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Student nurses’ perceptions of their educational environment at a school of nursing in Western Cape province, South Africa: A cross-sectional study

Student nurses’ perceptions of their educational environment at a school of nursing in Western... Curationis ISSN: (Online) 2223-6279, (Print) 0379-8577 Page 1 of 11 Original Research Student nurses’ perceptions of their educational environment at a school of nursing in Western Cape province, South Africa: A cross-sectional study Authors: Background: Educational environments have been found to bear a substantial relationship Katlego D.T. Mthimunye with the academic performance and success, as well as the retention, of students. Felicity M. Daniels Objectives: The study objectives were to (1) evaluate the educational environment as perceived Affiliations: by undergraduate nursing students at a school of nursing (SON) in Western Cape province School of Nursing, University and (2) investigate whether the educational environment, or components thereof, is perceived of the Western Cape, negatively or positively among undergraduate nursing students of different year level, gender, Cape Town, South Africa home language and ethnicity. Corresponding author: Method: A quantitative research method with a cross-sectional design was implemented. Data Katlego Mthimunye, katlegomthimunye@ were collected from 232 undergraduate nursing students from a SON at a university in Western icloud.com Cape province, South Africa. The subscales and the items of the educational environment questionnaire were compared among undergraduate nursing students. Data were analysed by Dates: means of the IBM Statistical Package for Social Sciences (IBM SPSS-24) using analysis of variances Received: 19 Feb. 2018 (ANOVAs), independent-sample t-tests, mean scores, standard deviations and percentages. Accepted: 12 Nov. 2018 Published: 08 Apr. 2019 Results: The mean score attained for the entire participant group was 195 (standard deviation [SD] = 24.2) out of 268 (equivalent to 72.8% of maximum score), which indicated that the How to cite this article: Mthimunye, K.D.T. & Daniels, educational environment was perceived substantially more positively than negatively. The F.M., 2019, ‘Student nurses’ overall mean score was significantly higher ( p < 0.05) for male students (M = 202; SD = 21) and perceptions of their for black students (M = 202; SD = 21). The digital resources (DR) subscale was the only subscale educational environment at a with a statement or item that was rated as absolute negative (M = 1.9; SD = 0.9). school of nursing in Western Cape province, South Africa: Conclusion: The educational environment at the institution concerned was perceived as A cross-sectional study’, predominantly positive by its undergraduate nursing students. Although the educational Curationis 42(1), a1914. environment was predominantly perceived as positive, the results of this study also indicated https://doi.org/10.4102/ curationis.v42i1.1914 that enhancements are required to improve the physical classroom conditions, skills laboratories, DR and the implemented teaching and learning strategies. It is vital for university Copyright: management to prioritise the creation of an educational environment which would ensure that © 2019. The Authors. quality learning takes place. Licensee: AOSIS. This work is licensed under the Keywords: student’s perceptions; educational environment; nursing education; Western Cape; Creative Commons South Africa. Attribution License. Introduction Teaching and learning in nursing education is undergoing substantial transformation worldwide (Aiken 2011; Benner 2012; World Health Organization 2013). These transformations challenge nursing schools to implement new strategies to facilitate high-quality teaching and learning (Benner 2012). The educational environment in particular plays a central role in the process of teaching and learning (Arzuman, Yusoff & Chit 2010; Cleveland & Fisher 2014; Davies et al. 2013; Korucu & Alkan 2011). The educational environment in nursing comprises both practical and theoretical learning settings (Billings & Halstead 2015). It also incorporates a variety of basic provisions such as the physical infrastructure, the teaching and learning processes, school resources or materials and the teacher–student relationship (Miles, Swift & Leinster 2012). In addition, for nursing students, an ideal educational environment should promote critical thinking and lifelong learning (Billings & Halstead 2015; Davis & Kimble 2011). However, it is also necessary to be aware that ‘demotivating elements such as perceived bias, poor role models, R Read online: ead online: Sc Scan this QR an this QR information overload, teacher-centered or disorganized teaching need to be identified and code with your code with your eliminated’ (Veerapen & McAleer 2010:2). As a further cautionary observation, Bruce, Klopper smart phone or smart phone or mobile de mobile device vice and Mellish (2011) suggest that nursing education requires a modern educational environment t to r o read online. ead online. which is focused more on the learning paradigm than on the teaching paradigm. http://www.curationis.org.za Open Access Page 2 of 11 Original Research TABLE 1: Summary of study population, sample and response rate. Background Year level Population ( N) Sample (n) Response n (%) First-year Bachelor of Nursing 74 19 14 (4.88) The literature reveals that educational environments have an Foundation (BNF 1) impact on students’ levels of success, achievement, Second-year Bachelor of Nursing 45 11 9 (3.14) Foundation (BNF 2) contentment and motivation (Arzuman et al. 2010). First-year Bachelor of Nursing (BN 1) 221 56 49 (17.07) Furthermore, Till (2005) and Arzuman et al. (2010) have Second-year Bachelor of Nursing 303 77 62 (21.60) suggested that students’ satisfaction with their educational (BN 2) environment is associated with the depth and quality of Third-year Bachelor of Nursing (BN 3) 240 61 48 (16.72) learning. Arzuman et al. (2010) and Al Ayed and Sheik (2008) Fourth-year Bachelor of Nursing 248 63 50 (17.42) (BN 4) reported that educational environment domains correlate Total 1131 287 232 (80.84) positively with the academic success and, ultimately, the retention of students. Therefore, students’ perceptions of their educational environment serve as a valuable foundation Context of the study for transforming and improving the quality of the educational This study was conducted in the SON at a university in the environment. In addition, Baeten et al. (2010) and Cheon et Western Cape province of SA. The SON offers a range of al. (2012) reported that students’ perceptions of their learning undergraduate and postgraduate programmes. The environment have a significant impact on the learning undergraduate programmes offered by the SON were the strategies that they may adopt. For example, Baeten et al. main focus of this study, and these include the 4-year Bachelor (2010) reported that students in the community and health of Nursing (BN) and 5-year Bachelor of Nursing Foundation sciences faculty exhibited a deep learning approach towards (BNF) programmes. their learning. Therefore, an environment that promotes quality and deep learning is vitally significant in ensuring Population, sample and sampling technique successful teaching of, and learning by, nursing students. Inclusion criteria Moreover, the improvement of the overall educational environment is likely to have a significant influence on the As a result of the apartheid system and segregation policies academic performance and retention of the nursing student in SA, the racial classification of population groups differs (Al Ayed & Sheik 2008; Arzuman et al. 2010; Till 2005). slightly from general classifications used around the world (Cornell & Hartmann 2007). For example, the term ‘coloured’ Evaluation of the students’ perceptions towards their in a South African context refers to a population group of educational environment at the school of nursing (SON) mixed race (Moultrie & Timæus 2003). In SA, the predominant would aid nurse educators and faculty staff in measuring racial groupings are classified as black, white, coloured and the quality of the teaching and learning taking place (Denz- Indian. The study population included all students registered Penhey & Murdoch 2009). Although numerous studies have for the BN and BNF programmes at the university concerned. been conducted globally, evaluating the perceptions of medical as well as nursing students’ perceptions of their Sampling technique educational environment (Colbert-Getz et al. 2014; Stratified random sampling was used to ensure that all levels Ostapczuk et al. 2012; Rahman et al. 2015; Yusoff 2012), we of the BN and BNF programmes were adequately represented are not aware of any studies evaluating nursing students’ (Table 1). In stratified random sampling, perceptions of their educational environments either in the population of interest is first divided into two or more groups South Africa (SA) or at the identified university in the based on characteristics that are important to the study, and then Western Cape province. members within each group are randomly selected. (Macnee & McCabe 2008:128) Objectives The objectives of this study were to: Sample size 2 2 The sample size equation n = (p) (1−p) (Z) /e with a 95% • evaluate the educational environment as perceived by confidence level ( Z = 1.96), an error rate (e) of 5% and a undergraduate nursing students at a SON in the Western proportion of the target population (p = 50%) revealed that a Cape province of SA sample of 384 is required to represent the population (Dean, • investigate whether the educational environment, or Sullivan & Soe 2013). An adjusted sample size of 287 was components thereof, was perceived negatively or derived using the equation n = n/(1 + (n – 1)/N), where the positively among undergraduate nursing students of a population (N) is 1131 (Dean et al. 2013). Furthermore, the different year level, gender or ethnicity. equation c = (N /N)n was used to calculate the sample size s a within each strata, where c is the sample size for stratum, N Methods is the population size for stratum, N is the total population Research design 1 Statistics South Africa continues to classify people into population groups as moving away from the pre-1994 apartheid-based system. This classification uses a A quantitative research method with a cross-sectional design, population group-based classification system that is no longer based on a legal using a researcher-developed survey, was used. definition, but rather on self-classification (Statistics South Africa 2016). http://www.curationis.org.za Open Access Page 3 of 11 Original Research size and n is the total sample size (Dean et al. 2013). Table 1 consistency reliability which revealed a Cronbach’s alpha summarises the study population sample as well as the coefficient of 0.945. The individual items of the instrument response rate. revealed a Cronbach’s alpha coefficient ranging from 0.943 to 0.945. This Cronbach’s alpha coefficient confirms that the items being measured were internally reliable (Field 2013). Research instrument and data collection According to Tavakol and Dennick (2011), a significant Data were collected using a researcher-developed Cronbach’s alpha coefficient ( ≥ 0.70) adds to the validity and questionnaire that was administered to the sampled accuracy of the instrument. Thus, an instrument cannot be undergraduate (BN and BNF) nursing students. The valid unless it is reliable (Tavakol & Dennick 2011). questionnaire consisted of a total score of 268 for 67 items on a four-point Likert scale (where 1 = strongly disagree, 2 = Validity of the instruments disagree, 3 = agree and 4 = strongly agree). For interpretation of the overall survey score, the following overall scores were The content validity of the questionnaire was established by considered based on quadrant parameters: 0–67 = very poor; the research supervisor (an expert in teaching and learning) 68–134 = poor; 135–201 = good; 202–268 = excellent. and a statistician. Their inputs were implemented to improve the items in the questionnaire. In addition, face validity was The survey consisted of demographic factors and eight conducted by 30 undergraduate nursing students during the subscales that were used to measure nursing students’ pilot test of the instrument to ensure accurate interpretation perception of the educational environment. The instruments’ of the content. During the face validity, none of the subscales and measurements included the following: participants requested verbal assistance and they responded to all the items included in the instrument. In general, the • physical classroom environment (PCE) – 11 items; participants in this pilot test reported that the instruction and maximum score = 44 the content of the instrument were well defined. • skills laboratory (SL) (on-campus) – six items; maximum score = 24 • SL (off-campus) – six items; maximum score = 24 Data processing and analysis • university library (UL) – five items; maximum score = 20 Data were analysed using the IBM Statistical Package for • digital resources (DR) – seven items; maximum score = 28 Social Sciences (IBM SPSS-24). Missing values were dealt • teaching and learning climate (TLC) – nine items; with by replacing them with the median of nearby points to maximum score = 36 avoid errors and skewness of the data. Descriptive and • teaching and learning strategies (TLS) – 11 items; inferential statistics were performed by means of frequencies, maximum score = 44 standard deviations (SDs) and percentages for the total score • nursing curriculum (NC) – 12 items; maximum score = 48. of the questionnaire and subscale scores of the whole sample as well as the specific BN and BNF groups, ethnic group and In this study, TLC refers to professional relationships among gender. For dichotomous variables (home language and students and educators, whereas TLS refers to the teaching gender), comparisons of overall and subscale mean scores and learning methodologies implemented at the SON. were achieved through a series of independent-sample t-tests. For variables with more than two values (ethnicity Items with a mean score of 3.0 or more indicate absolute and year level of study), a series of one-way analysis of positive aspects. Items with a mean score of 2.0 or below variances (ANOVAs) were performed to compare all the indicate absolute negative aspects and need immediate groups. Where one-way ANOVAs were not possible owing intervention. Items with a mean score of between 2.0 and 3.0 to violation of the significant homogeneity of variances ( p < are aspects of the educational environment that warrant 0.05), the alternative statistical test – Welch ANOVA – was improvement. used. The significance level for ANOVA was established at p < 0.05. Where significant ( p < 0.05) differences between the Reliability of research instrument groups were found, a post hoc Tukey’s honestly significant A pilot test of the instrument preceded the actual data difference (HSD) test for multiple comparisons was used to collection to ensure reliability of the data collection verify where the variances occurred between the groups. instrument. Perneger et al. (2015) suggested that, to produce Where no significant ( p > 0.05) differences between the significant results from a pretest, a minimum sample size of groups were found (equal variances not assumed), a 30 participants is recommended. Questionnaires were nonparametric Games–Howell post hoc test set for multiple administered to 30 undergraduate nursing students (selected comparisons was used to verify where the variances occurred via convenience sampling) who were not included in the between the groups. main study. The questionnaire was then administered to the same group 2 weeks later to ensure test–retest reliability Ethical considerations (Polit & Beck 2010). The test–retest reliability revealed an intraclass correlation coefficient of 0.954, indicating an Ethics in research is a serious matter and researchers need to excellent correlation coefficient (Field 2013). Finally, the adhere to strict rules (Denscombe 2014). Participation in the reliability process involved calculating the internal study was voluntary and was based on participants’ consent. http://www.curationis.org.za Open Access Page 4 of 11 Original Research Ethics clearance (HS17/1/42) was obtained from the with an SD of 24.2. These results indicate that, generally, the university ethics committee. Permission to conduct the study educational environment, as perceived by undergraduate at the identified SON was obtained from the registrar of the nursing students at the identified university, was good but university as well as the director of the SON. could be improved upon. The total scores varied significantly between year levels (F = 7.098; p < 0.000). Post hoc (5, 226) analysis using Tukey’s HSD test indicated that first-year BN Results students had a significantly positive perception ( p < 0.000) Participants about their overall educational environment as compared A total of 232 (80.84%) students out of the 287 stratified with the senior students (third- and fourth-year BN students). random sample completed the survey. The demographic data revealed that of the 232 students, 182 (78.45%) were Skills laboratory (on-campus) scores varied significantly females and 50 (21.55%) were males. More than half (n = 132; between the year levels of the undergraduate programme 56.90%) of the participants were of black ethnicity, followed (F = 6.341; p = 0.000). SL (off-campus) scores varied (5, 226) by coloured students (n = 74; 31.90%), white students (n = 18; significantly between the year levels ( F = 4.242; p = 0.001). (5, 226) 7.76%) and Indian students (n = 4; 1.72%). The category Likewise, taken together, the results of Tukey’s post hoc HSD classified as ‘other ’, which included all the students who did statistics for both on- and off-campus SL indicated that not belong to any of the four main categories as classified by generally first-year BN students have a significantly positive Statistics South Africa (2016), comprised four (1.72%) (p < 0.05) perception about the skills laboratories compared students. The youngest participant was 18 years old and the with second-, third- and fourth-year BN students. oldest was 49 years old. The mean age of the study participants was 23.02 (SD = 5.11) years. Of the 232 participants, 63 Digital resources mean scores varied significantly between (27.16%) spoke English as their home language, whereas the year levels (F = 4.982, p = 0.000). Post hoc Tukey’s HSD (5, 226) remaining 169 (72.84%) spoke other languages including statistics indicated that first- and second-year BN students IsiXhosa and Afrikaans. had a significantly positive perception ( p < 0.005) about the DR, as compared with the third-year BN students. Overall mean scores by year level of study Teaching and learning climate mean scores varied A one-way between-groups ANOVA was performed to significantly ( F = 7.254, p = 0.000). Post hoc Tukey’s HSD compare the nursing students’ perceptions regarding their (5, 226) statistics suggest that the first-year BN students had a educational environment for each year level of study in the significantly positive perception ( p < 0.005) about the TLC as undergraduate programme. Subscale means and SDs for the compared with their senior third- and fourth-year BN whole sample as well as for each year level are summarised students. Likewise, Tukey’s post hoc HSD statistics revealed in Table 2. For this ANOVA, the outcome variables were that second-year BN students had a significantly positive found to be normally distributed and equal variances were perception (p < 0.005) about the TLC as compared with assumed except for the UL subscale, which revealed a fourth-year BN students. Levene’s statistic of F = 4.8; p < 0.000. As the assumption (5, 226) of homogeneity of variance was not met for the UL subscale, The TLS mean score varied significantly ( F = 2.773, p = the Welch statistical test was performed and the results (5, 226) 0.019). Tukey’s post hoc HSD statistics results indicated that revealed Welch’s F = 1.81, which was found to be (5, 55.08) first-year BN students had a significantly positive perception not significant ( p = 0.127). The Games–Howell post hoc (p = 0.032) towards the TLS implemented at the identified comparison test revealed that there was no statistical university as compared with the fourth-year BN students. difference between all unique pairwise comparisons. The mean score of the students’ perceptions regarding the The total mean score for all the students who participated in NC varied significantly ( F = 5.469, p = 0.000). Tukey’s the present study was 195 (72.8% of the maximum score), (5, 226) post hoc HSD test results indicated that first-year BN students TABLE 2: Mean (standard deviation) and overall scores by year level. Domains BNF 1 BNF 2 BN 1 BN 2 BN 3 BN 4 All F p Tukey’s HSD < 0.05 Physical classroom environment (PCE) 32 (3.3) 33 (3.2) 32 (4.8) 31 (5.4) 30 (5.9) 30 (5.9) 31 (5.4) 1.303 0.264 - Skills laboratory (SL) (on-campus) 18 (2.0) 18 (2.3) 19 (3.2) 16 (3.7) 15 (3.7) 16 (3.2) 17 (3.6) 6.341 0.000* BN 1–BN 2, BN 1–BN 3, BN 1–BN 4 Skills laboratory (SL) (off-campus) 18 (3.0) 18 (2.5) 18 (3.1) 16 (3.3) 16 (3.8) 16 (3.2) 17 (3.4) 4.242 0.001* BN 1–BN 2, BN 1–BN 3, BN 1–BN 4 University library (UL) 16 (2.1) 15 (2.3) 16 (2.5) 16 (2.7) 14 (4.0) 16 (2.8) 16 (3.0) 1.81 0.127 - Digital resources (DR) 20 (3.0) 19 (2.7) 21 (3.6) 19 (3.4) 17 (3.6) 19 (3.7) 19 (3.7) 4.982 0.000* BN 3–BN 1, BN 3–BN 2 Teaching and learning climate (TLC) 28 (3.7) 27 (3.7) 30 (3.8) 28 (4.7) 26 (5.3) 25 (5.4) 27 (3.7) 7.254 0.000* BN 1–BN 3, BN 1–BN 4, BN 2–BN 4 Teaching and learning strategies (TLS) 34 (3.3) 44 (4.7) 34 (4.6) 33 (5.6) 31 (5.3) 31 (6.4) 32 (5.5) 2.773 0.019* BN 1–BN 4 Nursing curriculum (NC) 38 (5.0) 37 (6.5) 39 (4.1) 37 (5.5) 36 (5.4) 33 (6.4) 37 (5.7) 5.469 0.000* BN 4–BN 1, BN4–BN2 Total 202 (12) 201 (22) 208 (19) 197 (23) 186 (25) 186 (26) 195 (24.2) 7.098 0.000 BN 1–BN 3, BN1–BN4 n 14 9 49 62 48 50 232 - - - BNF 1, first-year Bachelor of Nursing Foundation; BNF 2, second-year Bachelor of Nursing Foundation; BN 1, first-year Bachelor of Nursing; BN 2, second-year Bachelor of Nursing; BN 3, third-year Bachelor of Nursing; BN 4, fourth-year Bachelor of Nursing; HSD, honestly significant difference; F, variation between group means; p, significance; *, p > 0.05. http://www.curationis.org.za Open Access Page 5 of 11 Original Research and second-year BN students had a significantly positive post hoc HSD test results revealed that there were no perception (p < 0.05) regarding the NC at the identified significant statistical differences between all unique pairwise comparisons. university as compared with the fourth-year BN students. The mean score of students’ perceptions of the TLC by Overall mean score by ethnicity ethnicity varied significantly ( F = 5.81, p = 0.000). Tukey’s (4, 227) A one-way between-groups ANOVA was performed to post hoc HSD statistics indicated that black students had a compare the nursing students’ perceptions regarding their more positive perception (p < 0.05) regarding the TLC at the educational environment for each ethnic group. Participants identified university compared with their coloured were divided into five groups based upon their ethnic counterparts as well as the category classified as ‘other’. demographics (black, coloured, Indian, white and other). Tukey’s post hoc HSD results also revealed that white Subscale means and SDs for ethnicity are displayed in students had a more positive perception (p < 0.05) regarding Table 3. For this ANOVA, the outcome variables were found the TLC compared with students classified in the category of to be normally distributed and equal variances were assumed ‘other ’. except for PCE, NC and total score, which revealed the following Levene’s statistics respectively: F = 2.59, p = The mean score of students’ perceptions regarding the TLS (4, 227) implemented at the identified university varied significantly 0.038; F = 3.36, p = 0.011 and F = 4.25, p = 0.002. As the (4, 227) (4, 227) (F = 6.24, p = 0.000). Tukey’s post hoc HSD statistics assumption of homogeneity of variance was not met for PCE, (4, 227) indicated that black students had a significantly positive NC and overall score, Welch statistics were performed. The perception (p < 0.05) of the TLS compared with coloured results for PCE revealed Welch statistic F = 2.38, which (4, 11.15) students and those classified as ‘other ’. was found to be not statistically significant ( p = 0.114). The Games–Howell post hoc comparison test revealed that there was no statistical difference between all ethnic groups in Gender differences pairwise comparisons. The results for NC revealed Welch An independent-samples t-test was performed to compare statistic F = 4.93, which was found to be statistically (4, 11.11) the nursing students’ perceptions regarding their educational significant ( p = 0.016). Post hoc comparison Games–Howell environment among male and female undergraduate nursing statistics indicated that black students had a more positive students. The overall mean score was significantly ( p < 0.05) perception (p < 0.05) towards the NC at the university higher for male students than for female students (t(230) = compared with their coloured counterparts. Welch statistic 2.3, p = 0.022). These results indicated that male students’ results for the overall score by ethnicity (F = 5.25) were (4, 11.09) perceptions regarding their teaching and educational found to be significant ( p = 0.013). The post hoc comparison environment were more positive compared with their female Games–Howell statistic indicated that, overall, black students counterparts. A summary of the independent-sample t-test had a more positive perception (p < 0.05) towards their for comparison of the subscale scores and gender is presented educational environment compared with their coloured in Table 4. counterparts. Overall mean scores for undergraduate students The mean score of the students’ perceptions regarding the on-campus (F = 4.85, p = 0.001) and off-campus (F = The mean scores for UL were the highest (3.1 out of 4), (4, 227) (4, 227) 3.21, p = 0.014) skills laboratories by ethnicity varied followed by TLC and NC (3.0 out of 4 for both subscales). The significantly. The post hoc Tukey’s HSD test results indicate remaining five subscales (PCE, SL [on-campus], SL [off- that black students had a positive perception (p < 0.05) scampus], DR and TLS) revealed mean scores below 3 out of regarding both on-campus and off-campus skills laboratories 4. The results revealed that the weakest subscale was DR compared with their coloured counterparts. with a mean score of 2.7 out of 4. Furthermore, the DR subscale was the only subscale with a statement or item that The mean score of the students’ perceptions regarding DR by was rated an absolute negative. Table 5 summarises the mean ethnicity varied significantly ( F = 2.83, p = 0.026). Tukey’s scores and interpretation of items under investigation. (4, 227) TABLE 3: Mean (standard deviation) and overall score by ethnicity. Domains Black Coloured Indian White Other F p Tukey’s HSD < 0.05 Physical classroom environment (PCE) 32 (5) 30 (5) 24 (7) 30 (6) 24 (10) 2.382 0.114 - Skills laboratory (SL) (on-campus) 18 (3) 16 (4) 16 (6) 16 (2) 15 (5) 4.847 0.001* Black–coloured Skills laboratory (SL) (off-campus) 18 (3) 16 (3) 15 (6) 17 (2) 15 (6) 3.208 0.014* Black–coloured University library (UL) 16 (3) 16 (3) 17 (2) 15 (2) 14 (3) 0.361 0.836 - Digital resources (DR) 19 (4) 19 (3) 15 (6) 19 (4) 16 (4) 2.827 0.026* - Teaching and learning climate (TLC) 28 (5) 26 (5) 26 (6) 27 (6) 20 (6) 5.809 0.000* Black–coloured, black–other, white–other Teaching and learning strategies (TLS) 33 (5) 31 (5) 27 (6) 30 (6) 25 (7) 6.235 0.000* Black–coloured, black–other Nursing curriculum (NC) 38 (5) 35 (5) 30 (11) 37 (7) 28 (8) 4.927 0.016* Black–coloured Overall 202 (21) 188 (22) 169 (45) 190 (26) 156 (46) 5.249 0.013 Black–coloured n 132 74 4 18 4 - - - *, p > 0.05; HSD, honestly significant difference; F, variation between group means; p, significance. http://www.curationis.org.za Open Access Page 6 of 11 Original Research TABLE 4: Mean score (standard deviation) and overall scores by gender nursing programme. The total score per year level ranged (N = 232). from 186 to 202, indicating that the perception of the Domains Female Male t p educational environment fell in the category of ‘good’. The Physical classroom environment (PCE) 31 (5) 32 (5) 2.089 0.038* subscale means scores ranging between 60.7% and 100% of Skills laboratory (SL) (on-campus) 16 (4) 18 (3) 2.100 0.037* the maximum scores also indicated a positive perception of Skills laboratory (SL) (off-campus) 17 (3) 18 (3) 1.789 0.075 University library (UL) 16 (3) 16 (3) 0.481 0.631 the educational environment. These results are consistent Digital resources (DR) 19 (4) 19 (4) 0.506 0.614 with the findings of the majority of the studies conducted Teaching and learning climate (TLC) 27 (5) 28 (4) 1.390 0.166 around the world (Brown et al. 2011; Hamid et al. 2013; Teaching and learning strategies (TLS) 32 (6) 33 (5) 1.624 0.106 Imanipour et al. 2015; Victor et al. 2016). Nursing curriculum (NC) 36 (6) 38 (5) 1.994 0.047* Overall 193 (25) 202 (21) 2.302 0.022 A few trends were noted between the year levels. Particularly, n 183 50 - - first-year BN students seemed to view their educational *, p > 0.05; t, Gosset’s Student distribution (difference between population means); p, significance. environment as more satisfactory than did second-, third- and fourth-year BN students with regard to both the on- campus and off-campus skills laboratories. Papathanasiou, Discussion Tsaras and Sarafis (2014) suggest that ‘students generally The aim of the present study was to evaluate the educational wish for a more positive clinical learning environment than environment as perceived by undergraduate nursing what they have experienced, especially when it comes to students at a SON. It also aimed to investigate whether the issues related to satisfaction, individualisation and educational environment, or parts thereof, was perceived innovation’. Therefore, it is pivotal that skills laboratories negatively or positively among undergraduate nursing where simulated clinical learning takes place are improved to students of different year level, gender or ethnicity. ensure the development of critical thinking among nursing students (Henderson et al. 2010). Perception of educational environment for the entire sample of undergraduate nursing students First- and second-year BN students viewed DR more favourably than did third- and fourth-year BN students. A Recent studies conducted across the world have been conclusive comparative study conducted by He et al. (2012), comparing in finding that the majority of undergraduate nursing students participants from two universities in the United States and perceive their educational environment as predominantly China with the aim of ‘identifying the opinions of positive (Brown, Williams & Lynch 2011; Hamid, Faroukh & Mohammadhosein 2013; Imanipour et al. 2015; Victor, Ishtiaq & undergraduate students on the importance of internet-based information sources when they undertake academic tasks’, Parveen 2016). A more positive perception (high mean overall score) of the educational environment by nursing students revealed that students use various DR including, but not indicates a more student-centred approach to teaching and limited to, search engines and social networking. Similarly, learning (Roff 2005). The present study revealed similar results. the findings of a cross-sectional study conducted by The total mean score for the entire sample of undergraduate Johansson et al. (2014) in Sweden revealed that most nursing nursing students was 195.2 (72.8%) which was well between 135 students regarded smart mobile devices to be useful in and 201, indicating that generally the students’ perception of the providing easy access to essential information to improve educational environment was more positive than negative. In evidence-based practice, record keeping, planning their work addition, the results were fairly consistent across the study and saving time. A conclusion that can be drawn is that subscales, ranging from 67.9% to 80%. However, these results improving access to efficient and reliable digital recourses fell short of achieving the ‘excellent’ ranking (total mean score of will ensure a positive educational environment that promotes between 202 and 268). A conclusion that can be drawn from quality teaching and learning (He et al. 2012; Johansson et al. these results is that although the overall students’ perception is 2014; Thongmak 2013). more positive and the identified educational environment is student-centred, the environment can nevertheless be further Likewise, the result of this study revealed that junior students improved. The enhancement of the educational environment is (first- and second-year BN students) viewed NC more likely to have a significant impact on the academic performance favourably than did the senior students (third- and fourth- and retention of nursing students (Al Ayed & Sheik 2008; year BN students). According to previous studies, students of Arzuman et al. 2010; Till 2005). The findings presented in Table an innovative curriculum tend to show more contentment 5 provide an overview of subscales for potential interventions to with their educational environments compared with students improve the quality of the educational environment as perceived of the traditional curriculum. The higher scores in the by the undergraduate nursing students. undergraduate nursing students’ perceptions towards their curriculum indicate a more student-centred curriculum Perception of educational environment by (Aghamolaei & Fazel 2010; Wang, Zang & Shan 2009). Fourth- year level year BN students also seemed to rate the TLS implemented A positive perception of the educational environment was as less favourable. A mixed-method study conducted by Sinclair and Ferguson (2009) revealed that: mutual for participants in all year levels of the undergraduate http://www.curationis.org.za Open Access Page 7 of 11 Original Research TABLE 5: Mean score (out of 4) of the items under study domains. Items Mean (SD) Interpretation Physical classroom environment (1) Classrooms are pleasant places to work 2.8 (0.8) Could be improved (2) Lighting is adequate and there is no glare 3.0 (0.8) Absolute positive (3) Ventilation is sufficient and the temperature is appropriate 2.7 (0.9) Could be improved (4) There is adequate space for movement 3.1 (0.8) Absolute positive (5) Furniture is arranged to best eect f ff or different activities 2.6 (0.8) Could be improved (6) Equipment and materials are easily accessible (computer, lighting system, projector, overhead projector) 2.6 (0.9) Could be improved (7) Adequate seating arrangements for students 2.9 (0.8) Could be improved (8) Students have adequate personal workspace 2.9 (0.7) Could be improved (9) Students can easily see the teacher and the black or white board 3.1 (0.7) Absolute positive (10) Furniture is suitable and well maintained 2.4 (0.8) Could be improved (11) Sound level in classroom is conducive or favourable to learning 2.8 (0.8) Could be improved Mean score 2.8 (0.5) Could be improved Skills laboratory: on-campus (12) Adequate in size 2.6 (0.9) Could be improved (13) Adequate lighting 3.2 (0.6) Absolute positive (14) Adequate ventilation 2.8 (0.8) Could be improved (15) Equipped with appropriate and sufficient equipment necessary for students’ practice of required clinical skills 2.8 (0.8) Could be improved (16) Equipped with appropriate and sufficient supplies (stock) necessary for student’s practice of required clinical skills 2.8 (0.8) Could be improved (17) Accessible to students outside regularly scheduled class times 2.6 (0.9) Could be improved Mean score 2.8 (0.6) Could be improved Skills laboratory: off-campus (18) Adequate in size 2.8 (0.8) Could be improved (19) Adequate lighting 3.1 (0.7) Absolute positive (20) Adequate ventilation 2.9 (0.8) Could be improved (21) Equipped with appropriate and sufficient equipment necessary for student’s practice of required clinical skills 2.9 (0.7) Could be improved (22) Equipped with appropriate and sufficient supplies (stock) necessary for student’s practice of required clinical skills 2.8 (0.7) Could be improved (23) Accessible to students outside regularly scheduled class times 2.2 (0.9) Could be improved Mean score 2.8 (0.6) Could be improved University library (24) Institutional library personnel offer orientation and demonstration of the library services 3.2 (0.8) Absolute positive (25) Library personnel provide assistance to students when needed 3.1 (0.8) Absolute positive (26) Library is user friendly for nursing students 3.0 (0.8) Absolute positive (27) Library has sufficient materials to support programme or classroom assignments 3.1 (0.8) Absolute positive (28) Library operating hours are convenient for students 3.3 (0.8) Absolute positive Mean score 3.1 (0.6) Absolute positive Digital resources (29) Computer laboratories are adequate to support learning (research, assignment completion, etc.) 2.9 (0.8) Could be improved (30) Eectiv ff e use of various mediums such as online teaching and learning (Ikamva) 3.1 (0.7) Absolute positive (31) Adequate resources for students during online assessments 2.9 (0.8) Could be improved (32) E-learning support services are readily accessible to all students 2.9 (0.7) Could be improved (33) Computer laboratories are available outside regular classroom hours 2.8 (0.9) Could be improved (34) Off-campus internet connectivity (Wi-Fi) is readily accessible 1.9 (0.9) Absolute negative (35) On-campus internet connectivity (Wi-Fi) is readily accessible 2.6 (0.9) Could be improved Mean score 2.7 (0.5) Could be improved Teaching and learning climate (36) Lecturers or clinical facilitators are approachable 3.2 (0.7) Absolute positive (37) Lecturers or clinical facilitators are concerned with developing my competence 3.2 (0.7) Absolute positive (38) Lecturers or clinical facilitators are able to communicate well with students 3.0 (0.8) Absolute positive (39) Lecturers or clinical facilitators have shown patience towards students 3.0 (0.8) Absolute positive (40) Lecturers or clinical facilitators provide good feedback to students 2.9 (0.8) Could be improved (41) Lecturers or clinical facilitators give students constructive criticism 3.0 (0.8) Absolute positive (42) Lecturers or clinical facilitators are well prepared for classes 3.2 (0.8) Absolute positive (43) I feel free to ask whatever question I want in class 2.9 (0.8) Could be improved (44) The environment encourages me to learn 2.9 (0.8) Could be improved Mean score 3.0 (0.6) Absolute positive Teaching and learning strategies (45) I am stimulated to actively participate in classroom 2.9 (0.7) Could be improved (46) The teaching strategy stimulates my thinking 2.9 (0.7) Could be improved (47) Teaching is student-centred (teaching addresses learning needs of individual students) 2.9 (0.7) Could be improved (48) Teaching is well integrated and focused 3.0 (0.6) Absolute positive Table 5 continues on the next page → http://www.curationis.org.za Open Access Page 8 of 11 Original Research TABLE 5 (Continues...): Mean score (out of 4) of the items under study domains. Items Mean (SD) Interpretation Physical classroom environment (49) The teaching method develops my confidence 2.9 (0.8) Could be improved (50) The time for teaching is sufficient 3.0 (0.7) Absolute positive (51) My learning needs are addressed 2.9 (0.8) Could be improved (52) Teaching is focused on the teacher 2.5 (0.8) Could be improved (53) I can understand the lecturers in classrooms 3.0 (0.7) Absolute positive (54) I am able to meet the learning outcomes through the teaching and learning strategies used 3.0 (0.7) Absolute positive (55) Clinical training activities prepare the student to perform eectiv ff ely in the clinical setting 3.2 (0.7) Absolute positive Mean score 2.9 (0.5) Could be improved Nursing curriculum (56) I am sure about the programme learning outcomes 3.0 (0.7) Absolute positive (57) The teaching and learning experience of the previous year prepared me well for this year 3.0 (0.9) Absolute positive (58) Time table arrangement allows for academic engagement 2.7 (0.9) Could be improved (59) Assessments are aligned to the outcomes provided in module guides 3.1 (0.7) Absolute positive (60) The curriculum provides an appropriate balance between theory and practice 2.9 (0.8) Could be improved (61) The learning outcomes are appropriate for the year level 3.1 (0.7) Absolute positive (62) The curriculum is organised in a way that facilitates my learning 3.0 (0.7) Absolute positive (63) The learning materials, including module guides, work books and so on, are clear 3.1 (0.7) Absolute positive (64) The programme thus far developed my ability to apply theory to practice 3.2 (0.6) Absolute positive (65) The programme thus far improved my problem-solving skills 3.1 (0.7) Absolute positive (66) The programme thus far developed my ability to think critically about the subject maer tt 3.2 (0.6) Absolute positive (67) The programme thus far helped me understand current issues in the nursing profession 3.2 (0.7) Absolute positive Mean score 3.0 (0.5) Absolute positive Total mean score 195.2 (24.2) Good SD, standard deviation. nursing students reported higher levels of satisfaction, Canada and the United Kingdom, respectively, revealed that effectiveness and consistency with their learning style when third-year students had a more positive perception of their exposed to the combination of lecture and simulation than the educational environment than the first- and second-year control group, who were exposed to lecture as the only method students. It is, however, important to acknowledge that first- of teaching and learning. (pp. 7–10) year BN students had year-long modules, and therefore their assessments were yet to happen. Furthermore, it is also Furthermore, a descriptive study conducted by Ozturk, essential to note that service department teaching essentially Muslu and Dicle (2008) using the California Critical Thinking occurs from second year. The same factors similarly apply to Disposition Inventory (CCTDI), which aimed at determining third- and fourth-year students by virtue of them having the critical thinking levels of undergraduate nursing students, been studying longer. Junior students (first and second years) revealed that nursing students who were exposed to problem- may be unable to give full account of the educational based learning (PBL) had higher critical thinking disposition environment at the SON because of not having experienced scores as compared with their counterparts who were the challenges that are faced by third- and fourth-year exposed to the traditional model. Therefore, it is vital that students at this stage of their training programme. This point nurse educators integrate various teaching strategies that are may have implications for the interpretation of this result, problem based and encourage self-directed learning (Kong et al. 2014; Ozturk et al. 2008). and therefore it must be interpreted with caution. A general trend that emerged from the students’ perceptions Perception of educational environment by of their educational environment by year level was that ethnicity senior (third- and fourth-year) BN students viewed the Previous studies evaluating the perceptions of students of educational environment at the selected university as less their educational environment categorised students based on satisfactory than the junior (first- and second-year) BN their immigrant background (Avalos, Freeman & Dunne students. The findings are consistent with those of Said, 2007; Palmgren & Chandratilake 2011). Some studies Rogayah and Hafizah (2009) and Hamid et al. (2013) who identified students of minority ethnic status to be at risk of revealed reduced scores for senior students. Hamid et al. experiencing difficulties in new educational environments (2013) suggested that: (Maduwanthi, Mudalige & Atapattu 2015; Ostapczuk et al. this trend could be due to the fact that students genuinely 2012). These variations in the calcifications of ethnicity made believed that their learning environment was deteriorating, and it difficult to compare previous studies with the ethnic thus were psychologically tired of being a student and looking background of students as categorised in the present study. forward to leaving student life. (p. 61) In this study, a positive perception of the educational environment was mutual for all ethnic groups. The total Conversely, contradictory findings noted in studies conducted by Till (2005) and Sayed and El-Sayed (2012) in score per ethnic group ranged from 169 to 202, indicating that http://www.curationis.org.za Open Access Page 9 of 11 Original Research the perception of the educational environment across all Implications for nursing education racial groups fell in the category of ‘good’. Although it is acknowledged that academic performance and success is unquestionably a complex phenomenon with A few trends were noted between ethnic groups. Black various contributing factors (Jeffreys 2015; Mthimunye, students seemed to view their educational environment as Daniels & Pedro 2018), nursing schools need to take steps more favourable than did coloured students and the category to ensure that the educational environment in which classified as ‘other ’, particularly with regard to NC, both on- they expect their students to thrive promotes a quality campus and off-campus skills laboratories, TLC and learning process. The findings of the present study are vital implemented TLS. These results provide evidence that it is in terms of understanding the environmental needs of imperative for the SON identified in this study to adopt a undergraduate nursing students in a South African multicultural learning environment (Giddens 2008). educational context. The implications for nursing education emerging from this study include the necessity of improving The present study revealed that ‘other’ category viewed the following: the TLC less favourably than did white students. Interestingly, a study conducted by Avalos et al. (2007) in • conditions of the PCE: this includes creating a pleasant Ireland reported a statistically significant difference place to work with adequate ventilation, temperature between Irish and non-Irish students’ perceptions of the regulation and adequate seating arrangements TLC. In addition, a study conducted by Palmgren and • conditions of the SL environment: this includes ensuring Chandratilake (2011) in Sweden revealed similar findings adequate ventilation, temperature regulation, accessibility and ensuring appropriate and sufficient equipment between students of Swedish and non-Swedish ethnic necessary for practice of required clinical skills background. These results should be interpreted with • DR as well as making provision for Internet access for caution because of the vast contextual differences between students who reside off-campus the present study and previous studies. Furthermore, the • TLS adopted at the identified SON. sample size for the categories that were found to be statistically different was relatively small. Taken together, it can be concluded that black students Limitations and recommendations viewed their educational environment as more favourable Although this study provides crucial evidence regarding than did other ethnic groups. This finding could be explained the educational environment at the SON, it would be by the fact that the majority of black students at the selected invaluable to conduct a similar study that includes students university are predominantly from previously disadvantaged from other departments in the community and health educational backgrounds and consequently might be more science faculty. The limitation that should be acknowledged appreciative of anything that was better than what they had in this study is that because of financial reasons and time previously experienced (University of the Western Cape constraints an adjusted sample size of 287 participants was 2018). calculated to ensure a sample that is representative of the study population (Dean et al. 2013). Similar studies should Perception of educational environment be conducted with larger samples at other universities and by gender nursing schools in South Africa and around the world to Previous studies conducted in the medical field comparing increase the generalisability of the findings beyond the gender differences revealed that female students were more investigated university. For future studies, we recommend positive about their educational environment compared to a qualitative follow-up study with the participants to gain their male counterparts (Jawaid et al. 2013; Lokuhetty et al. in-depth understanding of the aspects that need to be 2010; Nahar et al. 2010; Riquelme et al. 2009). However, the improved. In addition, it would be interesting for future same cannot be said of the nursing field. Similar to the study studies to evaluate the relationship between students’ conducted by Victor et al. (2016) in Pakistan, the results of perceptions of their educational environment and academic the present study revealed that male students viewed the performance. educational environment more favourably than did their female counterparts. However, it must be acknowledged Conclusion that the trend was not statistically significant for all subscales This study’s findings conclude that the selected participants of the educational environment (off-campus SL, UL, DR, at the identified university generally perceived their TLC and TLS) at the identified SON. These findings may educational environment as being more positive than result from the fact that male nursing students are a minority negative. Regarding students’ general perceptions of the group and are known to receive special treatment from subscales, enhancements are required in the PCE, skills educators as well as clinical supervisors, and therefore they laboratories (both on-campus and off-campus), DR and the might have a preponderance of positive experiences (Moss- implemented TLS. In contrast, and completing the range of Racusin et al. 2012). Kouta and Kaite (2011) indicated that gender bias in nursing education could have an influence on subscales, the students’ perceptions of the subscales UL, TLC perceptions of the educational environment. and NC seem to require minimal enhancements, if any. It is http://www.curationis.org.za Open Access Page 10 of 11 Original Research Dean, A.G., Sullivan, K.M. & Soe, M.M., 2013, OpenEpi: Open source epidemiologic essential for university management and the SON to prioritise statistics for public health, viewed June 2017, from http://www.openepi.com/ the suggested improvements based on the results of this SampleSize/SSCC.htm study to create an educational environment that promotes Denscombe, M., 2014, The good research guide: For small-scale social research projects, McGraw-Hill Education, London. quality learning. Denz-Penhey, H. & Murdoch, J.C., 2009, ‘A comparison between findings from the DREEM questionnaire and that from qualitative interviews’, Medical Teacher 31(10), e449–e453. https://doi.org/10.3109/01421590902849552 Acknowledgements Field, A., 2013, Discovering statistics using IBM SPSS statistics , Sage, Thousand Oaks, CA. Competing interests Giddens, J.F., 2008, ‘Achieving diversity in nursing through multicontextual learning environments’, Nursing Outlook 56(2), 78–83. https://doi.org/10.1016/j. The authors declare that they have no financial or personal outlook.2007.11.003 relationships that may have inappropriately influenced them Hamid, B., Faroukh, A. & Mohammadhosein, B., 2013, ‘Nursing students’ perceptions in writing this article. The views expressed in this article are of their educational environment based on the DREEM model in an Iranian University’, The Malaysian Journal of Medical Sciences 20(4), 56–63. the authors’ own and do not reflect an official position of the He, D., Wu, D., Yue, Z., Fu, A. & Thien Vo, K., 2012, ‘Undergraduate students’ interaction institution or the funder. with online information resources in their academic tasks: A comparative study’, Aslib Proceedings 64(6), 615–640, Emerald Group Publishing Limited. https://doi. org/10.1108/00012531211281715 Authors’ contributions Henderson, A., Creedy, D., Boorman, R., Cooke, M. & Walker, R., 2010, ‘Development and psychometric testing of the clinical learning organisational culture survey (CLOCS)’, Nurse Education Today 30(7), 598–602. https://doi.org/10.1016/j. 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Student nurses’ perceptions of their educational environment at a school of nursing in Western Cape province, South Africa: A cross-sectional study

Curationis , Volume 42 (1) – Apr 8, 2019

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0379-8577
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2223-6279
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10.4102/curationis.v42i1.1914
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Curationis ISSN: (Online) 2223-6279, (Print) 0379-8577 Page 1 of 11 Original Research Student nurses’ perceptions of their educational environment at a school of nursing in Western Cape province, South Africa: A cross-sectional study Authors: Background: Educational environments have been found to bear a substantial relationship Katlego D.T. Mthimunye with the academic performance and success, as well as the retention, of students. Felicity M. Daniels Objectives: The study objectives were to (1) evaluate the educational environment as perceived Affiliations: by undergraduate nursing students at a school of nursing (SON) in Western Cape province School of Nursing, University and (2) investigate whether the educational environment, or components thereof, is perceived of the Western Cape, negatively or positively among undergraduate nursing students of different year level, gender, Cape Town, South Africa home language and ethnicity. Corresponding author: Method: A quantitative research method with a cross-sectional design was implemented. Data Katlego Mthimunye, katlegomthimunye@ were collected from 232 undergraduate nursing students from a SON at a university in Western icloud.com Cape province, South Africa. The subscales and the items of the educational environment questionnaire were compared among undergraduate nursing students. Data were analysed by Dates: means of the IBM Statistical Package for Social Sciences (IBM SPSS-24) using analysis of variances Received: 19 Feb. 2018 (ANOVAs), independent-sample t-tests, mean scores, standard deviations and percentages. Accepted: 12 Nov. 2018 Published: 08 Apr. 2019 Results: The mean score attained for the entire participant group was 195 (standard deviation [SD] = 24.2) out of 268 (equivalent to 72.8% of maximum score), which indicated that the How to cite this article: Mthimunye, K.D.T. & Daniels, educational environment was perceived substantially more positively than negatively. The F.M., 2019, ‘Student nurses’ overall mean score was significantly higher ( p < 0.05) for male students (M = 202; SD = 21) and perceptions of their for black students (M = 202; SD = 21). The digital resources (DR) subscale was the only subscale educational environment at a with a statement or item that was rated as absolute negative (M = 1.9; SD = 0.9). school of nursing in Western Cape province, South Africa: Conclusion: The educational environment at the institution concerned was perceived as A cross-sectional study’, predominantly positive by its undergraduate nursing students. Although the educational Curationis 42(1), a1914. environment was predominantly perceived as positive, the results of this study also indicated https://doi.org/10.4102/ curationis.v42i1.1914 that enhancements are required to improve the physical classroom conditions, skills laboratories, DR and the implemented teaching and learning strategies. It is vital for university Copyright: management to prioritise the creation of an educational environment which would ensure that © 2019. The Authors. quality learning takes place. Licensee: AOSIS. This work is licensed under the Keywords: student’s perceptions; educational environment; nursing education; Western Cape; Creative Commons South Africa. Attribution License. Introduction Teaching and learning in nursing education is undergoing substantial transformation worldwide (Aiken 2011; Benner 2012; World Health Organization 2013). These transformations challenge nursing schools to implement new strategies to facilitate high-quality teaching and learning (Benner 2012). The educational environment in particular plays a central role in the process of teaching and learning (Arzuman, Yusoff & Chit 2010; Cleveland & Fisher 2014; Davies et al. 2013; Korucu & Alkan 2011). The educational environment in nursing comprises both practical and theoretical learning settings (Billings & Halstead 2015). It also incorporates a variety of basic provisions such as the physical infrastructure, the teaching and learning processes, school resources or materials and the teacher–student relationship (Miles, Swift & Leinster 2012). In addition, for nursing students, an ideal educational environment should promote critical thinking and lifelong learning (Billings & Halstead 2015; Davis & Kimble 2011). However, it is also necessary to be aware that ‘demotivating elements such as perceived bias, poor role models, R Read online: ead online: Sc Scan this QR an this QR information overload, teacher-centered or disorganized teaching need to be identified and code with your code with your eliminated’ (Veerapen & McAleer 2010:2). As a further cautionary observation, Bruce, Klopper smart phone or smart phone or mobile de mobile device vice and Mellish (2011) suggest that nursing education requires a modern educational environment t to r o read online. ead online. which is focused more on the learning paradigm than on the teaching paradigm. http://www.curationis.org.za Open Access Page 2 of 11 Original Research TABLE 1: Summary of study population, sample and response rate. Background Year level Population ( N) Sample (n) Response n (%) First-year Bachelor of Nursing 74 19 14 (4.88) The literature reveals that educational environments have an Foundation (BNF 1) impact on students’ levels of success, achievement, Second-year Bachelor of Nursing 45 11 9 (3.14) Foundation (BNF 2) contentment and motivation (Arzuman et al. 2010). First-year Bachelor of Nursing (BN 1) 221 56 49 (17.07) Furthermore, Till (2005) and Arzuman et al. (2010) have Second-year Bachelor of Nursing 303 77 62 (21.60) suggested that students’ satisfaction with their educational (BN 2) environment is associated with the depth and quality of Third-year Bachelor of Nursing (BN 3) 240 61 48 (16.72) learning. Arzuman et al. (2010) and Al Ayed and Sheik (2008) Fourth-year Bachelor of Nursing 248 63 50 (17.42) (BN 4) reported that educational environment domains correlate Total 1131 287 232 (80.84) positively with the academic success and, ultimately, the retention of students. Therefore, students’ perceptions of their educational environment serve as a valuable foundation Context of the study for transforming and improving the quality of the educational This study was conducted in the SON at a university in the environment. In addition, Baeten et al. (2010) and Cheon et Western Cape province of SA. The SON offers a range of al. (2012) reported that students’ perceptions of their learning undergraduate and postgraduate programmes. The environment have a significant impact on the learning undergraduate programmes offered by the SON were the strategies that they may adopt. For example, Baeten et al. main focus of this study, and these include the 4-year Bachelor (2010) reported that students in the community and health of Nursing (BN) and 5-year Bachelor of Nursing Foundation sciences faculty exhibited a deep learning approach towards (BNF) programmes. their learning. Therefore, an environment that promotes quality and deep learning is vitally significant in ensuring Population, sample and sampling technique successful teaching of, and learning by, nursing students. Inclusion criteria Moreover, the improvement of the overall educational environment is likely to have a significant influence on the As a result of the apartheid system and segregation policies academic performance and retention of the nursing student in SA, the racial classification of population groups differs (Al Ayed & Sheik 2008; Arzuman et al. 2010; Till 2005). slightly from general classifications used around the world (Cornell & Hartmann 2007). For example, the term ‘coloured’ Evaluation of the students’ perceptions towards their in a South African context refers to a population group of educational environment at the school of nursing (SON) mixed race (Moultrie & Timæus 2003). In SA, the predominant would aid nurse educators and faculty staff in measuring racial groupings are classified as black, white, coloured and the quality of the teaching and learning taking place (Denz- Indian. The study population included all students registered Penhey & Murdoch 2009). Although numerous studies have for the BN and BNF programmes at the university concerned. been conducted globally, evaluating the perceptions of medical as well as nursing students’ perceptions of their Sampling technique educational environment (Colbert-Getz et al. 2014; Stratified random sampling was used to ensure that all levels Ostapczuk et al. 2012; Rahman et al. 2015; Yusoff 2012), we of the BN and BNF programmes were adequately represented are not aware of any studies evaluating nursing students’ (Table 1). In stratified random sampling, perceptions of their educational environments either in the population of interest is first divided into two or more groups South Africa (SA) or at the identified university in the based on characteristics that are important to the study, and then Western Cape province. members within each group are randomly selected. (Macnee & McCabe 2008:128) Objectives The objectives of this study were to: Sample size 2 2 The sample size equation n = (p) (1−p) (Z) /e with a 95% • evaluate the educational environment as perceived by confidence level ( Z = 1.96), an error rate (e) of 5% and a undergraduate nursing students at a SON in the Western proportion of the target population (p = 50%) revealed that a Cape province of SA sample of 384 is required to represent the population (Dean, • investigate whether the educational environment, or Sullivan & Soe 2013). An adjusted sample size of 287 was components thereof, was perceived negatively or derived using the equation n = n/(1 + (n – 1)/N), where the positively among undergraduate nursing students of a population (N) is 1131 (Dean et al. 2013). Furthermore, the different year level, gender or ethnicity. equation c = (N /N)n was used to calculate the sample size s a within each strata, where c is the sample size for stratum, N Methods is the population size for stratum, N is the total population Research design 1 Statistics South Africa continues to classify people into population groups as moving away from the pre-1994 apartheid-based system. This classification uses a A quantitative research method with a cross-sectional design, population group-based classification system that is no longer based on a legal using a researcher-developed survey, was used. definition, but rather on self-classification (Statistics South Africa 2016). http://www.curationis.org.za Open Access Page 3 of 11 Original Research size and n is the total sample size (Dean et al. 2013). Table 1 consistency reliability which revealed a Cronbach’s alpha summarises the study population sample as well as the coefficient of 0.945. The individual items of the instrument response rate. revealed a Cronbach’s alpha coefficient ranging from 0.943 to 0.945. This Cronbach’s alpha coefficient confirms that the items being measured were internally reliable (Field 2013). Research instrument and data collection According to Tavakol and Dennick (2011), a significant Data were collected using a researcher-developed Cronbach’s alpha coefficient ( ≥ 0.70) adds to the validity and questionnaire that was administered to the sampled accuracy of the instrument. Thus, an instrument cannot be undergraduate (BN and BNF) nursing students. The valid unless it is reliable (Tavakol & Dennick 2011). questionnaire consisted of a total score of 268 for 67 items on a four-point Likert scale (where 1 = strongly disagree, 2 = Validity of the instruments disagree, 3 = agree and 4 = strongly agree). For interpretation of the overall survey score, the following overall scores were The content validity of the questionnaire was established by considered based on quadrant parameters: 0–67 = very poor; the research supervisor (an expert in teaching and learning) 68–134 = poor; 135–201 = good; 202–268 = excellent. and a statistician. Their inputs were implemented to improve the items in the questionnaire. In addition, face validity was The survey consisted of demographic factors and eight conducted by 30 undergraduate nursing students during the subscales that were used to measure nursing students’ pilot test of the instrument to ensure accurate interpretation perception of the educational environment. The instruments’ of the content. During the face validity, none of the subscales and measurements included the following: participants requested verbal assistance and they responded to all the items included in the instrument. In general, the • physical classroom environment (PCE) – 11 items; participants in this pilot test reported that the instruction and maximum score = 44 the content of the instrument were well defined. • skills laboratory (SL) (on-campus) – six items; maximum score = 24 • SL (off-campus) – six items; maximum score = 24 Data processing and analysis • university library (UL) – five items; maximum score = 20 Data were analysed using the IBM Statistical Package for • digital resources (DR) – seven items; maximum score = 28 Social Sciences (IBM SPSS-24). Missing values were dealt • teaching and learning climate (TLC) – nine items; with by replacing them with the median of nearby points to maximum score = 36 avoid errors and skewness of the data. Descriptive and • teaching and learning strategies (TLS) – 11 items; inferential statistics were performed by means of frequencies, maximum score = 44 standard deviations (SDs) and percentages for the total score • nursing curriculum (NC) – 12 items; maximum score = 48. of the questionnaire and subscale scores of the whole sample as well as the specific BN and BNF groups, ethnic group and In this study, TLC refers to professional relationships among gender. For dichotomous variables (home language and students and educators, whereas TLS refers to the teaching gender), comparisons of overall and subscale mean scores and learning methodologies implemented at the SON. were achieved through a series of independent-sample t-tests. For variables with more than two values (ethnicity Items with a mean score of 3.0 or more indicate absolute and year level of study), a series of one-way analysis of positive aspects. Items with a mean score of 2.0 or below variances (ANOVAs) were performed to compare all the indicate absolute negative aspects and need immediate groups. Where one-way ANOVAs were not possible owing intervention. Items with a mean score of between 2.0 and 3.0 to violation of the significant homogeneity of variances ( p < are aspects of the educational environment that warrant 0.05), the alternative statistical test – Welch ANOVA – was improvement. used. The significance level for ANOVA was established at p < 0.05. Where significant ( p < 0.05) differences between the Reliability of research instrument groups were found, a post hoc Tukey’s honestly significant A pilot test of the instrument preceded the actual data difference (HSD) test for multiple comparisons was used to collection to ensure reliability of the data collection verify where the variances occurred between the groups. instrument. Perneger et al. (2015) suggested that, to produce Where no significant ( p > 0.05) differences between the significant results from a pretest, a minimum sample size of groups were found (equal variances not assumed), a 30 participants is recommended. Questionnaires were nonparametric Games–Howell post hoc test set for multiple administered to 30 undergraduate nursing students (selected comparisons was used to verify where the variances occurred via convenience sampling) who were not included in the between the groups. main study. The questionnaire was then administered to the same group 2 weeks later to ensure test–retest reliability Ethical considerations (Polit & Beck 2010). The test–retest reliability revealed an intraclass correlation coefficient of 0.954, indicating an Ethics in research is a serious matter and researchers need to excellent correlation coefficient (Field 2013). Finally, the adhere to strict rules (Denscombe 2014). Participation in the reliability process involved calculating the internal study was voluntary and was based on participants’ consent. http://www.curationis.org.za Open Access Page 4 of 11 Original Research Ethics clearance (HS17/1/42) was obtained from the with an SD of 24.2. These results indicate that, generally, the university ethics committee. Permission to conduct the study educational environment, as perceived by undergraduate at the identified SON was obtained from the registrar of the nursing students at the identified university, was good but university as well as the director of the SON. could be improved upon. The total scores varied significantly between year levels (F = 7.098; p < 0.000). Post hoc (5, 226) analysis using Tukey’s HSD test indicated that first-year BN Results students had a significantly positive perception ( p < 0.000) Participants about their overall educational environment as compared A total of 232 (80.84%) students out of the 287 stratified with the senior students (third- and fourth-year BN students). random sample completed the survey. The demographic data revealed that of the 232 students, 182 (78.45%) were Skills laboratory (on-campus) scores varied significantly females and 50 (21.55%) were males. More than half (n = 132; between the year levels of the undergraduate programme 56.90%) of the participants were of black ethnicity, followed (F = 6.341; p = 0.000). SL (off-campus) scores varied (5, 226) by coloured students (n = 74; 31.90%), white students (n = 18; significantly between the year levels ( F = 4.242; p = 0.001). (5, 226) 7.76%) and Indian students (n = 4; 1.72%). The category Likewise, taken together, the results of Tukey’s post hoc HSD classified as ‘other ’, which included all the students who did statistics for both on- and off-campus SL indicated that not belong to any of the four main categories as classified by generally first-year BN students have a significantly positive Statistics South Africa (2016), comprised four (1.72%) (p < 0.05) perception about the skills laboratories compared students. The youngest participant was 18 years old and the with second-, third- and fourth-year BN students. oldest was 49 years old. The mean age of the study participants was 23.02 (SD = 5.11) years. Of the 232 participants, 63 Digital resources mean scores varied significantly between (27.16%) spoke English as their home language, whereas the year levels (F = 4.982, p = 0.000). Post hoc Tukey’s HSD (5, 226) remaining 169 (72.84%) spoke other languages including statistics indicated that first- and second-year BN students IsiXhosa and Afrikaans. had a significantly positive perception ( p < 0.005) about the DR, as compared with the third-year BN students. Overall mean scores by year level of study Teaching and learning climate mean scores varied A one-way between-groups ANOVA was performed to significantly ( F = 7.254, p = 0.000). Post hoc Tukey’s HSD compare the nursing students’ perceptions regarding their (5, 226) statistics suggest that the first-year BN students had a educational environment for each year level of study in the significantly positive perception ( p < 0.005) about the TLC as undergraduate programme. Subscale means and SDs for the compared with their senior third- and fourth-year BN whole sample as well as for each year level are summarised students. Likewise, Tukey’s post hoc HSD statistics revealed in Table 2. For this ANOVA, the outcome variables were that second-year BN students had a significantly positive found to be normally distributed and equal variances were perception (p < 0.005) about the TLC as compared with assumed except for the UL subscale, which revealed a fourth-year BN students. Levene’s statistic of F = 4.8; p < 0.000. As the assumption (5, 226) of homogeneity of variance was not met for the UL subscale, The TLS mean score varied significantly ( F = 2.773, p = the Welch statistical test was performed and the results (5, 226) 0.019). Tukey’s post hoc HSD statistics results indicated that revealed Welch’s F = 1.81, which was found to be (5, 55.08) first-year BN students had a significantly positive perception not significant ( p = 0.127). The Games–Howell post hoc (p = 0.032) towards the TLS implemented at the identified comparison test revealed that there was no statistical university as compared with the fourth-year BN students. difference between all unique pairwise comparisons. The mean score of the students’ perceptions regarding the The total mean score for all the students who participated in NC varied significantly ( F = 5.469, p = 0.000). Tukey’s the present study was 195 (72.8% of the maximum score), (5, 226) post hoc HSD test results indicated that first-year BN students TABLE 2: Mean (standard deviation) and overall scores by year level. Domains BNF 1 BNF 2 BN 1 BN 2 BN 3 BN 4 All F p Tukey’s HSD < 0.05 Physical classroom environment (PCE) 32 (3.3) 33 (3.2) 32 (4.8) 31 (5.4) 30 (5.9) 30 (5.9) 31 (5.4) 1.303 0.264 - Skills laboratory (SL) (on-campus) 18 (2.0) 18 (2.3) 19 (3.2) 16 (3.7) 15 (3.7) 16 (3.2) 17 (3.6) 6.341 0.000* BN 1–BN 2, BN 1–BN 3, BN 1–BN 4 Skills laboratory (SL) (off-campus) 18 (3.0) 18 (2.5) 18 (3.1) 16 (3.3) 16 (3.8) 16 (3.2) 17 (3.4) 4.242 0.001* BN 1–BN 2, BN 1–BN 3, BN 1–BN 4 University library (UL) 16 (2.1) 15 (2.3) 16 (2.5) 16 (2.7) 14 (4.0) 16 (2.8) 16 (3.0) 1.81 0.127 - Digital resources (DR) 20 (3.0) 19 (2.7) 21 (3.6) 19 (3.4) 17 (3.6) 19 (3.7) 19 (3.7) 4.982 0.000* BN 3–BN 1, BN 3–BN 2 Teaching and learning climate (TLC) 28 (3.7) 27 (3.7) 30 (3.8) 28 (4.7) 26 (5.3) 25 (5.4) 27 (3.7) 7.254 0.000* BN 1–BN 3, BN 1–BN 4, BN 2–BN 4 Teaching and learning strategies (TLS) 34 (3.3) 44 (4.7) 34 (4.6) 33 (5.6) 31 (5.3) 31 (6.4) 32 (5.5) 2.773 0.019* BN 1–BN 4 Nursing curriculum (NC) 38 (5.0) 37 (6.5) 39 (4.1) 37 (5.5) 36 (5.4) 33 (6.4) 37 (5.7) 5.469 0.000* BN 4–BN 1, BN4–BN2 Total 202 (12) 201 (22) 208 (19) 197 (23) 186 (25) 186 (26) 195 (24.2) 7.098 0.000 BN 1–BN 3, BN1–BN4 n 14 9 49 62 48 50 232 - - - BNF 1, first-year Bachelor of Nursing Foundation; BNF 2, second-year Bachelor of Nursing Foundation; BN 1, first-year Bachelor of Nursing; BN 2, second-year Bachelor of Nursing; BN 3, third-year Bachelor of Nursing; BN 4, fourth-year Bachelor of Nursing; HSD, honestly significant difference; F, variation between group means; p, significance; *, p > 0.05. http://www.curationis.org.za Open Access Page 5 of 11 Original Research and second-year BN students had a significantly positive post hoc HSD test results revealed that there were no perception (p < 0.05) regarding the NC at the identified significant statistical differences between all unique pairwise comparisons. university as compared with the fourth-year BN students. The mean score of students’ perceptions of the TLC by Overall mean score by ethnicity ethnicity varied significantly ( F = 5.81, p = 0.000). Tukey’s (4, 227) A one-way between-groups ANOVA was performed to post hoc HSD statistics indicated that black students had a compare the nursing students’ perceptions regarding their more positive perception (p < 0.05) regarding the TLC at the educational environment for each ethnic group. Participants identified university compared with their coloured were divided into five groups based upon their ethnic counterparts as well as the category classified as ‘other’. demographics (black, coloured, Indian, white and other). Tukey’s post hoc HSD results also revealed that white Subscale means and SDs for ethnicity are displayed in students had a more positive perception (p < 0.05) regarding Table 3. For this ANOVA, the outcome variables were found the TLC compared with students classified in the category of to be normally distributed and equal variances were assumed ‘other ’. except for PCE, NC and total score, which revealed the following Levene’s statistics respectively: F = 2.59, p = The mean score of students’ perceptions regarding the TLS (4, 227) implemented at the identified university varied significantly 0.038; F = 3.36, p = 0.011 and F = 4.25, p = 0.002. As the (4, 227) (4, 227) (F = 6.24, p = 0.000). Tukey’s post hoc HSD statistics assumption of homogeneity of variance was not met for PCE, (4, 227) indicated that black students had a significantly positive NC and overall score, Welch statistics were performed. The perception (p < 0.05) of the TLS compared with coloured results for PCE revealed Welch statistic F = 2.38, which (4, 11.15) students and those classified as ‘other ’. was found to be not statistically significant ( p = 0.114). The Games–Howell post hoc comparison test revealed that there was no statistical difference between all ethnic groups in Gender differences pairwise comparisons. The results for NC revealed Welch An independent-samples t-test was performed to compare statistic F = 4.93, which was found to be statistically (4, 11.11) the nursing students’ perceptions regarding their educational significant ( p = 0.016). Post hoc comparison Games–Howell environment among male and female undergraduate nursing statistics indicated that black students had a more positive students. The overall mean score was significantly ( p < 0.05) perception (p < 0.05) towards the NC at the university higher for male students than for female students (t(230) = compared with their coloured counterparts. Welch statistic 2.3, p = 0.022). These results indicated that male students’ results for the overall score by ethnicity (F = 5.25) were (4, 11.09) perceptions regarding their teaching and educational found to be significant ( p = 0.013). The post hoc comparison environment were more positive compared with their female Games–Howell statistic indicated that, overall, black students counterparts. A summary of the independent-sample t-test had a more positive perception (p < 0.05) towards their for comparison of the subscale scores and gender is presented educational environment compared with their coloured in Table 4. counterparts. Overall mean scores for undergraduate students The mean score of the students’ perceptions regarding the on-campus (F = 4.85, p = 0.001) and off-campus (F = The mean scores for UL were the highest (3.1 out of 4), (4, 227) (4, 227) 3.21, p = 0.014) skills laboratories by ethnicity varied followed by TLC and NC (3.0 out of 4 for both subscales). The significantly. The post hoc Tukey’s HSD test results indicate remaining five subscales (PCE, SL [on-campus], SL [off- that black students had a positive perception (p < 0.05) scampus], DR and TLS) revealed mean scores below 3 out of regarding both on-campus and off-campus skills laboratories 4. The results revealed that the weakest subscale was DR compared with their coloured counterparts. with a mean score of 2.7 out of 4. Furthermore, the DR subscale was the only subscale with a statement or item that The mean score of the students’ perceptions regarding DR by was rated an absolute negative. Table 5 summarises the mean ethnicity varied significantly ( F = 2.83, p = 0.026). Tukey’s scores and interpretation of items under investigation. (4, 227) TABLE 3: Mean (standard deviation) and overall score by ethnicity. Domains Black Coloured Indian White Other F p Tukey’s HSD < 0.05 Physical classroom environment (PCE) 32 (5) 30 (5) 24 (7) 30 (6) 24 (10) 2.382 0.114 - Skills laboratory (SL) (on-campus) 18 (3) 16 (4) 16 (6) 16 (2) 15 (5) 4.847 0.001* Black–coloured Skills laboratory (SL) (off-campus) 18 (3) 16 (3) 15 (6) 17 (2) 15 (6) 3.208 0.014* Black–coloured University library (UL) 16 (3) 16 (3) 17 (2) 15 (2) 14 (3) 0.361 0.836 - Digital resources (DR) 19 (4) 19 (3) 15 (6) 19 (4) 16 (4) 2.827 0.026* - Teaching and learning climate (TLC) 28 (5) 26 (5) 26 (6) 27 (6) 20 (6) 5.809 0.000* Black–coloured, black–other, white–other Teaching and learning strategies (TLS) 33 (5) 31 (5) 27 (6) 30 (6) 25 (7) 6.235 0.000* Black–coloured, black–other Nursing curriculum (NC) 38 (5) 35 (5) 30 (11) 37 (7) 28 (8) 4.927 0.016* Black–coloured Overall 202 (21) 188 (22) 169 (45) 190 (26) 156 (46) 5.249 0.013 Black–coloured n 132 74 4 18 4 - - - *, p > 0.05; HSD, honestly significant difference; F, variation between group means; p, significance. http://www.curationis.org.za Open Access Page 6 of 11 Original Research TABLE 4: Mean score (standard deviation) and overall scores by gender nursing programme. The total score per year level ranged (N = 232). from 186 to 202, indicating that the perception of the Domains Female Male t p educational environment fell in the category of ‘good’. The Physical classroom environment (PCE) 31 (5) 32 (5) 2.089 0.038* subscale means scores ranging between 60.7% and 100% of Skills laboratory (SL) (on-campus) 16 (4) 18 (3) 2.100 0.037* the maximum scores also indicated a positive perception of Skills laboratory (SL) (off-campus) 17 (3) 18 (3) 1.789 0.075 University library (UL) 16 (3) 16 (3) 0.481 0.631 the educational environment. These results are consistent Digital resources (DR) 19 (4) 19 (4) 0.506 0.614 with the findings of the majority of the studies conducted Teaching and learning climate (TLC) 27 (5) 28 (4) 1.390 0.166 around the world (Brown et al. 2011; Hamid et al. 2013; Teaching and learning strategies (TLS) 32 (6) 33 (5) 1.624 0.106 Imanipour et al. 2015; Victor et al. 2016). Nursing curriculum (NC) 36 (6) 38 (5) 1.994 0.047* Overall 193 (25) 202 (21) 2.302 0.022 A few trends were noted between the year levels. Particularly, n 183 50 - - first-year BN students seemed to view their educational *, p > 0.05; t, Gosset’s Student distribution (difference between population means); p, significance. environment as more satisfactory than did second-, third- and fourth-year BN students with regard to both the on- campus and off-campus skills laboratories. Papathanasiou, Discussion Tsaras and Sarafis (2014) suggest that ‘students generally The aim of the present study was to evaluate the educational wish for a more positive clinical learning environment than environment as perceived by undergraduate nursing what they have experienced, especially when it comes to students at a SON. It also aimed to investigate whether the issues related to satisfaction, individualisation and educational environment, or parts thereof, was perceived innovation’. Therefore, it is pivotal that skills laboratories negatively or positively among undergraduate nursing where simulated clinical learning takes place are improved to students of different year level, gender or ethnicity. ensure the development of critical thinking among nursing students (Henderson et al. 2010). Perception of educational environment for the entire sample of undergraduate nursing students First- and second-year BN students viewed DR more favourably than did third- and fourth-year BN students. A Recent studies conducted across the world have been conclusive comparative study conducted by He et al. (2012), comparing in finding that the majority of undergraduate nursing students participants from two universities in the United States and perceive their educational environment as predominantly China with the aim of ‘identifying the opinions of positive (Brown, Williams & Lynch 2011; Hamid, Faroukh & Mohammadhosein 2013; Imanipour et al. 2015; Victor, Ishtiaq & undergraduate students on the importance of internet-based information sources when they undertake academic tasks’, Parveen 2016). A more positive perception (high mean overall score) of the educational environment by nursing students revealed that students use various DR including, but not indicates a more student-centred approach to teaching and limited to, search engines and social networking. Similarly, learning (Roff 2005). The present study revealed similar results. the findings of a cross-sectional study conducted by The total mean score for the entire sample of undergraduate Johansson et al. (2014) in Sweden revealed that most nursing nursing students was 195.2 (72.8%) which was well between 135 students regarded smart mobile devices to be useful in and 201, indicating that generally the students’ perception of the providing easy access to essential information to improve educational environment was more positive than negative. In evidence-based practice, record keeping, planning their work addition, the results were fairly consistent across the study and saving time. A conclusion that can be drawn is that subscales, ranging from 67.9% to 80%. However, these results improving access to efficient and reliable digital recourses fell short of achieving the ‘excellent’ ranking (total mean score of will ensure a positive educational environment that promotes between 202 and 268). A conclusion that can be drawn from quality teaching and learning (He et al. 2012; Johansson et al. these results is that although the overall students’ perception is 2014; Thongmak 2013). more positive and the identified educational environment is student-centred, the environment can nevertheless be further Likewise, the result of this study revealed that junior students improved. The enhancement of the educational environment is (first- and second-year BN students) viewed NC more likely to have a significant impact on the academic performance favourably than did the senior students (third- and fourth- and retention of nursing students (Al Ayed & Sheik 2008; year BN students). According to previous studies, students of Arzuman et al. 2010; Till 2005). The findings presented in Table an innovative curriculum tend to show more contentment 5 provide an overview of subscales for potential interventions to with their educational environments compared with students improve the quality of the educational environment as perceived of the traditional curriculum. The higher scores in the by the undergraduate nursing students. undergraduate nursing students’ perceptions towards their curriculum indicate a more student-centred curriculum Perception of educational environment by (Aghamolaei & Fazel 2010; Wang, Zang & Shan 2009). Fourth- year level year BN students also seemed to rate the TLS implemented A positive perception of the educational environment was as less favourable. A mixed-method study conducted by Sinclair and Ferguson (2009) revealed that: mutual for participants in all year levels of the undergraduate http://www.curationis.org.za Open Access Page 7 of 11 Original Research TABLE 5: Mean score (out of 4) of the items under study domains. Items Mean (SD) Interpretation Physical classroom environment (1) Classrooms are pleasant places to work 2.8 (0.8) Could be improved (2) Lighting is adequate and there is no glare 3.0 (0.8) Absolute positive (3) Ventilation is sufficient and the temperature is appropriate 2.7 (0.9) Could be improved (4) There is adequate space for movement 3.1 (0.8) Absolute positive (5) Furniture is arranged to best eect f ff or different activities 2.6 (0.8) Could be improved (6) Equipment and materials are easily accessible (computer, lighting system, projector, overhead projector) 2.6 (0.9) Could be improved (7) Adequate seating arrangements for students 2.9 (0.8) Could be improved (8) Students have adequate personal workspace 2.9 (0.7) Could be improved (9) Students can easily see the teacher and the black or white board 3.1 (0.7) Absolute positive (10) Furniture is suitable and well maintained 2.4 (0.8) Could be improved (11) Sound level in classroom is conducive or favourable to learning 2.8 (0.8) Could be improved Mean score 2.8 (0.5) Could be improved Skills laboratory: on-campus (12) Adequate in size 2.6 (0.9) Could be improved (13) Adequate lighting 3.2 (0.6) Absolute positive (14) Adequate ventilation 2.8 (0.8) Could be improved (15) Equipped with appropriate and sufficient equipment necessary for students’ practice of required clinical skills 2.8 (0.8) Could be improved (16) Equipped with appropriate and sufficient supplies (stock) necessary for student’s practice of required clinical skills 2.8 (0.8) Could be improved (17) Accessible to students outside regularly scheduled class times 2.6 (0.9) Could be improved Mean score 2.8 (0.6) Could be improved Skills laboratory: off-campus (18) Adequate in size 2.8 (0.8) Could be improved (19) Adequate lighting 3.1 (0.7) Absolute positive (20) Adequate ventilation 2.9 (0.8) Could be improved (21) Equipped with appropriate and sufficient equipment necessary for student’s practice of required clinical skills 2.9 (0.7) Could be improved (22) Equipped with appropriate and sufficient supplies (stock) necessary for student’s practice of required clinical skills 2.8 (0.7) Could be improved (23) Accessible to students outside regularly scheduled class times 2.2 (0.9) Could be improved Mean score 2.8 (0.6) Could be improved University library (24) Institutional library personnel offer orientation and demonstration of the library services 3.2 (0.8) Absolute positive (25) Library personnel provide assistance to students when needed 3.1 (0.8) Absolute positive (26) Library is user friendly for nursing students 3.0 (0.8) Absolute positive (27) Library has sufficient materials to support programme or classroom assignments 3.1 (0.8) Absolute positive (28) Library operating hours are convenient for students 3.3 (0.8) Absolute positive Mean score 3.1 (0.6) Absolute positive Digital resources (29) Computer laboratories are adequate to support learning (research, assignment completion, etc.) 2.9 (0.8) Could be improved (30) Eectiv ff e use of various mediums such as online teaching and learning (Ikamva) 3.1 (0.7) Absolute positive (31) Adequate resources for students during online assessments 2.9 (0.8) Could be improved (32) E-learning support services are readily accessible to all students 2.9 (0.7) Could be improved (33) Computer laboratories are available outside regular classroom hours 2.8 (0.9) Could be improved (34) Off-campus internet connectivity (Wi-Fi) is readily accessible 1.9 (0.9) Absolute negative (35) On-campus internet connectivity (Wi-Fi) is readily accessible 2.6 (0.9) Could be improved Mean score 2.7 (0.5) Could be improved Teaching and learning climate (36) Lecturers or clinical facilitators are approachable 3.2 (0.7) Absolute positive (37) Lecturers or clinical facilitators are concerned with developing my competence 3.2 (0.7) Absolute positive (38) Lecturers or clinical facilitators are able to communicate well with students 3.0 (0.8) Absolute positive (39) Lecturers or clinical facilitators have shown patience towards students 3.0 (0.8) Absolute positive (40) Lecturers or clinical facilitators provide good feedback to students 2.9 (0.8) Could be improved (41) Lecturers or clinical facilitators give students constructive criticism 3.0 (0.8) Absolute positive (42) Lecturers or clinical facilitators are well prepared for classes 3.2 (0.8) Absolute positive (43) I feel free to ask whatever question I want in class 2.9 (0.8) Could be improved (44) The environment encourages me to learn 2.9 (0.8) Could be improved Mean score 3.0 (0.6) Absolute positive Teaching and learning strategies (45) I am stimulated to actively participate in classroom 2.9 (0.7) Could be improved (46) The teaching strategy stimulates my thinking 2.9 (0.7) Could be improved (47) Teaching is student-centred (teaching addresses learning needs of individual students) 2.9 (0.7) Could be improved (48) Teaching is well integrated and focused 3.0 (0.6) Absolute positive Table 5 continues on the next page → http://www.curationis.org.za Open Access Page 8 of 11 Original Research TABLE 5 (Continues...): Mean score (out of 4) of the items under study domains. Items Mean (SD) Interpretation Physical classroom environment (49) The teaching method develops my confidence 2.9 (0.8) Could be improved (50) The time for teaching is sufficient 3.0 (0.7) Absolute positive (51) My learning needs are addressed 2.9 (0.8) Could be improved (52) Teaching is focused on the teacher 2.5 (0.8) Could be improved (53) I can understand the lecturers in classrooms 3.0 (0.7) Absolute positive (54) I am able to meet the learning outcomes through the teaching and learning strategies used 3.0 (0.7) Absolute positive (55) Clinical training activities prepare the student to perform eectiv ff ely in the clinical setting 3.2 (0.7) Absolute positive Mean score 2.9 (0.5) Could be improved Nursing curriculum (56) I am sure about the programme learning outcomes 3.0 (0.7) Absolute positive (57) The teaching and learning experience of the previous year prepared me well for this year 3.0 (0.9) Absolute positive (58) Time table arrangement allows for academic engagement 2.7 (0.9) Could be improved (59) Assessments are aligned to the outcomes provided in module guides 3.1 (0.7) Absolute positive (60) The curriculum provides an appropriate balance between theory and practice 2.9 (0.8) Could be improved (61) The learning outcomes are appropriate for the year level 3.1 (0.7) Absolute positive (62) The curriculum is organised in a way that facilitates my learning 3.0 (0.7) Absolute positive (63) The learning materials, including module guides, work books and so on, are clear 3.1 (0.7) Absolute positive (64) The programme thus far developed my ability to apply theory to practice 3.2 (0.6) Absolute positive (65) The programme thus far improved my problem-solving skills 3.1 (0.7) Absolute positive (66) The programme thus far developed my ability to think critically about the subject maer tt 3.2 (0.6) Absolute positive (67) The programme thus far helped me understand current issues in the nursing profession 3.2 (0.7) Absolute positive Mean score 3.0 (0.5) Absolute positive Total mean score 195.2 (24.2) Good SD, standard deviation. nursing students reported higher levels of satisfaction, Canada and the United Kingdom, respectively, revealed that effectiveness and consistency with their learning style when third-year students had a more positive perception of their exposed to the combination of lecture and simulation than the educational environment than the first- and second-year control group, who were exposed to lecture as the only method students. It is, however, important to acknowledge that first- of teaching and learning. (pp. 7–10) year BN students had year-long modules, and therefore their assessments were yet to happen. Furthermore, it is also Furthermore, a descriptive study conducted by Ozturk, essential to note that service department teaching essentially Muslu and Dicle (2008) using the California Critical Thinking occurs from second year. The same factors similarly apply to Disposition Inventory (CCTDI), which aimed at determining third- and fourth-year students by virtue of them having the critical thinking levels of undergraduate nursing students, been studying longer. Junior students (first and second years) revealed that nursing students who were exposed to problem- may be unable to give full account of the educational based learning (PBL) had higher critical thinking disposition environment at the SON because of not having experienced scores as compared with their counterparts who were the challenges that are faced by third- and fourth-year exposed to the traditional model. Therefore, it is vital that students at this stage of their training programme. This point nurse educators integrate various teaching strategies that are may have implications for the interpretation of this result, problem based and encourage self-directed learning (Kong et al. 2014; Ozturk et al. 2008). and therefore it must be interpreted with caution. A general trend that emerged from the students’ perceptions Perception of educational environment by of their educational environment by year level was that ethnicity senior (third- and fourth-year) BN students viewed the Previous studies evaluating the perceptions of students of educational environment at the selected university as less their educational environment categorised students based on satisfactory than the junior (first- and second-year) BN their immigrant background (Avalos, Freeman & Dunne students. The findings are consistent with those of Said, 2007; Palmgren & Chandratilake 2011). Some studies Rogayah and Hafizah (2009) and Hamid et al. (2013) who identified students of minority ethnic status to be at risk of revealed reduced scores for senior students. Hamid et al. experiencing difficulties in new educational environments (2013) suggested that: (Maduwanthi, Mudalige & Atapattu 2015; Ostapczuk et al. this trend could be due to the fact that students genuinely 2012). These variations in the calcifications of ethnicity made believed that their learning environment was deteriorating, and it difficult to compare previous studies with the ethnic thus were psychologically tired of being a student and looking background of students as categorised in the present study. forward to leaving student life. (p. 61) In this study, a positive perception of the educational environment was mutual for all ethnic groups. The total Conversely, contradictory findings noted in studies conducted by Till (2005) and Sayed and El-Sayed (2012) in score per ethnic group ranged from 169 to 202, indicating that http://www.curationis.org.za Open Access Page 9 of 11 Original Research the perception of the educational environment across all Implications for nursing education racial groups fell in the category of ‘good’. Although it is acknowledged that academic performance and success is unquestionably a complex phenomenon with A few trends were noted between ethnic groups. Black various contributing factors (Jeffreys 2015; Mthimunye, students seemed to view their educational environment as Daniels & Pedro 2018), nursing schools need to take steps more favourable than did coloured students and the category to ensure that the educational environment in which classified as ‘other ’, particularly with regard to NC, both on- they expect their students to thrive promotes a quality campus and off-campus skills laboratories, TLC and learning process. The findings of the present study are vital implemented TLS. These results provide evidence that it is in terms of understanding the environmental needs of imperative for the SON identified in this study to adopt a undergraduate nursing students in a South African multicultural learning environment (Giddens 2008). educational context. The implications for nursing education emerging from this study include the necessity of improving The present study revealed that ‘other’ category viewed the following: the TLC less favourably than did white students. Interestingly, a study conducted by Avalos et al. (2007) in • conditions of the PCE: this includes creating a pleasant Ireland reported a statistically significant difference place to work with adequate ventilation, temperature between Irish and non-Irish students’ perceptions of the regulation and adequate seating arrangements TLC. In addition, a study conducted by Palmgren and • conditions of the SL environment: this includes ensuring Chandratilake (2011) in Sweden revealed similar findings adequate ventilation, temperature regulation, accessibility and ensuring appropriate and sufficient equipment between students of Swedish and non-Swedish ethnic necessary for practice of required clinical skills background. These results should be interpreted with • DR as well as making provision for Internet access for caution because of the vast contextual differences between students who reside off-campus the present study and previous studies. Furthermore, the • TLS adopted at the identified SON. sample size for the categories that were found to be statistically different was relatively small. Taken together, it can be concluded that black students Limitations and recommendations viewed their educational environment as more favourable Although this study provides crucial evidence regarding than did other ethnic groups. This finding could be explained the educational environment at the SON, it would be by the fact that the majority of black students at the selected invaluable to conduct a similar study that includes students university are predominantly from previously disadvantaged from other departments in the community and health educational backgrounds and consequently might be more science faculty. The limitation that should be acknowledged appreciative of anything that was better than what they had in this study is that because of financial reasons and time previously experienced (University of the Western Cape constraints an adjusted sample size of 287 participants was 2018). calculated to ensure a sample that is representative of the study population (Dean et al. 2013). Similar studies should Perception of educational environment be conducted with larger samples at other universities and by gender nursing schools in South Africa and around the world to Previous studies conducted in the medical field comparing increase the generalisability of the findings beyond the gender differences revealed that female students were more investigated university. For future studies, we recommend positive about their educational environment compared to a qualitative follow-up study with the participants to gain their male counterparts (Jawaid et al. 2013; Lokuhetty et al. in-depth understanding of the aspects that need to be 2010; Nahar et al. 2010; Riquelme et al. 2009). However, the improved. In addition, it would be interesting for future same cannot be said of the nursing field. Similar to the study studies to evaluate the relationship between students’ conducted by Victor et al. (2016) in Pakistan, the results of perceptions of their educational environment and academic the present study revealed that male students viewed the performance. educational environment more favourably than did their female counterparts. However, it must be acknowledged Conclusion that the trend was not statistically significant for all subscales This study’s findings conclude that the selected participants of the educational environment (off-campus SL, UL, DR, at the identified university generally perceived their TLC and TLS) at the identified SON. These findings may educational environment as being more positive than result from the fact that male nursing students are a minority negative. Regarding students’ general perceptions of the group and are known to receive special treatment from subscales, enhancements are required in the PCE, skills educators as well as clinical supervisors, and therefore they laboratories (both on-campus and off-campus), DR and the might have a preponderance of positive experiences (Moss- implemented TLS. In contrast, and completing the range of Racusin et al. 2012). Kouta and Kaite (2011) indicated that gender bias in nursing education could have an influence on subscales, the students’ perceptions of the subscales UL, TLC perceptions of the educational environment. and NC seem to require minimal enhancements, if any. It is http://www.curationis.org.za Open Access Page 10 of 11 Original Research Dean, A.G., Sullivan, K.M. & Soe, M.M., 2013, OpenEpi: Open source epidemiologic essential for university management and the SON to prioritise statistics for public health, viewed June 2017, from http://www.openepi.com/ the suggested improvements based on the results of this SampleSize/SSCC.htm study to create an educational environment that promotes Denscombe, M., 2014, The good research guide: For small-scale social research projects, McGraw-Hill Education, London. quality learning. Denz-Penhey, H. & Murdoch, J.C., 2009, ‘A comparison between findings from the DREEM questionnaire and that from qualitative interviews’, Medical Teacher 31(10), e449–e453. https://doi.org/10.3109/01421590902849552 Acknowledgements Field, A., 2013, Discovering statistics using IBM SPSS statistics , Sage, Thousand Oaks, CA. Competing interests Giddens, J.F., 2008, ‘Achieving diversity in nursing through multicontextual learning environments’, Nursing Outlook 56(2), 78–83. https://doi.org/10.1016/j. The authors declare that they have no financial or personal outlook.2007.11.003 relationships that may have inappropriately influenced them Hamid, B., Faroukh, A. & Mohammadhosein, B., 2013, ‘Nursing students’ perceptions in writing this article. The views expressed in this article are of their educational environment based on the DREEM model in an Iranian University’, The Malaysian Journal of Medical Sciences 20(4), 56–63. the authors’ own and do not reflect an official position of the He, D., Wu, D., Yue, Z., Fu, A. & Thien Vo, K., 2012, ‘Undergraduate students’ interaction institution or the funder. with online information resources in their academic tasks: A comparative study’, Aslib Proceedings 64(6), 615–640, Emerald Group Publishing Limited. https://doi. org/10.1108/00012531211281715 Authors’ contributions Henderson, A., Creedy, D., Boorman, R., Cooke, M. & Walker, R., 2010, ‘Development and psychometric testing of the clinical learning organisational culture survey (CLOCS)’, Nurse Education Today 30(7), 598–602. https://doi.org/10.1016/j. K.D.T.M., primary student researcher, was responsible for nedt.2009.12.006 the conceptualisation of the study, data collection, data Imanipour, M., Sadooghiasl, A., Ghiyasvandian, S. & Haghani, H., 2015, ‘Evaluating analysis and discussion. F.M.D. was the study leader, the educational environment of a nursing school by using the DREEM inventory’, Global Journal of Health Science 7(4), 211–216. https://doi.org/10.5539/gjhs. supervised the conceptualisation of the study and guided the v7n4p211 methodology for the study. Jawaid, M., Raheel, S., Ahmed, F. & Aijaz, H., 2013, ‘Students’ perception of educational environment at Public Sector Medical University of Pakistan’, Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences 18(5), 417–421. 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