this way about half the time; 3 = Sometimes true of me; I feel this way more
than half time; 4 = usually true of me; I feel this way more than half time; 5 =
Almost always true of me; there are very few times when I don’t feel this way. The
possible scores range therefore from 58 to 290. The total scores obtained by each
individual were used to indicate his/her level of readiness for self-directed learning in
relation to Guglielmino and Guglielmino’s (1991) norms. A high score indicates a
high readiness for self-directed learning. The scores and corresponding levels are
shown in Table 2.4.
Table 2.4: Levels of readiness for self-directed learning
Scores Level of readiness for self-directed learning
58 – 176
177 – 201
202 – 226
227 – 251
252 – 290
Low
Below average
Average
Above average
High
Source: The learning preferences assessment (Guglielmino & Guglielmino, 1991, p.8)
The original study by Guglielmino found a mean score for the adults completing the
SDLRS in Canada of 214, and a standard deviation of 25.6 (Guglielmino &
49
Guglielmino, 1991). A Cronbach’s alpha reliability coefficient of 0.87 was estimated
for the self-directed learning readiness scale; the split half reliability was estimated to
be 0.94 (Guglielmino, 1989a).
Supporting evidence from previous research has identified that the SDLRS is a
reliable instrument. This evidence is provided by many authors in early studies
(Brockett; 1985; Graeve, 1987; Hall-Johnsen, 1985; Skaggs, 1981; Wiley, 1983).
Other supportive studies acknowledge the validity of the instrument (Adenuga, 1991;
Bonham, 1989; Crook, 1985; Curry, 1983; Darmayanti, 1994; Delahaye & Choy,
2000; Finestone, 1984; Hassan, 1981; Long & Agyekum, 1988; Savoi, 1980).
The reliability of the SDLRS was measured by Delahaye and Smith (1995) with an
Australian sample. They obtained an alpha coefficient of 0.67 for the SDLRS scores
for a sample of 200 Technical and Further Education (TAFE) and university
students, aged below 49 years, pursuing business administration courses. When those
aged below 20 years were excluded from the analysis, Delahaye and Smith (1995)
found that the alpha coefficient rose to 0.72. They suggest that students under the age
of 20 years appear not to have settled into a preferred learning style, cautioning that
the use of the SDLRS with students under the age of 20 years may not be
appropriate. Delahaye and Smith (1995) recommended further investigations into the
use of the instrument with that age group. However, Warner, Christie and Choy
(1998) studied the level of readiness for self-directed learning of 524 Vocational
Education and Training (VET) learners using the SDLRS and found no significant
difference between level of readiness for self-directed learning of those age groups
15 to 20 years and 21 to 25 years. They found that there was a difference between the
50
levels of readiness for self-directed learning of those aged below 25 years and those
over 25 years.
In their review, Delahaye and Choy (2000) concluded that the SDLRS can be used
with acceptable confidence to provide an accurate measurement of readiness for self-
directed learning for Australian students. However, as indicated by other users, they
also suggest that caution must be exercised when interpreting the results of the
SDLRS.
The SDLRS has also been used in an Indonesian study (Darmayanti, 1994).
Darmayanti found a mean score for 391 Indonesian Open University students of
215.5, and a standard deviation of 21.9. The mean score of the sample in
Darmayanti’s study was one and half points higher than the mean score of the
normative population of Guglielmino’s study. The mean score of Darmayanti’s study
also shows that students of the Indonesian Open University have an average
readiness for SDL, which is similar to that in Guglielmino’s study (1978). A
Cronbach’s alpha reliability coefficient of .87 was estimated for the SDLRS in the
pilot study, and in the main study reliability was estimated at .91 (Darmayanti, 1994).
While the SDLRS has received support as a reliable and valid means for measuring
readiness for self-directed learning, Brookfield (1985) cautioned against capricious
use of this instrument. He argued that the construction of the instrument favours
those who are relatively educationally advantaged and it may not be suitable for
measuring levels of readiness for self-directed learning for working class adults. His
view is also shared by Brockett (1985). Likewise, Field (1989) has argued that the
SDLRS is better suited to measure the love and enthusiasm for learning and may not
be suitable to measure the level of readiness for self-directed learning. Field (1989)
51
claimed that a high score on positively phrased items and a low score on negative
items do not necessarily correspond to readiness for self-directed learning.
The instrument has also been criticised, Candy (1991) and West and Bentley (1991)
have also questioned the basic structure of the SDLRS. The SDLRS has weaknesses
that have been identified by other researchers (Brockett, 1985; Leeb, 1985; Long &
Walsh, 1992). Brockett and Field found that 12 of the 58 items did not significantly
correlate to the total score, while Lebb found 11 items did not. Long and Walsh
found that the 17 reverse-scored items displayed a lower correlation with the total
score data than their positively scored counterparts. For that reason, Caffarella and
O’Donnell (1989) called for additional verification studies using subjects from
different economic, ethnic, and cultural backgrounds. This view was vigorously
debated by a number of researchers with no resolution.
In defending her instrument, Guglielmino (1989b) responded that it measures the
level of readiness to engage in self-directed learning at the time that it is answered,
suggesting that the level could change. The SDLRS contains both positively and
negatively phrased items, where 17 items (out of 58) are reverse-scored. Guglielmino
(1989b) highlighted that a high score on some negatively phrased items such as item
14: “Difficult study doesn’t bother me if I’m interested in something” and item 33:
“I don’t have any problem with basic study skills” indicates a high level of self-
direction. Similarly, a low score on some positively phrased items such as item 7: “In
a classroom, I expect the teacher to tell all class members exactly what to do at all
times” also indicates a high level of self-direction. Guglielmino (1978) included
negatively scoring items (reverse items) in the SDLRS to avoid the subjects from
developing a response set. A response is developed if the rating is similar on all
52
questions; the subjects then develop a tendency not to read the items carefully.
Guglielmino’s (1989b) study showed that all of the reverse items, except one, had
item correlation of 0.30 or higher. Despite the debate around the questionnaire,
according to Walker and Long (1997), Guglielmino’s self-directed learning readiness
scale (SDLRS) remains the most widely used instrument to assess readiness for self-
directed learning in education at this time.
2.4 Summary
This chapter outlined the literature on self-directed learning. An overview of
conceptions of teaching and learning and student approaches to learning were
provided. The definition of self-directed learning was presented as well as a
conceptual model of self-directed learning. The two teaching strategies utilised to
improve self-directed learning in nursing students in Central Kalimantan and the
characteristics of the instrument used in assessing self-directed learning completed
the chapter. The next chapter outlines the methodology used in this study.
53
CHAPTER THREE
METHODOLOGY
3.0 Introduction
This chapter describes the methodology used to address the research questions for
the study. The research questions were:
1. What were students’ levels of readiness for self-directed learning (SDL)
before the educational intervention as measured by the Self Directed Learning
Readiness Scale (SDLRS)?
2. Was there a difference in students’ readiness scores for SDL between the
intervention and control groups at pre-test?
3. Was there a difference in students’ readiness scores for SDL following the
educational intervention?
4. What factors contributed to students’ readiness for SDL?
5. What were the students’ perceptions of SDL before and after the educational
intervention?
6. What were clinical instructors’ perceptions of students’ clinical activities
during the educational intervention period?
This chapter begins by presenting the research design. This is followed by the
population and sample, sampling technique, ethical considerations associated with
the study, and independent and dependent variables. Data collection tools are
explained with justification for their inclusion. This is followed by procedures for
data collection, a brief explanation of the pilot study, and the educational
intervention program (EIP). Analytical plans for quantitative data are outlined in
54
relation to each hypothesis, as well as the data analysis for qualitative data; these are
presented at the end of the chapter. The chapter then concludes with a summary.
3.1 Research design
A mixed or multi-method approach that included quantitative and qualitative
methods was used to address the research questions for this study. Brewer and
Hunter (1989) state that the benefits of a mixed method approach allow the
exploitation of the potential strengths of each paradigm to better inform the focus of
the study.
The quantitative component of the study was used to evaluate the impact of the
educational intervention on students’ readiness for SDL using the SDLRS. Two
collection points, before and after the introduction of the intervention, allowed the
researcher to examine the impact of the intervention (Polit & Hungler, 1999)—in this
case the structured educational intervention.
To gain the fullest understanding of the participants’ experiences of using SDL a
qualitative method was also used for the study. Students’ perceptions of SDL and
clinical instructors’ perceptions of students’ clinical activities regarding SDL were
explored. To gather qualitative data, focus group discussions (FGD) were employed.
By using focus groups, quantitative research findings were expanded and enhanced.
The research design is outlined in Figure 3.1.
55
Inte
rven
tion Pre-test
SDLRS & Demographic questionnaire Focus group discussion(students)
Educational program 4-day workshop 4-day skill practice at nursing lab 12-week implementation 3 tutorial meetings Self-directed learning module & Learning plans
Post test SDLRS FGD: students and clinical instructors
Con
trol
Pre-test SDLRS & Demographic questionnaire Focus group discussion (students)
Educational program as usual
Post test: SDLRS FGD: students and clinical instructors
Figure 3.1: Research design used in the study
The quantitative aspect of the study used a non-equivalent control group design with
pre- and post- tests of an intervention and control group, which evaluated the impact
of a structured educational intervention on students’ readiness for SDL in a diploma
nursing program in Central Kalimantan, Indonesia. The quantitative aspect of the
study also involved the collection of data that potentially contributed to students’
readiness for SDL.
A structured educational intervention was developed and used for nursing education
in Central Kalimantan to introduce SDL concepts, followed by implementation of
SDL into the learning situation. The SDL concepts were implemented as part of one
nursing subject for second year students. The structured educational intervention
aimed to improve students’ self-directed learning abilities by increasing their
participation in their own learning.
The intervention group participated in four days of workshops which introduced SDL
concepts followed by four days of practice in the nursing school laboratory for
selected nursing skills. A self-directed module and learning plan was used in the
study to operationalise principles of SDL. Students received the self-directed module
56
at the beginning of the program. To support students’ efforts to implement SDL
concepts for twelve weeks, three tutorial meetings were held in weeks 3, 6, and 9 of
their program.
Maas, Buckwalter, Reed, and Specht (1998) note that when the non-equivalent
control group design is employed, the control group may also receive a treatment.
The control group received the teaching approaches normally used in the nursing
school that had agreed to participate as the control condition for this study. The usual
practices were teacher-centred rather than student-centred. Students in the control
group received the self-directed learning module after the post- test data were
collected.
The quantitative aspect of the study evaluated the impact of the educational
intervention for SDL by using the Self-Directed Learning Readiness Scale (SDLRS)
developed by Guglielmino (1978). The analyses of the quantitative data addressed
hypotheses that were developed from the first four research questions:
• Hypothesis 1: The students’ level of readiness for SDL as measured by
SDLRS would be lower than established group norms (Guglielmino, 1978)
• Hypothesis 2: There would be no significant difference between the
intervention and control group SDLRS scores at pre-test
• Hypothesis 3: Self-directed learning readiness scores of students who
participated in the educational intervention program over fourteen weeks
would be significantly increased compared to the scores of students who did
not participate
57
• Hypothesis 4: Variables such as group (intervention-control), gender, birth
order, father’s educational background and mother’s educational background
would significantly contribute to students’ readiness for SDL.
The qualitative part of the study used focus group discussions (FGD) to collect
qualitative data from students and clinical instructors. A focus group is defined by
Krueger (1994, p.18) as “a carefully planned (group) discussion designed to obtain
perceptions on a defined area of interest in a permissive, non-threatening
environment”. The purpose of students’ FGD in this study was to explore students’
perceptions of SDL and general factors that may influence their readiness for SDL.
The aim of conducting FGD for clinical instructors was to explore their perceptions
of students’ clinical activities regarding SDL. The qualitative data from the clinical
instructors provided a holistic view of the factors that were thought to contribute to
students’ activities in clinical practice. FGD with students and clinical instructors
extended the knowledge about students’ SDL approaches. Collectively, the focus
group discussions explored factors that contribute to readiness for SDL from the
perspective of students and their clinical instructors. Students were asked their
perceptions of SDL before and after intervention to address research question five:
5. What were the students’ perceptions of SDL before and after the educational
intervention?
Clinical instructors were asked their perceptions of students’ clinical activities to
address research question six:
6. What were clinical instructors’ perceptions of students’ clinical activities
during the educational intervention period?
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3.2 Population and sample
The target population for this study was all second-year nursing students who were
enrolled in a nursing school in Central Kalimantan at the time of the study
(September 2003 to March 2004). The population of this research study therefore
consisted of all nursing students from four nursing schools in Central Kalimantan,
Indonesia. There was total of approximately 560 students in these schools at the time
of the study.
The sample for the study was nursing students in the second year of their studies.
This was justified on the basis that students in their first semester of first year do not
study nursing-specific subjects, as prescribed by the Indonesian nursing curriculum.
Students commence their nursing subjects in the second semester of the first year of
their course. There were approximately 60 second-year students at each school. To
be eligible for the study the students had to meet the following criteria: be in their
second year of nursing study at the time of the research study and be willing to be
involved in the research study.
3.3 Sampling technique
3.3.1 Quantitative sampling
A random sampling procedure is generally recommended and argued to be the most
rigorous in allowing for generalisability (Bowling, 2002; Buckwalter, Maas &
Wakefield, 1998; Polit & Hungler, 1999; Punch, 1999). However, important
considerations such as costs, time and convenience for determining sampling designs
are also raised as critical issues (Neuman, 2000).
59
Randomisation of individuals to groups within this sample was not possible because
of the nature of the study design and educational system in nursing schools in
Indonesia. If the researcher had randomly allocated students to either control or
experimental groups from the same school or the same area, there would have been
the opportunity for discussion of the intervention between members of both research
groups, as students would have time together in clinics or in the class. The time
together would provide opportunities to discuss aspects of the intervention, which
may have caused contamination of the data collected from the control group and
experimental group. The control group may have inadvertently adopted some aspects
of the intervention in their method of study.
Random selection of schools was possible, however, as they were located in different
districts. Of the four nursing schools in Central Kalimantan, two of these were
similar in funding, size, human resources, and curricula. Based on those similarities,
these two schools were selected to be in the study. Following a letter of agreement
from the nursing schools, both heads of the nursing schools were invited to attend a
meeting. Information about the study was given to them, including the purpose and
procedures of the study. They were told that students’ participation in the study was
voluntary and that the students could withdraw at any time. One of these two schools
was randomly allocated to become the ‘intervention school’, and the other became
the ‘control school’. Simple random sampling using a coin toss, ‘heads’ as
intervention and ‘tails’ as control, was used to draw which school became the
intervention school or control school.
One of the major outcome variables in this study was the SDLRS scores. The sample
size for the study was estimated from mean scores for SDLRS, with 50 participants
60
in each group, assuming a baseline average SDLRS score of 190 points (SD = 18).
With this sample size it was possible to detect mean changes over time of 10 units or
more with 80% power at 95% significant level (one-tailed). Therefore, the power is
considered to be adequate with a sample of this size. To allow for eligible students
who may refuse to participate and a further 10% of respondents who could withdraw
or be excluded during the study, the sample needed to be inflated by 20% (to n = 60
per group). Thus, 120 eligible second-year nursing students were needed to be
approached to retain 50 participants in each group by the end of the study.
Students from second year classes were asked to volunteer to participate in the study.
A total of 101 students participated in the study. Forty-seven of fifty students in the
intervention school volunteered to participate, and forty-four of sixty students in the
control school volunteered to participate in the research study. Gay (2003) cautions
about generalising results obtained from volunteers to the population being studied,
suggesting that samples could be biased. This study among nursing students is the
first of its kind in Indonesia and therefore exploratory in nature. It will need to be
repeated to verify any variances before generalising to the larger population of
nursing students.
3.3.2 Qualitative sampling
3.3.2.1 Student participants
Participant students were also invited to participate in focus group discussion (FGD).
Twenty-four second-year students from each school, giving a total of forty-eight
students, volunteered to participate in FGD. Each school had two groups for FGD
pre- intervention and one group post- intervention. The FGD were undertaken in two
nursing schools in Central Kalimantan. Each group consisted of eight participants
and a total of six focus groups were conducted across the two schools.
61
3.3.2.2 Clinical instructor participants
Clinical instructors from the intervention school and control school were invited to
participate in focus groups. The FGD for clinical instructors was held at the end of
the study. Twelve clinical instructors volunteered and consented to participate in the
two focus group discussions. The clinical instructor groups comprised six nurses
from the intervention and six nurses from the control group.
3.4 Ethical considerations
The study was granted ethical approval from the University Human and Research
Ethics Committee, Queensland University of Technology, and permission from the
Regional Body Research and Development (Balitbangda), Central Kalimantan
Province. All potential student participants in this study were given verbal
information and written information sheets about the study and informed of their
rights. They were informed that participation in the study was voluntary and that they
could withdraw at any time without explanation, and that withdrawal would have no
effect on their current or future study. The participants were assured that their
academic progress or future study would not be affected by their decision to
participate, or not participate, in the research study.
In anticipating that some students may feel unable to refuse due to their cultural
background in Indonesia, the researcher made it very clear to all potential
participants that she was not an employee of their schools or affiliated with them in
anyway, and had no capacity to intervene in their academic progress or future study.
The researcher provided ongoing support during the educational intervention
program. Opportunities were provided for participants to ask questions at any time,
and the researcher was freely available to answer all participant questions related to
62
the study. If required, students could also talk freely with the head of the nursing
school if they had any concerns about the study. All students were assured about the
confidentiality of their responses. All information collected was confidential and was
not disclosed to anyone other than the researcher. No names appeared on any results
and a coding system known only to the researcher was developed and used.
It was considered that the risks for students from this research study were minimal.
However, a potential risk existed if students perceived a threat to their academic
progress if they did not participate, or a heightened expectation of their performance
if they did participate. The intervention group could also believe that the educational
intervention program increased their study load. The control group could think that
they were treated unfairly because they did not participate in the educational
intervention program. In order to reduce the risk for students, it was explained to the
students during a group presentation how they could benefit from this study. The
intervention group could increase their knowledge and basic skills in SDL. The
control group got the same module as the experimental group at the end of the study.
An information sheet (Appendix 5 and 6) and written consent form (Appendix 7) was
given to each student.
3.5 Dependent and independent variables
The dependent variable or outcome variable in this study was students’ readiness for
SDL scores at post- test. This variable is a continuous variable. The students’
readiness for SDL was measured by the SDLRS (Guglielmino, 1978). The main
independent variable or explanatory variable was the group (intervention or control
group). Additional independent variables were selected in response to the literature
63
in the area of SDL, which suggests these factors may influence SDL, and included
age and gender.
As there were no previous published studies in SDL in nursing education in
Indonesia, the following variables were considered by the researcher to potentially
affect the students’ readiness for SDL and hence the following data also were
collected: first born order (yes/no; dichotomous variable), father’s educational
background (categorical), and mother’s educational background (categorical
variable). The pre-test SDL scores were used as a covariate.
3.6 Instrument
Two questionnaires were used to collect the quantitative data in the study—the
SDLRS and a demographic questionnaire.
3.6.1 Self-Directed Learning Readiness Scale (SDLRS)
The SDLRS is a self-report questionnaire that uses a 58-item Likert scale.
Individuals respond by indicating whether each item on the scale is: 1 = Almost
never true of me; I hardly ever feel this way; 2 = Not often true of me; I feel this
ways about half the time; 3 = Sometimes true of me; I feel this way more than half
time; 4 = Usually true of me; I feel this way more than half the time; 5 = Almost true
of me; there are very few times when I don’t feel this way. The SDLRS contains both
positively and negatively phrased items, where 41 of the items are positively phrased
and 17 negatively phrased. The questionnaire is designed to measure the attitudes,
values and abilities of an individual relating to his/her readiness to engage in self-
directed learning at the time of response. According to Guglielmino and Guglielmino
(1991), the SDLRS collects data on the following aspects: openness to learning
64
opportunities, self-concept as an effective learner, initiative and independence in
learning, informed acceptance of responsibility for one’s own learning, love of
learning, creativity, positive orientation on the future, ability to use basic study, and
problem solving skills.
The readiness is assessed as a total score with possible scores ranging from 58 to
290. A high score indicates a high readiness for self-directed learning. These scores
are then converted into bands of readiness: low [58 to 176], below average [177 to
201], average [202 to 226], above average [227 to 251], and high [252 to 290]
(Guglielmino & Guglielmino, 1991).
The original study by Guglielmino was undertaken in the USA with college students.
The mean score was obtained in Guglielmino’s study of 214, with a standard
deviation of 25.6. This mean score has been used for comparison purposes in many
studies (Bulik & Romero, 2000; Delahaye & Choy, 2000; Jones, 1992; McCauley &
McClelland, 2004). According to Guglielmino and Guglielmino (2005) more than
500 major organisations from around the world have used the SDLRS, and more than
100,000 adults and 100,000 children have completed the SDLRS. The majority of the
studies have been conducted in western and developed countries. The instrument has
been translated into more than 17 languages, including French, Spanish, German,
Italian; Finnish; Japanese; Chinese; Korean; Greek; Portuguese, Arabic, Russian,
Indonesia and has a 27 year history of usage (Guglielmino & Guglielmino, 2005).
It takes about 30 minutes to complete the SDLRS (Guglielmino & Guglielmino,
1991). The total scores obtained by each individual are used to indicate his/her level
of readiness for SDL in relation to SDL norms. The scores and corresponding levels
(see Table 2.4), and the nursing students’ SDLRS scores in the current study could
65
therefore be compared to the normative data provided by Guglielmino and
Guglielmino (1991).
The SDLRS was developed and has been widely used in English speaking countries,
where the educational system and cultural background is different from that of
Indonesia. Therefore, accurate translation of the instrument (SDLRS) for use with an
Indonesian population was important. Prieto (1992) argued that the goal of the
translator is to produce a translation which will be equivalent to the source and
understood by the audience for whom it is translated. The SDLRS had been used in a
previous Indonesian study (Darmayanti, 1994). For the purpose of the study the
SDLRS was translated into Indonesian in 1992 and has been piloted and used to
collect data on students’ readiness for SDL with Indonesian Open University
students. The procedure for translation in Darmayanti’s study combined methods
suggested by Brislin (1980) and Prieto (1992): a committee approach, a back
translation, and a pre-test procedure or a pilot testing of the translated instrument.
The Indonesian version of SDLRS in Darmayanti’s study was piloted on 37
Indonesian Open University students and was then administered to 391 Indonesian
Open University students in the main study. Based on the procedure of translation
outlined in Darmayanti’s study the translated SDLRS was regarded as a sufficiently
reliable and accurate translation. Darmayanti found that the outcome of the pilot and
main study showed that Indonesian Open University students were familiar with
SDL concepts and the instrument was easy to comprehend. Therefore, she concluded
it to be suitable for Indonesian Open University students.
However, Indonesia is diverse in ethnicity and language as there are approximately
3000 ethnic groups and 250 languages and dialects. Despite “Bahasa Indonesia”
66
being the national language, the majority of Indonesians have a language other than
Indonesian as their “first” language. Sechrest, Fay and Zaidi (1988) identified that
dialect differences and regional differences in colloquial speech and idiom all
contribute to potential sub cultural research problems. As a result, it was thought
appropriate for the present study to check the Indonesian SDLRS for language and
dialect influences.
In order to use the SDLRS it was necessary to purchase the instrument from the
author. The SDLRS was translated into Indonesian contemporary language based on
suggestions from Darmayanti (1994). She suggested adding further explanations for
students in parentheses for items in number 33 and 53 to ensure that the students
would understand the items clearly. The original Indonesian translation of SDLRS is
11 years old and tended to have a ‘Javanese influence’. For example, the word ‘ajeg’
(constant) in parentheses for item number 33 is not common to non-Javanese so the
word ‘ajeg’ was not added in parentheses for the current translation.
Five bilingual Indonesian undergraduate students studying in Brisbane were asked to
complete the translated SDLRS and they were also asked to give feedback on the
items that were not clear enough from their point of view. No changes were made to
the translated SDLRS draft. The draft of the translated SDLRS was then sent to a
registered translator to check for accuracy and appropriateness of translation. After it
was checked by the registered translator, the translated SDLRS was considered as a
second draft. The second draft of the SDLRS was pilot tested before administration
to participants in the main study. The SDLRS is provided in Appendix 1.
67
3.6.2 Demographic questionnaire
A demographic questionnaire (see Appendix 2) was developed by the researcher
based on literature related to SDL. Personal characteristics that were likely to
influence readiness and ability for SDL were identified from the literature. The
demographic questionnaire therefore included the following participants’
characteristics: gender; age; birth order (First born: yes-no); father’s educational
background (≤Junior High School or ≥Senior High School), and mother’s
educational background (≤Junior High School or ≥Senior High School).
3. 7 Procedure of data collection
Letters were sent to the head of each nursing school expressing a request to conduct
the research study at the nursing schools and seeking permission to do so. Letters of
agreement from the schools were provided before conducting the research study.
Subsequent to ethical approval being obtained, the eligible students were identified
from administration records and they were invited to participate in the research study
through invitations on notice boards and through teaching staff.
Prospective participants then attended a meeting where the researcher made it very
clear to students that their participation was voluntary and they were free to withdraw
anytime. Information sheets and consent forms were distributed to the participants
and they were asked to read and sign the consent form and return their consent form
to the researcher. After informed consent was obtained, the prospective participants
from the intervention school and the control school completed the pre-test
questionnaires. Both the intervention group and the control group were post- tested
for SDL after 14 weeks. During the 14-week period, students from the intervention
school participated in the educational intervention program.
68
Following the pre-test, the prospective participants in both intervention and control
groups were invited to attend an initial focus group discussion (FGD). The FGD
were held to collect qualitative data on students’ perceptions of SDL and used
modified guidelines by Myers (1999). The guidelines outline each step of the process
for the researcher and the assistant; from before participants arrive to when they
leave. The same guidelines were used to conduct all FGD. Table 3.1 shows the
modified focus group protocol used in the study.
Table 3.1: Modification of focus group protocol
No Phase Specifics
Source: Myers (1999 p.105)
69
Each group was asked a generic set of questions about their perceptions and practice
of SDL. In doing this, the researcher used a FGD interview script; it was a plan for
covering topics so the desired information was obtained. The FGD interview scripts
provide a series of questions framed together to answer the research questions. The
scripts began with an ice-breaker question which required little reflection and worked
up to more penetrating questions (key questions). This allowed participants to warm
to the context and subject matter before being asked to explore the subject which
took more thought or was more difficult to discuss. The length of each group
interview varied between 90 to 120 minutes and was audio taped for transcription.
Table 3.2 show the FGD script for students before the educational intervention
program (EIP).
Table 3.2: Student focus group script before intervention
1. Thank you for participating in this program
2. Introduce purpose of focus group
3. Ice-breaker question: Have you heard about self-directed learning?
4. 4. Key questions
• What does self-directed learning mean to you?
• What do you think self-directed learning involves?
• What teaching and learning issues will arise if self-directed learning was
implemented?
5. Summary question: these are the main point raised today
• Do you agree?
• Is there anything you would like to add?
Thank you very much for your participation in this focus group and good bye.
The script was used for the intervention and control groups before the EIP and was
also used for control group FGD after EIP. The following table presents the FGD
script for students in intervention group after the intervention program was
70
completed (Table 3.3). This interview script was only used for the intervention
group, as only this group could talk about the SDL activities.
Table 3.3: Student focus group script after intervention
1. Thank you for participating in this FGD
2. Introduce purpose of FGD
3. Ice-breaker question:
• Did you enjoy the program?
• What did you learn?
4. Key questions
a. What does self-directed learning mean to you?
b. Generally, describe your SDL activities
c. What do you think are the benefits of self-directed learning?
d. What teaching and learning issues will arise if self-directed learning was
implemented?
5. Summary question: these are the main point raised today……
• Do you agree?
• Is there anything you would like to add?
Thank you very much for your participation in this focus group and good bye.
Clinical instructors’ perceptions of students’ clinical activities in clinical settings
during the implementation period were explored through FGD at the end of the
study.
The FGD interview script was used for clinical instructors from both groups and is
presented in Table 3.4.
71
Table 3.4: Clinical instructor focus group script 1. Thank you for participating in this program;
2. Introduce purpose of focus group;
3. Ice-breaker questions
• Can you tell me, what did students do in clinical practice?
• What did you think about the clinical practice?
4. Key questions
a. Do you think the 2nd year students were “more active” in clinical practice compared
to 3 months before? (If “yes”, continue to question b, if “no”, skip to question 5)
b. Can you give some examples of students being “more active”?
c. What do you think the implication of students being “more active” to your
workload?
d. What issues will arise relevant to your professional development if students are
more active?
5. Summary question: these are the main point raised today……………
• Do you agree?
• Is there anything you would like to add?
Thank you very much for your participation in this focus group and good bye.
3.8 Pilot study
Polit and Hungler (1999) state that the main focus of a pilot study is to assess the
adequacy of the data collection plan. Although the SDLRS had already been used
with Indonesian Open University students and has good reported reliability and
validity (Cronbach’s alpha = 0.91), a pilot study was conducted using the SDLRS
with the diploma nursing students to ascertain if the instrument was appropriate for
use with them. The pilot study is discussed in detail in Chapter Four.
3.9 Educational intervention
Intervention activities took the form of a structured educational intervention
program. The activities of the intervention in this study included introducing and
implementing the concepts of SDL, and evaluating the impact of the intervention on
72
students’ readiness for SDL. The main objective of the intervention was to improve
students’ self-directedness in learning.
Rombothan (1995) pointed out that the first steps undertaken to improve a learner’s
self-directed ability are to assess the current level of readiness for SDL that the
individual is able to exhibit. One of the ways to justify the level of SDL is to use an
assessment tool known as SDLRS (Guglielmino, 1978). The level of students’
readiness for SDL in the current study was assessed before and after the intervention
using the SDLRS.
The educational intervention program comprised a four-day workshop, a four-day
skills practice in a nursing laboratory and three days a week for 12 weeks of clinical
practice in hospital settings to apply SDL concepts. A self-directed module and
learning plans were used to operationalise the SDL concepts. Piskurich and Piskurich
(2003) state that support systems are needed to assist students’ efforts to become
self-directed learners. In order to provide support for students, three tutorial meetings
were held in weeks 3, 6, and 9 during the implementation period. The educational
intervention program is discussed in more detail in Chapter Five.
3.10 Data analysis
3.10.1 Quantitative data analysis
The data obtained from the questionnaire were analysed using the SPSS statistical
software package version 12. Each response was coded and entered into the software
database to conduct statistical procedures such as descriptive statistics, one sample t-
test, independent-samples t-test, analysis of covariance and multiple regression
analysis. The level of significance was set at .05.
73
Descriptive statistics were used to explain demographic data. A one sample t-test was
conducted to examine differences on SDLRS scores between sample study scores
and the norm group scores (Guglielmino, 1978). The difference on SDLRS scores
between intervention and control groups at pre-test was examined using an
independent sample t-test. Analysis of Covariance (ANCOVA) was conducted to
explore differences between groups (intervention and control groups) on post test
SDLRS. Multiple regression was employed in this study to explore the relationship
between scores on post test SDLRS and independent variables—including group
(intervention and control), gender, birth order (first born and non first born), father’s
educational background (less than or equal to Junior high school and more than or
equal to Senior high school), and mother’ educational (background: less than or
equal to Junior high school and more than or equal to Senior high school).
3.10.2 Qualitative data analysis
The aim of the qualitative component of the study was to ascertain and analyse
nursing students’ perceptions about SDL and their clinical instructors’ perceptions
about students’ activities in clinical practice before and after the introduction and
implementation of an educational intervention.
The transcripts from the FGD were analysed by thematic content analysis using
guidelines proposed by Burnard to identify emerging themes (Burnard, 1991).
Burnard’s original guidelines comprised 14 steps. The guidelines were adapted from
Glaser and Strauss’ grounded theory approach (Glaser & Strauss, 1967), work on
content analysis (Babbie, 1979; Couchman & Dawson, 1990; Fox, 1982), and from
other sources concerned with analysis of qualitative data (Bryman, 1988; Field &
Morse, 1985). The method employs a step-by-step approach to coding and
74
categorising focus group transcripts. For the purpose of this study, Burnard’s
guidelines were modified from 14 stages to 17 steps. All focus groups were analysed
using the same processes. The modification of Burnard’s guidelines is summarised in
Table 3.5 and outlined in more detail in the results section of this thesis (see Chapter
6).
Table 3.5: Modification of Stages of Thematic content Analysis
1 Transcription of taped interviews into original language (Indonesian)
2. Transcriptions read and notes made about general themes
3 Transcriptions were translated from original language (Indonesian) into English
4 The transcriptions were then checked by a registered translator for accuracy of
translation and quality of data
5 Open coding–Re-read transcripts and developing descriptive categories
6 Independent preliminary themes by two researchers–three lists of themes were
developed
7 Transcribed the three lists into separate document
8 Reviewed the three lists for commonalities/link between any of them and grouped
together into categories
9 Each group was explored for subcategories. Repetitious or very similar categories were
removed to produce a final list
10 The two researchers were asked to verify the accuracy of categorisation system
11 Modifications were made to produce final list
12 Re-read transcripts to check a true representation of the interview had been captured
13 Section transcripts were identified and coded under corresponding categories
14 “Cut” and “pasted” the section of transcripts in step 13
15 Results from step 14 were translated back to original language while keeping the
English categorisation for further analysis*
16 Returned the thematic content analysis results (original language) to the focus group
participants to check for “truth value”
17 Write up the findings alongside relevant literature and research, using direct quotes
from the transcripts to further illustrate the point under discussion
*Maintain copies of complete transcript for future reference.
Source: Adapted from Burnard (1991)
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3.11 Summary
This chapter outlined the rationale for the study design. Population and sample,
sampling technique, and independent and dependent variables were also presented.
Instrument and data collection methods were explained and reliability coefficients
reported. Ethical considerations and potential risks were described. Data analysis
plans completed the chapter. The following chapter outlines the pilot study.
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CHAPTER FOUR
PILOT STUDY
4.0 Introduction
Many authors have confirmed that the importance of a pilot study is to provide
information for a main study (Lakey & Wingate, 1998; Polit & Hungler, 1999).
Buckwalter, Maas, and Wakefield (1998) make the point that a pilot study is strongly
recommended before conducting any major experimental study. According to Polit
and Hungler (1999) the main focus of a pilot study is to assess the adequacy of the
data collection plan. The proposed data collection and analysis procedure can then be
evaluated and changed as needed. Polit and Hungler (1999) make further comment
on the importance of pilot studies, even when the data collection plan involves the
use of existing standardised instruments.
The main study was to use the SDLRS, which had already been used with Indonesian
Distance Learning students (Darmayanti, 1994), and had good reported reliability
and validity (Cronbach’s alpha = 0.91). However, for the current research, a pilot
study was conducted using the SDLRS with nursing students in Central Kalimantan
to ascertain if the instrument was appropriate for use with them. Testing of the
educational intervention was not possible due to time constraints associated with
fully pilot testing a 14-week intervention, but data from the pilot study could be used
to test the recruitment method. In addition, the pilot study would provide insights
into the students’ levels of SDL readiness, which could help to inform the content of
the educational intervention program.
77
There were two purposes for conducting the pilot study:
• To examine the internal reliability and test-retest reliability of the Indonesian
version of SDLRS;
• To trial the recruitment method.
Two questions were used to guide the pilot study:
• What was the reliability of the Indonesian version of the Self-Directed
Learning Readiness Scale (SDLRS) when used among student nurses from
Central Kalimantan, Indonesia?
• Did the recruitment method achieve the required sample?
This chapter begins by presenting a description of the design, sample, instrument,
and procedures for the collection of data. Analytical approaches to the data are then
presented, followed by results and discussion. The chapter concludes with a
summary.
4.1 Design
A descriptive exploratory design was used for the pilot study. A survey was
administered at two time points. Data were collected using the SDLRS and a
demographic questionnaire. At Time 1, participants were asked to complete the
SDLRS and the demographic questionnaire, and at Time 2 they were asked to
complete the SDLRS. The period of time between Time 1 and Time 2 was two
weeks.
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4.2 Sample
Participants selected for the pilot study came from the same population that was to be
used for the main study. The population for the main study was to be all second-year
nursing students from four nursing schools in Central Kalimantan at the time of the
study (September 2003 to March 2004). These schools had approximately 560
second-year students. The sample for the pilot study was chosen to ensure they had
similar characteristics to those of the main study. The pilot study was therefore
carried out in a school of nursing in Central Kalimantan, Indonesia, which was a
different school to those involved in the main study.
Nieswiadomy (1993) indicates there is no set number of participants needed for a
pilot study. The sample size for the pilot must be large enough to detect flaws or
weaknesses in the methodology and will depend on the overall size of the population.
Treece and Treece (1986) recommend that a pilot study sample be one-tenth the size
of the sample proposed for the main study. This pilot study used the Treece and
Treece (1986) suggestion on the sample size. The desired sample size for the main
study was at least 100 participants so the minimal sample size of the pilot study was
10 participants. A total of 54 second-year students from a total of 520 students in the
pilot school volunteered to participate in the study. It was decided to include all
voluntary participants in the pilot to ensure a large enough sample size. The larger
than required sample size would provide a good description of SDL for nursing
students in Central Kalimantan. This information would be very useful for designing
and planning the educational intervention.
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4.3 Instruments
Two questionnaires were used in the pilot study. Guglielmino’s Self-Directed
Learning Readiness Scale (SDLRS) was used to collect data on students’ readiness
for SDL and a demographic questionnaire was used to collect data on gender, age,
birth order, father’s educational background, and mother’s educational background.
The Self-Directed Learning Readiness Scale (SDLRS), a commercially available
self-report instrument (see Appendix 1), was developed by Guglielmino (1978). It
has become the most widely used and well-respected instrument for the assessment
of readiness for SDL (Guglielmino & Klatt, 1993; Harvey & Harvey, 1995; Walker
& Long, 1997; McCune, 1988).
The SDLRS is reported to have a Cronbach’s alpha reliability coefficient of .87
(Guglielmino, 1978). As described by McCune, Guglielmino, and Garcia (1990), the
latest reliability estimate based on a varied sample of 3,151 adults, was 0.94. Wiley
(1983), in a study of 104 undergraduate nursing students, used a test-retest of SDLRS
and reported a Cronbach’s alpha coefficient of .91 (pre-test) and .79 (post-test). It is
important to note that the time between the administrations of the two tests was nine
weeks. This may have affected the reliability coefficient at the post-test. Another
study reported on the test-retest reliability of SDLRS (Finestones, 1984). This study
reported a reliability coefficient of .92 (Time 1) and .82 (Time 2). However, the time
between the two tests was not reported. Studies in Indonesia that used the SDLRS
have reported Cronbach’s alpha coefficients of .87 at pilot study and .91 at main
study (Darmayanti, 1994).
80
A demographic questionnaire (Appendix 2) was developed by the researcher based
on literature related to SDL. Personal characteristics that were likely to influence
readiness and ability for SDL were identified from the literature. The demographic
questionnaire therefore sought information regarding the following characteristics of
participants: gender; age; birth order (First born: yes-no); father’s educational
background (≤Junior High School or ≥ Senior High School), and mother’s
educational background (≤Junior High School or ≥ Senior High School).
4.4 Procedure
A letter was sent to the head of the pilot school expressing an intention to conduct
the pilot study and seeking permission to do so. A letter of agreement from the pilot
school was provided before conducting the pilot study. Subsequent to ethical
approval from Queensland University of Technology (QUT) and from the Regional
Body Research and Development Office (Balitbangda), all eligible students were
identified from the pilot school administration records. The students were invited to
participate in the pilot study through an invitation on notice boards and through
teaching staff who informed students about the study during scheduled classes. Prior
to commencement of the pilot study, an information meeting was held with second
year students. An information sheet was given to those who attended the meeting to
explain the purpose and procedure of the study. Students were told their participation
was voluntary and that they could withdraw at any time, and that non-participation
would not affect their academic results or future study. They were told that all
information would be treated confidentially.
Students who agreed to participate in the pilot study were asked to sign a consent
form (Appendix 7). Fifty-four second year students from a total of 300 second-year
81
students in the pilot school agreed to participate in the pilot study for Time 1 and
Time 2, and they also signed the consent form. The questionnaires were then
distributed to participants after the meeting and they were asked to complete the
questionnaires at the same time in one room.
The length of time it took to administer the SDLRS for students in the pilot study
was noted. It took approximately twenty-five minutes for the students to complete
the SDLRS at Time 1 (range between 24 and 32 minutes) compared to thirty minutes
as noted in the literature (Guglielmino & Guglielmino, 1991). To identify issues such
as ambiguity and misinterpretation of the question, students were asked to comment
on the SDLRS.
After two weeks, participants were asked to come back together to complete the
SDLRS again and to give their comments. The time to administer the SDLRS for
Time 2 was also noted. The range of time to complete the SDLRS for Time 2 was
between 20 and 35 minutes.
4.5 Data analysis
Quantitative analysis was undertaken using the Statistical Package for the Social
Sciences version 12 (SPSS version 12). The main purpose of data analysis in the
pilot study was to assess the reliability of the instrument for the Indonesian nursing
students and to trial data analysis techniques.
The data analysis included univariate analysis of key variables using frequency
distribution, measures of central tendencies and normality, and bivariate analysis
using χ². Independent sample t-tests were used to evaluate the difference in mean
scores between groups based on the demographic data—including gender, age, birth
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order, father’s educational background, and mother’s educational background.
Internal consistency and temporal stability of the SDLRS were examined with inter-
item correlation (Cronbach’s alpha), Pearson’s correlation, and Bland Altman scatter
plot (1986). Statistical significance was set at alpha .05.
4.6 Results
This section describes the demographic characteristics of the pilot sample,
descriptive statistics for SDLRS and analysis of internal consistency and temporal
stability of SDLRS. It concludes with some general comment about SDLRS.
4.6.1 Demographic characteristics of the pilot sample
Demographic data relating to the pilot sample are presented in Table 4.1.
Table 4.1: Demographic data of pilot sample
Chi-square test
Variables Total (n=54) n (%)
χ² P value
3.630
0.06 Gender Male Female
20 (37) 34 (63)
0.296 0.59
Age ≤ 20 years ≥ 21 years
29 (54) 25 (46)
0.296 0.59
Birth order: First born Yes No
25 (46) 29 (54)
8.96
0.003
Father’s educational background ≤ JHS1
≥ SHS2
16 (30) 38 (70)
1.185
0.276
Mother’s educational background ≤ JHS1
≥ SHS2
23 (43) 31 (57)
1JHS = Junior High School 2 SHS = Senior High School
83
Overall, the sample consisted mainly of females (63%) with 37% of males.
Participants’ ages ranged from 18 to 24 years (M = 20.48 and SD = 1.15). More
participants were within the age group ≤ 20 years (54%) compared to the age group ≥
21 years (46%). Similarly, just over half of the participants were not first-born
children (54%). There were more participants whose fathers (70%) and mothers
(57%) had completed at least senior high school, compared to parents who had just
completed junior high school.
A one-sample chi-square test was conducted to assess whether the proportions of
participants were equal for the selected demographic variables. The result indicated
that there were no significant differences between demographic variables, except for
father’s educational background. There was a significant difference in father’s
educational background. Significantly, more students in the pilot study had fathers
who had completed at least senior high school χ² (1, N= 54) = 8.96, p= .003.
The sample characteristics indicated that the pilot sample demographics were
consistent with those of nursing students in Central Kalimantan or in Indonesia.
4.6.2 Readiness for self-directed learning
The mean and standard deviation of Time 1 and Time 2 SDLRS scores were
calculated. The overall mean and standard deviation for the sample at Time 1 was
188.59 and 17.33, respectively. The mean and standard deviation for the sample at
Time 2 was 189.30 (SD = 16.88). Table 4.2 presents the mean and standard deviation
for the SDLRS scores at Time 1 for each of the demographic variables. Those data
indicate that the pilot sample had mean SDLRS scores lower than those reported in
the literature.
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Table 4.2: Means and standard deviations of SDLRS scores at Time 1
Demographic variables Mean (SD) t p
Gender Male Female
185.45 190.44
(16.62) (17.72)
- 1.02
.31
Age ≤ 20 year ≥ 21 year
187.34 190.04
(15.82) (19.17)
-.56
.57
Birth order: First born Yes No
188.44 188.72
(20.47) (14.47)
-.06
.95
Father’s educational background ≤JHS1 ≥ SHS2
188.75 188.53
(17.89) (17.34)
.043
.97
Mother’s educational background ≤JHS1 ≥SHS2
185.91 190.58
(17.09) (17.52)
-.98
.33
1JHS = Junior High School
2SHS = Senior High School
The data suggest that female nursing students, older nursing students and nursing
students whose mother had completed at least senior high school had higher SDLRS
scores than male nursing students, young nursing students, and nursing students
whose mother had completed junior high school education. However, an independent
sample t-test was used to examine the mean differences between the two groups for
each variable. The results showed that there were no significant differences for any
of the demographic variables (see Table 4. 2). The distribution of the sample within
the five levels of readiness as suggested by Guglielmino and Guglielmino (1991)
were examined. The distribution of the sample is shown in Table 4.3.
85
Table 4.3: Level of readiness for self-directed learning at Time 1
Level of readiness
Score Time 1 n (%)
Low 50–176 16 (30)
Below average 177–201 26 (48)
Average 202–226 11 (20)
Above average 227–251 1 (2)
High 252–290 0 0
Of the total number of 54 participants at Time 1, 30% had a low level of readiness,
48% were below average, 20% were average, and only 2% were above average. Not
one participant had a high level of readiness. This result clearly showed that the
majority of participants (78%) had below average and low levels of readiness for
SDL.
4.6.3 Internal consistency
Cronbach’s alpha was used to assess internal consistency for the SDLRS in the
current pilot study. Based on sample data of 54 students, the Cronbach’s alpha was
0.85 (Time 1) and 0.84 (Time 2). These data indicate that for the current sample of
nursing students in Central Kalimantan, the internal consistency was good. These
data are consistent with other reported studies. The SDLRS has good internal
consistency with a Cronbach’s alpha coefficient reported of 0.87 in the initial study
(Guglielmino & Guglielmino, 1991). As described by McCune, Guglielmino, and
Garcia (1990), the latest reliability estimate, based on a varied sample of 3,151
adults, was 0.94. The SDLRS has been used to assess readiness for self-directed
learning in Indonesian Open University students. In a pilot study (Darmayanti,
1994), a Cronbach’s alpha was reported for Indonesian Open University students
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(n=37) of 0.87, and in a main study (N= 391), the Cronbach’s alpha was reported as
0.91.
4.6.4 Temporal stability
A Pearson’s correlation coefficient was calculated to determine the strength of
relationship between responses (n=54) to the SDLRS over time, with two weeks
between Time 1 and Time 2. The result was r = 0.985 (p<0.001). Figure 4.1 shows
the agreement of the measurement at Time 1 and Time 2.
140 160 180 200 220 240
Average of two measurements
-6
-4
-2
0
2
4
6
Diffe
renc
e in
test
scor
es (t
ime2
- tim
e1)
Comparing test two weeks apart
of test
Bland-Altman plot for reproducibility
Figure 4.1: Bland-Altman plot for reproducibility of SDLRS Scores
The level of agreement between responses at both administrations was plotted using
a method described by Bland and Altman (1986). The level of agreement for each
participant was within 95% confidence estimates (- 5.22 and 6.62), indicating that the
SDLRS was stable over time. The mean difference was 0.70 and standard deviation
was 3.02.
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4.6.5 General comment on the SDLRS
Following completion of the SDLRS, students were asked for their comments, if they
were able to understand the entire questions and if the questions were clear and easy
to understand. All responded that it was clear and easy to follow the meaning of the
questions. Their comments were supported by the time taken to complete the
SDLRS. The shortest time was 24 minutes at Time 1 and 20 minutes at Time 2. The
longest time to complete the SDLRS at Time 1 was 32 minutes and at Time 2 was 35
minutes. The times are very similar to the times reported in the literature
(Guglielmino & Guglielmino, 1991), and indicated that the students did not find the
questions difficult or time consuming. Other supporting evidence came from the
questionnaires, as all the questions were answered and there were no missing data
from the questionnaires.
4.7 Discussion
The findings of the pilot study show that the age and demographics are consistent
with second year nursing students in Central Kalimantan and in Indonesia. The pilot
study showed that the instrument for the study—the Indonesian version of the
SDLRS—could be used effectively in the Indonesian setting. It is effectiveness was
shown by:
• the internal consistency estimated by Cronbach’s alpha coefficients of 0.84
(Time 1) and 0.85 (Time 2)
• the reproducibility shown by the Bland and Altman plot
• the temporal stability estimated by the Pearson’s coefficient (.98)
• the lack of difficulty the students reported understanding and responding to
the questions
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• the relatively short time to complete the SDLRS.
The descriptive results of the pilot study showed that the mean SDLRS score of Time
1 was 188.59 (SD= 17.33). The Time 2 mean was 189.30 (SD = 16.88). Compared to
the data from the Guglielmino study (1978) where the mean of SDLRS was 214
(SD= 25.6), the pilot study scores are lower. Darmayanti’s study (1994) of
Indonesian students reported a mean SDLRS of 215.5 (SD= 21.9). Both of these
studies reported higher SDLRS means compared to the current pilot study.
Seventy-eight per cent of students in the pilot study had SDLRS scores that placed
them in the “below average” and “low” level of readiness for SDL group. Compared
to the finding of Darmayanti’s study (1994), which found that approximately 25.5%
of the sample had above average level of readiness for self-directed learning, the
finding of the pilot study showed a lower percentage of students (2%) with above
average levels. One fifth of the overall percentage of students (20%) in the pilot
study had average scores.
The different results of the pilot study from Darmayanti’s study (1994) might be
explained by the characteristics of students involved in Darmayanti’s study. The
students were likely to have had a high self-directed learning readiness before they
enrolled in the university program. Their motivation to enrol in distance learning at
the Indonesian Open University suggests that they may have had high levels of SDL
before commencing their university studies. A second explanation could be that the
Indonesian Open University already uses SDL concepts in their educational system.
As a distance learning institution, Indonesian Open University students require a
different approach from the passive engagement approach mainly used by
conventional education institutions such as the pilot school. A third explanation
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could relate to the differences between cohorts. Approximately 70% of Darmayanti’s
(1994) samples were mature students (working students) compared to the pilot
sample of high school graduate students. Furthermore, 79% of Darmayanti’s samples
came from big cities in Indonesia (Java), whereas the pilot sample came from a
relatively remote area, in Central Kalimantan.
The pilot data confirm that the nursing students in Central Kalimantan were likely to
have low levels of SDL readiness. Confessore (1991) says that some people have a
low level of readiness because they have consistently been exposed to “other-
directed” instruction (teacher-centred approaches). The pilot study finding seems to
support Confessore’s views, as the educational system that is used in all nursing
schools in Indonesia involves “other-directed” instruction. Furthermore, the nursing
students had graduated from high school within two years and high schools in
Indonesia also use teacher-centred approaches.
Given the level of SDLRS scores reported in the pilot study, nursing students in
Central Kalimantan are likely to experience difficulties as the education system
moves away from teacher-centred approaches and introduces a student focus. The
data from the pilot study clearly demonstrates the need to assist students to develop
knowledge and skills in SDL.
No significant differences of readiness for SDL were found for gender, age, birth
order, father’s educational background and mother’s educational background.
Therefore, in the pilot study the difference between these variables did not affect the
students’ readiness for SDL.
A total of 54 participants from a total of 520 students in the pilot school volunteered
to participate in the pilot study. The desired sample size for the pilot study was at
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least 10 participants. The invitation on notice boards and through teaching staff, and
the information meeting prior to the study successfully attracted students to
participate in the pilot study. Thus, the recruitment method was appropriate to
achieve the required sample in the pilot study and there were no difficulties with the
recruitment process.
4.8 Summary
The pilot study used the SDLRS to collect data on students’ readiness for SDL and,
based on the data obtained for this pilot study and the results of the statistical
analysis, the following conclusions were drawn:
• The SDLRS could be used effectively in Indonesia in a culture which is
different from the original culture in which the instrument was developed;
• The majority of students in the pilot school had below average and low levels
of readiness for SDL;
• There were no significant differences in students’ readiness for SDL for the
selected demographic variables;
• The recruitment method was appropriate to achieve the required sample.
The following chapter outlines the educational intervention program that was
developed to assist the students to improve their knowledge and skills related to
SDL.
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CHAPTER FIVE
EDUCATIONAL INTERVENTION PROGRAM
5.0 Introduction
In Central Kalimantan, the majority of nursing education is conducted through a
traditional lecturing approach that focuses on the transfer of knowledge from teacher
to students. It places a greater value on didactic and non-student-centred methods,
with students seen as the receivers and teachers the transmitters of knowledge.
Central Kalimantan nursing students desire to be as successful as nurses educated in
western systems. However, significant improvements are needed in teaching and
learning approaches to better prepare students to be professional nurses. Nursing
education in Central Kalimantan needs to prepare students as lifelong learners, and
the students need to develop self-directed learning skills so they can continue to
provide effective nursing care throughout their nursing careers in a rapidly changing
healthcare environment (Health Professional Project V, 1998).
Successful implementation of self-directed learning (SDL) concepts is dependent not
only upon the students’ readiness to participate in SDL but also upon the nursing
education institution’s ability to facilitate SDL. Becoming self-directed learners is
not an easy process for either students or teachers. According to D’A Slevin and
Lavery, (1991) teachers who have operated in a traditional mode within curriculum
constraints of the past may find it difficult to adjust to a more student-centred
curriculum. Similarly, students in all types of curricula require some degree of
ongoing support from their teachers, especially students who have experienced
traditional modes of learning in their previous study and have never been faced with
self-directed learning. Therefore, students need to be introduced to SDL concepts,
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experience the SDL process, and be supported in their efforts to improve their self-
directed learning abilities. Thus, nursing education should provide support for
students to become self-directed learners. The Educational Intervention Program
(EIP) outlined in the following section was developed in response to this need in
Central Kalimantan.
Results from the pilot study indicated that 78% of diploma nursing students had a
low or below average ability to self-direct their learning, encompassing quite a
dominant percentage of the pilot sample. It was assumed that the level of readiness
for SDL for the majority of nursing students in Central Kalimantan was similar to
that of the pilot sample, as they came from the same population. Time constraints of
the project and many limitations in nursing education in Central Kalimantan—for
instance human resources, teaching/learning materials (e.g. library, laboratory
equipment) as well as funding—had to be considered in developing the intervention.
The educational intervention program was developed as a planned classroom
approach to prepare students for SDL. It was designed to enhance the students’ self-
direction by creating planned experiences of SDL in the classroom setting.
This chapter presents the educational intervention program (EIP) that was used in
this study. The chapter begins by presenting the conceptual framework for the EIP.
This is followed by an overview of traditional diploma nursing curriculum structure
in Indonesia, specifically in Central Kalimantan; and activities of teaching and
learning in nursing education in Central Kalimantan. Control group learning
activities and intervention group activities are provided in the next section. The final
sections present the organisation of the EIP and evaluation of the EIP. The chapter
concludes with a summary.
93
5.1 Conceptual framework of the Educational Intervention
Program
Self-directed learning (SDL) is an important component in lifelong learning skills,
but to date there has been little emphasis on SDL in Indonesian nursing curricula
(Sister School Project, 2002). It would seem that there is a need to address this issue
and to investigate how best to facilitate SDL in the Indonesian nursing curriculum.
Introducing and providing students with the opportunities to experience SDL has
been suggested as one strategy for improving quality of teaching and learning in
nursing education in Central Kalimantan (Sister School Project, 2002). It has also
been assumed that introducing SDL approaches and improving students’ self-
learning abilities will assist students to become more “active” in, and to take more
responsibility for, their own learning.
A conceptual framework was constructed to guide teaching and learning of SDL in
this research study. The conceptual framework for the study is adapted from the
work of Grow’s (1991) staged self-directed learning (SSDL) model and the teacher-
student control continuum (TSCC) model developed by D’A Slevin and Lavery
(1991). This conceptual framework formed the basis for the educational intervention
program.
The conceptual framework comprises the stages of SDL, teacher and student roles in
every stage as proposed by Grow (1991), and the role relationship between teacher
and student as proposed by D’A Slevin and Lavery (1991). This conceptual
framework facilitated and guided the development of SDL knowledge and skills in
nursing students in Central Kalimantan, and appears as Figure 5. 1.
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Stage SDL Stage 1# Stage 2# Stage 3 Stage 4
Teacher role
(SSDL) Authority/expert content Motivator/guide Facilitator Consultant
Student role
(SSDL) Dependent learner Interested learner Involved learner Self-directed
Teacher-student
Interaction (TSCC)
Teacher direction Partnership Facilitation Students direction
#Shaded area denotes stages being addressed in the current study
Source: Adapted from Grow, 1991, and D’A Slevin and Lavery, 1991
Figure 5.1: Conceptual framework integrating Staged Self-Directed Learning (SSDL) and Teacher-Student Control Continuum (TSCC)
According to Cresswell (1994, p.97) “[a] conceptual framework explains either
graphically or in narrative form, the main dimensions to be studied–the key factors or
variables—and the presumed relationship among them”. Sarantakos (1993, p.93)
explains “[i]n this sense frameworks guide research and coordinate researchers’
activities”. Similarly, Burns and Grove (2005, p.131) state: “[a] framework is the
abstract, logical structure of meaning that guides the development of the study and
enables the researcher to link the finding to body of knowledge”. The conceptual
framework for the educational intervention program was developed from its relevant
literature and was intended to guide the teaching and learning of SDL knowledge and
skills in order to enhance this ability in Central Kalimantan nurses. The educational
intervention used in this study focused on two stages of self-directed learning (SDL).
The SSDL model was developed by Grow (1991) and proposes that students advance
through stages of increasing self-direction in classroom settings. The model is
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grounded in the situational leadership model of Hersey and Blanchard (1988), and
describes four distinct stages of learners. The SSDL model outlines how teachers can
assist students to become more self-directed in their learning. Within each of these
stages, Grow (1991) outlines a possible role for the teacher and students and how
they are related.
The SSDL model comprises four stages, with students as dependent learners who
need an authority figure (teacher) to tell them what to do in Stage 1; while in Stage 2,
students are interested learners who are motivated and confident but largely need
teacher-direction of the subject matter to be learned. Within Stage 3, students are
involved learners who have intermediate self-direction with both basic skills and
knowledge and view themselves as being ready and able to explore a specific subject
with a good guide. The final stage, Stage 4, sees students as learners of high self-
direction who are willing and able to plan, execute, and evaluate their own learning
with or without the help of others.
Results from the pilot study indicated that 78% of diploma nursing students were low
and below average in their ability to self-direct their learning. Based on this
assumption, this study was designed to focus only on two stages of SDL: Stage 1 and
Stage 2. The reason not to include Stage 3 and Stage 4 of Grow’s SSDL model was
because in Stage 3 students are involved learners (learners of intermediate self-
direction), and in Stage 4 they are learners of high self-direction with the capability
to plan, to complete and evaluate their own learning with or without the help of an
expert/teacher. Because of time constraints and cost for this study as well as many
constraints in nursing education, such as limited teaching and learning materials and
limited books in the library, it was reasonable to aim for Stage 2 as an optimal goal
96
for students in the study. Stage 2 of the SSDL model is the stage in which students
have moderate self-direction.
However, as the pilot study result has shown, the students in their second year of
study at nursing schools in Central Kalimantan contained a mixture of different
abilities and stages of readiness for SDL (low and below average levels), it would be
difficult to match teaching styles to student stages, as suggested by the SSDL model.
Therefore it was decided to begin the intervention by teaching towards dependent
learners (Stage 1), as the majority of the students’ SDL readiness was below average.
It was planned to gradually change the teacher’s role to “guide” and “motivator” to
introduce a mismatch between teaching style and students’ stage as the SSDL
suggests, so that students can move to becoming “interested” learners (Stage 2).
The model presented by Grow (1991) is worthy of note, particularly with regard to
teacher accountability in terms of introducing SDL However, in the context of
supervision of students throughout the course, in regard to individualised learning in
the classroom setting, the model is rather limited. There is a particular issue in
diploma nursing education in Central Kalimantan, where the class size comprises 50
to 60 students, and there are time restrictions and a statutory curriculum. It is
therefore unrealistic to match teaching style to address individual students’ stages as
suggested by SSDL (Grow, 1991). Students are treated as if they have similar
abilities and levels of readiness for SDL, when in fact students have a mixture of
different abilities and stages of readiness for SDL.
In the time constraints dictated by the curriculum, specific learning outcomes are
being met and there are statutory responsibilities to confirm the achievement of
learning outcomes. The SSDL model does not give sufficient emphasis to the need to
97
build the students’ responsibility for their own learning. Nor does it put enough stress
on assisting teachers to facilitate learning. Meeting students’ needs is important in
developing skills for SDL. The Teacher-Student Control Continuum (TSCC) model
offers a partnership model that can be applied in this situation, so the TSCC model
was integrated into the design to fill the gap in conducting the Educational
Intervention Program (EIP).
The Teacher Student Control Continuum (TSCC) model was developed by D’A
Slevin and Lavery (1991). It identifies and focuses upon various levels of control
over the learning process. The TSCC model proposes to maximise SDL through a
sharing of control in learning between students and teacher. In the role relationships
there is an implied shift away from the traditional role in which the teacher is
superordinate and students subordinate, toward a more equal partnership. The TSCC
model comprises four levels of interaction: the first involves total teacher direction at
this level and the teacher makes all program decisions, and controls both planning
and evaluating. In the second level, partnership control is shared by the teacher and
students. The third level is when students have a high control of learning, and the
teacher enables but does not lead; and, the last level is student self-direction. There is
no teacher influence at all, students plan and control the program.
According to D’A Slevin and Lavery the TSCC model requires students to be
proactive in organising and undertaking the required study. The teacher has an
important role in terms of providing direction, support and advice, as required, and
monitoring their progress. The importance of promoting students’ responsibility for
their own learning should be balanced with the teacher’s responsibility for ensuring
that specified outcomes have been achieved.
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The TSCC model was incorporated into the intervention by using this technique of
teacher-direction on the learning process, then gradually moving to partnership and
shared control for learning by students and teachers. The teacher direction and the
partnership stages were applied to sessions in the workshop and skill practice in the
nursing laboratory. The partnership teaching approach was applied gradually in
tutorial sessions.
The focus of the study was to move students from Stage 1 to Stage 2 as proposed by
Grow (1991). Teachers and students are connected at each stage by different
processes of interaction as proposed by D’A Slevin and Lavery (1991). More details
for Stage 1 and Stage 2 are discussed in the following section.
Within Stage 1, students are seen as dependent learners (learners of low self-
direction), and teachers as experts or authorities. The interaction between teacher and
students is hierarchical, with expert content transmitted to the dependent learner. The
nursing students in Central Kalimantan are at this stage and teaching and learning
takes place using a teacher-centred approach. Students in Stage 1 are dependent
learners or low in self-direction. They respond to directional techniques and they
expect direction or demonstration from their teachers, especially when learners are
new to a subject or unfamiliar with the content of the learning. Furthermore, when
students have not had any experience in taking responsibility for their own learning,
they need explicit direction (Cranton, 1992).
At Stage 2, students are interested learners who have moderate self-direction and
teachers act as motivators or guides. The interaction is still hierarchical in nature,
however, the role of the teacher changes from content expert to motivator of
learning, as students move to a moderate level of self-direction. This stage was used
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to guide teaching and learning approaches in the educational intervention program.
Teachers wish to move their students from Stage 1 to Stage 2 by changing their
approach from expert content provider to motivator. To achieve this, different modes
of teaching will be used, such as, discussion, and demonstration followed by guided
practice. Students should be trained in basic skills, such as developing goal setting so
they will later be able to use them without high levels of supervision.
The expected outcomes are that students will advance to Stage 2 with increased
abilities for self-directed learning, and increased scores of readiness for self-directed
learning. Another expected outcome is positive perceptions toward self-directed
learning.
5.2 Overview of traditional curriculum structure
The Indonesian diploma nursing curriculum is used for all nursing education in
Indonesia, including Central Kalimantan. This curriculum is six semesters in length
and consists of 40 subjects. Every semester has a different number of subjects. The
subjects in the nursing curriculum can be divided into three major areas: supporting
theoretical science, professional nursing subjects, and clinical nursing subjects. Each
nursing subject is divided into a number of topics and skills to learn (See Chapter
One). According to the Sister School Project (2002), the Indonesian diploma nursing
curriculum provides more emphasis on teacher-centred approaches.
5.3 Traditional teaching and learning activities
In diploma nursing education in Central Kalimantan the semester length is 20 weeks,
including the examination period; this is divided into 16 weeks of teaching and
learning activities, and four weeks for the mid test and final tests. According to the
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Indonesian nursing curriculum for second-year students, throughout each of the 16
weeks, the students have three days of classroom teaching and three days of clinical
practice. The classroom teaching includes lectures and practical sessions in the
nursing laboratory.
The subjects in the third semester (year 2), when the intervention was introduced,
are: Medical Surgical Nursing 1 (MSN1), Medical Surgical Nursing 2 (MSN2),
Health Education, Nursing Documentation, and Nursing Profession. Traditionally,
each subject is managed in a team (three to five lecturers), with one lecturer being
the subject coordinator to ensure that all topics are implemented, with a lesser
emphasis on “how” topics are implemented. The majority of information is provided
via lectures. Students memorise and reproduce only the information provided to them
by teachers. Seminars and group discussions are also used, however, the way the
seminar and group discussions are organised primarily facilitates only the transfer of
information. In essence, students provide a mini lecture to other students.
Practical sessions involve the transfer of specific skills. Students are perceived to
have learnt the skill when they can copy or reproduce it. In the nursing laboratory,
students follow sets of rules or procedures by imitating or copying examples. In the
practical sessions, one lecturer demonstrates a nursing skill to the class followed by
one group of 10 to 12 students re-demonstrating the nursing skill to the rest of the
class. Two or three students from this group role model the skill and one student
verbally describes what is happening. The rest of the presenting group is involved in
answering audience questions. After the question and answer session, the lecturer
gives feedback both to the presenters and audience.
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For the clinical placement component, students are divided into groups and the
number of groups depends on how many clinical placements are available.
Traditionally, second-year students are divided into five groups (with 10–12 students
per group) for their hospital clinical placement, including the emergency unit, two
general wards, the paediatric ward, and the maternity ward. During their clinical
placement, students are supervised by clinical instructors, and sometimes by clinical
teachers. The clinical instructor is a ward nurse who is expected to teach students in
the clinical setting, and the clinical teacher is the coordinator of the nursing subject.
However, effective monitoring is intermittent because only one clinical instructor per
ward is appointed to supervise students in the clinical practice. Moreover, the clinical
instructors are committed to their primary tasks of caring for patients. Patients-per-
nurse ratios in the hospital are typically in the range of six to eight patients per nurse.
However, most of the patients who come to the hospitals are acutely ill and they have
high dependent care needs. The nurses are very busy looking after very sick and
acutely ill patients. When clinical instructors are absent from duty the students rely
on their own efforts to practice the skills.
The clinical teachers’ contact has traditionally been at two points, the beginning and
the end of the clinical placement. Between these times the students usually work
alone without direction, and the development of clinical skills is dependent on what a
particular placement has to offer.
5.4 Control group activities
To evaluate the educational intervention program (EIP), the program was
implemented with an intervention group and results were compared to those of a
control group. This section outlines the activities of the control group as they
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continued to use traditional teaching and learning activities. This is followed by the
description of intervention group activities in the next section.
The students in the assigned control group (N=54) undertook the traditional
curriculum as described previously. There was no change to the teaching team or the
usual lecture format for the control school. The majority of teaching was provided
via lectures, and the skill practice involved teachers demonstrating a skill followed
by one group re-demonstrating the skill to the rest of the class. Therefore, only the
presenting group experienced “hands-on” practice.
The students in the control group completed the same questionnaires, pre- and post-
test, as the intervention group. These were the demographic questionnaire, and
SDLRS. The activities of the control group for the third semester are displayed in
Table 5.1.
Table 5.1: Control group activities
Week Activities 0 Pre-test and Focus group discussion (FGD) 1–10 Regular activities 3 days class & 3 days clinical practice 11–12 Mid test 13–17 Regular activities 3 days class & 3 days clinical practice 18 Post test and FGD 19–20 Final test The week before classes began, 54 students completed the pre-test questionnaire and
focus group discussions (FGD) were held with 16 students. In Weeks 1 to 10,
students’ regular activities comprised three days in the classroom to learn five
subjects and three days of clinical practice in a hospital setting as a component of
Medical Surgical Nursing 1 (MSN1) and Medical Surgical Nursing 2 (MSN2). At
weeks 11 to 12 students undertook mid tests. In weeks 13 to 17 they continued the
regular activities of three days in the classroom and three days of clinical practice. At
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week 18 students completed the post- test questionnaire and focus group discussion
(FGD). In weeks 19 and 20 they undertook final tests for all the subjects in the third
semester.
5.5 Overview of intervention group activities
The students assigned to the intervention group (N = 47) undertook the educational
intervention program (EIP) designed to introduce and implement SDL concepts in
their learning. Given the low level of SDL readiness in the pilot study, it was
assumed that not all students would be ready for SDL approaches and that there may
be difficulties in adapting to SDL. The students had never been faced with SDL in
their previous study and the SDL concept was new to them. Therefore, the
introduction of SDL concepts and skills using a familiar teaching approach was
considered to be one way to reduce this concern.
The introduction of the SDL concepts was given in workshops across four days. The
workshops included lectures, and practice in small groups. The aim was to use a
teaching strategy that was familiar to students and then move them gradually towards
the desired teaching and learning strategy. Learning plans and a self-directed module
were used to operationalise SDL concepts and they were introduced in the
workshops. As the workshops were conducted over four consecutive days, and the
skill practice (also over four consecutive days), the other four subjects for the third
semester were reorganised by changing their order of presentation. Teaching the
other four subjects commenced in week three, after the eight days of workshops and
skill practice.
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In Week 1, the students participated in the four days of workshops to introduce the
SDL concepts and skills related to SDL. A two-day clinical practice in a hospital
setting was also scheduled for the first week. In Week 2, students participated in four
days of skill practice in a nursing laboratory for body fluid skills and two days
clinical practice in a hospital. For Weeks 3 to 10 students did the regular activities of
three days of classes doing other MSN1 topics and the other four subjects, and three
days of clinical practice. During these eight weeks the students worked through the
SDL module and did their learning plans. The first tutorial was held in Week 5,
followed by the second tutorial in Week 8. In Weeks 9 and 10 students undertook
their mid test. For Weeks 13 to 16 students went back to their regular activities of
three days of classes and three days of clinical practice as suggested by the
Indonesian nursing curriculum for second-year students. They continued to work
through their SDL module and did their learning plans, as well as the other MSN1
topics and the four subjects for the third semester. The third tutorial was held in
Week 13. At Week 16 the implementation of SDL finished. The students completed
the post- test for SDLRS and FGD in Week 17. For Weeks 17 and 18 students went
back to three days in the classroom and three days on clinical practice. In Weeks 19
and 20 students completed their final tests that marked the end of the semester. The
intervention group activity is shown in Table 5.2.
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Table 5.2: Intervention group activities
Week Regular activities Intervention activities 0 Pre-test and Focus group discussion (FGD) 1 Clinical practice 4 day SDL workshops 2 Clinical practice 4 days skill practice at nursing laboratory 3–4 Class & clinical practice Commenced SDL module & learning plans 5 Class & clinical practice 1st SDL tutorial 6–7 Class & clinical practice SDL module & learning plans 8 Class & clinical practice 2nd SDL tutorial 9–10 Class & clinical practice SDL module & learning plans 11–12 Mid test - 13 Class & clinical practice 3rd SDL tutorial 14–16 Class & clinical practice SDL module & learning plans 17 Class & clinical practice Post test and FGD 18 Class & clinical practice 19–20 Final test
5.6 Organisation of Educational Intervention Program
The aim of the Educational Intervention Program (EIP) for the intervention group
was to increase students’ knowledge of, basic skills in, and attitudes towards, self-
directed learning (SDL) and to motivate students to become less passive and more
active in their learning. At the end of the EIP, it was expected that students would
have developed:
• capabilities to demonstrate an understanding of the key concepts and
principles of self-directed learning;
• competence in applying the basic skills of self-directed learning.
As the diploma nursing curriculum is produced at a national level, self-directed
learning (SDL) could not be fully implemented for all topics in a nursing subject.
Therefore SDL was introduced in one topic—in the subject Medical Surgical
Nursing 1 (MSN1). MSN1 is the first in a series of five medical surgical nursing
subjects focusing on medical and surgical health issues that impact on children,
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adults and older people. There are four topics in MSN1: immune disorders, body
fluid disorders, neurological disorders, and endocrine disorders. Traditionally, the
immune disorders topic is covered in three weeks, and followed by the body fluid
disorders topic (also three weeks). The neurological disorders topic is covered in five
weeks, and the endocrine disorders topic is covered in the last five weeks.
MSN1 focuses on the issues of acute and/or chronic illness in the context of immune
disorders, body fluid disorders, neurological disorders, and endocrine disorders. The
content of this subject covers nursing assessment, care planning and care evaluation
for people in hospital settings with health problems related to immune disorders,
body fluid disorders, neurological disorders, and endocrine disorders. The skills
introduced in Medical Surgical Nursing 1 (MSN1) include physical assessment,
administration of insulin, wound care, parenteral therapy, insertion of urinary
catheters, and insertion of nasogastric tubes.
To facilitate the introduction of self-directed learning for the intervention group the
MSN1 subject was reorganised by changing the topic order, and replacing face-to-
face teaching hours with preparatory SDL activities in one topic. The educational
intervention (EIP) was introduced and applied to the body fluid topic. The body fluid
topic was chosen as the topic for the self-directed learning educational intervention
because cases of body fluid disorders are very common in Indonesia and Central
Kalimantan. Infectious diseases such as malaria, typhoid, and haemorrhagic fever are
major causes of body fluid disorders, so it is beneficial for students to prepare well
for such cases. The other three topics, immune disorders, neurological disorders, and
endocrine disorders, were taught in traditional lecture format.
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The original place in the content sequence for the body fluid topic was second, and
the session format for the body fluid topic included 12 hours of lectures, and 10
hours of skill practice in the nursing laboratory. The body fluid topic order was
changed to the beginning of the semester and the 12 hours of lectures were changed
to a self-directed format with ongoing tutorials. The 10 hours of skills practice at the
nursing laboratory remained. This topic was therefore not completed in three weeks
but carried out over 14 weeks. The time that would have been used for body fluid
topic lectures was used as workshops to introduce SDL concept and skills.
The EIP was carried out by the researcher and three faculty staff who usually taught
MSN1 from the nursing school, these included the subject coordinator, nursing
laboratory coordinator, and a lecturer responsible for the body fluid topic. During the
EIP, the researcher’s role was to run the workshops and teach and guide students in
the tutorials, and the three staff assisted in the skill development in the laboratory and
supervised clinical practice.
To enhance self-direction for the students in the intervention group there were two
steps—preparation and implementation. The organisation of the EIP can be seen in
Figure 5.2.
Step 1: Preparation Step 2: Implementation
4 days workshops 4 days skills practice in nursing laboratory Self-directed learning module (SDL module)
12 week implementation: SDL module Learning plans 3 tutorial meetings
Figure 5.2: The activities of the educational intervention program
Step 1, preparation, included four days of workshops and four days of skills practice
in the nursing laboratory and introduction of the SDL module. Step 2,
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implementation, included 12 weeks implementation of the SDL module and learning
plans, and three tutorial support meetings. Details of the workshops, modules and
skill practice are presented in the next section.
5.6.1 Step 1: Preparation
Three sessions comprised the preparation step. These includied four days of
workshops, four days of skills practice in the nursing laboratory, and the introduction
to the SDL module. The workshops, skills practice and SDL module are discussed in
more detail in the following section.
5.6.1.1 Workshops
The purpose of the workshops was to introduce the concepts and skills related to
SDL and to make sure that every student received the same concepts. The workshops
introduced and explored the following topics: self-directed learning, time
management, generating questions and learning plans. The workshops were
conducted in a classroom using a lecture format followed by practice in small
groups. The formal objectives of the workshops were that, at the end of the workshop
sessions, students will have developed:
• an understanding of key concepts/principles of SDL;
• an understanding of how to manage time related to learning activities;
• an understanding of how to generate different types of questions;
• skills to carry out a learning plan.
The workshop was opened by the head of the nursing school and was attended by
faculty staff and students. The head of the nursing school highlighted the importance
of the EIP for the students. He also motivated the students to participate actively in
all EIP activities, and asked students to raise questions with the researcher. The four
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days of workshop were conducted from 8 am to 3 pm except on Friday, where 11 am
to 1 pm was granted as prayer time for Muslim students. The time included five
hours for interactive learning, and two hours for lunch, two breaks and prayer time.
Students needed to complete an attendance record to check their attendance for the
day sessions. All students’ attendance was 100%. The researcher acted as a teacher
and a tutor in the workshop. All topics were presented by the researcher. Each of the
content areas was dealt with in a similar fashion. This involved a didactic overview
providing essential information. Details about the workshop activities can be seen in
Table 5.3.
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Table 5.3: The workshop activities No Activities Content Method Time SDL
stage Day 1
Opening workshop Interactive Lecture
SDL topics: Introduction of SDL: Definition of SDL Benefits of SDL Competencies for SDL Tools for SDL
Didactic Lecture format
30 mins 120 mins
Stage 1
Distribute SDL module
Body fluid module Explanation of task
60 mins
Interactive Lecture
Time management Didactic Lecture format
60 mins
Practice time management in small group (3 students)
Working group 60 mins Stage 2
Interactive Lecture
Generating questions Lecture format 60 mins Stage 1
Practice asking questions in group (3 students)
Working group
60 mins Stage 2
Library tour 60 mins
Day 2
Interactive Lecture
Introduction Learning plans: Definition of Learning plans Benefit of learning plans Component of learning plans Format of learning plans
Lecture format Give example of learning plans
120 mins Stage 1
Coaching with immediate feedback
180 mins Stage 1
Day 3
Practice learning plans: Develop group learning plans
Assessing learning need Formulate learning goals Identifying learning resources Evaluating learning outcomes
Guided practice Working in small group
Stage 2
Coaching with immediate feedback
240 mins Stage 1
Practice learning plans: Develop individual learning plans
Assessing learning need Formulate learning goals Identifying learning resources Evaluating learning outcomes
Guided practice Working in small group
Stage2
Day 4
Closing workshops
30 mins
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Two models guided the changes to the teacher-directed design: the Staged Self-
Directed Learning (SSDL) model (Grow, 1991), and the Teacher Student Control
Continuum (TSCC) model (D’A Slevin & Lavery, 1991). These two models provide
direction on how classroom settings can promote SDL, and assumptions about the
ways teachers and students relate to each other (these two models were discussed in
detail of the beginning of this chapter). Stages 1 and 2 of the SSDL (Grow, 1991)
were used in the process of teaching and learning in the workshop, and teacher
direction and partnership of TSCC (D’A Slevin & Lavery, 1991) were used in the
teaching and learning in the tutorials.
In Stage 1, the students’ role is that of dependent learners. They learn the assigned
topic matter, and how to identify what to learn, how to organise content for learning,
and how to recall what has been learnt. According to Gibbons (1994, p.5), in this
stage students are “learning how to learn from a teacher”. The teacher’s role is one of
expert and authority. According to Cranton (1992), students expect direction or
demonstration from their teacher, especially when they have not had any experience
in taking responsibility for their own learning. The researcher acted as an expert
providing information via lectures. Strategies for teaching and learning included
lectures, teacher direction and individual tutorials. Topic content was carefully
taught, and learning was carefully managed by the researcher. Students received a
copy of the overheads so that they could more fully participate in the interactive
lecture, rather than be busy writing notes. Students were given explicit directions on
what to do.
In Stage 2, teachers helped to move students from stage 1 to stage 2 by changing
teaching approaches from expert content provider to motivator. To achieve this,
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different teaching approaches were used. At this stage, students are “learning how to
teach a topic to oneself” (Gibbons, 1994, p.5). Students, as interested learners, were
guided through the process of learning, and how to learn the topic content, by the
researcher acting as teacher. The students learned how to plan and organise the
topics, how to work with others, how to take action, check progress and get things
done. To achieve this, the teaching and learning strategies included discussion and
demonstration followed by guided practice and close supervision. The lectures were
followed by practice in small groups with the researcher encouraging students to
work through their tasks by themselves. The students then did some group work on
their task with the researcher moving between groups and giving individual
feedback.
As the workshop topics introduced to students were new, more time was spent on
these areas. Each of the four topics (Self-directed learning, Time management,
Generating different types of questions, and Learning plans) presented in the
workshops is briefly discussed below:
1. Self-directed learning (SDL)
The aim of the SDL topic was to provide students with knowledge of SDL.
At the end of this session it was intended that students would be able to:
• define the concept of SDL;
• describe the benefits of SDL;
• discuss the purpose of SDL;
• describe competencies for SDL;
• describe tools for SDL.
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The SDL topic covered the importance of SDL, the definition of SDL that was used
in this study, the benefits of SDL, competencies for SDL, and tools for SDL.
2. Time management
Time is an unrenewable resource. No one can manage time but self-management is
possible. The aim of the time management topic was to provide students with the
basic knowledge and skills on how to manage their time for learning. On completion
of this session it was intended that students would be able to:
• demonstrate an understanding of time management in learning activities;
• explain the benefits of time management in learning activities;
• plan and document learning activities effectively;
• understand the time management of learning activities skills as a tool for SDL.
The time management topic covered the purposes for time-management in learning
activities, along with the benefits and format of time management. Skills addressed
in this session included systematic planning and documenting of learning activities.
In the time management session, students learnt how to analyse their daily routine in
order to identify the areas where time was wasted, to plan the day for learning
activities and decide what was achieved.
3. Generating different types of questions
According to King (1994), teaching students to ask their own questions can help
students become more independent in their learning and assume more responsibility
for meeting their learning needs. King (1990, 1992) indicates that previous research
has shown that when students are asked to generate their own questions they usually
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produce questions that require only the recall of factual materials, rather than critical
questions.
King (1994) has developed an instructional procedure for teaching students to pose
their own thought-provoking questions. The instructional procedure uses generic
questions to guide students in formulating their own questions related to materials to
be discussed. According to King (1994), these generic question stems are based on
the higher levels of Bloom’s taxonomy of thinking—including application, analysis
and evaluation. The questions serve as a stimulus to induce high level thinking
(King, 1994). King states further that students need to be trained to produce critical
questions because they do not spontaneously generate such questions.
The aim of the generating questions session was to provide students with a guide to
questioning to enable them to create different types of questions.
At the end of this session it was intended that students would have:
• understood the importance of asking critical questions;
• gained competence to develop their own critical questions;
• understood about asking questions as a tool for SDL.
The generating question topic covered the importance of asking questions,
instructions about how to generate questions (King, 1994) and Bloom’s levels of
thinking (Anderson & Sosniak, 1994). The skill addressed in the session was how to
develop different types of questions. This session used stem/guided questions
developed by King (1994) and these are shown in Table 5.4.
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Table 5.4: Stem/guided questions
Generic Questions Specific Thinking Skill Induced
Source: King (1994, p. 14)
4. Learning plan
According to Knowles (1990), teaching students to use a learning plan is the most
effective way to help students structure their learning. Learning plans are also
considered potentially useful in nursing education for individualising learning,
promoting independence and instilling habits of lifelong learning (Chan & Chien,
2000). The aim of the learning plan session was to provide students with the basic
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knowledge and skills of learning plans. At the end of the learning plan session it was
intended that students would have:
• a basic understanding of learning plans;
• basic skills to carry out a learning plan;
• an understanding about assessing learning needs;
• an understanding of developing learning goals;
• an understanding of identifying learning resources;
• an understanding of evaluating learning outcomes;
• an understanding about learning plans as tools for SDL.
The learning plan topic covered the definition of learning plans used in this study, the
benefits of learning plans, assessing learning needs, formulating learning goals,
identifying resources, evaluating outcomes, and learning format used in the study.
Skills addressed in these sessions included assessing learning needs, formulating
learning goals, identifying resources, evaluating outcomes, and using learning
formats. The students were guided to make their own learning plans and, as part of
their learning plans, to develop objectives to undertake during their clinical practice.
This study used the learning plan format developed by McAllister (1996). The
learning plan format can be seen in Figure 5.3.
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Learning Plans
Source: McAllister (1996)
Figure 5.3: Learning plan format used in this study
5.6.1.2 Skills practice
The purpose of skills practice in the nursing laboratory was for students to develop
competencies related to the body fluid topic prior to their experience in the practice
placement area. The skills practice is an integral part of body fluid topic. Nicol and
Bavin (1999) state that practice in a nursing laboratory enables students to develop
nursing skills at their own speed, in a safe environment before exposure to real
clients or patients. The laboratory also provides a suitable environment for
developing dexterity, and learning opportunities can be structured and predictable.
Clinical skills can be controlled according to students’ level of skill and learning
needs, lowering the anxiety of both students and teachers.
Lesson plans for laboratory sessions were provided to encourage active practice by
all students in order to achieve mastery and clinical competence. Biggs (1999b)
states when clear objectives are provided to students they are more likely to use deep
learning approaches. The nursing skills practised in the laboratory related to the body
fluid topic and included physical assessment, insertion of intravenous therapy,
insertion of nasogastric tube and insertion of urinary catheter.
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The formal objectives of skill practice in the laboratory are stated below:
At the end of skill practice sessions it was proposed that students will be able to:
• demonstrate basic skills for physical assessment;
• demonstrate basic skills for insertion of intravenous therapy;
• demonstrate basic skills for insertion of nasogastric tube;
• demonstrate basic skills for insertion of urinary catheter.
The nursing laboratory facilities could only accommodate a maximum of 20
students. The students were divided into three groups with 16 students in each group.
Three teaching staff taught the skills in the laboratory and the researcher was there to
provide help if needed. Skill demonstration and coaching were used as teaching
approaches in the nursing laboratory. Each group was supervised by a member of the
teaching staff. In these sessions, students had a 2.5 hour session devoted to skills
practice.
The skills were demonstrated by teaching staff and then practised by students to
ensure that they had some notion of how to perform a range of basic procedures
before contact with real clients or patients. All non-invasive skills were practised by
students on each other, with the advantage that students not only learn how to
perform the skills but also how it feels to be a patient. It also encouraged them to
focus on normal physiology before progressing to potentially abnormal signs with
real patients. Invasive skills were practised using a mannequin and students practised
in pairs. The skill activities are shown in Table 5.5.
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Table 5.5: Skill activities in the nursing laboratory
Day Activities Content Method Time SDL stage
Day 1
Skills practice Students divided into 3 groups, each group coached by a teacher.
Physical assessment Intravenous therapy Insertion nasogastric tube Insertion urinary catheter
Demonstration
150 mins
Stage 1
Day 2 Skills practice Students divided into 3 groups, each group coached by a teacher.
Physical assessment Intravenous therapy Insertion nasogastric tube Insertion urinary catheter
Coaching with immediate feedback Working in pairs
150 mins Stage 1 Stage 2
Day 3 Skills practice Students divided into 3 groups, each group coached by a teacher.
Physical assessment Intravenous therapy Insertion nasogastric tube Insertion urinary catheter
Coaching with immediate feedback Working in pairs
150 mins Stage 1 Stage 2
Day 4 Skills practice Students divided into 3 groups, each group coached by a teacher.
Physical assessment Intravenous therapy Insertion nasogastric tube Insertion urinary catheter
Coaching with immediate feedback Working with peers
150 mins Stage 1 Stage 2
On day 1, students divided into three groups and each group was supervised by a
member of the teaching staff. The skills were then demonstrated by a member of
teaching staff. Teacher-centeredness was used as a method of teaching, the teacher
was actively doing the demonstration and the students were passively watching the
skills demonstration. On Day 2 to Day 4, students did skill practice and the teachers
coached them with immediate feedback.
5.6.1. 3 Body fluid module
To provide activities and a structure for the students to develop their learning plans,
an SDL module was developed by the researcher based on the body fluid topic in the
Indonesian nursing curriculum. This module was only used with the intervention
group. The SDL module was given to students and they were provided with an
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explanation about how to use the SDL module (body fluid content) and how to work
through it for 14 weeks. The objectives of the body fluid module were:
At the end of the EIP it was indented that students will have:
• knowledge and understanding about body fluids;
• knowledge and understanding about caring for patients with a fluid imbalance;
• basic skills to use SDL in the body fluid topic;
• an understanding about self-directed modules as a tool for SDL.
Students were expected to carry out activities in the module throughout the 14 weeks
either by themselves or in a group. The body fluid module was provided for students
in Indonesian as well as the reading from textbooks such as Fundamental of Nursing
and Medical Surgical Nursing which is available in Indonesian translation. For the
purpose of this study copy of the body fluid module in English is provided in
Appendix 3.
5.6.2 Step 2: Implementation
The objective of the 12 weeks implementation was to encourage students to take time
to self-direct their learning and to practise skills of SDL continuously within the
support structure of a classroom. Another objective was to move students from being
dependent learners (Stage 1) toward becoming interested learners (Stage 2) through a
change in the teaching strategy and a move towards sharing more control over
learning. It was generally accepted that students would assume a “degree” of control
over their learning process. The researcher was acting as a tutor to encourage
students to use the knowledge that they had obtained from the workshop. The 12-
week implementation period was conducted at the hospital and in the classroom
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setting. In the clinical setting, the students were supervised by clinical instructors and
had more clinical teachers (three clinical teachers) compared to the control group
(one clinical teacher) and they had more contact. In their learning plans students had
developed the objectives to undertake during clinical practice. The learning plan was
used to guide their regular clinical practice to encourage integration of theory with
practice. During the implementation period there were three tutorials to support
students’ efforts to apply SDL concepts.
All students’ learning plans related to completing the self-directed module and the
nursing skills related to body fluids. The content focus on the learning plans was
knowledge about body fluids from the SDL module and nursing skills related to the
body fluid topic including: physical assessment, intravenous therapy, insertion of
nasogastric tube, and insertion of urinary catheter. Despite the content of the learning
plans being the same for all students (knowledge about body fluid and skills related
to body fluid), each student had a different focus and a different pace in completing
the module and acquiring the nursing skills. Some students paid more attention to
physical assessment, while others concentrated on nursing procedures in intravenous
therapy, insertion of urinary catheter, or insertion of nasogastric tube.
Piskurich and Piskurich (2003) state that support systems are needed to assist
students’ efforts to become self-directed learners. In this study, support was provided
through tutorial sessions. The implementation activities are shown in Table 5.6.
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Table 5.6 Implementation of SDL concepts Week Activities Contents Methods Setting Stage
1—2 Individual clinical
practice Individual learning plans and self-directed module
Self-direction Clinical setting
Stage 2 SSDL
Individual clinical practice
Individual learning plans and self-directed module
Self-direction
Clinical setting
Stage 2 SSDL
3
Tutorial 1 (Individual)
Discussion
Classroom setting
TSCC: teacher direction
4—5 Individual clinical practice
Individual learning plans and self-directed module
Self-direction Clinical setting
Stage 2 SSDL
Individual clinical practice
Individual learning plans and self-directed module
Self-direction Clinical setting
Stage 2 SSDL 6
Tutorial 2 (Small group of 4)
Discussion Classroom setting
TSCC: partnership
7–8 Individual clinical practice
Individual learning plans and self-directed module
Self-direction Clinical setting
Stage 2 SSDL
Individual clinical practice
Individual learning plans and self-directed module
Self-direction
Clinical setting
Stage 2 SSDL
9
Tutorial 3 (Larger group 9 or 10)
Discussion Classroom setting
TSCC: partnership
10—12 Individual clinical practice
Individual learning plans and self-directed module
Self-direction Clinical setting
Stage 2 SSDL
Three tutorial sessions were held during the implementation period to assist students
in their efforts to adopt self-directed learning attitudes and techniques. The
researcher acted as a teacher and motivator in tutorial sessions. From weeks 1 to 12
students did clinical practice using learning plans to guide their activities. They were
supervised by clinical instructors and clinical teachers. Tutorials were held in weeks
3, 6, and 9. Each tutorial is discussed in more detail in the following section.
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The first tutorial session was conducted to meet individual needs. The researcher and
individual students discussed issues relating to the students’ learning plans and the
self-directed module. The researcher encouraged students to ask questions, raise
issues on applying learning plans and using the self-directed module. In this tutorial
the researcher took an active role to give the students direction. In accordance with
the first type of TSCC (D’A Slevin & Lavery, 1991), teacher direction was used to
interact with students. Students were given feedback on their learning plans, which
allowed them to review and improve their learning plans, hopefully strengthening
their learning plans for the next tutorial. Every student was reminded to take more
control over their learning for the next tutorial by asking questions and raising issues
relating to problems. Ten students per day were self-scheduled for an individual
tutorial day and each student received 30 minutes of feedback and discussion.
For the second tutorial students were divided into 12 groups. There were four
students self-scheduled in each group. In line with the second type of TSCC (D’A
Slevin & Lavery, 1991), a partnership was used to interact with students and control
of learning was shared by the teacher and student. The researcher changed the role
from “give more direction and less listening” to “give more listening and less
direction”. The researcher and students discussed group problems and individual
problems in applying learning plans and using the self-directed module. In the group
tutorial sessions the researcher used the students’ contribution as the basis for
discussions and guided them to find solutions for their problems. Two hours were
provided for each group and three groups were scheduled for group tutorials per day.
For the third tutorial students were divided into five groups according to their clinical
placement. Group tutorials were scheduled for two and half hours to discuss
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problems in applying learning plans and the self-directed module. Two groups were
self-scheduled for group tutorials per day. The strategy for interaction was similar to
that of the second tutorial. Students’ contributions were used as the basis for
discussion and the researcher guided the group to provide the answers.
5.7 Evaluation of Educational Intervention Program
Pre-testing was conducted prior to commencement of the study using Guglielmino’s
Self-directed Learning Readiness Scale (SDLRS) and focus group discussion (FGD)
was used to collect qualitative data relating to students’ perceptions of SDL before
EIP. Post-testing was conducted using the SDLRS after completing the twelve weeks
of implementation. In addition, focus group discussions were held to collect
qualitative data. The FGD elicited students’ perceptions of SDL, the effectiveness of
the EIP, and clinical instructors’ perceptions of the students’ clinical activities.
Evaluation for the body fluid topic was included in the MSN1 mid test and final test.
5.8 Summary
This chapter outlined the educational intervention program (EIP) that was used in
this study. The conceptual framework was presented. An overview of traditional
diploma nursing curriculum structure in Indonesia, specifically in Central
Kalimantan was provided. The activities of the control group and intervention group
were outlined as well as the organisation of the EIP. Evaluation of the EIP completed
the chapter. The following chapter describes the results of the study.
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CHAPTER SIX
QUANTITATIVE RESULTS
6.0 Introduction
This chapter describes the results from quantitative data collected prior to, and
following, the educational intervention program. Students’ readiness for SDL data
was collected using the SDLRS (Guglielmino, 1978). A demographic questionnaire
was used to collect selected demographic variables that related to SDL. The chapter
begins by presenting descriptive statistics of demographic variables for the whole
sample, and the intervention and control groups. The results include frequencies and
percentages. This is then followed by descriptive statistics of readiness for SDL. The
results include mean (M), standard deviation (SD) and range. Such analysis was
considered important in the initial stage of data analysis to summarise and
understand the data (Punch, 1999).
A one-sample t-test was conducted to evaluate differences between SDLRS scores of
the current study and group norm scores (Guglielmino, 1978). The result was used to
address Hypothesis 1: The students’ level of readiness for SDL as measured by
SDLRS would be lower than the established group norm (Guglielmino, 1978).
An independent sample t-test was conducted to examine differences on SDLRS
scores between intervention and control groups at pre-test. A level of readiness for
SDL as suggested by Guglielmino and Guglielmino (1991) was calculated. The
result was used to address Hypothesis 2: There would be no significant difference
between the intervention and control group SDLRS scores at pre-test.
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Results from post-test were analysed using analysis of covariance (ANCOVA) to
address Hypothesis 3: Self-directed learning readiness scores of students who
participated in the educational intervention program (EIP) over fourteen weeks
would be significantly increased compared to the average scores of students who did
not participate. This test determined the relationship between the educational
intervention and students’ readiness for SDL, while controlling for pre-test scores.
Multiple regression was employed to find out the predictors of readiness for SDL,
including the demographic and educational intervention variables. The multiple
regression was undertaken to address Hypothesis 4: Variables such as group
(intervention-control), gender, birth order, father’s educational background and
mother’s educational background would significantly contribute to students’
readiness for SDL.
The Statistical Package for the Social Science (SPSS) version 12 was used to analyse
the quantitative data and statistical significance was set at alpha .05.
6.1 Demographic characteristics
One hundred and one second-year students participated in the study. The number
represented approximately 10% of total students enrolled in four nursing schools in
Central Kalimantan. Table 6. 1 shows the demographic data of the sample.
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Table 6.1: Frequency of demographic variables of sample
Variables N Percentages (%)
Group Intervention Control
47 54
46.5 53.5
Gender Male Female
37 64
36.6 63.4
Age: ≤20 year ≥21 year
57 44
56.4 43.6
Birth order: First-born Yes No
43 58
42.6 57.4
Father’s educational background ≤ JHS 1
≥ SHS 2 36 65
35.6 64.4
Mother’s educational background ≤ JHS ≥ SHS
53 48
52.5 47.5
1 JHS = Junior High School
2 SHS = Senior High School
Of the sample of 101, forty-seven participants were in the intervention group and
fifty-four were in the control group. Overall, the sample consisted mainly of female
students (63%), with approximately a third (37%) being male students. The age of
the participants ranged from 19 to 25 years (M = 20.59, SD = 1.22), with 56% of
participants aged ≤ 20 years and 44% aged ≥ 21 years. Nearly half (43%) of the
participants were first-born, and 64% of the students’ fathers had graduated from
high school or university. However, only 47% of the participants’ mothers had
graduated from high school or university. Generally, in Indonesia, men are more
highly educated than women are. The students’ characteristics in this sample were
similar to other nursing students at diploma level in Central Kalimantan or Indonesia.
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To check for any differences in demographic variables between groups at pre-test the
chi-square test for independence was conducted. Table 6.2 shows differences
between intervention and control groups at the pre-test. No significant differences for
gender, age group, birth order, father’s educational background and mother’s
educational background were identified.
Table 6.2: Demographic differences between intervention and control groups
Chi-square test Variables intervention n (%)
control n (%) X² P- value
Gender Male Female
17 (36) 30 (64)
20 (37) 34 (63)
0.00
1.000
Age: ≤ 20 year ≥ 21 year
31 (66) 16 (34)
26 (48) 28 (52)
2.56
.11
Birth order: First born Yes No
25 (53) 22 (47)
18 (33) 36 (67)
3.28
.07
Father’s educational background ≤ JHS 1
≥ SHS 2
14 (30) 33 (70)
22 (41) 32 (59)
0.88
.35
Mother’s educational background ≤ JHS ≥ SHS
22 (47) 25 (53)
31 (57) 23 (43)
0.75
.39
1 JHS = Junior High School 2 SHS = Senior High School
Of the total second-year students from intervention and control schools, the
percentage who participated in the study at pre-test and post-test was high (92%).
There was no attrition throughout the study. The lack of attrition may relate to the
use of intact groups for intervention or control conditions; additionally, the cultural
background features such as respect for authority (teachers) may have resulted in
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students continuing to participate until the end of the study. The next section of this
chapter presents the results for the SDLRS to address the hypotheses.
6.2 Level of readiness for SDL
Hypothesis 1: The students’ level of readiness for SDL as measured by SDLRS
would be lower than established group norms (Guglielmino, 1978).
Within a possible range of 58–290, the pre-test scores ranged from 143 to 235. The
mean and standard deviation of the SDLRS scores for the whole sample was 196.48
and 16.63 respectively. As expected, the mean readiness scores reported by the
nursing students in Central Kalimantan were lower than those reported for USA
students, M = 214, SD = 25.59 (Guglielmino, 1978). This mean has been used as a
norm for comparison purposes in various studies (Bulik & Romero, 2000;
Darmayanti, 1994; Delahaye & Choy, 2000; Jones, 1992; McCauley & McClelland,
2004).
A one sample t-test was conducted on the study sample’s SDLRS scores to evaluate
whether the mean was significantly different from the normative mean (M = 214),
the accepted mean for adult learners in general (Guglielmino, 1978). The sample’s
mean of 196.48 (SD = 16.67) was significantly different from 214, t (100) = −10.59,
p = .000. The 95% confidence interval for the sample’s mean ranged from 175.67 to
182.24.
The mean score for Australian undergraduate students is reported as 203, SD = 21.6
(Delahaye & Choy, 2000). In Irish undergraduate students the SDLRS scores are
reported as 215.80, SD = 22.99 (McCauley & McClelland, 2004). The SDLRS mean
for Indonesian Open University students in Indonesia (N = 369) is reported as 215.5,
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SD = 21.9 (Darmayanti, 1994). The lowest score in the current study (143) was also
lower than that noted in Darmayanti’s (1994) study. The range of SDLRS scores in
Darmayanti’s study was 148–268. In addition to having significantly lower SDLRS
scores than normative data (based on the US students), the students in the current
study have lower scores than students in Australia, Ireland and Indonesia. This data
confirms the hypothesis about students’ readiness for SDL.
6.3 Differences in pre-test scores
Hypothesis 2: There would be no significant difference between the intervention and
control group SDLRS scores at pre-test
The intervention and control groups’ means for SDLRS scores at pre-test were
calculated. The scores are presented in Table 6. 3.
Table 6.3: SDLRS scores at pre-test
SDLRS scores
Intervention (n = 47)
Control (n = 54)
Mean
SD
Range
190.72
18.57
143–235
201.48
12.95
170–229
An independent sample t-test to analyse the difference between the two group means
was performed. The assumptions for t-test were met. The scores for both intervention
and control groups were normally distributed. The Levene’s test indicated that the
samples had equal variances (p = .87). The hypothesis was not confirmed, in fact the
analysis showed that there was a significant difference in scores t (99) = −3.42, p =
0.001. The mean SDLRS score was higher in the control group than in the
intervention group.
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Students’ level of readiness at pre-test was also examined according to the five levels
as suggested by Guglielmino and Guglielmino (1991)—low, below average, average,
above average, and high. The distribution of the intervention and control group
within the five levels of readiness is shown in Table 6. 4.
Table 6.4: Different levels of readiness for SDL at pre-test
Intervention group Control group Scores
Level of readiness n (%) n (%)
50–176 Low 9 (19) 2 (4)
177–201 Below average 27 (57) 27 (50)
202–226 Average 8 (17) 24 (44)
227–251 Above average 3 (7) 1 (2)
252–290 High 0 0
At the pre-test, 76% of the intervention group and 54% of the control group were in
the “low” and “below average” ranges. Only 7% and 2% of the intervention and
control groups, respectively, were in the “above average” range. No students were in
the “high” range for SDL readiness in the pre-test. More students in the control group
scored in the average range and above average than in the intervention group (46%
vs. 24%).
Despite the randomisation of the two schools to intervention or control group, the
students in the control group had high SDLRS scores. These data do not support the
hypothesis that pre-test scores between the groups would not differ. The different
SDLRS scores between intervention and control groups might be explained by
external factors of readiness for SDL in the control group. The library, in terms of
number of books and longer hours of services, was better in the control group than
intervention group. Another explanation could be that the “home-work”, the
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traditional method of SDL in Indonesia, was more often used in the control group
than in the intervention group.
6.4 Impact of the educational intervention program
Hypothesis 3: Self-directed learning readiness scores of students who participated in
the educational intervention program (EIP) over fourteen weeks would be
significantly increased compared to the scores of students who did not participate.
To examine changes in SDL readiness following the introduction of the educational
intervention program (EIP), differences between the intervention and control groups’
pre- and post- test scores were calculated. Means and standard deviations for pre-
and post- test SDLRS scores for intervention and control groups are shown in Table
6.5.
Table 6.5: Mean and Standard Deviations of SDLRS by group
SDLRS (pre-test) SDLRS (post test) Group Mean
(SD)
Mean
(SD)
Intervention
Control
190.72
201.48
(18.57)
(12.95)
203.04
193.18
(18.51)
(17.36)
Because the SDLRS scores of the two groups were significantly different at pre-test,
it was considered necessary to control for pre-test SDLRS scores. The pre-test scores
for each participant were therefore used as a co-variate. A one-way between group
analyses of covariance was conducted to compare differences between the groups
(Pallant, 2001). The independent variable was group—intervention or control—and
the dependent variable was post-test SDLRS scores. A preliminary check was
conducted to ensure that there were no violations of the assumptions of normality,
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linearity, homogeneity of variance of regression slopes. The assumptions were all
met.
After adjusting for pre-intervention scores, there was a significant difference between
the two groups on post-test scores for the SDLRS, F (1, 98) = 63.25, p = .000, Partial
Eta Square = .39. This result indicated that the intervention group improved their
readiness for SDL after the educational intervention program. It is interesting to note
that despite having higher SDLRS scores at pre-test, the control group scores
decreased following the intervention. As expected, Hypothesis 3 is confirmed. The
SDLRS scores for intervention and control groups at pre- and post- test shown in
Figure 6.1.
170
180
190
200
210
220
230
Pre-test Post test
Intervention
control
Figure 6.1: Graph of SDLRS scores for intervention and control groups at pre- and post- test
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6.5 Influence of educational intervention and demographic
variables
Hypothesis 4: Variables such as group (intervention-control), gender, birth order,
father’s educational background and mother’s educational background would
significantly contribute to students’ readiness for SDL.
A standard multiple regression was performed with SDLR post-test scores as the
dependent variable and intervention-control group, gender, birth order and parents’
educational level as independent variables. Analysis was performed using SPSS
regression and SPSS frequencies for evaluation of assumptions. A preliminary check
was conducted to evaluate the assumption of sample size, outliers, multicollinearity,
normality, linearity, homocedasticity, and independence of residual. The result of
evaluation of assumptions led to transformation of the dependent variable to reduce
the number of outliers, reduce skewness, and improve the normality,
homocedasticity, and linearity. No cases had missing data (n = 101). Logarithmic
transformation was used on SDL readiness post-test scores.
Overall, the five variables explained 15% of the variation in readiness for SDL
scores (R2= .148, p = .009). Two of the independent variables contributed
significantly to the prediction of readiness for SDL scores as logarithmically
transformed. Results showed that intervention–control group had the strongest
unique contribution (β = −. 243, p = .01) with the intervention group having higher
SDL readiness scores compared to the control group. The beta value for gender was
slightly less (β = .240, p = .01) with females reporting higher SDLRS scores than
males. Finally, birth order (β = .026, p= .79), father’s educational background (β =
.076, p = .50), and mother’s educational background (β = .086, p = .74), did not make
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significant contributions to explain SDLRS post test scores (dependent variable).
Therefore, as hypothesised, group and gender were important contributors to SDLRS
scores, while birth order and parents’ educational level were not. Students who
participated in the educational intervention program and female students had high
levels of readiness for SDL.
6.6 Summary
This chapter has presented the quantitative results. The demographic data showed
that intervention and control groups had equivalent demographic characteristics in
the sample. Levels of students’ readiness for SDL were assessed and compared to the
norm score. Intervention and control group scores on pre- and post- tests were
provided, as well as results from multiple regression. It was found that students’
scores in SDL measures in the intervention group changed during the educational
intervention program, compared to these measures for students in the control group.
Levels of readiness for SDL improved for the intervention group from ‘below
average’ to ‘average’ compared to the control group who scored in the ‘below
average’ range before and after the study. The next chapter presents the qualitative
findings.
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CHAPTER SEVEN
QUALITATIVE FINDINGS
7.0 Introduction
This chapter presents the findings from the focus group discussions (FGDs) from
both students and clinical instructors. The FGDs for students in the research study
was designed to investigate the research question: What were the students’
perceptions of self-directed learning before and after the educational intervention
program? The FGDs for clinical instructors addressed the research question: What
were the clinical instructors’ perceptions of students’ activities in clinical practice
during the educational intervention program? The chapter begins by presenting an
overview of data collection and this is followed by data analysis. Findings from
students’ FGDs before EIP, from both intervention and control groups, are presented
in the next section followed by FGDs after the EIP for both groups. Findings from
clinical instructors are presented in the final section. The chapter then concludes with
a summary.
7.1 Data collection
In order to understand students’ perceptions of self-directed learning (SDL) and to
enrich the quantitative results, a qualitative technique was employed. Focus group
discussion (FGD) was used as the data collection technique. The FGD can be defined
as a qualitative research technique using discussion among a small group of people
(4–12 people) in a comfortable, non-threatening environment to obtain perceptions
about an area of interest, a topic of study or a given problem (Kitzinger, 1994;
Krueger, 1994; Lederman, 1990; McDaniel & Bach, 1994; Morgan, 1995).
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It has been suggested that FGD is particularly useful to explore people’s shared
knowledge and experiences and can be used to examine not only what people think
but how and why they think that way (Kitzinger, 1995). According to McDaniel and
Bach (1994) the FGD facilitates group interaction to stimulate participants and
provide insights and data that are not accessible without the stimulus of a group.
Furthermore, McDaniel and Bach state that the use of FGD can stimulate new ideas
that may never surface in an individual interview. Group participants can also be
encouraged to add to those commentaries as they hear what other group participants
contribute. Lederman (1990) indicates that, in a FGD, the group rather than the
individual is interviewed and being within the group provides a safe atmosphere.
Data generated in FGD are often richer and deeper than data in one-on-one interview
situations. Lederman (1990) also noted that openness is encouraged because the
participants in the group understand and feel comfortable with one another.
Participants also draw social strength from each other as the group provides support
to its members in the expression of new ideas.
Considering the benefits of FGD among homogenous participants on focal topics, it
was sufficient to use FGD as a data collection technique for this study cohort of
nursing students in Central Kalimantan as they are not accustomed to expressing
their perceptions or opinions individually in their everyday learning activities. Eight
FGDs were conducted to collect qualitative data. The FGDs for students included six
focus groups: four focus groups were conducted before the educational intervention
program (EIP), comprising two FGDs from the intervention group and two FGDs
from the control group. Two FGDs were conducted after the EIP, one FGD from
each group. The number of participants in each FGD was eight, giving a total of 48
participants for the six FGDs.
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Two focus groups were conducted to collect clinical instructors’ perceptions about
students’ clinical activities in clinical settings. One FGD was conducted for clinical
instructors from the intervention group and one FGD for the control group. All
clinical instructors’ focus groups were held after the intervention. The number of
participants in each FGD was six, giving a total of 12 participants for the two FGDs.
All the FGDs for students and clinical instructors were held in the nursing schools’
meeting rooms as the rooms were comfortable, air-conditioned, non-threatening and
conducive to discussion of sensitive topics. The setting of the FGDs was around the
table as this allowed the participants to see each other. The researcher acted as the
moderator and was responsible for ensuring that key questions were discussed and
that all individual students or clinical instructors participated in the discussion.
Within the FGD sessions, the researcher was helped by an assistant who was
responsible for keeping notes of the discussion and managing the tape recorder. The
length of each FGD ranged from one and a half to two hours.
The FGDs used the modified guidelines developed by Myers (1999). The guidelines
outline each step of the process for the researcher and the assistant from before
participants arrive, to when they leave (see Chapter Three). The FGDs used an
interview script: a plan for covering topics so that the desired information was
obtained. The scripts began with an ice-breaker question that required little reflection
and worked up to more penetrating questions (key questions) thereby allowing
participants to warm to the context and subject matter before being asked to explore
the subject, which took more thought or was more difficult to discuss.
The FGD script for students before the educational intervention program (EIP) was
used for the intervention and control group before the intervention, and was also used
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for the control group FGD after EIP. The script contained one icebreaker question,
three key questions and two summary questions (see Chapter Three). Once
introductions had been made, the purpose of the study explained, and permission
granted to tape record the session, the researcher began with an icebreaker question.
One participant was asked to answer this question, and then each participant was
asked to respond to, add to, or clarify the response. After each participant had
answered the icebreaker question, three key questions were asked with each
participant answering. The researcher ended the session with a summary of the
discussion, seeking verification from the student participants. The same processes
were used to conduct all FGDs.
The FGD script after the intervention was used after the EIP was completed. This
interview script was only used for the intervention group, as only this group could
talk about the SDL activities. The script contained two icebreaker questions, four key
questions and two summary questions (see Chapter Three).
Two clinical instructor FGDs were held after the intervention was completed. The
FGD interview script was used for clinical instructors from both groups. The script
contained two icebreaker questions, four key questions and two summary questions
(see Chapter Three). Again, the same processes as described for the students’ FGDs
were used to conduct FGDs for clinical instructors.
7.2 Data analysis
All focus group discussions were tape-recorded and the recordings were then
transcribed into the original language (Indonesian). The transcripts were read and
content analysed using the guidelines by Burnard (1991). Burnard’s original
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guidelines comprised 14 stages and, for this study , this was modified to 17 steps (as
described in Chapter Three). These steps were as follows:
• Step 1: The recordings were transcribed into the original language
(Indonesian) by the researcher. Eight recordings were transcribed, which
resulted in 84 pages of transcriptions.
• Step 2: The transcripts were read and notes made on the general themes
arising from the data.
• Step 3: The transcripts were translated from their original language
(Indonesian) into English by the researcher.
• Step 4: The English transcriptions were checked by a registered translator for
accuracy of translation and quality of data.
• Step 5: The English transcripts were then read and a list of themes developed.
This process of “open coding” helped focus the analysis on the concept being
explored and statements unrelated to this were excluded at this point. Open
coding is the process of organising, sorting, and coding data. Open coding by
words was used, rather than by number, as words provide more meaning than
the conversion of words to numbers, which can render data meaningless
(Miles & Huberman, 1994).
• Step 6: The English transcripts were also read independently by two
researchers for quality of data and preliminary themes. Together with the
researcher’s list, three lists of themes were developed.
• Step 7: These three lists of themes were transcribed into a separate document
by the researcher.
• Step 8: The three lists were reviewed for commonalities/links between any of
them and grouped together into categories.
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• Step 9: Once grouped together, further refinements were undertaken and each
group was explored for subcategories. Repetitious or very similar categories
were removed to produce a final list.
• Step 10: In an effort to enhance the validity of the categories and guard against
researcher bias, the two researchers were also asked to verify the accuracy of
the category system.
• Step 11: After discussion with them, minor modifications were made to the
categories and some of the original categories were collapsed and reduced to
produce the final list of categories and subcategories.
• Step 12: Transcripts were then re-read alongside the final list of categories to
check that a true representation of the interviews had been captured.
• Step 13: Sections of transcript were then identified and coded, under
corresponding categories.
• Step 14: Sections of the transcripts in Step 13 were ‘cut’ and ‘pasted’ onto
separate documents.
• Step 15: The results from Step 14 were translated back into the original
language (Indonesian).
• Step 16: As the validating step, the results of the thematic content analysis in
the original language (Step 15) were returned, via email, to the focus group
participants to check for “truth values.” No comment or corrections were
made so it was assumed that the participants agreed with the interpretation of
the transcripts.
• Step 17: The final steps in Burnard’s method of thematic content analysis are
related to the writing up of the findings alongside relevant literature and
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research, using direct quotes from the transcripts to further illustrate the point
under discussion.
7.3 Findings
This section presents the findings from both students and clinical instructors. The
student FGDs will be presented in two parts: students’ perceptions before EIP and
students’ perceptions after EIP. The clinical instructors’ FGDs will be presented in
one part. All parts use a similar structure and include examples of FGD transcripts,
followed by category development from open coding, and quotes from the FGDs.
The same processes were used to analyse all FGD data.
7.3.1 Students’ perceptions of SDL before the intervention
Two groups from the intervention group and two groups from the control group were
analysed separately. In the course of this process it became clear that themes and
categories were similar. Therefore, these data are being presented as representative of
both control group and intervention group prior to the commencement of the EIP.
Two categories were generated from the students’ focus group data before the
intervention and, under these categories, all of the data were accounted for. Data
from students’ FGDs was examined for themes using open coding. This process is
exemplified by the following data in Table 7. 1.
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Table 7.1: Themes developed from FGDs before the intervention
Line FGD Transcript Open Coding 1 R: What does self-directed mean to you? 2 S: Self-directed learning is looking for and Learning alone 3 retrieving knowledge alone 4 S: Self-directed learning is to know anything that Learning without help 5 I do not know without help from other 6 S: Self-directed learning such as learning after Activities outside 7 school hours, reading materials that have been given to classroom 8 us and doing home work. 9 S: Self-directed learning is the learning method Distant learning 10 That is similar to distant learning. We are given learning 11 materials and study guide, and we learn using our 12 self-effort. 13 S: Self-directed learning is an individual learning for Learning for test 14 test. 15 R: What teaching and learning issues will arise if 16 self-directed learning is implemented 17 S: A major problem of self-directed learning method Teachers inactivity 18 could be inactivity by lecturer. Students and others 19 may perceive teachers are lazy and students learn 20 by themselves. 21 S: In self-directed learning we do constant learning, Less leisure time 22 we will get more stressed because in doing this we 23 do not have enough time for relaxing 24 S: In self-directed learning we can do badly in test Incorrect learning 25 because the material we have learnt could be 26 different from test material, so students could fail in 27 test. For me it is safe to learn the materials from our 28 lecturers. 29 S: I think in using self-directed learning we need a Increased cost 30 lot of books as learning resources and it can 31 increase cost to buy the books Students’ perceptions about SDL focused on two areas: ‘self-activity’, and
‘consequences’. The students expressed their concept of SDL as a ‘self-activity’.
However, they also acknowledged that SDL had consequences. Each of these two
categories comprised a number of subcategories as shown in Table 7.2.
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Table 7.2: Category development from FGDs before intervention
Category Subcategory • Learning alone • Learning without help • Activities outside classroom • Distant learning
Self-activity
• Learning for test • Teacher inactivity • Less leisure time • Incorrect learning
Consequences
• Increased cost The category of ‘self-activity’ had five subcategories: ‘learning alone’, learning
without help’, ‘activities outside classroom’, ‘distant learning’, and ‘learning for
test’. The category of ‘consequences’ had four subcategories: ‘teacher inactivity’,
‘less leisure time’, ‘incorrect learning’, and ‘increased cost’.
The category, ‘self-activity’, and the five subcategories highlighted that students
viewed SDL as something that they did alone and without help. In addition, they
considered SDL was something that took place outside of the classroom, which they
did to prepare for tests. The following statements give examples of the five ways in
which students viewed SDL as a ‘self-activity’.
Learning alone
One student highlighted this by stating:
“Self-directed learning is to learn alone; to know anything that I do not know without help from others.”
Another student reiterated this by adding:
“Self-directed learning is looking for and retrieving knowledge alone.”
Learning without help
One student identified this subcategory by stating:
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“Self-directed learning is learning without direction from others.”
Another student supported this by stating:
“Self-directed learning is to know anything that I do not know without help from others.”
Activities outside classroom
For this subcategory a student stated:
“Self-directed learning activities, such as learning after school hours, reading lecture materials that have already been given to us, and doing homework as well as possible.”
One student confirmed this by stating:
“Self-directed learning means to me I learn alone with activities outside classroom.”
Distant learning
This subcategory was identified by the following student statement:
“Self-directed learning is the learning method that is similar to distance learning. We are given learning materials and a study guide, and we learn using our self-effort.”
Another student highlighted this subcategory by stating:
“Self-directed learning is learning similar to open junior high school, no teacher present, no classes; it uses materials and a study guide without help from others.
Learning for test
This subcategory was identified by the following example:
“Self-directed learning is an individual learning for tests.”
One student supported this by stating:
“Self-directed learning is learning alone, reading and memorising lecture materials, tidying up lecture notes, finishing assignments, so I will ready for the test.”
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The second category, ‘consequences’, showed that students had concerns about the
effects that SDL may have on them and their teachers. The following statements give
examples of the four consequences that most concerned students.
Teacher inactivity
One student identified this subcategory by stating:
“A major problem of a self-directed learning method could be inactivity by lecturers. Students and others may perceive teachers are lazy and students learn only by themselves.”
Another student highlighted the issue of teacher inactivity by stating:
“Problem of self-directed learning could be decreased face to face lecture. Students may perceive teachers are not capable in either teaching or subject content.”
Less leisure time
One student highlighted the issue of using self-directed learning by stating:
“In using self-directed learning we do constant learning, we will get more stressed because in doing this we do not have enough time for relaxing.”
Another student supported this subcategory by stating:
“We will have less time for relaxing because the self-directed learning makes us do constant learning, concentrating on learning and thinking critically.”
Incorrect learning
A student identified this subcategory by stating:
“We can do badly in test because the material we have learnt could be different from test material, so students could fail in test.”
Another student supported this subcategory by stating:
“ . . . if we make a mistake it could be a fatal mistake because no one will give correction before it happens.”
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Increased cost
This subcategory was highlighted by one student who stated:
“I think in using self-directed learning we need a lot of books as learning resources and it can increase our costs to buy the books.”
Another student stated:
“Self-directed learning will increase the cost of learning due to high price of books.”
These categories and subcategories, which were expressed before the study
commenced, indicated that the students had a limited view of SDL and were
concerned about its impact. They appeared to have some understanding of the shift
away from the focus on the teacher as the only way to obtain knowledge. However,
they expressed a view that the ‘self-activity’ needed to be done ‘alone’ and ‘without
help’. Naturally, the students had concerns about the impact ‘self-study’ could have
on them and their teachers.
7.3.2 Students’ perceptions of SDL after the intervention
The same processes were used to develop categories, and this time the categories
were different between the control group and the intervention group. The control
group categories were the same as at the pre- data collection point. The main control
group categories were still ‘self-activity’ and ‘consequences’. These results are now
presented in Table 7.3. Two categories emerged from open coding of FGD data from
the control group after the study. Students’ perceptions about SDL still focused on
two areas: ‘self-activity’, and ‘consequences’. The students expressed their concept
of SDL as a ‘self-activity’. However, they also acknowledged that SDL had
consequences. Each of these two categories comprised a number of subcategories as
shown in Table 7.4.
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Table 7.3: Themes developed from the control group after the intervention
Line FGD Transcript Open Coding 1 R: What does self-directed mean to you? 2 S: Self-directed learning is learning alone to solve Learning alone 3 problems 4 S: Self-directed learning is learning using self effort Learning without help 5 without included other in the activities 6 S: Self-directed learning means to me is informal Activities outside 7 education and activities outside campus we can classroom 8 learn less important things such as cooking and 9 woven 10 S: Self-directed learning is the learning by Learning for test 11 memorising lecture materials for test so I can get 12 better scores 13 R: What teaching and learning issues will arise if 14 self-directed learning is implemented 15 S: Problem of self-directed learning could be Increase laziness 16 learning from teacher become less interesting 17 because I can learn alone using self-directed 18 learning so that increases laziness to listen to the 19 teacher. 20 S: . . . we are young adult because we do self-directed Less leisure time 21 learning by ourselves we lost time for relaxing. 22 S: According to me the results of self-directed Not optimum results 23 learning is different from lecture, the result is not 24 optimum because we use self-effort without 25 guidance 26 S: Problem can arise such as students are Difficult to change 27 Accustomed to learn from teacher and have 28 difficulty changing their learning habit. The category of ‘self-activity’ had four subcategories: ‘learning alone’, ‘learning
without help’, ‘activities outside classroom’, and ‘learning for tests’. The category of
‘consequences’ also had four subcategories: ‘increased laziness, ‘less leisure time’,
‘not optimal results’, and ‘difficult to change’.
The category ‘self-activity’ and the four subcategories highlighted that students
viewed SDL similarly to their pre-intervention understanding: learning alone and
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without help. In addition, they considered SDL was something that took place
outside of the classroom, which they did to prepare for tests.
Table 7.4: The category development from the control group after the intervention
Category Subcategory • Learning alone • Learning without help • Activities outside classroom
Self activity
• Learning for test • Increased laziness • Less leisure time • Not optimal results
Consequences
• Difficult to change The following statements giving examples of the four ways in which students viewed
SDL as a ‘self-activity’.
Learning alone
One student highlighted this by stating:
“Self-directed learning is learning alone without help from others.”
Another student reiterated this by adding:
“Self-directed learning is learning alone to solve problems.”
Learning without help
One student identified this subcategory by stating:
“Self-directed learning is learning using self-effort without including others in the activity.”
Another student supported this by stating:
“Self-directed learning is an individual activity to solve problems without help from others.”
Activities outside classroom
For this subcategory a student stated:
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“I have heard self-directed learning when I was at junior high school. According to our teacher self-directed learning is learning alone. Self-directed learning means to me I learn alone with activities such as learning at home as well as possible to improve my scores.”
One student confirmed this by stating:
“Self-directed learning means to me informal education and activities outside campus we can learn less important things such as cooking, and wavering”.
Learning for test
This subcategory was identified by the following example:
“Self-directed learning is learning individually using such activities: summarise and memorise learning materials, and prepare for tests.”
One student supported this by stating:
“Self-directed learning is learning by memorising lecture materials for tests so I can get better scores.”
The second category: ‘consequences’ and the four subcategories showed that
students had concerns about the effects that SDL may have on them and their
teachers. They considered the results of SDL were different from the results of
lectures. In addition, they were concerned that they may have difficulties adopting
the SDL methods. The following statements give examples of the four consequences
that most concerned students.
Increased laziness
One student identified this subcategory by stating:
“The problem of self-directed learning could be learning from a teacher becomes less interesting because I can learn alone using self-directed learning so that increases laziness to listen the teacher.”
Another student highlighted the issue of increased laziness by stating:
“A major problem of self-directed learning could be I do not pay attention to the teacher because I implement self-directed learning that increases my laziness to attend the class.”
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Less leisure time
One student highlighted the issue of using self-directed learning by stating:
“ . . . we are young adults, because we do self-directed learning by ourselves we lost time for relaxing.”
Another student supported this subcategory by stating:
“We will have less time for relaxing because if we use self-directed learning we always learn alone, we do not have time for social life and less communication with others.”
Not optimal results
A student identified this subcategory by stating:
“According to me the results of SDL is different from lecture; the result is not optimum because we use self-effort without guidance.”
Another student supported this subcategory by stating:
“If the self-directed learning is implemented I am quite sure the results will be unsatisfactory because of the limited resources. It will make students that are initially diligent become lazy because at the time they have curiosity about something, there are no resources available so that the curiosity becomes dimmer.”
Difficult to change
This subcategory was highlighted by one student who stated:
“Problems can arise such as students are accustomed to learning from teachers and have difficulties changing their learning habit.”
Another student stated:
“Problem will arise such as difficulty to adjust to new methods I mean self-directed learning because students find it very difficult to change learning habits that have already become a tradition in this school.”
These categories and subcategories, which were expressed after the study had
finished, indicated that the students in the control group still had a limited view of
SDL and were concerned about its impact. They appeared to have some
understanding of the shift away from the focus on the teacher and that it may make
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them less respectful of their teachers. However, they expressed a view that the ‘self-
activity’ needed to be done ‘alone’ and ‘without help’ and had an impact on their
learning, as the students’ purpose of learning is to pass the tests. Naturally, the
students had concerns about the effect ‘self-study’ could have on them and their
teachers.
However, the analysis of the intervention group data revealed different categories.
The open coding of FGDs from students in the intervention group after the EIP is
shown in Table 7.5
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Table 7.5: Themes developed from the intervention group after the intervention
Line FGD Transcript Open coding 1 R: What does self-directed mean to you 2 S: Self-directed learning is using one’s initiative for Individual initiative 3 learning, using self effort to search for things. 4 S: Self-directed learning is a process of learning, Learning with or 5 where we do self-directed learning with or without without help 6 help from other. 7 R: What did you think the benefit of self- 8 directed learning? 9 S: . . . in using self-directed learning I know how to Direction in learning 10 arrange my study effectively and I have direction in 11 learning 12 S: . . . it increased knowledge and motivation for self- Increased motivation 13 development in learning as compared to previous 14 method of learning 15 S: Self-directed learning renewed my ways of Increased 16 learning , and I felt it changed the process of self-confidence 17 learning and increased my self-confidence 18 S:. . . . using self-directed learning method learning Incremental learning 19 does not pile up, because we learn bit by bit. 20 R: What teaching and learning issues will arise if 21 the self-directed learning will be implemented? 22 S: . . . communication between school of nursing and Communication 23 clinical practice needs to be improved. 24 S: . . . supporting materials for both theory and Learning materials 25 practice should be provided fully. 26 S: . . . training program should be given to clinical Knowledge and skills 27 instructors so they know how to direct students.
Three categories emerged from open coding of data from the intervention group after
the study. Students’ perceptions about SDL focused on three areas: ‘process of
learning’, ‘advantages’, and ‘areas needing improvement’. Each of categories
comprised a number of subcategories as shown in Table 7.6.
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Table 7.6: Category development for intervention group after intervention
Category Subcategory • Individual initiative Process of learning • Learning with or without help • Direction in learning • Increased motivation • Increased self confidence
Advantages
• Incremental learning • Communication • Learning materials
Areas needing improvement
• Knowledge and skills The category of ‘process of learning’ had two subcategories: ‘individual initiative’
and ‘learning with or without help’. The category of ‘advantages’ had four
subcategories: ‘direction in learning’, ‘increased motivation’, ‘increased self-
confidence’ and ‘incremental learning’. The category of ‘areas needing
improvement’ had three subcategories: ‘communication’, ‘learning materials’, and
‘knowledge and skills’.
The category ‘process of learning’ and the two subcategories highlighted that
students in the intervention group had changed their view of SDL as something that
they did based on individual initiative and with or without help. The following
statements give examples of the two ways in which students viewed SDL as a
‘process of learning’.
Individual initiative
This subcategory was identified by the following example:
“Self-directed learning is using one’s initiative for learning, using self effort to search for things”
Learning with or without help
A student identified this subcategory by stating:
“Self-directed learning is a process of learning where we do self-directed learning with or without help from others.”
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The category of ‘advantages’ and the four subcategories highlighted that students in
the intervention group had changed their view of SDL as they considered SDL was
something that benefits them. The following statements give examples of the four
ways in which students viewed that SDL has ‘advantages’.
Direction in learning
The following student statement highlights this subcategory:
“Using self-directed learning, I know how to arrange my study effectively and I have direction in learning”
Increased motivation
For this subcategory a student stated:
“Self-directed learning increased knowledge and motivation for self development in learning as compared to previous methods of learning.”
Increased self-confidence
This subcategory was identified by the following example:
“Self-directed learning renewed my ways of learning, and I felt a change in the process of learning and an increase in my self-confidence.”
Incremental learning
One student stated:
“In self-directed learning we can arrange the time for learning effectively and learning does not pile up”
One student supported this subcategory by stating:
“ . . . using self-directed learning method learning does not pile up because the learning materials are learnt little by little.”
The category of ‘areas needing improvement’ and the three subcategories highlighted
that students in the intervention group had changed their view of SDL as they had a
tendency to see learning changes as challenges to improve rather than merely as
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problems. The following statements give examples of the three ways in which
students viewed SDL has ‘areas needing improvement’.
Communication
This subcategory was identified by the following example:
“Communication between school of nursing and clinical practice needs to be improved.”
Learning materials
One student suggested this by stating:
“Supporting materials for both theory and practice should be provided in full.”
Knowledge and skills
This subcategory was identified by the following example:
“Training program should be given to clinical instructors so they know how to direct students.”
These categories and subcategories, which were expressed after the study, indicate
that the students in the intervention group had changed their views of SDL. They
appeared to have some understanding that the shift away from the focus on the
teacher would help their self-confidence improve.
7.4 Clinical instructors’ focus group discussions
Two focus groups were conducted to collect clinical instructors’ perceptions about
students’ clinical activities in clinical settings. One FGD was conducted for clinical
instructors in the intervention group and one FGD for clinical instructors in the
control group. All clinical instructors’ focus groups were conducted after the EIP,
however, they were asked about activities in clinical practice before and after the
intervention. The analysis of data used the same process of coding. These two groups
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were analysed separately and the group categories were compared. It is interesting to
note that for categories before the EIP their responses were the same. Post-
intervention, the control group categories were the same as they were at pre-
intervention, however, the post intervention data for the clinical instructors from the
intervention group was different because the students were doing different activities.
Five categories were generated from the clinical instructors’ focus group data from
the intervention group, and four categories emerged from clinical instructors in the
control group. Under these categories, all of the data were accounted for. The section
begins with FGD from clinical instructors from the control group, followed by
findings from clinical instructors from the intervention group.
7.4.1 Clinical instructors from the control group
Data from clinical instructors in the control group were examined for themes using
open coding. The coding process is exemplified by the following data in Table 7.7.
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Table 7.7: Themes development from control group clinical instructors
Line FGD Transcript Open coding 1 R: Can you tell me what students did in clinical 2 practice? 3 CI: All of them are passive when doing practice in the Doing everything in 4 hospital, whereas not all nurses take care of them. Nurses group 5 did not care if students understand or not, 6 moreover they always working in group. 7 CI: In reality they are passive and many times students Passive 8 can not give proof to clinical instructor about their 9 activities in hospital. 10 R: What do you think about the clinical practice? 11 CI: There is no appropriate planning on what students Unclear clinical 12 do and expect to accomplish in clinical practice. objectives 13 CI: There is lack of coordination between clinical field Lack coordination 14 and school of nursing, teacher only comes twice—at 15 the beginning and the end of clinical practice. 16 R: Do you think second year students are “more 17 active” in clinical practice compared to three 18 months before? 19 CI: . . . is still the same, they are only waiting for orders
and Waiting for orders
20 many time they come late and go home early. These is 21 my observation recently. 22 CI: . . . they do not have initiative and after finishing the Do not ask questions 23 procedures they never ask any questions 24 CI: I have seen them still inactive and they have less Less curiosity 25 curiosity, even though they have already been given tasks 26 such as in laboratory, they only do the task and do not 27 have curiosity about other units In addressing the research question regarding the students’ clinical activities in
clinical settings, three categories emerged from open coding of data from clinical
instructors in the control group. Two categories emerged from the clinical
instructors’ perceptions of clinical practice before the EIP: ‘lack of self-confidence’,
and ‘lack of planning’. One category emerged from clinical instructors’ perceptions
of clinical practice after the EIP: ‘lack of initiative’. Category development from
clinical instructors in the control group is presented in Table 7.8.
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Table 7.8: Category development from control group clinical instructors
Category Subcategory Before intervention Lack of self-confidence • Doing everything in group • Passive Lack of planning • Unclear clinical objectives • Lack of coordination After intervention Lack of initiative • Waiting for orders • Do not ask questions • Less curiosity The category of ‘lack of self-confidence’ and the two subcategories highlighted that
clinical instructors had their views of students in doing their clinical activities as
lacking in self-confidence. The following statements give examples of the two ways
in which clinical instructors viewed students’ clinical activities as ‘lacking in self-
confidence’.
Doing everything in groups
One clinical instructor highlighted this by stating:
“They always work in groups when doing practice in the hospital.”
Passive
The following clinical instructor statement highlights this subcategory:
“In reality, students are passive and many times they cannot give proof to clinical instructor about their activities in hospital.”
Another clinical instructor supported this by stating:
“All of them are passive when doing practice in the hospital, whereas not all nurses take care of them.”
The category of ‘lack of planning’ and the two subcategories highlighted that clinical
instructors viewed student clinical activities as lacking preparation. The following
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statements give examples of the two ways in which clinical instructors viewed
students’ clinical activities as having ‘lack of planning’.
Unclear clinical objectives
This subcategory was identified by the following example;
“There is no appropriate planning as to what students do or what they are expected to accomplish in clinical practice.”
Lacking of coordination
One clinical instructor stated:
“There is a lack of coordination between the clinical field and school of nursing, the teacher only came twice, at the beginning and at the end of clinical practice.”
The category of ‘lack of initiative’ and the three subcategories highlighted that
clinical instructors in the control group had their views of students doing their
clinical activities as still inactive. The following statements give examples of the
three ways in which clinical instructors viewed students’ activities in clinical settings
as ‘lacking in initiative’.
Waiting for orders
For this subcategory a clinical instructor stated:
“ . . . is still the same, they are only waiting for orders from nurses and many times they come late and go home early. This is my observation recently.”
Do not ask questions
One clinical instructor confirmed this subcategory by stating:
“They do not have initiative and after they finish the procedures they never ask any questions.”
Less curiosity
This subcategory was identifying by the following clinical instructor’s statement:
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“I have seen them still inactive and they have less curiosity, even though they have already been given tasks such as in laboratory, they only do the task and do not have any curiosity about other unit.”
7.4.2 Clinical instructors from the intervention group
Data from clinical instructors from intervention group were analysed for themes
using the same process as the clinical instructors’ FGD from the control group. The
coding process is exemplified by the following data in Table 7.9.
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Table 7.9: Themes development from clinical instructor in intervention group Line FGD Transcript Open coding 1 R: Can you tell me what students did in clinical 2 practice? 3 CI: They do not have self-confidence to communicate Doing everything in 4 with patients, they were confused and did everything group 5 in groups 6 CI: They always wait for us to give orders, whereas we are Passive 7 very busy caring for the patients. 8 R: What do you think about the clinical practice? 9 CI: There is no evidence that students can do the skill Unclear clinical 10 and clinical objective is unclear. objectives 11 CI: The clinical practice is uncoordinated even though Lack coordination 12 the distance between hospital and nursing school is 13 very close but the nursing school staff never come to 14 the hospital to monitor whether the students practice 15 or not 16 R: Do you think second year students are “more 17 active” in clinical practice compared to three 18 months before? 19 CI: They are more active than before. They have more Ready for practice 20 confidence and curiosity to do the skills, when I guided 21 them they were more ready. I thought they got both 22 theory and practice beforehand in the laboratory 23 CI: Obviously they have clinical practice goals and Have clinical 24 they can articulate clearly the competencies they are objectives 25 looking for. 26 CI: Students are more active in wanting to accomplish Actively accomplishes 27 the competencies they should get in clinical practice the skills 28 CI: It is easy to discuss things with them; we can Teaching becomes 29 exchange opinions and knowledge. Teaching more interesting 30 becomes more interesting and worthwhile, both of us are 31 ready for collaboration 32 CI: . . . because they asked many questions we got Increased motivation 33 many ideas, and we came to know what we did not 34 know, or we know only partly, so that I have motivation 35 to improve my knowledge and to learn more deeply. 36 CI: It is easier to guide them in clinical practice Reduced burden 37 because their participation is high, they have self 38 confidence so that I do not need to direct them over 39 and over so clinical teaching becomes more interesting 40 CI: There is an interaction between students and Increased interaction 41 tutors. Sometimes they know the knowledge earlier 42 and we discussed it. 43 CI: They were more creative and want to practice all Good learning 44 things. They feel free and asked many questions, with environment 45 students like this I felt more enthusiasm to direct them 46 and it challenges me to read more to improve my 47 knowledge In addressing the research question of the students’ clinical activities in clinical
settings, five categories emerged from the open coding of data from clinical
instructors in the intervention group. Two categories emerged from clinical
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instructors’ perceptions of clinical practice before the EIP: ‘lack of self-confidence’,
and ‘lack of planning’. Three categories emerged from clinical instructors’
perception of clinical practice after the EIP: ‘confidence working alone’, ‘enhancing
job satisfaction’, and ‘improve clinical teaching’. Category development from
clinical instructors in the intervention group is shown in Table 7.10.
Table 7.10: Category development from intervention group clinical instructors
Category Subcategory Before intervention Lack of self-confidence • Doing everything in groups • Passive Lack of planning • Unclear clinical objectives • Lack of coordination After intervention Confidence working alone • Ready for practice
• Have clinical objectives • Actively accomplish the skills
Enhancing job satisfaction • Teaching becomes more interesting • Increased motivation • Reduced burden
Improve clinical teaching • Increased interaction • Good learning environment The category of ‘lack of self-confidence’ and the two subcategories highlighted that
clinical instructors viewed students in clinical practice as working with less
confidence and being inactive. The following statements give examples of the two
ways in which clinical instructors viewed students’ clinical activities as ‘lacking in
self-confidence’.
Doing everything in groups
One clinical instructor highlighted this by stating:
“They always practice in groups, one student does the skills and other watches him/her.”
Another clinical instructor agreed and stated:
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“ . . . it seems likely that the preparation of clinical practice either in theory or practice is inadequate. Students seem to lack self-confidence and feel uncertain about doing nursing tasks, and they always work in groups.”
Passive
The following clinical instructor statement highlighted this subcategory:
“They are always passive and wait for us to give orders, whereas we are very busy caring for the patients.”
Another clinical instructor agreed and stated:
“ . . . it’s always the case that it’s the nurses who always actively ask them, whereas the students are still passive.”
The category of ‘lack of planning’ and the two subcategories highlighted that clinical
instructors viewed student clinical activities as lacking in preparation. The following
statements giving examples of the two ways in which clinical instructors viewed
students’ clinical activities as ‘lack of planning’.
Unclear clinical objectives
This subcategory was identified by the following example;
“Their activities are not arranged properly because there are no guidelines for clinical learning so they only follow routine activities in the wards.”
One clinical instructor supported this by stating:
“Students doing practice in our ward just do routine tasks, such as when they come they read the ward report, and there is no clear concept of what they want to learn or to do in clinical practice.”
Lack of coordination
One clinical instructor confirmed this subcategory by stating:
“The clinical practice is uncoordinated even though the distance between hospital and nursing school is very close, but the nursing school staff never come to the hospital to monitor whether the students are practising or not.”
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These categories expressed the students’ activities before intervention. The
category of ‘confidence working alone’ and the three subcategories highlighted
that clinical instructors in the intervention group had changed their views of
student clinical activities after the intervention as something that students did
confidently working alone. The following statements give examples of the three
ways in which clinical instructor viewed students as ‘confident working alone’.
Ready for practice
For this subcategory a clinical instructor stated:
“ . . . there is really a change in clinical practice, they are more confident to do nursing intervention under guidance such as inserting drips, calculating medicine doses, and giving injections to clients.”
The following clinical instructor statement highlights this subcategory:
.” . . . they did nursing interventions in groups, and they just used to hang around, but now they have confidence to do nursing interventions alone; if they have spare time they read patient reports and also they go to patient’s room to communicate, something that they did not have the confidence to do before.”
Have clinical objectives
This subcategory was identified by the following example:
“Obviously they have clinical practice goals and they can articulate clearly the competencies they are looking for.”
Actively accomplish the skills
One clinical instructor confirmed this subcategory by stating:
“Students are more active in wanting to accomplish the competencies they should get in clinical practice”
The category of ‘enhancing job satisfaction’ and the three subcategories highlighted
that clinical instructors had changed their views of student clinical activities after
intervention. They viewed the students as being more active, which had an impact on
their clinical teaching workload and their professional development. The following
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statements give examples of the three ways in which clinical instructors viewed the
clinical teaching activity as ‘enhancing job satisfaction’.
Teaching becomes more interesting
This was highlighted by one clinical instructor who stated:
“ . . . because students are more active and they asked many questions, tutors know what students prefer to learn in clinical practice; it is easy to discuss things with them, there is an interaction between students and tutors. Teaching becomes more interesting and worthwhile; both of us are ready for collaboration.”
Another clinical instructor stated:
“It is easier to guide them in clinical practice because their participation is high; they have self-confidence so that I do not need to direct them over and over so clinical teaching become stimulating.”
Reduced burden
One clinical instructor stated:
“ . . . the implication of students being more active is to make it easier for me to guide them in clinical practice, because their participation is high and they have self-confidence. Maybe they have read the theory beforehand and prepared in the laboratory or library, such as I saw from second-year student performance at a recent clinical practice.”
Another clinical instructor supported this by identifying:
“Actually with students being more active it is not a burden for us; on the contrary it is makes our workload lighter. For example, in the Emergency Department when a patient comes in, the students ask what and how things are to be done, the tutor gives directions, and they do it.”
Increased motivation
This subcategory was identified by the following example:
“They asked many questions and we got many ideas, and we came to know what we did not know, or we know only partly, so that I have motivation to improve my knowledge and to learn more deeply.”
The category of ‘improved clinical teaching’ and the two subcategories highlighted
that clinical instructors had changed their views of student clinical activities after the
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intervention and their views of students being ‘more active’ had a good impact on
clinical teaching/learning. The following statements give examples of the three ways
in which clinical instructors viewed the clinical teaching activity as ‘improved
clinical teaching’.
Increased interaction
For this subcategory a clinical instructor stated:
“There is an interaction between students and tutors. Sometimes they know the knowledge earlier and we discuss it.”
Good learning environment
This subcategory was identified by the following clinical instructor statement:
“They were more creative and wanted to practise all things. They feel free and asked many questions; with students like this I felt more enthusiasm to direct them and it challenges me to read more to improve my knowledge.”
7.5 Summary
This chapter presented the qualitative findings from FGDs for both students and
clinical instructors. Data analysis was outlined and theme and category development
was presented with quotes to support each category. The FGDs revealed that
perceptions of students’ in the intervention group changed during the EIP, compared
to the students in the control group. Increased self-confidence, incremental learning,
and having direction in learning were identified as benefits of SDL. Knowledge and
skills in SDL, learning materials and communication were identified as important
issues that needed to be improved. Clinical instructors’ perceptions of students’
clinical activities confirmed that students in the intervention group were ‘more
active’ compared to the control group who were considered to be ‘still inactive’. The
following chapter outlines the discussion and recommendations.
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CHAPTER EIGHT
DISCUSSION AND RECOMMENDATIONS
8.0 Introduction
Getting a new idea adopted, even when it has obvious advantages, is often very difficult. Many innovations require a lengthy of period, often of many years, from the time they become available to the time they are widely adopted. Therefore, a common problem for many individuals and organisations is how to speed up the rate of diffusion of an innovation. Rogers (1994, p.1)
The previous two chapters have outlined the results from the quantitative and
qualitative data related to self-directed learning readiness collected prior to, and
following, an educational intervention. Levels of nursing students’ readiness for self-
directed learning (SDL) in the sample collected prior to the educational program, as
measured by self-directed learning readiness scale (SDLRS) developed by
Guglielmino (1978), were: 64% in the ‘below average’ range; 32% in the ‘average
range’ and only 4% in the ‘above average’; there were no students in the ‘high’
range. This result was similar to those of pilot study, 78% ‘below average’, 20% of
students in the ‘average’, 2% ‘above average’ and also no students scoring in the
‘high’ range for SDL. Therefore, the data collected prior to the intervention program
confirmed low levels of readiness for SDL and confirmed the traditional teacher-
centred approach in Indonesia.
The introduction of SDL concepts through an educational intervention program (EIP)
improved the level of readiness for SDL in the intervention group from ‘below
average’ to ‘average’ compared to the control group who remained in the ‘below
average’ range. Group and gender variables contributed significantly to the
prediction of readiness for SDL. The intervention group’s perceptions of SDL
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changed during the EIP from SDL as ‘learning alone without help’ to ‘process of
learning based on individual initiative, with or without help’. Increased self-
confidence, incremental learning, increased motivation to learn and having direction
in learning were identified through focus group discussion (FGD) as benefits of SDL.
Knowledge and skills in SDL, learning materials and communication were identified
as important issues that needed to be improved. Clinical Instructors’ perceptions of
students’ clinical activities supported the change in students and confirmed that
students in the intervention group were ‘more active’ compared to the control group
who were ‘still inactive’. Overall, the results from the study confirmed the expected
effect of the EIP on students’ SDL readiness.
This study is the first of its kind to examine an intervention to improve nursing
students’ readiness for SDL in Indonesia. This final chapter discusses the outcomes
of the study and the factors which contribute to the readiness for SDL in nursing
students. The findings will be examined in relation to contemporary literature on
readiness for SDL. The results of the quantitative data are discussed first followed by
those from the qualitative data according to the research questions examined.
Limitations of the study are then discussed. The chapter concludes with a discussion
of implications and recommendations for research and nursing education.
8.1 Research Question One
• What were students’ levels of readiness for self-directed learning (SDL)
before the educational intervention as measured by the Self-Directed Learning
Readiness Scale?
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Hypothesis 1: The students’ level of readiness for SDL as measured by SDLRS
before the educational intervention would be lower than established group norms
(Guglielmino, 1978).
The self-directed learning readiness scale (SDLRS) scores for this study, before the
educational intervention program were lower than the scores reported by
Guglielmino (1978) when SDLRS was established 27 years ago. The majority of
students’ readiness for SDL was found to be ‘below average’ (64%) and no students
scored in the ‘high’ range for SDL. The students’ mean SDL score was significantly
different from the established norms (Guglielmino, 1978). The studies that were the
basis for the norms involved participants from a developed country (USA) in which
the cultural and educational system are different and learning resources are not a
problem. The present study used second-year nursing students from a relatively rural
area in a developing country, Indonesia.
The mean scores from the study were also lower than other studies in Indonesia
(Darmayanti, 1994) and other countries—such as with undergraduate students in
Australia (Delahaye & Choy, 2000) and Ireland (McCauley & McClelland, 2004).
The lowest score in the current study was also lower than that noted in the
Indonesian study (Darmayanti, 1994). In addition to having significantly lower
SDLRS scores than normative data (based on the USA students), the students in the
current study also had lower scores than studies in Australia, Ireland and Indonesia.
The overall lower scores of readiness for SDL may reflect the educational and
cultural background of the participants. To understand why, it is necessary to
consider the cultural and educational system in Central Kalimantan and Indonesia.
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Despite the extraordinary pace of modernisation, the phenomenon of human
communication in education through the oral tradition is still strongly held in Central
Kalimantan and Indonesia. Traditional beliefs and expectations in Indonesia
regarding learning have placed the teacher in the roles of content expert and authority
figure. Students have not been given many opportunities to assess their personal
needs as a basis for learning; the students usually expect the teacher to be an
authority on whatever topic matter is being discussed. According to Dunbar (1991),
the strong tradition of oral communication in Indonesia has created a popular
perception that learning is a relationship with a teacher that is oral and hierarchical.
The dynamics of the relationship are usually described as learning as a passive
activity, whereas teaching is active. Furthermore, Dunbar says acquisition of
knowledge and development of skills and techniques in Indonesia are seen to be
passive replications of what a teacher does and says, leading to the widespread use of
rote learning to pass semester examinations from primary school through to
undergraduate programs. This perception is still present today in nursing students in
Central Kalimantan, as reported by the Sister School Project (2002) (see Chapter
One).
Teacher-centred methods have dominated Indonesian nursing education. Indonesian
nursing students focus their efforts on passing examinations and passively submit to
the authority and direction of their teachers. The students are acculturated to believe
they are not empowered to teach themselves and create meaning through independent
cognitive effort. Teachers speak their knowledge and students take notes, often
verbatim, as they are used to traditional teaching approaches. Furthermore, the
students view learning activities using various resources outside the classroom as a
waste of time because they believe the learning may not be optimal or correct.
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In Indonesia or Central Kalimantan, most teachers in nursing education can
communicate only in the official language (Indonesian) of the country and therefore,
to explore professional innovations in nursing education outside Indonesia depends
on information being available through translation. This influences the diploma
nursing education courses, specifically in Central Kalimantan, to still use traditional
approaches. It is assumed that the reason why teachers and students in Central
Kalimantan not using SDL methods is that they have not been introduced to, or
prepared for, SDL.
Confessore (1991) states that some students have a low level of readiness for SDL
because they have consistently been exposed to “other-directed” instruction [teacher-
centred approaches]. The findings of the current study seem to support Confessore’s
views as the educational system used in all nursing schools in Indonesia involves
teacher-centred approaches. Furthermore, the nursing students had graduated from
high schools in Indonesia, which also use teacher-centred approaches.
The real situation in the nursing schools in Central Kalimantan may have influenced
how nursing students interpreted the questions. For example, one question, ‘I think
libraries are boring places’, was likely to be influenced by their experience of the
libraries, which have only a small number of books, the majority of which are out of
date and not relevant to course content, limited chairs and tables, limited lighting,
and no air conditioning in a hot equatorial climate. It is therefore understandable if
the majority of students gave a high rating to the statement regarding the library
being a boring place, leading to a low score on that question. According to Dunbar
(1991) there is no pressing need in Indonesia for serious reading, and the skill of
writing is not fostered in teacher–centred methods. For most students, there is no
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need to express ideas, observations, or opinions in an extended literacy form. This is
a possible reason why the nursing schools pay less attention to the development of
their own libraries.
This situation is different in countries where the original SDLRS was developed
(USA). The libraries in countries such as Australia, United Kingdom, Canada and
USA are likely to have a much richer and broader collection of recent journals, books
and other learning materials than is available in the school or university libraries in
Indonesia or Central Kalimantan. Furthermore, the SDL model in western culture
assumes that students are capable of independent learning behaviours and tha, on
entry, they are psychologically prepared for the personal demands imposed by a
teacher-independent, self-study regime (Guglielmino & Guglielmino, 1991).
However, Indonesian learners are acculturated from primary school to avoid
behaviours or statements that may be interpreted by others to be expressions of
personal autonomy (Dunbar, 1991).
Prior to the study the students appeared to have an understanding that confirmed
Dunbar’s (1991) views about Indonesia: that learning is a passive activity and
teaching is active. This was also indicated by the students who were passive in their
learning and waiting to be taught by their teachers. These data confirmed the
hypothesis that students’ readiness for SDL as measured by SDLRS before the
educational intervention would be lower than established group norms (Guglielmino,
1978).
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8.2 Research Question Two
• Was there a difference in students’ readiness scores for SDL between the
intervention and control groups at pre-test?
Hypothesis 2: There would be no significant difference between the intervention and
control group SDLRS scores at pre-test.
It was assumed that there would be no significant difference in pre-test scores
between the intervention and control group as they came from the same population,
and use the same educational system and curriculum. Furthermore, human resources,
funding and size of these schools were similar. Demographic variables of these two
groups including gender, age, birth order, father’s educational background and
mother’s educational background were checked and no significant differences were
found.
Despite having randomly assigned the two schools to either intervention or control
group, there was a significant difference in SDL readiness scores prior to
commencing the EIP. The mean SDLRS score was higher in the control group than
in the intervention group. More students in the control group scored in the average
and above average range than in the intervention group (46% vs 24%).
To understand this difference, it is necessary to examine the external factors
influencing readiness for SDL in both intervention and control groups. As noted
previously, the library is a very important learning resource for SDL. The library, in
terms of number of books and opening hours, was better in the control group than in
the intervention group. Another explanation could be that “homework”, often used as
a traditional method of SDL in Indonesia, was used more in the control group than in
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the intervention group. However, this traditional method of SDL is not systematically
used in teaching/learning and is only used as a substitute for face-to-face lectures.
The homework method is often used by medical doctors who teach tropical diseases
topics. At times when they are very busy with patients in hospital or out-patient
clinics, they cannot attend classes to teach so they give learning materials to the
subject coordinator and asked students to copy and read the learning materials. The
doctors would then explain the reading materials in the next lectures. This situation
was more likely to occur in the control group than the intervention group.
As the pre-test scores were significantly different between intervention and control
group it was considered necessary to control for pre-test SDLRS scores. Therefore,
the pre-test scores for each participant were used as co-variates in data analysis. The
different SDLRS scores between intervention and control groups did not support the
hypothesis that pre-test scores between the groups would not differ.
8.3 Research Question Three
• Was there a difference in students’ readiness scores for SDL following the
educational intervention?
Hypothesis 3: Self-directed learning readiness scores of students who participated in
the educational intervention program over fourteen weeks would be significantly
increased compared to scores of students who did not participate.
The educational intervention program (EIP) was designed to introduce the concept of
SDL and to facilitate students to increase their understanding of the concepts and
basic skills of SDL. Given the low level of readiness for SDL, the different cultural
and educational system, and the many constraints in nursing education—such as
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limited teaching and learning materials and limited books in the library—it was
reasonable to aim for Stage 2 as an optimal goal for students in the study. Stage 2 of
the SSDL model is the stage in which students have moderate self-direction.
The effect of the EIP was supported by the significant increases in readiness for SDL
in the intervention group following implementation of the education program. The
results of this study indicate that, after controlling for pre-test differences, the mean
readiness scores of the intervention group improved compared to the control group.
The change in the intervention group by only one category (e.g. from ‘below
average’ range to ‘average’ range) was expected, given the low base that the students
had at the commencement of the study.
According to Grow (1991), the important movement implicit in the SSDL model is
the movement from dependent to self-directed learning. The EIP involved changes in
thinking and behaviour in learning for second-year nursing students in the
intervention group. Given the low level of readiness for SDL, it was considered a
realistic goal to move students from Stage 1, dependent learner, to Stage 2, motivated
learner. In doing this, it was very clear that it was not possible to just pick up the
SDL approach from western culture and introduce SDL in a western way. The study
confirmed that it is really important to select elements of SDL, to introduce those
elements and then to work incrementally on those elements to see how they are
working. For the current study, SDL was introduced through a classroom setting and
a teacher-centred approach. The EIP introduced selected elements that would fit
within the culture and background of students and the nursing schools in Central
Kalimantan. This study was designed to introduce the innovation by melding Grow’s
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(1991) and D’A Slevin and Lavery’s (1991) ideas with the culture of nursing
education in Central Kalimantan.
In addition, the EIP was designed to incrementally move the students through the
early stages of SDL. The strategies used in the EIP were selected relevant to the
stages of SDL that were being targeted in the EIP. According to Grow (1991), as the
students in Stage 2 of SSDL are interested learners, it was important in this stage to
introduce students to the basic skills of SDL, such as goal setting. Based on this
assumption, this study was designed to focus only on two stages of SDL: Stage 1 and
Stage 2. The reason not to include Stage 3 and Stage 4 of Grow’s SSDL model was
because in Stage 3 students are involved learners (learners of intermediate self-
direction), and in Stage 4 they are learners of high self-direction with the capability
to plan, complete and evaluate their own learning with or without the help of an
expert/teacher. According to Grow (1991) fully self-directed learning is not possible
in an institutional setting due to statutory educational regulations and time
constraints. Because of time and cost constraints of this study, as well as many
constraints in nursing education, such as limited teaching and learning materials and
limited books in the library, it was reasonable to aim for Stage 2 as an optimal goal
for these students. Stage 2 of SSDL model is the stage in which students have
moderate self-direction.
8.4 Research Question Four
• What factors contributed to students’ readiness for SDL?
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Hypothesis 4: Variables such as group (intervention–control), gender, birth order,
father’s educational background and mother’s educational background would
significantly contribute to students’ readiness for SDL.
From the five variables that were examined as potential influencing factors on
students’ readiness for SDL, two contributed significantly to the prediction of
readiness. These were group (intervention–control) and gender. Students who were
in the intervention group and were female were more likely to report higher SDL
readiness.
Several explanations may explain why female students had higher readiness for SDL
than male students. As the nursing area is dominated by female students, and the
nursing school is not the first choice for male students in Indonesia, it may influence
male students in responding to SDL readiness. The male students may not be highly
motivated to study nursing in the first place and therefore may be less likely to want
to be self-directed in their studies. Another explanation could be the different
learning styles between female and male students. Price (1978), states that male
students prefer a more unstructured design than female students. Using learning
plans, as suggested by Knowles (1986), might be an example of a learning strategy
that would be preferred by those who have a structured learning style. Since the
study used learning plans to develop readiness for SDL, this strategy may have
worked better for female students than male students. However, more research is
needed to clarify this assumption. Many studies have reported that female students
had higher SDLRS scores compared to their male counterparts (Darmayanti, 1994;
Guglielmino, 1978), however these studies did not report the reason for the
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differences and no study has been found in the literature that has examined this
difference.
The other three factors that were assumed to influence readiness for SDL in nursing
students in Central Kalimantan included birth order, father’s educational background
and mother’ educational background. These factors did not influence students’
readiness for SDL and the possible reasons are outlined below.
Birth order is a unique value in Indonesian culture, specifically in Central
Kalimantan. Traditional beliefs and expectations in Indonesia regarding the first-born
child have placed the first-born child in the role of authority figure for their little
sisters or brothers. First-born children learn from their early childhood to have
responsibility and that they should be a good role model for their sisters and brothers.
Their parents place great pressures on them to succeed, in both education and career
no matter what their gender is. In Central Kalimantan, the importance of a first-born
child has created a new attribute for their parents. For example, when a married
couple have not yet had their first-born child, they may be called by their given name
in informal daily communication. After their first child is born the parents are
identified by their first-born child’s name. For instance, if the child’s name is
‘Katrina’ the father is known as ‘Bapa Katrina’ (Katrina’s father), and so the mother
is known as ‘Mama Katrina’ (Katrina’s mother).
Considering the unique aspects of the first-born child in Central Kalimantan culture
it was assumed the birth order might influence readiness for SDL. This assumption
was based on the characteristics and attributes of control and authority that are given
to first-born order. Control is identified as an important variable in SDL. However,
this assumption was not supported in this study as first-born order did not influence
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the readiness for SDL. The possible explanation for this finding is that the first-born
child may obey their parents and do whatever their parents ask them, rather than
taking their individual initiative, especially in learning. Therefore, it appears that any
control and authority given to first-born students did not carry over into their learning
process and that, like the other students, they were more comfortable with the teacher
as the authority figure directing their learning.
The role of father and mother in Indonesian culture are unique compared to western
culture. Traditional beliefs and expectations in Indonesia regarding parents’ roles
have placed the parents (father and mother) in the roles of authority figures. The
culture has shaped how children behave towards their parents. The children should
respect and obey their parents and the parents have the responsibility to educate their
children as well as possible. The responsibility for funding will end when the child
gets married or gets a job. Considering the unique aspect of the relationship between
parents and children in Indonesian culture it was assumed that the parents’
educational background would influence readiness of SDL. However, the results of
the study did not support this assumption. The father and mother’s educational
background did not influence the readiness for SDL in their children. It is difficult to
compare and contrast this finding as this is unique for Indonesia because of the
specific culture. Moreover, no study on these topic areas has been found in
Indonesia. More studies are needed in these topic areas in the future to develop more
understanding and to add to the body of knowledge.
8.5 Research Question Five
• What were the students’ perceptions of SDL before and after the educational
intervention?
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The focus group discussion (FGD) prior to commencement of the study revealed that
students from both the intervention and control groups had similar perceptions of
SDL. They had a limited view of SDL and perceived SDL as a ‘self-activity’ without
direction from their teachers. They also viewed SDL as learning alone without help,
similar to distance learning, with no class and no teacher guidance. In addition, they
viewed the purpose of SDL as an activity to prepare for tests. This view seems to
support Dunbar’s views (1991) that Indonesian students focus their learning efforts
to pass tests. The students also viewed SDL as having consequences, including
teacher inactivity.
The students were concerned about the impact of SDL: if the teachers did not teach
in the classroom then probably the teacher would not teach them and what could the
students do? Again this perception seems to support Dunbar’s (1991) statement that
teaching is active and learning is a passive activity. These views, which were
expressed before the study commenced, indicated that the nursing students in Central
Kalimantan had a limited view of SDL and were concerned about its impact.
However, the FGD data from the intervention group after the EIP revealed that the
perceptions of SDL of students in the intervention group changed during the EIP,
compared to students in the control group. The control group perceptions of SDL
were the same as pre-intervention. The students’ perceptions still focused on self-
activity and consequences. The students were also concerned about the results of
SDL activities. They believed the results of SDL activities would not be optimal or
correct compared to teacher-centred methods. This is understandable because the
students do not have a comprehensive understanding of SDL and they were used to
teacher-centred methods and had never been exposed to SDL approaches. Another
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consequence that concerned students in the control group was ‘increased laziness’ to
attend lectures and ‘difficulty to change’ learning habits. They appeared to have
some understanding of the shift away from teacher-centeredness that may make them
less respectful to their teachers. These views, which were expressed after the study
had finished, indicated that the students in the control group still had limited views of
SDL and were concerned about its effects.
The analysis of the intervention group data revealed that students had different
perceptions of SDL after the EIP. The students’ perceptions about SDL had changed
from self-activity based on learning alone without help from others, to a process of
learning based on individual initiative, with or without help from others. The
intervention students’ perceptions focused on three areas: ‘process of learning’,
‘advantages’ of SDL’ and ‘areas needing improvement’. It seems that they had a
tendency to see learning changes as challenges to improve, rather than as problems.
Increased self-confidence, incremental learning, increased motivation, and having
direction in learning were identified as benefits of SDL by students in the
intervention group. These students identified issues that needed to be improved that
included knowledge and skills in SDL, learning materials and communication. The
views expressed after the EIP indicated that the students in the intervention group
had changed their views of SDL. They appeared to have some understanding that the
shift away from teacher-centred approaches would improve their self-confidence and
increase their motivation for learning. It can be assumed that the changes in the
intervention group were a result of the EIP. The students had an understanding and
basic skills for SDL. Furthermore, they experienced the SDL process in their
teaching/learning for 14 weeks as proposed by Grow’s (1991) SSDL model, this
aimed to move students from dependent to the early stage of self-directed learners.
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8.6 Research Question Six
• What were clinical instructors’ perceptions of students’ clinical activities
during the educational intervention period?
When the clinical instructors were asked about their perceptions of students’ clinical
activities before the intervention program, they perceived them as ‘lacking in self-
confidence’ and ‘lacking in planning’. They indicated that the students always did
their clinical activities in groups as evidence of lack of self-confidence. In addition,
they viewed the students’ clinical activities as lacking in planning. It is interesting to
note that clinical instructors from both intervention and control groups had similar
perceptions of students’ clinical activities.
The post-intervention data for the clinical instructors from the intervention group was
different because the students were doing different activities. The FGD data from the
clinical instructors in the intervention group revealed that the clinical instructors’
perceptions of students’ clinical activities in the intervention group changed during
the EIP compared to those of the clinical instructors from the control group. The
perceptions’ of the clinical instructors from the control group were the same as
occurred before the intervention. Clinical instructors in the control group still
perceived students as being inactive when doing their clinical practice.
The FGD data from the clinical instructors in the intervention group revealed that
clinical instructors had different perceptions of students’ clinical activities after the
EIP. The clinical instructors’ perceptions about students in doing their clinical
activities were: ‘confident working alone’, ‘enhancing job satisfaction’, and
‘improved clinical teaching’. Clinical instructors perceived that students in the
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intervention group were ‘more active’ than before the intervention. It seems that the
students had a tendency to work alone more than in groups. This is consistent with
what the students said about their self-confidence improving. Furthermore, the
clinical instructors believed students were more active in facing challenges to
improve their professional development, rather than as a burden. They also identified
that working with students who are more active would improve their clinical
teaching, as the interaction between the students and the clinical instructors increased
and this raised many discussions between them. The clinical instructors’ views
expressed after the EIP indicated that the clinical instructors in intervention group
had changed their views of student activities in the clinical setting. They appeared to
have some understanding that the students who were ‘more active’ had a good
impact on their job and their professional development. Clinical instructors’
perceptions of students’ clinical activities confirmed that students in the intervention
group were ‘more active’ compared to those in the control group who were
considered to be ‘still inactive’. The clinical instructor’ perceptions of the students
being “more active” and “more confidence working alone” support that the students
were taking more personal responsibility for their learning. The changes in students’
behaviour indicate that they had embraced the concepts of SDL and were trying to be
more active and self directed in their learning.
8.7 Limitations of the study
The findings of the study need to be interpreted after due consideration of the
following limitations. The study was conducted in two schools in Central
Kalimantan, Indonesia. The schools chosen for this study might not adequately
represent the population of second-year nursing students in Indonesia as the majority
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of diploma nursing schools are on Java and Sumatra islands, which are more
developed areas compared to Central Kalimantan. Moreover, since the participants
were not selected randomly, there was a potential selection bias, so the results of the
study may only be generalised to a limited population of nursing schools in
Indonesia. However, the study participants are representative of nursing students in
Central Kalimantan.
This could not be blinded study as both the intervention and control group were fully
aware of their participation in the study and this may have introduced bias to the
results. Another limitation of the study was that the researcher personally conducted
the majority of the intervention and this may have introduced investigator bias. A
further limitation was the nature of the SDL activities in the clinical component. The
students in the intervention group were facilitated by three staff whereas the students
in the control group were facilitated by one staff member. Access to more clinical
facilitators may have encouraged the students in the intervention group to ask more
questions and to seek clarification more often. This access to more facilitators may
have influenced the students learning outcomes.
The instrument (SDLRS) used in this study was selected as relevant to the present
study and it has also generally been reported to have a high reliability and validity in
previous studies. Although it has been tested and widely used in western countries
and the items of the SDLRS can be applied to most students, some of the findings
may have been influenced by demographic features, including cultural differences
relevant to the Indonesian population. There may be variations between the present
study population and the population where the instruments have previously been
developed and tested.
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A pilot test was conducted before the main study and the SDLRS results were lower
compared to those of previous studies in Indonesia or other countries. This may be
related to the different characteristics of participants within this study and the
previous Indonesian study, where the participants in the latter were mature students
compared to the pilot study participants, who were high school graduates. No other
studies were found similar to the present study. It was therefore difficult to compare
and contrast the results of the present study with those of previous studies and the
replication of this study to other settings in Indonesia is needed.
The length of the study was not sufficient to enable students to move to a higher
level of SDL readiness as proposed by the SSDL framework (Grow, 1991). Further
education for students and teachers/clinical instructors, as well as more learning
resources, will be needed to systematically integrate SDL concepts across the whole
curriculum. Therefore, a longitudinal study is needed as SDL is introduced into
nursing schools in Central Kalimantan. In the current study it was not possible to
examine the students’ end of semester examination results because different
assessment techniques were used between intervention and control groups. In the
future studies it may be beneficial to examine the outcomes of any experiential
activities in term of students’ grades in end of semester examinations.
8.8 Implications
This study makes a significant contribution to nursing education in Indonesia,
specifically in promoting lifelong learning and SDL in nursing students, in curricula
development, and in teaching and learning practices for the following reasons.
Firstly, didactic instruction was replaced with an interactive approach by utilising
SDL strategies and devices to facilitate SDL abilities. It showed that a learning
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environment could be systematically and incrementally implemented to assist
students and teachers to integrate theory and practice. Secondly, the conceptual
framework made it easy to manage a complex concept such as SDL. Thirdly, the EIP
was effective and can be duplicated through other studies. This will enable the
effective development and evaluation of SDL.
The findings of this study also present other implications. The SDLRS, which was
developed by Guglielmino (1978) for the North American culture, can be used
effectively in the Indonesian culture. The findings also contribute to the enrichment
of cross-cultural research related to SDL.
The findings imply that Indonesian nursing education can help students to improve
their readiness for SDL. Nursing education can plan activities to assist students to
develop their knowledge, skills and attitudes to be self-directed learners who are
expected to carry over their skills and behaviour in their nursing career. In planning
activities for SDL, nursing schools should realise the culture, educational system,
and the individual students are different from the education within western systems.
The selection of instructional methods to introduce SDL concepts should meet
students’ needs and nursing school budgets, and then gradually use other strategies.
These findings also indicated that external factors such as nursing curricula, learning
materials, knowledge and skills in SDL, and communication between nursing school
and clinical practice, and between teacher and student are important. Student-centred
approaches need to be further developed, implemented and supported.
This study also makes a significant contribution to nursing practice and global health
practice. The study used methods supported by the Technology Model of
Intervention Fidelity (Santacroce, Maccarelli & Grey, 2004). These methods
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included: manual development; training and supervision; and regular monitoring of
intervention delivery. Santacroce, et al. (2004) state that the use of the Technology
Model of Intervention Fidelity can ultimately advance the development of nursing
intervention research and evidence-based practice.
In general, the EIP improved nursing students’ level of SDL readiness. Ongoing
research is therefore needed for further clarification of the strategy and development
of educational innovations to support students’ efforts to become self-directed
learners. Integration of SDL approaches across the subjects in nursing curricula is
recommended to get the maximum benefit of SDL approaches.
8.9 Recommendations
Based on the results of the present study, recommendations are suggested as follows:
1. Systematic and incremental integration of SDL approaches into the diploma
nursing curriculum can be cost effective for developing countries such as
Indonesia.
2. A longitudinal study is recommended to introduce SDL in nursing education
from first-year to third-year students. The results of this study can help
nursing education staff plan activities to assist students to direct their own
learning, since SDL requires a different approach from the teacher-centred
methods used in traditional teaching/learning interactions.
3. Additional instructional methods for SDL—such as critical thinking and
reflection are recommended to be introduced in the future studies.
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4. Since there is a limited number of studies on the topic of self-directed learning
that have been conducted in nursing education, other studies in this area are
recommended to enable comparison with the current study and to obtain better
understanding of the dynamics of self-directed learning in other nursing
schools. The sample of this study was drawn from two diploma nursing
schools. Further studies are therefore suggested by involving other diploma
nursing schools in other provinces in Indonesia.
5. A comparison of self-directed learning readiness between students at nursing
schools and other conventional diploma programs in Indonesia, such as
nutrition, physiotherapy, and midwifery, is recommended since there has been
no such study. The results of this study might contribute to a more
comprehensive understanding of students’ readiness of SDL from health
diploma programs in Indonesia.
6. Other studies that include variables related to SDL, such as learning style, are
recommended since there has no been such study in an Indonesian culture.
8.10 Conclusion
Overall, the results and findings answered the research questions and were consistent
with the conceptual framework. Some results of this study were also consistent with
those of previous studies. The EIP significantly improved the level of readiness for
SDL in the intervention group compared to the control group. The EIP involved
major changes in thinking and behaviour in learning practice for nursing students.
The outcome of the EIP extended beyond the perspective of nursing students and
included positive perceptions of clinical instructors in the intervention group who
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worked with nursing students in clinical practice. This was encouraging and supports
the EIP’s conceptual framework and the theory of adult learning. Unless the students
start to move from being ‘passive recipients’ to more ‘active participants’, the
nursing students who graduate from Central Kalimantan nursing schools will be left
behind in a rapidly changing health care environment.
It was difficult to compare and contrast the results of the present study directly
because no other similar studies were found. This study provides information about
the impact of the educational intervention program on students’ readiness for self-
directed learning. Although several limitations were found, the students in the
intervention group reported that the EIP had benefits for them. The EIP improved
nursing students’ readiness for SDL and had a positive impact on students’
perceptions of SDL. Introducing the concept of SDL through the EIP was found
acceptable by the sample and was deemed feasible to implement within Indonesian
nursing education.
This chapter has outlined the major findings from the study and drawn conclusions
from the results of the research questions and hypotheses. The study recorded the
level of SDL readiness in Indonesian diploma nursing students before and after an
educational intervention. This provided baseline data for future study comparisons as
the research method incorporated a control group who experienced teacher-centred
approaches and an intervention group who had an educational intervention program
alongside teacher-centred approaches. Implications for nursing education in
Indonesia have been presented, as well as the larger benefits for nursing practice and
global health practice. Recommendations for future research have been outlined,
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including integration of the SDL approaches into the nursing curriculum as well as
replication of the study in other diploma nursing programs.
In conclusion, the study has demonstrated that learning theories can be adapted and
implemented in culturally appropriate ways. Such adaptations can impact on student
learning and prepare students for practice in a complex and rapidly changing health
care system.
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APPENDIX 1 SDLRS-A
Name: ……………………….. Sex: ……….. Birth date: …………………….
Date of testing: …………………….. Location of Testing: …………………...
Questionnaire Instructions: This is a questionnaire designed to gather data on learning preferences and attitude towards learning. After reading each item, please indicate the degree to which you feel that statement is true of you. Please read each choice carefully and circle the number of the response which best expresses your feeling. There is no time limit for the questionnaire. Try not to spend too much time on any one item, however, your first reaction to the question will usually be the most accurate. Responses Items:
Almost never true of me; I hardly ever feel this way.
Not often true of me; I feel this way less than half the time.
Sometimes true of me; I feel this way about half the time.
Usually true of me; I feel this way more than half the time.
Almost always true of me; there are very few times when I don’t feel this way.
1. I’m looking forward to learning as long as I’m living.
1 2 3 4 5
2. I know what I want to learn.
1
2 3 4 5
3. When I see something that I don’t understand, I stay away from it.
1 2 3 4 5
4. If there is something I want to learn, I can figure out a way to learn it.
1 2 3 4 5
5. I love learn. 1 2 3 4 5 6. It takes me a while to get started on new projects.
1
2
3
4
5
7. In a classroom, I expect the teacher to tell all class members exactly what to do at all times.
1 2 3 4 5
8. I believe that thinking about who
1 2 3 4 5
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you are, where you are, and where you are going should be a major part of every person’s education. 9. I don’t work very well on my own.
1 2 3 4 5
10. If I discover a need for information that I don’t have, I know where to go to get it.
1 2 3 4 5
11. I can learn things on my own better than most people.
1 2 3 4 5
12. Even if I have a great idea, I can’t seem to develop a plan for making it work.
1 2 3 4 5
13. In a learning experience, I prefer to take part in deciding what will be learn and how.
1 2 3 4 5
14. Difficult study doesn’t bother me if I’m interested in something.
1 2 3 4 5
15. No one but me is truly responsible for what I learn.
1 2 3 4 5
16. I can tell whether I’m learning something well or not.
1 2 3 4 5
17. There are so many things I want to learn that I wish that there were more hours in a day.
1 2 3 4 5
18. If there is something I have decided to learn, I can find time for it, no matter how busy I am.
1 2 3 4 5
19. Understanding what I read is a problem for me.
1 2 3 4 5
20. If I don’t learn, it’s not my fault.
1
2
3 4 5
21. I know when I need to learn more about something.
1 2 3 4 5
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22. If I can understand something well enough to get a good grade on a test, it doesn’t bother me if I still have questions about it.
1 2 3 4 5
23. I think libraries are boring places.
1 2 3 4 5
24. The people I admire most always learning new things.
1 2 3 4 5
25. I can think of many different ways to learn about a new topic.
1 2 3 4 5
26. I try to relate what I am learning to my long-term goals.
1 2 3 4 5
27. I am capable of learning for myself almost anything I might need to know.
1
2 3
4 5
28. I really enjoy tracking down the answer to a question.
1 2 3 4 5
29. I don’t like dealing with questions where there is not one right answer.
1 2 3 4 5
30. I have a lot of curiosity about things.
1 2 3 4 5
31. I’ll glad when I’m finished learning.
1 2 3 4 5
32. I’m not as interested in learning as some other people seem to be.
1 2 3 4 5
33. I don’t have any problem with basic study skills.
1 2 3 4 5
34. I like to try new things, even if I’m not sure how they will turn out.
1 2 3 4 5
35. I don’t like it when people who really know what they’re doing point out mistake that I am making.
1 2 3 4 5
36. I’m good at thinking of unusual ways to do things.
1 2 3 4 5
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37. I like to think about the future.
1 2 3 4 5
38. I’m better than most people are at trying to find out the things I need to know.
1 2 3 4 5
39. I think of problems as challenges, not stop signs.
1 2 3 4 5
40. I can make myself do what I think I should.
1 2 3 4
5
41. I am happy with the way I investigate problems.
1 2 3 4 5
42. I become a leader in group learning situations.
1 2 3 4 5
43. I enjoy discussing ideas.
1 2 3 4 5
44. I don’t like challenging learning situations.
1
2 3 4 5
45. I have a strong desire to learn new things.
1 2 3 4 5
46. The more I learn, the more exciting the world becomes.
1 2 3 4 5
47. Learning is fun. 1 2 3 4 5 48. It’s better to stick with the learning methods that we know will work instead of always trying new ideas.
1 2 3 4 5
49. I want to learn more so that I can keep growing as a person.
1 2 3 4 5
50. I am responsible for my learning – no one else is.
1 2 3 4 5
51. Learning how to learn is important to me.
1 2 3 4 5
52. I will never be too old to learn new things.
1 2 3 4 5
53. Constant learning is a bore.
1 2 3 4 5
54. Learning is a tool for life.
1 2 3 4 5
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55. I learn several new things on my own each year.
1 2 3 4 5
56. Learning doesn’t make any difference in my life.
1 2 3 4 5
57. I am an effective learner in the classroom and on my own.
1 2 3 4 5
58. Learners are leaders.
1 2 3 4 5
©1977, Lucy. M. Guglielmino
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APPENDIX 2 DEMOGRAPHIC QUESTIONNAIRE
This questionnaire is designed to collect your demographic data. Please read and
answer all questions in this sheet by ticking the most relevant box.
1. School of Nursing: 1. Kuala Kapuas 2. Sampit 2. Name: ………………………………... 3. Gender: 1. Male 2. Female 4. Date of birth: …………………………...
5. First born: 1. Yes 2. No 6. Father’s educational background:
1. ≤ Senior High School
2.≥ Senior High School
7. Mother’s educational background:
1. ≤ Senior High School
2. ≥ Senior High School
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APPENDIX 3 FLUID AND ELECTROLYTE BALANCE (SELF-
DIRECTED LEARNING MODULE)
Introduction to self-directed learning module
Fluid imbalances are very common in Indonesia. Infection and malnutrition are still major
causes of many cases of fluid imbalance especially in children and elderly people. Better
understanding of fluid and electrolyte balance is a foundation for caring for patients with
fluid imbalance. In this module we will lead you through a set of selected readings and
exercises are designed to improve your understanding of fluid and electrolyte balance.
Focus
Throughout this module we focus on fluid imbalance and nursing care for patients with fluid
imbalance.
Aim
The primary aim is to improve the practices of fluid imbalance care through developing
nursing students’ knowledge and its application. The secondary aim of the module is to raise
the quality of care nursing students provide for patients who have fluid imbalance.
Objectives
Upon completion of this module you should be able to:
1. Apply concepts, learned in this module to plan nursing care for patients with fluid
imbalance
2. Recognise the key components of good nursing care plans for patients with fluid
imbalance
3. Demonstrate the ability to systematically evaluate the quality of nursing care for
fluid imbalance patients
4. Recognise the signs and symptoms of fluid imbalance and report them accurately
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5. Recognise transfusion reactions and intervene appropriately when a reaction occur.
Audience
This module is intended for the use of nursing students, or other nurses and health care
workers, who wish to improve their skills in fluid imbalance and thus improve general
wellbeing of people for whom they care. It is expected that the people using the module will
have foundation knowledge in anatomy and physiology in fluid and electrolyte homeostasis.
Limitation of the module
This module has been developed at a time when there has been considerable interest in the
care of patients with fluid imbalances. It is limited, however by the knowledge available at
the time of its development and the practices of fluid and electrolyte imbalance that have
been derived from this knowledge. The module is intended for nursing students, nurses or
other health care workers, who have a basic understanding of fluid function in the body. It
should be read in that context. It will not contain sufficient background information for
novice students nor will it contain highly scientific or technical information that is not the
general province of nurses. For that reason other readings have been suggested in references
in conjunction with the body fluid topic.
How to use this module
This module has been designed to step you through a set of selected reading and exercises
that build on each other and that will improve your general understanding of fluid balance
and care. You can work at a pace that is comfortable for you. There are exercises built into
the module that will help you assess your learning progress. If you unable to complete an
exercise we encourage you to re-read the information that precedes the exercise/s and then
attempt the exercise/s again. It is important to understand each section as you work through
the module to build on those that preceded it. Sufficient informational resources will be
included in the module to allow for its completion.
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Part 1: Foundation science: fluid and electrolyte balance
Fluid and electrolyte imbalance are common problems for many patients in all settings.
Physiological homeostasis is dependent on normal fluid and electrolyte balance. Because any
physiologic derangement can upset fluid and electrolyte balance to some degree, virtually
every patient is at some risk of fluid imbalance. The foundation of science is very important
for nurses in Indonesia to understand the phenomena of fluid imbalance in conjunction with
better quality of nursing cares that they provide for patient with fluid imbalance.
Objectives (Part 1)
When you have completed the readings and associated activities in part 1 of the module, it is
expected that you will be able to:
1. Explain the differences between fluid balance and fluid imbalance;
2. Explain the differences between fluid deficit and fluid excess;
3. Recognise the signs and symptoms of fluid and electrolyte imbalance and report
them accurately;
4. Reflect on your own understanding of fluid imbalance and identify opportunities for
self-improvement in this area.
Toward deeper understanding of fluid balance
Why is deeper understanding of the phenomenon of fluid balance so important? One of the
challenges nurses face is caring for patients who are suffering from fluid imbalance. As a
nurse you are very involved in providing care for patients who are experiencing fluid
imbalance. Given the complex nature of fluid balance it is reasonable to assume that
increasing your understanding of this experience will allow you to improve the quality of
nursing care which your patients receive. The following readings provided a broad overview
of key aspects associated with understanding the function of body fluid. Before you start
these readings, take a moment to think about the reflective questions that follow:
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Reflective question
From your experiences, what is your understanding of the phenomena of fluid balance and
what it means to those who experience fluid imbalance? What are the reasons for your view?
Reading 1.1
Boley, R., Polaski, A. & Porta, D (2001). Anatomy and physiology review: The cell. In J, Black., J, Hawks., & A, Keene. (Eds.), Medical–Surgical Nursing: Clinical management for positive outcomes (pp.206-214). London: W. B. Saunders Company.
Reading 1.2
White, B. (2001). Client with fluid imbalances: Promoting positive outcomes. In J, Black., J, Hawks., & A, Keene. (Eds.), Medical–Surgical Nursing: Clinical management for positive outcomes (pp.215-232). London: W. B. Saunders Company. Reading 1.3.
White, B. (2001). Client with electrolyte imbalances: Promoting positive outcomes. In J, Black., J, Hawks., & A, Keene. (Eds.), Medical–Surgical Nursing: Clinical management for positive outcomes (pp.233-258). London: W. B. Saunders Company. Reading 1.4.
Hansen, M. (2001). Acid-Base Balance. In J, Black., J, Hawks., & A, Keene. (Eds.), Medical–Surgical Nursing: Clinical management for positive outcomes (pp.259-272). London: W. B. Saunders Company.
Now that you have completed these readings, begin working through the next section of the
module. Go to Activity 1. 1.
When you have finished, proceed to activity 1.2 and 1. 3.
Activity 1.1 - Fluid balance
Take a few moments to note down your answers to the questions based on your
knowledge/understanding/experience to date
1. What is fluid balance?
2. What is the purpose of fluid balance?
3. What is fluid imbalance?
4. How do you understand fluid imbalance?
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Activity 1.2 – Body fluid: composition & function
Review your understanding of anatomy and physiology of body fluid – pay special
attention to:
1. Composition of body fluid;
2. Function of body water;
3. Function of electrolytes.
Hint: consult Boley, R., Polaski, A. & Porta, D.(2001). Anatomy and physiology review: The cell. In J, Black., J, Hawks., & A, Keene. (Eds.), Medical–Surgical Nursing: Clinical management for positive outcomes (pp.206-214). London: W. B. Saunders Company.
Activity 1.3 – Fluid imbalance
Review your knowledge and understanding of the following:
1. Type of body fluid;
2. Distribution of body fluid
3. Type of fluid imbalance;
As you read through the information note down key points or make diagrams to assist your
understanding.
Hint: Consult Potter, P., and Perry, A. (2001) Fundamental of Nursing (5th ed.). Philadelphia: Mosby Inc, pp 1196 – 1197 and any recent anatomy and physiology and/or nursing texts.
Test yourself by completing the following:
Thirst centre stimuli affect the following: • …………………. • ………………… • ………………… • …………………
Nursing knowledge base
Fluid and electrolyte imbalance may affect anyone regardless of age, sex, colour or religious
beliefs. Infants, severely ill adults, and the elderly are frequently at greater risk because of
their inability to respond independently to the early warning of an impending problem.
Severe compromises may lead to irreversible health problems.
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Activity 1.4 Review your understanding/knowledge of factors which are thought to impact upon an
individual’s is body fluid. While you are reading make a brief note about each of the
following risk factors for fluid and electrolyte imbalances:
Age;
Chronic diseases;
Trauma;
Therapies; and
Gastro intestinal losses.
If you wish, refer to White, B. (2001). Client with fluid imbalances: Promoting positive outcomes. In J, Black., J, Hawks., & A, Keene. (Eds.), Medical–Surgical Nursing: Clinical management for positive outcomes (pp.215-232). London: W. B. Saunders Company.
Now go to Activity 1.5 to review your knowledge and check out your understanding of key
points contained in this section of the module.
Activity 1.5 – Knowledge review
Body fluids are made up of ………….. and ……….. They also move into and out of the
cells, bringing in ………….., ………….., and ……….. and taking out ………..
The continual movement of fluids is necessary to maintain a stable condition in the
internal environment. The maintenance of a constant favourable condition in the
internal environment is called ………. Many factors contribute to the continuous
motion of the body fluid. Among the more important are ……………….,
……………., and …………….. Types of body fluid are …………., …………,
………. and …………….. Although all of the electrolytes perform important
functions, those of major significance to the nurse who is caring for patients with fluid
and electrolyte imbalance are: ………., ………., …………, ………., ……….. and
………..
Two categories of fluid imbalance are: …………. and …………..
Hint: Refer to White, B. (2001). Client with fluid imbalances: Promoting positive outcomes. In J, Black., J, Hawks., & A, Keene. (Eds.), Medical–Surgical Nursing: Clinical management for positive outcomes (pp.215-232). London: W. B. Saunders Company.
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Therapy for fluid and electrolyte imbalance
Intravenous therapy
Administration through the veins is the most common means by which water; electrolytes,
nutrients and some drugs may be given when oral intake is not possible or must be
supplemented. Some terms related to the concentration of an intravenous fluid, and effect
this has on cells, are important to understand. Before you start Activity 1.6, please take a
moment to think about the reflective questions that follow:
Now go to Activity 1.6 to review your knowledge and check out your understanding of key
points contained in this section of the module.
Activity 1.6
Please provide a brief definition and give an example for each of the following:
Sensible water loss;
Solution;
Isotonic;
Hypotonic;
Hypertonic;
Oedema.
Reflection learning
Reflection is an essential part of ongoing personal and professional development. As a
student you are asked to diarise your reflections on pre-set readings and/or learning activities
Reflective questions
Take a few moments to jot down 3 terms/categories related to concentration of an
intravenous fluid, and effect this has on cells that you have encountered in your clinical
experience to date.
1. What was the context in which you encountered these terms?
2. Did you use your knowledge about these terms to inform your nursing care? If so,
how?
3. How might you use this knowledge in the future?
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set out in this module. This reflection might be prompted as a result of reading through and
thinking about the material provided, and/or as a result of experiences that happen during the
clinical practice that you are currently undertaking. You can record anything in a diary. Of
particular relevance to this unit, however, are insights that you have developed in relation to
issues contained within the readings, the ideas which arise from your thinking or from
comment of others, your emotional response to people and/or events, and how you feel you
have changed – or not changed. All are examples of entries which you might include.
Reflection
The process of reflecting can be viewed in a number of ways, however one useful strategy
is to ask your self a series of questions and then seek to answer them. Some suggested
questions for your reflection include:
1. What have I learnt most from this set of readings & learning activities?
2. In what ways is this knowledge important? What do I think about this
concept/issue?
3. How will I used this new knowledge in the future?
Your answers to these questions are designed to assist you to ascribe some meaning to
your experience, to understand and validate that meaning and to identify a positive
outcome with respect to your practice.
Part 2: Nursing responsibilities in caring for patients with fluid imbalance
In the healthy person, fluid intake and output are approximately equal. Illness almost always
increases the body’s needs for fluids and causes a decrease or loss of the body’s ability to
ingest or tolerate fluid through the usual oral route. Illness also may interfere with the body’s
ability to eliminate fluid or it may cause the body to excrete excessive amounts of fluids.
Therefore, signs and symptoms of fluid imbalance may either serve as a diagnostic clue for
illness or occur as a result of the drugs and therapies used to treat illness. Monitoring fluid
balance is an important nursing activity because of the significant role that fluid balance
plays in health and illness, and because direct client observations are the most reliable and
accurate ways to do this monitoring. The primary technical skills used to monitor fluid
balance are intake and output measurement.
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Objectives (Part 2):
When you have completed this reading and focus questions/learning activities in Part 2 of
this module it is expected that you will be able to:
1. Discuss general principles of fluid imbalance assessment;
2. Describe principles of effective nursing care for patients with fluid imbalance;
3. Critically analyse the nurse’s role with respect to nursing care;
4. Reflect on your own nursing care practice and identify opportunities for further
improvement.
Nursing assessment of fluid imbalance
There are two main situations where a nurse may be involved in assessing patients with fluid
imbalance. These are in emergency situations and in non-emergency settings. In Part 2 of the
module we will be concerned primarily with assessing patients in non-emergency settings.
Assessment for fluid and electrolyte imbalance includes: the nursing history, physical and
behavioural assessment, measurement of intake and output, daily weight, and specific
laboratory data. To start the learning activities for Part 2, go to activity 2.1
Activity 2.1
Note down what the following terms mean to you (use phrases, word descriptors, etc.)
Nursing history;
Nursing assessment;
Fluid imbalance assessment;
Measurement intake and output;
Physical and behavioural assessment.
Hint: If you wish, consult to Potter, P. and Perry, A. (2001) Fundamental of Nursing (5th ed.). Philadelphia: Mosby Company, pp: 1194 – 1249, and/or other nursing textbooks for discussion on these terms.
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Physical assessment
There is no specific physical assessment to assess fluid and electrolyte imbalance. Common
abnormal assessment findings involving a number of major body systems offer clues to
possible fluid and electrolyte imbalance. A thorough examination is necessary, because fluid
and electrolyte imbalances can affect all body systems. While examining each system, nurses
observe signs and symptoms expected as a result of any imbalance.
Planning care for patients with fluid and electrolyte imbalance
During the planning process the nurse again thinks critically, synthesising information from
multiple resources. Critical thinking ensures that the patient’s plan of care integrates both the
nurse’s scientific and nursing knowledge, as well as all the knowledge the nurse has gathered
about the individual patient. The patient’s clinical condition will determine which diagnoses
take the greatest priority. Many nursing diagnoses in the area of fluid and electrolyte
imbalance are of highest priority, because the consequences for the patient can be serious or
even life threatening.
As a general rule nursing care for fluid and electrolyte imbalance should be planned to
support the body in its efforts to balance the fluid and electrolytes. The type of body fluid
imbalance is a central factor in deciding what care is appropriate. You have learnt to
distinguish between body fluid deficit and excess. When you plan the patient’s care each of
these factors must be taken into consideration. This is one good reason why assessment
should always precede planning your nursing care, because during assessment you will have
identified any factors that could influence body fluid balance.
Consultation with the patient’s physician may assist in setting realistic time frames for the
goals of care. During planning the nurse collaborates as much as possible with the patient
and family and other members of the interdisciplinary health care team, such as for IV
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therapy and pharmacy. The nurse also incorporates patient preferences and resources into the
plan of care.
Implementation
Although fluid and electrolyte imbalance can occur in all settings, changes in acute care
delivery systems place more demanding expectations on the nurse. Today the nurse must
manage the patient’s complex medical care in a shorter span of time while being expected to
perform more difficult technological skills. When implementing nursing care plans, some
activities and conditions which should be taken into consideration. These include:
daily weight and intake and output;
enteral replacement of fluids;
restriction of fluids;
parenteral replacement of fluid and electrolytes;
health promotion.
Evaluation of patient care
There are two important aspects in evaluation of patient care: patient care and patient
expectations. The evaluation of a patient’s clinical status is especially important if an acute
fluid and electrolyte imbalance exists. The patient’s condition can change very quickly, and
the nurse must be able to recognise signs and symptoms of impending problems. To do this
well, nurses integrate what they know about the health alterations, the effects of medications
and fluids, and the patient’s presenting clinical status.
For patients with less acute alterations evaluation is likely to occur over a longer period of
time. In this situation the nurse’s evaluation may be focused more on behavioural changes
such as client ability to follow dietary restriction. The patient’s level of progress determines
whether the nurse needs to continue or revise the plan of care. If goals do not meet expected
outcomes, the nurse may need to consult with a physician and discuss additional methods.
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Once outcomes have been met, the nurse can resolve the nursing diagnosis and focus on
other priorities.
Reading 2.1
Lewis, S., Heitkemper, M. and Dirksen, S. (2000). Medical Surgical Nursing: Assessment and management of clinical problems (5th ed.). St Louis: Mosby Inc, pp. 323 – 351.
Review and application
Take a few moments to work through activity 2.2
Activity 2.2
Case study: fluid and electrolyte imbalance.
Pak Bungas, a-42-year-old man with typhoid fever and mild hypertension.
Subjective data:
Complaining of overall weakness, and thirst;
Has diarrhoea and frequent urination;
Objective date
Heart rate 88 and irregular;
Blood pressure 150/100;
Dry oral mucous membranes.
Body temperature; 390C;
His physician has ordered a less fibres and soft diet. Kemicytine capsule 500 mgm
four times a day (per-oral) and B Complex three times a day (per-oral)
Critical thinking questions:
1. Based on his clinical manifestations, what fluid imbalance does Pak Bungas have?
What are the reasons for your answer?
2. What additional assessment data should the nurse obtain?
3. What are risk factors for fluid and electrolyte imbalance in general or in this
scenario?
4. What potentially dangerous electrolyte imbalance does his symptom suggest?
Textbook: refer to any tropical medicine and medical surgical or fundamental of nursing type of textbook and read through the section provided on fluid and electrolyte imbalance and assessment.
For more practice after finishing activity 2.2 please work with activity 2.3 and activity 2.4 at
your pace.
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Activity 2.3
Mr. Wong is a 35-year-old patient who has suffered a severe gastro intestinal upset
producing nausea, vomiting and diarrhoea. His physician has prescribed IV fluids.
List observations you should make while caring for Mr. Wong; and the reasons for
your choices
What nursing measures might be taken to relieve his symptoms? What is the basis
of your suggestions? What medication might you expect him to receive?
What are your responsibilities regarding Mr. Wong’s Intravenous therapy? Why it
is necessary to check the infusion frequently? Would you measure intake and
output? In what electrolytes might Mr. Wong be deficient?
After finishing activity 2.3 please continue to activity 2.4. You can discuss the questions
with your classmates.
Activity 2.4
Caroline has just received a new patient on her unit who is to receive 1 unit of RBCs with
in the next hour.
What nursing actions are necessary before administering blood?
What are signs and symptoms of a transfusion reaction?
Can Caroline delegate the administration of blood to a nursing assistant or a
nursing student on her team? Why or why not?
Ongoing professional development
Working your way through this self-learning module suggests that you are interested in your
ongoing professional development. The module has it limitations, however. In this module
we have considered the care of patients with fluid imbalance that are relatively
uncomplicated and straight forward. As you develop your knowledge and skills, you will
need to care for more complicated patients. A good place to start finding out about the best
care that you can offer is to keep reading about fluid imbalance topics. Use the library
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facilities that are available to you, ask more experienced nurses about what they have learnt
from their work; as well as doctors who give instruction for balancing body fluids.
Another thing you can do to keep up-to-date in practice is to read the literature that is
published by drug companies (about their product). You may need to get this information
from the pharmacy at the hospital, health centre or from whoever orders the stock. Try
collecting information in the same way as ants would collect and store food for future needs.
You never know when it will be useful.
Final comment is to remind you that you must practice and increase your clinical judgements
because it will reflect your professional development. As your knowledge and skill develops
you will become more confident in judgements you make and you will be able to make more
refined decisions.
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APPENDIX 4 INFORMATION FOR PARTICIPANTS (PILOT STUDY)
Program title: Improving Indonesian Nursing Students’ Self-Directed Learning Readiness
Chief investigator: Djenta Saha
Address : Jln. George Obos Gg. Husada no. 2 Palangkaraya 73111 Indonesia
Ph. 536-25214
This study is the basis of a dissertation in a Doctor of Philosophy qualification at Queensland University of Technology (QUT) and will be performed by Djenta Saha under the guidance of an academic staff member Prof. Helen Edwards.
Description of the project This project will develop, implement and evaluate a training program to improve readiness for self directed learning among nursing students in Central Kalimantan. Participant involvement in the program will include: Your participation in this project will be in the pilot study only. This will involve the completion of one questionnaire about self-directed learning two times. I estimate for completion of the questionnaire will take about 30 minutes. The expected outcomes of the pilot study as follows:
• Provide a questionnaire to assess self-directed learning that suitable to use in nursing education in Central Kalimantan
• Assessed the proposed questionnaire for use in a project on training program in nursing education in Central Kalimantan.
Expected benefit for you:
Your involvement in this program has the potential to benefit you by increasing your awareness of self-directed learning within nursing education.
Risks No risks to you have been identified due to participation in the program. Confidentiality All information you supply for the program will be treated in confidence and securely stored during the study period and for five years afterwards, until the data is destroyed. Only the researcher will access to the data. Anonymity and confidentiality will be safeguarded in any publication of results. Voluntary participation Your participation in the program is entirely voluntary, and you are free to withdraw at any time without comment or penalty. Your decision will in no way impact upon your academic progress or future study.
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Concerns/complaint All participants in this study are welcome to contact Djenta Saha (chief investigator) regarding any questions or concerns/complaints you may have about this study. If at any time you are not satisfied with this respond or any concern relating to ethical conduct in this study you may contact the head of ‘BALITBANGDA’ office on 536 – 34364.
Thank you for considering participation in this study, your participation is greatly appreciated.
214
APPENDIX 5 INFORMATION FOR PARTICIPANTS
(INTERVENTION GROUP)
Program title: Improving Indonesian Nursing Students’ Self-Directed Learning Readiness
Chief investigator: Djenta Saha Address: Jln. George Obos Gg. Husada no. 2 Palangkaraya, 73111 Indonesia Ph. 536-25214. This study is the basis of a dissertation in a Doctor of Philosophy qualification at Queensland University of Technology (QUT) and will be performed by Djenta Saha under the guidance of an academic staff member Prof. Helen Edwards.
Description of the project: This project will develop, implement and evaluate a training program to improve readiness for self-directed learning among nursing students in Central Kalimantan. Participant involvement in the program would include Participation in this part of the project involves the completion of two questionnaires about self-directed learning. You will receive the first questionnaire shortly. The second questionnaire will be distributed in approximately 4 months time. I anticipate that will take about 30 minutes to complete each. In addition, you may be invited to participate in a focus group discussion of approximately 60-90 minutes duration. The purpose of the focus group discussion is to gain a better understanding of students’ perception about self directed learning. The discussion will be run by chief investigator. Participation in the focus group will be voluntary and you can withdraw any time without comment or penalty. Expected outcomes Increase students’ knowledge and skills of self-directed learning. Expected benefit for you Your involvement in this program has the potential to benefit you because you will increase your knowledge and skills in self-directed learning as a firm foundation to be a lifelong learner. Risks Neither completion of the questionnaires or participation in the focus group discussion involves any known risks to participants.
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Confidentiality of the data All information you supply for the program will be treated in confidence. All confidential records will be kept in a locked filling cabinet. Any information stored in the computer files is protected by password (know only to the researcher) and coded to protect anonymity. Only the researcher has access to the computer database. Coding sheets separate to data records. Aggregate data only will be published and no individual participants will be identified. Voluntary participation Your participation in the program is entirely voluntary and you are free to withdraw from the study at anytime without comment or penalty. Your decision will in no way impact upon your academic progress or future study. Questions or concerns/complaints
All participants in this study are welcome to contact Djenta Saha (chief investigator) regarding any questions or concerns/complaints you may have about this study. If at any time you are not satisfied with this respond or any concern relating to ethical conduct in this study you may contact the head of ‘BALITBANGDA’ office on 536 – 34364.
Thank you for considering participation in this study, your participation is greatly appreciated.
216
APPENDIX 6 INFORMATION FOR PARTICIPANTS (CONTROL
GROUP)
Program Title: Improving Indonesian Nursing Students’ Self-Directed Learning Readiness
Chief investigator: Djenta Saha Address: Jln. George Obos Gg. Husada no. 2 Palangkaraya, 73111 Indonesia Ph. 536-25214. This study is the basis of a dissertation in a Doctor of Philosophy qualification at Queensland University of Technology (QUT) and will be performed by Djenta Saha under the guidance of an academic staff member Prof. Helen Edwards.
Description of the program:
This research study intends to increase quality of teaching and learning through development and implement a self-directed training program in nursing education in Central Kalimantan.
Your involvement in the program would include: • Giving your written consent • Having pre and post tests • Receive training modules in the end of study • You may be invited to participate in a focus group discussion of approximately
60-90 minutes duration. Expected outcomes • Increase students’ knowledge and skills of self-directed learning • Increase students’ responsibility of their own learning • Students will become ‘less passive’ and ‘more active’ in their learning. Expected benefit for you Your involvement in this program has the potential to benefit you in the following ways: increased awareness of self-directed learning as a firm foundation to be a lifelong learner. Risks No risks to you have been identified due to your participation in this program.
217
Confidentiality of the data All information you supply for the program will be treated in confidence. All confidential records will be kept in a locked filling cabinet. Any information stored in the computer files is protected by password (know only to the researcher) and coded to protect anonymity. Only the researcher can access to the computer database. Coding sheets separate to data records. Aggregate data only will be published and no individual participants will be identified. Voluntary participation Your participation in the program is entirely voluntary and you are free to withdraw from the study at anytime without comment or penalty. Your decision will in no way impact upon your academic progress or future study. Questions or concerns/complaints
All participants in this study are welcome to contact Djenta Saha (chief investigator) regarding any questions or concerns/complaints you may have about this study. If at any time you are not satisfied with this respond or any concern relating to ethical conduct in this study you may contact the head of ‘BALITBANGDA’ office on 536 – 34364.
Thank you for considering participation in this study, your participation is greatly appreciated.
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APPENDIX 7 CONSENT FORM
Program title: Improving Indonesian Nursing Students’ Self-Directed Learning
Readiness
Chief investigator: Djenta Saha Ph. 536-25214. Participant’s name: __________________________________ My signature below indicates: 1. I have read the Participant Information Sheet; 2. I understand the nature and purpose of the study; 3. I have been given the opportunity to ask questions regarding the research study; 4. I understand that the confidentially of all information I provide will be
safeguarded; 5. I understand that participation is voluntary, and I am free to withdraw from the
study at any time without comment or penalty; 6. I consent to participate in this program. Signature: __________________________ Date: ____________________ (Participant) I have explained the nature and purpose of this study to the above participant and have answered their questions. Investigator: ___________________________Date: ____________________
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Appendix 8
Sister School Project (SSP) Central Kalimantan Province Executive Summary
(Reference: Brown, D. & Cooke, M. (2002). Teaching and Learning Methodologies. Report. Ministry of Health and Social Welfare, Central Kalimantan, Republic Indonesia)
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