Discussion:
The aim of this study was to explore the activities of Msc nursing students for self directed learning. The findings revealed that the students actively involved in their learning and adopted different learning activities and strategies to benefit from different working and learning environments. This active involvement makes students more proficient, flexible, resourceful, and qualified learners.
Nurse educators can promote this active learning process by developing a standard curriculum that motivates students’ creativity and active participation in the learning process. Considering students’ preferred activities for SDL, assists in developing a flexible learner-centred curriculum that allows students to develop and use their learning strategies effectively (22). It also assists nursing educators to provide a learning environment, which supports and facilitates students’ learning and increases their professional maturity, and improves health care quality (23).
The study findings revealed that the four main activities that nursing students do in their SDL were “sensory perceptions”, “knowledge construction”, “problem orientation” and “interaction with others”.
These activities can be compared with the Kolb’s experiential learning theory. In Kolb’s Learning Cycle (1981), through reflective observation the leaner observes, listens, and assesses subjects critically from different points of view to find their meanings and underlying causes. Then through abstract conceptualization the learner use thinking and logic for promoting learning. Consequently, learners use reflective observation and abstract conceptualization for assimilating their knowledge and experience, and finally through active experimentation the learners apply this experiences (Kolb)24.
Study findings showed that the students learned mainly, in class and clinical settings, through sensory perception. Participants declared that they learn more effectively from visual Medias such as medical pictures, videos and power points in class and through their self learning. Also careful observation of patients, colleagues, physicians and clinical instructors’ behaviour in clinical settings, were important strategies for learning. Findings of a qualitative study conducted by Suikkala and Leino-Kilpi showed observing different patients, help nursing students to promote their learning (25). Baraz, Memarian and Vanaki (2014) also noted that nursing students closely observe the performance of physicians, practicing nurses and their clinical instructors to promote their learning (26). These findings confirm that observational learning is one of the important strategies that student use for acquiring knowledge and expertise.
Another strategies students used for SDL were active listening in class and clinical rounds, and listening to the patients and their visitors. Ghiyasvandian, Malekian and Cheraghi also reported active listening as one of the activities that nurses do for achieving knowledge and information (28). Gidman (2013) also noted that listening actively and communicating effectively with care recipients, as a valuable source of information, can help nurses promote their learning (27).
In addition to acquiring information through sensory perception, students tried to construct their knowledge through “active engagement in situation”, “active rehearsal”, “absorption of information” and “selecting appropriate learning strategy”. The students engaged actively in the learning situations and preferred practical training rather than theoretical ones. Also they were trying to carry out the theoretical issues in practice. Hartigan-Rogers et al. (2007) believed that the using of obtained skills and knowledge in everyday practice is a learning strategy that smoothes the progression of students’ professional socialization (29). Keeling and Templeman, (2013) also noted that active involvement in clinical care improves students’ comprehension of clinical interventions and helps them think more critically (30). Westein, Sundler and Berglund (2015) believed that nursing students could determine their own deficiencies by practicing their knowledge in practical training; and through practice, they understand how to improve their nursing performances (31).
In order to learn more efficiently and fixing the subjects in the mind, the students used active rehearsal strategies such as repeating, reviewing, summarization, note-taking, and highlighting. Shank believed that repeating of information including word by word repetition, underlying the materials, note-taking and summarization are different forms of mental reviewing. Self-repetition of information is an effective way for those materials needed to be memorized and mental reviewing has the key role in keeping in mind the knowledge. Reviewing can be used for sophisticated sorts of learning, but it should be included something more than sole repetition of information. Other types of useful reviewing methods consist of under lining the material or highlighting the information and also summarizing them (32). The findings of Shahidi et al who studied the quality of study skills among the students of Fasa university of Medical Sciences showed that taking notes is the most important study strategy for succeeding in the exams (33). The results of other studies also showed that note-taking increases the motivation for progression among students (34) and reviewing and mental rehearsal of the procedures lead to promote clinical performance (35).
During searching and learning the materials, the students were trying to achieve a general view about the subject and make a connection between new subject and their previous data to create their own cognitive map. Then according to the needs, they were investigating and learning more specific materials. Harpaz, Balik and Ehrenfeld described significant learning as an attraction of concepts and arguments into existing cognitive constructions. They believed that significant learning propels the learner to assess each subject from different aspects and determine the connections between different areas of knowledge, to fill the knowledge gap independently. Accordingly, it helps clarifying existing knowledge, completing it, and improving critical thinking (36). Also many studies have emphasized the effectiveness of the concept mapping method in educating and evaluating the nursing student (37, 38).
Considering different learning conditions, the students selected appropriate learning strategy. Mostly they preferred learning strategies which help them to understand more deeply. They generally preferred visual, practical and interpreting strategies of learning. Similarly Wetzing’s investigation on nurses’ preferences in applying learning strategies showed that nurses prefer to be educated by visual strategies such as practical demonstration including multimedia presentation and simulation. Moreover they also prefer to be educated by practical demonstration or simulation activities in order to reinforce their learning (39).
Other activities for learning in our participants were searching and questioning. The students struggled to use their own sense of curiosity to improve their learning. They preferred questioning and answering strategy for class teaching; they also attempted to make questions from the text they were reading. Nicoll and Tracy (2007) also believed that applying questioning properly facilitates the process of learning. Questioning motivates students to participate in the learning process and help them achieving higher comprehension skills through obtaining profound, detailed understanding of the subject. Good questions can encourage problem solving and critical thinking in students through arousing their curiosity, capturing their attention, and focusing on important points. It can also promote active learning by exploration of new experiences and application of knowledge (40). Profetto-McGrath, Smit, Day and Yonge (2004) discussed the value of questioning skills of students and tutors in nursing programs and noted that they should ask kinds of questions that promote critical thinking skills (41).
Problem perception was another strategy that participants used for problem based and self directed learning. Cooke and Moyle mentioned that problem-based learning approach can promote problem solving and critical thinking in students. It also encourages students to identifying their own learning needs and participate actively in their self directed learning process. Furthermore it facilitates team working, creative learning from peers and the integration of knowledge (42). Findings of Ozturk, Muslu, and Dicle showed that the self-directed and active nature of PBL develops students’ ability to think critically, be tolerant of others’ opinions and evaluate inconsistent data before concluding (43). Working in sophisticated health care settings, nursing students must develop their problem solving skills in order to deliver safe and professional care for their patients.
The students stated that interpersonal interaction and partnership with others in different affairs, such as class group discussion and conversation with others, played an important role in their learning process. Students extended and validated their understanding through group discussions and reflections. Baghcheghi, Koohestani and Rezaei (2011) also believed that small group teaching enables students to discuss. They noted that using participatory learning methods in the classes with theoretical subjects improve nursing students’ communication skills and the range of follow-ups conducted by them for solving the problems (44).Westin, Sundler and Berglund noted that students learned from each other, deepen their knowledge and improved their nursing skills during the training and discussion within study groups (45).
The students selected the scholars and the nurses with high level of experience and knowledge as their own ideal models. They were also trying to reach the scientific and professionals situation of their optional models. Fluit, Bolhuis, Stuyt and Laan (2011) believed that a good role model can enormously affect the development of students’ competence and confidence in nursing discipline (46) The findings of a review study carried out by Baldwin, Mills, Birks, and Budden (2014) also showed that nursing students adopt experienced nurses as their role models for transferring their knowledge to practice and demonstrating professionalism (47)