Student nurse transition from traditional to problem-based learning

© 2008 The AuthorsJournal compilation © 2008 Blackwell Publishing Ltd.

Learning in Health and Social Care

,

7

, 2, 114–123

Original article

Blackwell Publishing Ltd

Student nurse transition from traditional to problem-based learning

Lynda

Smith

RGN/RSCN BA MAEd PhD

1

*

&

Valerie

Coleman

RGN/RSCN

RCNT

BSc

MA

2

1

Lecturer, University of Sheffield, School of Nursing and Midwifery, Humphry Davy House, Goldensmithies Lane, Wath Upon Dearne, S63 7ER, UK

2

Nursing Lecturer, University of Sheffield, School of Nursing and Midwifery, Humphry Davy House, Goldensmithies Lane, Wath Upon Dearne, S63 7ER, UK

Abstract

Problem-based learning (PBL) continues to be a feature of many nursing programmes

and has been the subject of a number of empirical studies. This study explored the

experience of PBL of a group of registered nurses undertaking a 1 year children’s

nursing programme. Focus group interviews at the end of the programme and

6 months post-qualification captured the student’s perceptions of how they

experienced learning to be a children’s nurse on this type of programme and

subsequently the impact it had had on them on their return to practice.

Themes identified by the focus groups centred on the transitions students have to

make to this type of learning and the need to let go of previous education expectations.

Adapting to the PBL process led to a range of strategies being employed by the group

to cope with the new demand, resulting in largely negative perceptions of PBL on

programme completion. The second focus group allowed the group time to reflect on

their experience and the impact of it on their role and presented a positive balanced

view of their experience. This included increased confidence, assertiveness, being more

questioning of practice and likely to search for and use evidence to underpin practice

than before this PBL programme.

This research demonstrates the need to provide more initial preparation at the

start of programmes to support the transition to PBL and provide ongoing

mechanisms for listening and responding to student concerns about the PBL process.

For those considering PBL in the future, blended approaches rather than curricula

wholly delivered by PBL may be more suited to shorter programmes of study.

However, the overall message from this research indicates that although the students

experienced difficulties in the process, the outcome did in fact meet their needs in the

longer term.

Keywords

curriculum evaluation

long-term impact,

post-registration

education,

problem-based

learning, student

experience,

transferable skills

*Corresponding author. Tel. 00114 222 9932; fax: 00114 222 9601; e-mail: [email protected]

The experience of problem-based learning 115


Introduction

Healthcare in the 21st century is increasingly being

delivered within a rapidly changing environment

where the nature of client care is often complex

and more demanding. This necessitates the need for

nurses who are competent and capable of thinking

critically if they are to practice effectively in today’s

healthcare system, that is the ability to understand,

not just acquire knowledge. Thus, the emphasis

is on the development of higher order intellectual

skills and abilities (

Fitness for Practice

, UKCC 1999)

and the development of lifelong learning skills (

Making

a Difference

, DoH 1999). The concept of problem-

based learning (PBL) has therefore gained momentum

in nurse education as it is seen to have the potential

to achieve these objectives.

The opportunity to encompass PBL as a curriculum

approach coincided with the revalidation of a second

pre-registration RN (Child) programme. As this was

a significant change, it was important to evaluate the

student experience of this type of learning.

Background literature

Since the introduction of the first PBL programmes

in the mid-1960s at McMaster University in Canada,

similar programmes have developed worldwide and

have spread from medicine to include many other

professions, who perceived benefits of employing a

problem-based approach to learning (Wilkie 2000).

Wilkie & Burns (2003) report the increasing interest

in PBL in nurse education since the 1990s in the UK

to overcome problems of theory overload, lack of

practice opportunities, poor integration of theory

to practice and government demands for lifelong

learning and the development of key transferable

skills. PBL sets learning in the context it will be needed

in the clinical environment and therefore has the

potential to directly mirror the ‘messy world’ of practice

(Wilkie 2000, p. 24) hence its attractiveness to

nursing.

Evaluation of PBL programmes

Studies that have evaluated PBL Programmes fall

into two main areas; either they aim to measure

student learning, usually by comparing conventional

approaches with PBL against specific outcomes, or

they explore the experience of students and lecturers

who have been involved in such programmes. Each

approach has its own strengths and weaknesses that

add to our understanding of the utility of problem-

based approaches to learning and teaching. Many

professional disciplines in healthcare have evaluated

their use of PBL in their programmes, particularly

medical education where it has been more extensively

used (see for example Albanese & Mitchell 1993;

Colliver 2000). The research highlights the complex

nature of PBL as a construct and the difficulties

involved in determining measures of effectiveness,

and therefore, the outcome is different opinions

on the merits of PBL. Woodward (2004) highlights

the need to develop a research agenda that will refine

our understanding of the effects of PBL. More

recent studies of medical education aims to explore

the impact of such approaches once doctors are

qualified and undertaking their professional roles

(see for example, O’Neill

et al

. 2003; Watmough,

Garden & Taylor 2006) and therefore focus on how

curricula using a PBL approach prepare the profes-

sional for their post.

PBL in nurse education

Nursing studies in relation to PBL have largely focused

on students undertaking a pre-registration nursing

programme where the curriculum has either been

completely PBL or a hybrid where there are elements

of both, more usual approaches and PBL.

Biley and Smith have published two reports into

PBL. In the first, Biley & Smith (1998) undertook

a study into the effectiveness of a PBL learning

programme in preparing adult branch nurses for

the reality of being a registered nurse. What emerged

strongly was the students’ sense of personal respon-

sibility for their learning and actions after graduation.

As Biley and Smith (p. 1028) state, ‘their education

has perpetuated a responsibility for lifelong learning

and instilled within them a confidence in their own

ability to learn competently and efficiently. They feel

empowered …’

The same authors in 1999 reported how final year

adult nursing students managed and made sense of

116 L. Smith & V. Coleman


a hybrid programme of PBL. Students had pre-

conceived ideas about education and themselves from

their prior experiences, which they found difficult to

reconcile with the process of PBL. The study identi-

fied that students felt devoid of the relative security

of the traditional educational process and therefore

subsequently reduced the PBL process to a task

orientated approach to find the right answers.

Biley and Smith concluded that the success of a PBL

programme may be limited if the issues identified in

this study are not addressed.

Other studies that have explored problem-based

learning in nursing have demonstrated overall satisfac-

tion with PBL but raised a number of concerns

similar to those expressed by Biley and Smith. Glasper’s

study (2001) of child branch nursing students found

that although there were many positives such as group

support, sharing experiences and gaining confidence

in a group setting the weaknesses highlighted the

difficulties of relying on other people to research

topics which was a problem when not everyone

pulled their weight in the group. At times they felt

the PBL approach lacked direction which is one of

the tensions in this approach between the need to

meet curriculum outcomes and enabling students to

have some control over their learning. Bebb & Pittam

(2004) used their evaluation to enable the course

team to make modifications to the programme as a

result of the students’ experience while at the same

time providing other educators with pointers when

considering developing their own programmes. This

again reinforces there is no one way of evaluating

PBL.

Research in terms of students undertaking further

nursing courses following initial registration as

nurses is more limited. These nurses are experienced

practitioners undertaking either continuing pro-

fessional development programmes (see for example

the work of Newman 2004), or as in the case of this

study, undertaking a second registration to become

children’s nurses. Newmans’ research evaluated the

effectiveness of PBL in a part-time continuing

nursing education programme. This study reported

lower levels of satisfaction and a higher drop-out

rate and concluded that PBL does not appear to

fit with expectations and values about teaching and

learning prevalent in the culture of nursing and the

National Health Service. The need for further research

with this group of nurses is therefore valuable in

furthering our understanding of the application of

PBL in a range of settings.

Research design

The aim of this qualitative study was to describe

and explore the learning experience and the longer-

term impact on their nursing practice of a cohort of

second registration pre-registration student nurses

undertaking a 1-year PBL programme leading to

registration as children’s nurses. PBL in the context

of this study is wholly based on triggers and fixed

resources sessions with no formal lectures. It would

be deemed as a hybrid approach as it uses fixed

resource sessions to assist the student’s learning (see

Glen & Wilkie 2000 for a detailed description).

Focus group interviews were undertaken on

completion of the programme and 6 months after.

The first interview explored student perceptions of

their learning experience during the year of the course,

the second explored the impact the programme had

had on them after they have returned to their usual

practice area. Both focus groups were undertaken by

a researcher outside of the programme team.

Focus groups were selected as the data collection

method because they explicitly use group interaction

to explore and clarify views that would not be

available during individual interviews (Goodman &

Evans 2006). It is dependent on group interaction

but as this was a homogenous group used to work-

ing and sharing together, some of the disadvantages

associated with focus groups such as dominance by

stronger members of the group would be negated.

A purposive sample was used and 11 students

following the PBL programme volunteered to

participate in the study and formed a single focus

group. The students all had experienced previous

nursing programmes that used more traditional

educational methods and therefore had preconceived

ideas about education and themselves as students. The

sample all had experience of practicing as registered

nurses by virtue of their initial registration on the

Nursing and Midwifery Council Professional

Register. A single group was utilized to maintain

the homogeneity of the sample in so far as they had



always worked together as one group. Eleven is within

the acceptable range for a focus group as figures of

five to 12 have been identified as suitable (Goodman

& Evans 2006).

Permission to carry out the research was given by

School of Nursing and Midwifery and the School’s

Research Ethics Advisory Group. Informed consent

was gained from all participants and they were

reassured that data would be disguised to protect

their identity and also the cohort from which the

sample were selected.

Data from the interviews were analysed using

Burnard’s (1991) method for analysing interview

transcripts in qualitative research. The aim is to

produce a detailed and systematic recording of the

themes and issues addressed in the interviews and to

link these to emergent categories.

Findings and discussion

Focus group 1: experience and perceptions of a PBL programme

Two themes emerged from the first focus, these were

letting go and playing the game.

Letting go

The findings from this focus group indicated very

strong negative feelings from the group about the

process of PBL and the demand that it makes upon

you. There was an overwhelming feeling that it

required significant self-adjustment to the learning

approach and some questioned whether they had

adjusted at all:

To be honest I don’t actually think I’ve adjusted. I’m

still … I still prefer the lessons where we’re actually given

the information to an extent and then you actually go off

and do the work yourself and bring it back.

The students brought with them learning styles

that were a result of previous learning experiences and

it was a challenge to approach knowledge and under-

standing in a different way. This led to feelings of

insecurity about what they were learning, how ‘deep’

they needed to explore subject matter. Hence, the

theme ‘letting go’:

Well, it’s just when you come on a year’s course that

usually somebody would do in 3 years, I think you need

to know what you need to know rather than just being left

out to find out for yourself if you’re in the right direction

or not. And it’s all right all these people feeding back,

but you can’t always remember what everybody’s feeding

back, can you?

They found it difficult to overcome these insecurities

and placed their emphasis on limitations in the

outcome rather than how the process was enabling

them to learn. They were concerned that they hadn’t

individually looked at everything and even though

everything had been covered by the group, how were

they going to retain it all:

… but I mean it’s only that person that’s looked in depth

at that particular subject area that is

au fait

with that and

everybody else, okay you can feed it back to me, but how

long are they going to retain it?

These insecurities about their knowledge were

reflected in an expressed need for more structure and

guidance to make sure that they knew what they

needed to know:

I thought it’d be more structured … this is what I’m going

to need to know … I think that is the thing – structure

and guidance, more fixed sessions.

Achieving a balance in the course delivery was

perceived as one way of overcoming some of these

tensions. It was very difficult to let go of the type of

teaching they had been exposed to previously and

because they hadn’t enjoyed the PBL approach,

they still wanted to ‘be taught’:

I mean when I did my nurse training before it were

like … there were more of a balance than this course has

been … you had so many taught sessions … but yet we

also did go off and find things out ourselves.

The balance between breadth and depth of

knowledge particularly about not knowing enough

did not disappear given the interview took place at

the end of the programme.

This transmitted itself into anxieties about the

expectations that would be placed on them by their

employers on return from their secondment:

… Worrying that there’ll be expectations that you’ve

learnt certain things and that you’re not wholeheartedly

sure that …



On a nursing course, it is essential that students

achieve competency in theory and practice in

order to safely care for their client group and this

was to some extent driving some of their difficulties

with the philosophy of PBL:

… there are crucial differences like … signifying that a

child’s septic is that their temperature goes down and not

up, but if you’ve not been in a situation on a ward that

tells you that, you wouldn’t have got it from the theory on

this course and that’s basic important information.

These concerns knowing what they needed to

know and coming to terms with breadth vs. depth

were bound in the students experience and perception

of the process of PBL which they perceived as difficult

throughout the year. How they managed and dealt

with it is the focus of the second theme ‘playing

the game’.

Playing the PBL game

This theme explores some of the issues surrounding

the structure and delivery of PBL and how the students

found the process restrictive and unresponsive to

their needs. As a result, they developed their own

coping strategies as a group.

The structure of the programme delivery

compounded some of the feelings of uncertainty

and anxiety about the breadth of their learning

particularly where it was felt to be rigid and un-

responsive to their need.

… I used to find getting the triggers very frustrating.

I thought it were a long way of going about giving us

questions. Why do we have to look at the facts? Why

do we have to come up with a hypothesis to then get

questions? … it just seemed such a waste of time.

For the students, it appeared PBL was a drawn-

out process and they did not see the value of the

individual steps that are designed to identify their

specific learning needs acknowledging previous

knowledge while developing their team working

skills. As this was the first time this programme had

used PBL and despite extensive preparation of

all those involved in its delivery, it was still a new

experience for many and required adjustment

on the part of the lecturers as well as the students.

Where there were problems, this just emphasized

the angst felt by the students about the process and

what they perceived to be time spent on unnecessary

parts of it:

We’ve had a fixed resource session and they’ve come in

and said, ‘Well, it’s PBL, you’re meant to tell me what I’m

going to teach you.’ And we’ve said, ‘Well, we don’t know.’

… ‘Well, we’ll go ahead and I’ll do my usual teaching that

I would usually’, and we’ve got a lot out of it.

In trying to engage the students in the process,

the lecturers tried to ensure the process was followed

as planned but the students perceived this as

inflexibility:

… it was supposed to be our direction … So, it got more

regimented … You will feed it back like this. You will do

it this way, or whatever.

This therefore impacted on student–lecturer

relationships and appeared more like a battle between

two opposing sides and resulted in the students

adopting strategies to manage their frustration:

… but we’ve got better at playing them at their own game

rather than got better at doing the work that we’ve been

told to do …

As experienced nurses and mature students,

they did not feel their voices were heard nor their

experiences valued. The rhetoric of valuing

maturity and experience was expressed but not

perceived to be a reality:

… they don’t acknowledge that you’re mature students

and that we’re here because we want to learn … we have

to do it the way they want it. So, that’s not true PBL, is it

because we’re supposed to be directing it for ourselves?

Well, that’s the way I interpreted it.

Overall, the course had been demanding and

they were exhausted by the end of it. There had been

no let up and the overwhelming demand placed on

them had taken its toll:

I think apart from maybe 2 weeks, the whole of the course

we’ve always had something that we’ve been doing on top

of the triggers and something that’s marked on top of the

triggers.

Discussion and conclusion – focus group 1

It is clear from the first focus group taking place so

soon after completing the course that the students



experience of it was very negative in terms of PBL as

a teaching and learning strategy. The structure of

PBL as presented on this course was difficult and the

students perceived a lack of flexibility in the process

and an unwillingness to respond to students’ per-

ceptions of some aspects of this process. Playing the

game was therefore a means of dealing with differences

in expectation between students and lecturers. They

also felt a lack of valuing of them as mature students

and the experience they brought to the course. These

experiences served to unite the group and support

was seen to be strong and important.

The feelings expressed in the focus group that the

outcomes would have been the same on any other

course cannot be refuted given the lack of evidence

to support PBL approaches being superior to conven-

tional ones. Where studies have measured differences

in learning approach, knowledge acquisition, academic

performance for example, there is not conclusive

evidence that PBL students’ score higher on the

variables being measured (see for example Rideout

et al

. 2002; Newman 2004). Tiwari

et al

. (2006)

measured the effect of problem-based learning on

students’ approaches to learning and found students

did adopt a deep approach but that isn’t to say that

students on traditional programmes don’t do

likewise. There is a large body of research that is

concerned with the benefits and limitations of PBL

but given the complexity and diversity of the

construct, it isn’t possible to say this approach is

definitively better than conventional curricula,

leaving those charged with developing curricula

to learn from the experience of their fellow

educationalists.

Although there is evidence of student satisfaction

on PBL programmes (Barrow, Lyle & Butterworth

2002; Rideout

et al

. 2002), these have often been

either hybrid programmes where PBL is not the sole

strategy or of a longer duration allowing more time

for student adjustment. As a year-long programme,

these students felt pressured to achieve the outcomes

of the course while at the same time adjusting to a

radically different style of learning. These findings

support those of Newman (2004) who as previously

highlighted reported lower satisfaction and increased

dropout. The students in this study did not leave,

because achieving the qualification was integral

to their nursing role and therefore what was evident

from this study was the sheer exhaustion and unease

experienced by them during the year.

At the end of the course, their feelings about

PBL were vehemently expressed and they did not

connect their very positive results, there were more

first class degree awards and results were overall

better academically than previous student groups,

with what they had put into PBL. They were just too

exhausted and never got to the point where they

viewed PBL as expressed by Engel (1997, p. 17), that

is, as a means of developing learning for capacity

rather than learning for the sake of acquiring

knowledge.

Findings – focus group 2

Six months after programme completion and quali-

fication, this group explored the impact of PBL on

their clinical practice. These themes emerged: engaging

in clinical practice, PBL programme value, PBL in

the future.

Engaging in clinical practice

Students were asked if the PBL course had made

differences to their current nursing role. Initial

responses referred to the product (Registered

Children’s Nurse qualification) of the programme.

…. 65% of the difference is the qualification allows you to

do things that before I wasn’t able to.

… They give you a level of respect that you never had

before. You may well have had the knowledge and the

skills but as long as you’ve got a qualification … they’re

not bothered how you got there …

Extrinsic reward in terms of qualification initially

was a greater motivating factor than an intrinsic

desire to learn. Newman (2004) reported similar

findings about extrinsic reward in an evaluation

of PBL effectiveness in a 6-month post-registration

nursing programme. The PBL programme did,

however, change student’s perceptions in practice:

… I look at things from a different perspective through

having the knowledge of paediatric nursing … the psycho-

social side of things that I perhaps look more deeply into

than I do just at the clinical side of things.



This student now appreciated the psycho-social

side of things more ‘deeply’, congruent with using a

PBL approach promoting deep as opposed to surface

learning (Marton & Säljö 1984; Margetson 1994).

Students were using learning and resources from

the course as they engaged in their current practice:

I’ve actually used some of the stuff. As much as we

moaned about the triggers and stuff, I’ve actually found a

use for some of them in the work that we’ve done …

PBL ‘triggers’, create an initial stimulus for learning

and should be perceived by students, as authentic

to real life practice (Price 2003). Engagement in the

PBL process also resulted in students developing

transferable key skills of assessing and questioning.

… you’ve got that qualification and that allows you to do

things that before I wasn’t able to do … about 30% of that

is some of the knowledge that you’ve gained during the

course … some of the experiences that you can bring into

it … the way that you assess things and perceive

things because you might raise questions about things.…

I raise questions about things that otherwise I might have

missed …

Constant questioning about the appropriateness

of everyday procedures in clinical practice is

common PBL graduate behaviour (Biley & Smith

1998, 1999, Williams 2004).

PBL programme value

Students were asked how well the programme

had equipped them for practice. Contrary to other

studies (Biley & Smith 1999; Horne

et al

. 2007),

these students viewed collaborative group working

positively. Effective PBL group working is an essential

element of this learning approach (Wilkie & Burns

2003) to develop team skills for interprofessional

working. Barrow

et al

. (2002) found that group

cooperation and cohesiveness were significant in the

PBL process. The students suggested that through

‘gelling’ with and being supported by their PBL group,

they developed valuable qualities/skills that were all

transferable to clinical practice (Barrow

et al

. 2002),

to enhance interprofessional working:

… we got used to being challenged … Because once we

did get to know one another and feel safe, … we were safe

to challenge as well …

The students were now appreciative of fixed resource

sessions recognizing their value, compared with

traditional lectures:

… the teaching sessions that we had, … , with them not

being set lectures, but having someone as a resource to go

in that we could talk about issues that were important to

us was a really good way of approaching it.… I don’t think

I would have understood as much if it had just been a

lecture that had been spouted than being able to stop and

talk and explore things.

The students identified that the PBL programme

developed their confidence enabling them to become

more assertive and challenging in practice:

I’ve been to a meeting … senior sister like looked at

me gob smacked because I was actually challenging about

something … she said, ‘You would never have done that

… “you have always spoke your mind and said what you

think, …” and I can’t tell you what you said, but it were

bloody good’.

… the other thing that the course has given me is that

when I sit at meetings and they want to go down one

route and we’ve done research into something and had

lots of evidence, I’ve got the confidence to sit there and

say … I’ve got the evidence that says …, that’s not the

way that we should be going and we should be doing it

that way, … the course has given me the confidence to be

assertive with the evidence that we’ve gathered with all the

triggers and stuff …

Confidence has been identified as an outcome of

other PBL programmes (Glasper 2001; Newman 2004;

Wood 2005). Other studies have provided evidence

of similar skill development attributed to PBL (Biley

& Smith 1998; Wood 2005; Horne

et al

. 2007).

Having ‘the evidence’ emerged as the key to being

confident and assertive in practice:

… I suppose that there’s a greater appreciation of use of

evidence-based practice to try and sort of sell things …

you sort of say, ‘Well this is what the literature says.

PBL in the future

Students identified that their preparation for this

PBL programme was inadequate, which has implica-

tions for future programmes. Preparation was given

during a pre-course study day, and in study skill

sessions early in the course. Lecturers were also

prepared for delivering a PBL curriculum over an



18-month period before programme commencement.

These mature students though had difficulty making

the transition from traditional to PBL, a common

finding (Biley & Smith 1999; Glasper 2001; Carey

& Whittaker 2002; Richardson & Trudeau 2003;

Newman 2004) suggesting that the transitional

period from traditional to problem-based learning

should be well supported by facilitators. Biley &

Smith (1999) found that tension was created in a PBL

pre-registration nursing programme because of

transition from traditional learning. Students were

indoctrinated into the need for pure knowledge

acquisition through past educational experiences.

One student suggested that a 1-year programme

was too short for flexibility, especially for mature

students with established learning patterns sub-

stantiating similar findings by Newman (2004) in

relation to post-registration students.

The students also found it difficult to measure the

effectiveness of their programme for practice after

6 months.

… You can’t measure what you’ve got from this course or

kind of course at this stage because I think its intangible

at the moment. You just can’t … it’s not measurable. It’s

not until you’re really out there …

During this time, the students had to transition

back to practice, re-establishing, re-building relation-

ships and consolidating on learning before making

practice changes. Biley & Smith (1998) also found

that students wanted to make changes in practice

but needed to first become accepted members of

the practice team.

The students expressed some reluctance to under-

take another PBL programme in the future, but did

not discount the possibility altogether after con-

solidating their learning.

Discussion

The second focus group presented a positive balanced

view of their PBL experience. The students had

developed transferable lifelong learning and other

key skills, which Glen & Wilkie (2000) state is more

important than remembering content. Students

had increased in confidence and assertiveness, were

questioning, prepared to challenge and used evidence

to underpin practice. They were using these skills in

clinical practice making links to how elements

of engaging in a PBL process had facilitated their

acquisition. Clinical colleagues also noticed that the

students were using these skills in practice.

Both focus groups identified that transition from

traditional to PBL was difficult, requiring thorough

preparation. The students experienced many

adaptation difficulties in making this transition.

Engaging in the PBL process was not enjoyable, there

were anxieties regarding clinical colleagues expecta-

tions about what should have been learnt on the

programme and students were perturbed that they

had not lived up to expectations in the first focus

group discussion.

Conversely, other findings from this study suggest

that using a PBL approach for a 1-year programme

produces competent, critically thinking nurses that

are fit for practice. PBL also facilitated the students

‘gelling’ together to work as a team. Effective nursing

and interprofessional team working is an integral

part of working in clinical practice as driven by

contemporary health and nursing policy.

These positive findings from the second focus group

discussion are supportive of the choice of a whole

PBL programme approach. Although student’s

experiences of engaging in the PBL process were

not enjoyable ones, 6 months later the outcome met

student’s needs.

This study has been valuable in understanding the

student experience of problem-based learning and

the impact of PBL on their future practice. It high-

lights that a demonstrable learning outcome alone is

not sufficient to offset problems experienced in the

educational process. The study adds to the body of

knowledge about PBL supporting some of the

findings of other studies, although further studies

are needed to cover a longer period of time after PBL

course completion to examine the impact on prac-

titioner’s lifelong learning and approach to practice.

Newman (2004) identified that PBL does not fit

in with the educational expectations and values that

are integral to the professional and occupational

cultures of nursing about ‘what should be learnt’.

Thorough student preparation for transition to a

PBL course is essential a finding that Barrow

et al

.

(2002) supports suggesting that initial tutor



feedback to PBL students needs to be substantial

to decrease student uncertainty and stress. Bebb &

Pittam (2004) concluded that there is also a need

to listen to and understand student perspectives to

modify ongoing curriculum design and delivery,

ensuring that the desired PBL process and final

outcomes are met in supportive educational environ-

ments, which would concur with our study.

Connolly & Donovan (2002) also identified

that students undertaking a PBL programme were

exhausted by the heavy workload of PBL suggesting

that a willingness to adopt a flexible approach is

required in wholly PBL programmes ensuring

that students expressed needs are met. Curriculum

developers should consider blended approaches

to teaching and learning especially for shorter

programmes, which Newman (2004) supports.

Anyone contemplating introducing PBL into their

programmes needs to consider how they can

minimize the problems experienced by students in

the PBL process to enable students to take advantage

of the many positive outcomes associated with this

learning approach.

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